The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest ha...The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest has been particularly pronounced in the context of critically illpatients,wherehealthcare-associatedpulmonary infections represent a significant challenge,driving continued exploration of inhaled antibiotics for intubated patients.Recent high-level evidence has shown a very promising application in the field of ventilator-associated pneumonia (VAP) prevention.^([1]).展开更多
AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 me...AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.展开更多
Hepatitis B and human immunodeficiency virus(HBV and HIV)infection share transmission patterns and risk factors,which explains high prevalence of chronic HBV infection in HIV infected patients.The natural course of HB...Hepatitis B and human immunodeficiency virus(HBV and HIV)infection share transmission patterns and risk factors,which explains high prevalence of chronic HBV infection in HIV infected patients.The natural course of HBV disease is altered by the HIV infection with less chance to clear acute HBV infection,faster progression to cirrhosis and higher risk of liver-related death in HIVHBV co-infected patients than in HBV mono-infected ones.HIV infected patients with chronic hepatitis B should be counseled for liver damage and surveillance of chronic hepatitis B should be performed to screen early hepatocellular carcinoma.Noninvasive tools are now available to evaluate liver fibrosis.Isolated hepatitis B core antibodies(anti-HBc)are a good predictive marker of occult HBV infection.Still the prevalence and significance of occult HBV infection is controversial,but its screening may be important in the management of antiretroviral therapy.Vaccination against HBV infection is recommended in non-immune HIV patients.The optimal treatment for almost all HIV-HBV co-infectedpatients should contain tenofovir plus lamivudine or emtricitabine and treatment should not be stopped to avoid HBV reactivation.Long term tenofovir therapy may lead to significant decline in hepatitis B surface Antigen.The emergence of resistant HBV strains may compromise the HBV therapy and vaccine therapy.展开更多
BACKGROUND The individual performances and the complementarity of Crohn’s disease(CD)activity index(CDAI),C-reactive protein(CRP)and faecal calprotectin(Fcal)to monitor patients with CD remain poorly inves-tigated in...BACKGROUND The individual performances and the complementarity of Crohn’s disease(CD)activity index(CDAI),C-reactive protein(CRP)and faecal calprotectin(Fcal)to monitor patients with CD remain poorly inves-tigated in the era of“tight control”and“treat to target”strategies.AIM To assess CDAI,CRP and Fcal variation,alone or combined,after 12 wk(W12)of anti-tumor necrosis factor(TNF)therapy to predict corticosteroids-free remission(CFREM=CDAI<150,CRP<2.9 mg/L and Fcal<250μg/g with no therapeutic intensification and no surgery)at W52.METHODS CD adult patients needing anti-TNF therapy with CDAI>150 and either CRP>2.9 mg/L or Fcal>250μg/g were prospectively enrolled.RESULTS Among the 40 included patients,13 patients(32.5%)achieved CFREM at W52.In univariable analysis,CDAI<150 at W12(P=0.012),CRP level<2.9 mg/L at W12(P=0.001)and Fcal improvement at W12(Fcal<300μg/g)or,for patients with initial Fcal<300μg/g,at least 50%decrease of Fcal or normalization of Fcal(<100μg/g)(P=0.001)were predictive of CFREM at W52.Combined endpoint(CDAI<150 and CRP≤2.9 mg/L and FCal improvement)at W12 was the best predictor of CFREM at W52 with positive predictive value=100.0%(100.0-100.0)and negative predictive value=87.1%(75.3-98.9).In multivariable analysis,Fcal improvement at W12[odd ratio(OR)=45.1(2.96-687.9);P=0.03]was a better predictor of CFREM at W52 than CDAI<150[OR=9.3(0.36-237.1);P=0.145]and CRP<2.9 mg/L(0.77-278.0;P=0.073).CONCLUSION The combined monitoring of CDAI,CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.展开更多
Chronic myeloid leukemia(CML)in minors is a rare disease which can be effectively treated by tyrosine kinase inhibitors(TKIs)since the year 2000.A majority of pediatricians will encounter one or two CML patients in th...Chronic myeloid leukemia(CML)in minors is a rare disease which can be effectively treated by tyrosine kinase inhibitors(TKIs)since the year 2000.A majority of pediatricians will encounter one or two CML patients in the course of their careers and will typically have to rely on written information along with their own intuition to provide care.Knowledge of response to TKIs and of agespecific side effects has an impact on the design of pediatric CML trials in many ways aiming to contribute toward greater predictability of clinical improvements.Information from a registry on a rare disease like CML offers the enormous benefit of enabling treating physicians to interact and share their collective experience.The International Registry on Pediatric CML(IR-PCML)was founded at Poitiers/France almost 10 years ago.Since then,the number of collaboration centers and in parallel of registered patients continuously increased(>550 patients as of December 2019).Ideally,from a given treatment center in a country data are transferred to a national coordinator who interacts with the IR-PCML.In the sense of quality assurance,the registry can offer dissemination of knowledge on state-of-the-art diagnostics(including reference appraisal),optimal treatment approaches,and follow-up procedures within a network that is exerting its strength via participation.With continuous growth during the recent years,very rare subgroups of patients could be identified(e.g.,CML diagnosed at age<3 years,children presenting with specific problems at diagnosis or during course of treatment)which had not been described before.Publications coming from the IR-PCML disseminated this useful information derived from patients who robustly participate and share information about their disease,among themselves and with their caregivers and clinicians.Patient input driving the collection of data on this rare leukemia is the basis for the considerable success of bringing new therapeutics into clinical use.展开更多
Introduction: Conventional metabolite analyses often require manual sample preparation, generating variability of measurements. This study describes a new method to quantify radiometabolites in blood, combining ultra ...Introduction: Conventional metabolite analyses often require manual sample preparation, generating variability of measurements. This study describes a new method to quantify radiometabolites in blood, combining ultra high performance liquid chromatography (UHPLC) and turbulent flow chromatography, an alternative fully automated process allowing analyte’s extraction. Methods: A new radiotracer for dopamine transporter imaging, namely LBT-999, was used to demonstrate the method’s robustness. Matrix effect, Turboflow column loading, linearity, specificity and precision were evaluated with in vitro samples of LBT-999 in human plasma. Radiodetector sensitivity and preliminary evaluation were respectively determined by analysis of calibrated samples of [18F]LBT-999 and blood samples from 4 healthy subjects injected with [18F]LBT-999, withdrawn at 5, 15, 30 and 45 min pi. Results: With three sequential loadings (3 × 100 μL) of the Turboflow column, mean coefficients of variation were 1%, below 2%, 2% and 30.9% for matrix effect, specificity, repeatability and intermediate precision, respectively. Correlation coefficients for linearity were superior to 0.97. Limits of detection and quantification of the radiodetector were fixed at 3 and 9 c/s. Retention times for [18F]LBT-999 and the two radiometabolites detected by radio-UHPLC were 6.5, 4.8 and 9.6 min. Forty-five min after the injection, parent fraction was still predominant with 57.8% ± 25% of the total radioactivity. Conclusions: An innovative approach, allying UHPLC and Turboflow column, was developed and its sensitivity, linearity, specificity and repeatability validated. Preliminary results of the clinical trial are in accordance with literature data, demonstrating its efficiency in radiometabolites quantification.展开更多
<strong><em>Introduction:</em></strong> Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in he...<strong><em>Introduction:</em></strong> Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in healthy individuals. Only placebo controlled double blind studies could provide the reliable data considering the physiologic nail growth. <strong><em>Objective:</em></strong> The objective of this study was to evaluate the efficacy of consumption of a micronutrient supplementation on linear nail growth and thickness. <strong><em>Subjects and Method:</em></strong> 60 healthy female volunteers aged 35 to 65 years old were enrolled, randomized blindly in treatment and placebo groups, taking one tablet per day for 3 months. The evaluation was performed on D0 and D90 ± 3 days by measuring the linear nail growth, nail thickness by high frequency ultrasound imaging and also subjects’ self-assessment. <strong><em>Results:</em></strong> All 60 subjects finished the study without any serious adverse event. At D90 both groups revealed a significant linear nail growth (5.20 ± 0.35 for treatment group (p = 0.001) and 5.15 ± 0.30 for placebo group (p = 0.001)). However, the difference between the treatment and placebo group was statistically significant (p = 0.01) demonstrating the efficacy of oral supplementation on linear nail growth. No significant difference was observed at D90 for nail thickness measured with HFUS between 2 groups. The self-assessment score regarding ?brittle nails? and ?split nails? was diminished non-significantly in both groups. <strong><em>Conclusion:</em></strong> The results observed in this trial revealed that the oral micronutrient supplementation can provide beneficial effect on nail growth. This result may be due to the whole formula as the single vitamin treatment like biotin was shown to be non-effective. A longer study would be needed to confirm the efficacy on nail thickness.展开更多
AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a...AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.展开更多
The majority of sarcomas are under the influence of a tumor microenvironment that dampens immune activity,resulting in resistance to monoclonal antibodies targeting immune checkpoints and reduced clinical effectivenes...The majority of sarcomas are under the influence of a tumor microenvironment that dampens immune activity,resulting in resistance to monoclonal antibodies targeting immune checkpoints and reduced clinical effectiveness.Preclinical studies indicate that targeting abnormal neoangiogenesis by inhibiting vascular endothelial growth factor receptor(VEGFR)can alter the TME,thereby promoting T cell infiltration and increasing tumor immunogenicity.The REGOMUNE study,a phase II clinical trial,assessed the therapeutic combination of regorafenib,a multityrosine kinase inhibitor that targets VEGFR2 and the PD-L1 blocker avelumab,in individuals with advanced“cold”STS characterized by a lack of mature tertiary lymphoid structures(mTLS).Forty-nine mTLSnegative STS patients were enrolled,including leiomyosarcoma(45%),synovial sarcoma(18%),and other subtypes.The objective response rate was 11.0%(95%CI:4.0%-22.0%),with median progression-free survival and overall survival of 1.8 months(95%CI,1.7-3.5 months)and 15.1 months,respectively.Frequent adverse events included grade 1 or 2 palmar-plantar erythrodysesthesia,fatigue,and diarrhea.On-treatment multiplex immunofluorescence analysis revealed significant increases in CD8+T cell and B cell infiltration and PD1 expression on immune cells.Plasma analysis indicated significant upregulation of soluble PD-L1(sPD-L1)levels and tryptophan consumption.Overall,these results indicate that anti-angiogenic therapy modulates the tumor microenvironment in patients with cold STS and highlight the need for complementary strategies to enhance the functional activity of immune cells in this particular setting.展开更多
There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been established.SCM may be defined a...There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been established.SCM may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular(LV)dysfunction and/or right ventricular dysfunction.Physicians should consider this diagnosis in patients with sepsis-associated organ dysfunction,and particularly in cases of septic shock that require vasopres-sors.Echocardiography is currently the gold standard for diagnosis of SCM.Left ventricular ejection fraction is the most common parameter used to describe LV function in the literature,but its dependence on loading condi-tions,particularly afterload,limits its use as a measure of intrinsic myocardial contractility.Therefore,repeated echocardiography evaluation is mandatory.Evaluation of global longitudinal strain(GLS)may be more sensi-tive and specific for SCM than LV ejection fraction(LVEF).Standard management includes etiological treatment,adapted fluid resuscitation,use of vasopressors,and monitoring.Use of inotropes remains uncertain,and heart rate control could be an option in some patients.展开更多
Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac...Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume overload.Obviously,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic monitoring.Hemodynamic monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical support.It is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient outcomes.In more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce mortality.In this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.展开更多
Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not usable.Methods:We retrospectively evaluated the outcomes of LT performed using the different alter...Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not usable.Methods:We retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA.Results:Between 2002 and 2017,1,677 LT were performed in our institution among which 141(8.4%)with unusable recipient HA were analyzed.Four groups were defined according to the site of anastomosis:the splenic artery(SA group,n=26),coeliac trunk(CT group,n=12),aorta using or not the donor’s vessel(Ao group,n=91)and aorta using a vascular prosthesis(Ao-P group,n=12)as conduit.The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups(5,5,8.5 and 16 for SA,CT,Ao and Ao-P group respectively,P=0.002),as well as fresh frozen plasma(4.5,2.5,10,17 for the SA,CT,Ao and Ao-P groups respectively,P=0.001).Hospitalization duration was also significantly increased in the Ao and Ao-P groups(15,16,24,26.5 days for the SA,CT,Ao and Ao-P groups respectively,P<0.001).The occurrence of early allograft dysfunction(EAD)(P=0.07)or arterial complications(P=0.26)was not statistically different.Level of factor V,INR,bilirubin and creatinine during the 7th postoperative days(POD)was significantly improved in the SA group.No difference was observed regarding graft(P=0.18)and patient(P=0.16)survival.Conclusions:In case of unusable HA,intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.展开更多
In intensive care units(ICUs),the decision to extubate is a critical one because mortality is particularly high in case of reintubation.Around 15%of patients ready to be weaned offa ventilator experience extubation fa...In intensive care units(ICUs),the decision to extubate is a critical one because mortality is particularly high in case of reintubation.Around 15%of patients ready to be weaned offa ventilator experience extubation failure leading to reintubation.The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation.High-flow nasal oxygen and non-invasive ventilation,may be used to prevent reintubation in patients with low(e.g.,patients without comorbidities and with short durations of mechanical ventilation)and high risk(e.g.,patients>65 years and those with underlying cardiac disease,chronic respiratory disorders,and/or hypercapnia at the time of extubation)of reintubation,respectively.However,non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation,and should therefore be used very carefully in this setting.The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs.Standard oxygen after a surgical procedure is adequate,even following major abdominal or cardio-thoracic surgery,but should probably be switched to high-flow nasal oxygen in patients with hypoxemic.Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects,it may actually improve the outcomes in postoperative patients with respiratory failure.This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.展开更多
Background:We investigated the criteria that hospitalized patients in intensive care units(ICUs)deem important when designating relatives who are best qualified to interact with the caregiving staff.Methods:We conduct...Background:We investigated the criteria that hospitalized patients in intensive care units(ICUs)deem important when designating relatives who are best qualified to interact with the caregiving staff.Methods:We conducted an exploratory,observational,prospective,multicenter study between March 1,2018,and October 31,2018,within two ICUs.A 12-item questionnaire was distributed to patients in the ICUs by the investigating physicians.Patients were considered eligible if they had a good understanding of the French language and if they had not officially designated surrogates before ICU admission.Results:Seventy-one patients whose average age was 63.9±17.3 years,of whom 21(29.5%)were females,completed the questionnaire.The average Charlson comorbidity score was 2.5±2.4,and the average Simplified Acute Physiology Score(SAPS II)was 39.8±16.5.The main etiology was respiratory infection(40.8%),followed by sepsis(23.9%).The most important criteria identified by patients when selecting reference persons were a good knowledge of the patient’s wishes and values,an emotional attachment to the patient,and being a family member.Conclusion:Our findings reveal that ICU patients considered the following criteria to be critical when designating reference persons:knowledge of their wishes and the existence of emotional and family attachments.展开更多
Acute respiratory distress syndrome(ARDS)was reported for the first time in 1967 in 12 patients with sudden respiratory failure due to a non-cardiogenic pulmonary edema.[1]Even though these patients had no underlying ...Acute respiratory distress syndrome(ARDS)was reported for the first time in 1967 in 12 patients with sudden respiratory failure due to a non-cardiogenic pulmonary edema.[1]Even though these patients had no underlying pulmonary disease,they rapidly developed severe hypoxemia,stiff lungs,and pulmonary bilateral infiltrates within a few days after a precipitating factor.Autopsy revealed a characteristic histological pattern of diffuse alveolar damage involving hyaline membranes,edema,necrosis,and cell proliferation.[2,3]The definition of ARDS evolved markedly over time and the Berlin definition,which was proposed in 2012,is currently the most recent one.[4]First,acute onset of respiratory symptoms appearing or worsening within 7 days of a clinical insult,thereby excluding patients who develop respiratory failure over more prolonged periods due to idiopathic pulmonary fibrosis,non-specific interstitial pneumonitis,organizing pneumonia,or pulmonary vasculitis.展开更多
Background:Healthcare pathways of patients with prostate cancer are heterogeneous and complex to apprehend using traditional descriptive statistics.Clustering and visualization methods can enhance their characterizati...Background:Healthcare pathways of patients with prostate cancer are heterogeneous and complex to apprehend using traditional descriptive statistics.Clustering and visualization methods can enhance their characterization.Methods:Patients with prostate cancer in 2014 were identified in the French National Healthcare database(Système National des Données de Santé—SNDS)and their data were extracted with up to 5 years of history and 4 years of follow‐up.Fifty‐one‐specific encounters constitutive of prostate cancer management were synthesized into four macro‐variables using a clustering approach.Their values over patient follow‐ups constituted healthcare pathways.Optimal matching was applied to calculate distances between pathways.Partitioning around medoids was then used to define consistent groups across four exclusive cohorts of incident prostate cancer patients:Hormone‐sensitive(HSPC),metastatic hormone‐sensitive(mHSPC),castration‐resistant(CRPC),and metastatic castration‐resistant(mCRPC).Index plots were used to represent pathways clusters.Results:The repartition of macro‐variables values—surveillance,local treatment,androgenic deprivation,and advanced treatment—appeared to be consistent with prostate cancer status.Two to five clusters of healthcare pathways were observed in each of the different cohorts,corresponding for most of them to relevant clinical patterns,although some heterogeneity remained.For instance,clustering allowed to distinguish patients undergoing active surveillance,or treated according to cancer progression risk in HSPC,and patients receiving treatment for potentially curative or palliative purposes in mHSPC and mCRPC.Conclusion:Visualization methods combined with a clustering approach enabled the identification of clinically relevant patterns of prostate cancer management.Characterization of these care pathways is an essential element for the comprehension and the robust assessment of healthcare technology effectiveness.展开更多
Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs pr...Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.展开更多
Background:Populations of French Polynesia(FP),where France performed atmospheric tests between 1966 and 1974,experience a high incidence of differentiated thyroid cancer(DTC).However,up to now,no sufficiently large s...Background:Populations of French Polynesia(FP),where France performed atmospheric tests between 1966 and 1974,experience a high incidence of differentiated thyroid cancer(DTC).However,up to now,no sufficiently large study of DTC genetic factors in this population has been performed to reach definitive conclusion.This research aimed to analyze the genetic factors of DTC risk among the native FP populations.Methods:We analyzed more than 300000 single nucleotide polymorphisms(SNPs)genotyped in 283 DTC cases and 418 matched controls born in FP,most being younger than 15 years old at the time of the first nuclear tests.We analyzed the genetic profile of our cohort to identify population subgroups.We then completed a genome-wide analysis study on the whole population.Results:We identified a specific genetic structure in the FP population reflecting admixture from Asian and European populations.We identified three regions associated with increased DTC risk at 6q24.3,10p12.2,and 17q21.32.The lead SNPs at these loci showed respective p-values of 1.66×10^(−7),2.39×10^(−7),and 7.19×10^(−7) and corresponding odds ratios of 2.02,1.89,and 2.37.Conclusion:Our study results suggest a role of the loci 6q24.3,10p12.2 and 17q21.32 in DTC risk.However,a whole genome sequencing approach would be better suited to characterize these factors than genotyping with microarray chip designed for the Caucasian population.Moreover,the functional impact of these three new loci needs to be further explored and validated.展开更多
文摘The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest has been particularly pronounced in the context of critically illpatients,wherehealthcare-associatedpulmonary infections represent a significant challenge,driving continued exploration of inhaled antibiotics for intubated patients.Recent high-level evidence has shown a very promising application in the field of ventilator-associated pneumonia (VAP) prevention.^([1]).
文摘AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.
文摘Hepatitis B and human immunodeficiency virus(HBV and HIV)infection share transmission patterns and risk factors,which explains high prevalence of chronic HBV infection in HIV infected patients.The natural course of HBV disease is altered by the HIV infection with less chance to clear acute HBV infection,faster progression to cirrhosis and higher risk of liver-related death in HIVHBV co-infected patients than in HBV mono-infected ones.HIV infected patients with chronic hepatitis B should be counseled for liver damage and surveillance of chronic hepatitis B should be performed to screen early hepatocellular carcinoma.Noninvasive tools are now available to evaluate liver fibrosis.Isolated hepatitis B core antibodies(anti-HBc)are a good predictive marker of occult HBV infection.Still the prevalence and significance of occult HBV infection is controversial,but its screening may be important in the management of antiretroviral therapy.Vaccination against HBV infection is recommended in non-immune HIV patients.The optimal treatment for almost all HIV-HBV co-infectedpatients should contain tenofovir plus lamivudine or emtricitabine and treatment should not be stopped to avoid HBV reactivation.Long term tenofovir therapy may lead to significant decline in hepatitis B surface Antigen.The emergence of resistant HBV strains may compromise the HBV therapy and vaccine therapy.
文摘BACKGROUND The individual performances and the complementarity of Crohn’s disease(CD)activity index(CDAI),C-reactive protein(CRP)and faecal calprotectin(Fcal)to monitor patients with CD remain poorly inves-tigated in the era of“tight control”and“treat to target”strategies.AIM To assess CDAI,CRP and Fcal variation,alone or combined,after 12 wk(W12)of anti-tumor necrosis factor(TNF)therapy to predict corticosteroids-free remission(CFREM=CDAI<150,CRP<2.9 mg/L and Fcal<250μg/g with no therapeutic intensification and no surgery)at W52.METHODS CD adult patients needing anti-TNF therapy with CDAI>150 and either CRP>2.9 mg/L or Fcal>250μg/g were prospectively enrolled.RESULTS Among the 40 included patients,13 patients(32.5%)achieved CFREM at W52.In univariable analysis,CDAI<150 at W12(P=0.012),CRP level<2.9 mg/L at W12(P=0.001)and Fcal improvement at W12(Fcal<300μg/g)or,for patients with initial Fcal<300μg/g,at least 50%decrease of Fcal or normalization of Fcal(<100μg/g)(P=0.001)were predictive of CFREM at W52.Combined endpoint(CDAI<150 and CRP≤2.9 mg/L and FCal improvement)at W12 was the best predictor of CFREM at W52 with positive predictive value=100.0%(100.0-100.0)and negative predictive value=87.1%(75.3-98.9).In multivariable analysis,Fcal improvement at W12[odd ratio(OR)=45.1(2.96-687.9);P=0.03]was a better predictor of CFREM at W52 than CDAI<150[OR=9.3(0.36-237.1);P=0.145]and CRP<2.9 mg/L(0.77-278.0;P=0.073).CONCLUSION The combined monitoring of CDAI,CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.
文摘Chronic myeloid leukemia(CML)in minors is a rare disease which can be effectively treated by tyrosine kinase inhibitors(TKIs)since the year 2000.A majority of pediatricians will encounter one or two CML patients in the course of their careers and will typically have to rely on written information along with their own intuition to provide care.Knowledge of response to TKIs and of agespecific side effects has an impact on the design of pediatric CML trials in many ways aiming to contribute toward greater predictability of clinical improvements.Information from a registry on a rare disease like CML offers the enormous benefit of enabling treating physicians to interact and share their collective experience.The International Registry on Pediatric CML(IR-PCML)was founded at Poitiers/France almost 10 years ago.Since then,the number of collaboration centers and in parallel of registered patients continuously increased(>550 patients as of December 2019).Ideally,from a given treatment center in a country data are transferred to a national coordinator who interacts with the IR-PCML.In the sense of quality assurance,the registry can offer dissemination of knowledge on state-of-the-art diagnostics(including reference appraisal),optimal treatment approaches,and follow-up procedures within a network that is exerting its strength via participation.With continuous growth during the recent years,very rare subgroups of patients could be identified(e.g.,CML diagnosed at age<3 years,children presenting with specific problems at diagnosis or during course of treatment)which had not been described before.Publications coming from the IR-PCML disseminated this useful information derived from patients who robustly participate and share information about their disease,among themselves and with their caregivers and clinicians.Patient input driving the collection of data on this rare leukemia is the basis for the considerable success of bringing new therapeutics into clinical use.
文摘Introduction: Conventional metabolite analyses often require manual sample preparation, generating variability of measurements. This study describes a new method to quantify radiometabolites in blood, combining ultra high performance liquid chromatography (UHPLC) and turbulent flow chromatography, an alternative fully automated process allowing analyte’s extraction. Methods: A new radiotracer for dopamine transporter imaging, namely LBT-999, was used to demonstrate the method’s robustness. Matrix effect, Turboflow column loading, linearity, specificity and precision were evaluated with in vitro samples of LBT-999 in human plasma. Radiodetector sensitivity and preliminary evaluation were respectively determined by analysis of calibrated samples of [18F]LBT-999 and blood samples from 4 healthy subjects injected with [18F]LBT-999, withdrawn at 5, 15, 30 and 45 min pi. Results: With three sequential loadings (3 × 100 μL) of the Turboflow column, mean coefficients of variation were 1%, below 2%, 2% and 30.9% for matrix effect, specificity, repeatability and intermediate precision, respectively. Correlation coefficients for linearity were superior to 0.97. Limits of detection and quantification of the radiodetector were fixed at 3 and 9 c/s. Retention times for [18F]LBT-999 and the two radiometabolites detected by radio-UHPLC were 6.5, 4.8 and 9.6 min. Forty-five min after the injection, parent fraction was still predominant with 57.8% ± 25% of the total radioactivity. Conclusions: An innovative approach, allying UHPLC and Turboflow column, was developed and its sensitivity, linearity, specificity and repeatability validated. Preliminary results of the clinical trial are in accordance with literature data, demonstrating its efficiency in radiometabolites quantification.
文摘<strong><em>Introduction:</em></strong> Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in healthy individuals. Only placebo controlled double blind studies could provide the reliable data considering the physiologic nail growth. <strong><em>Objective:</em></strong> The objective of this study was to evaluate the efficacy of consumption of a micronutrient supplementation on linear nail growth and thickness. <strong><em>Subjects and Method:</em></strong> 60 healthy female volunteers aged 35 to 65 years old were enrolled, randomized blindly in treatment and placebo groups, taking one tablet per day for 3 months. The evaluation was performed on D0 and D90 ± 3 days by measuring the linear nail growth, nail thickness by high frequency ultrasound imaging and also subjects’ self-assessment. <strong><em>Results:</em></strong> All 60 subjects finished the study without any serious adverse event. At D90 both groups revealed a significant linear nail growth (5.20 ± 0.35 for treatment group (p = 0.001) and 5.15 ± 0.30 for placebo group (p = 0.001)). However, the difference between the treatment and placebo group was statistically significant (p = 0.01) demonstrating the efficacy of oral supplementation on linear nail growth. No significant difference was observed at D90 for nail thickness measured with HFUS between 2 groups. The self-assessment score regarding ?brittle nails? and ?split nails? was diminished non-significantly in both groups. <strong><em>Conclusion:</em></strong> The results observed in this trial revealed that the oral micronutrient supplementation can provide beneficial effect on nail growth. This result may be due to the whole formula as the single vitamin treatment like biotin was shown to be non-effective. A longer study would be needed to confirm the efficacy on nail thickness.
基金Supported by Inserm-ANRS(French National Institute for Health and Medical Research-ANRS/France REcherche Nord and Sud Sida-hiv Hépatites)
文摘AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.
基金Institut National du Cancer,from the Association pour la Recherche contre le Cancer and by the Agence Nationale de la Recherche(ANR 21 RHUS 0010).
文摘The majority of sarcomas are under the influence of a tumor microenvironment that dampens immune activity,resulting in resistance to monoclonal antibodies targeting immune checkpoints and reduced clinical effectiveness.Preclinical studies indicate that targeting abnormal neoangiogenesis by inhibiting vascular endothelial growth factor receptor(VEGFR)can alter the TME,thereby promoting T cell infiltration and increasing tumor immunogenicity.The REGOMUNE study,a phase II clinical trial,assessed the therapeutic combination of regorafenib,a multityrosine kinase inhibitor that targets VEGFR2 and the PD-L1 blocker avelumab,in individuals with advanced“cold”STS characterized by a lack of mature tertiary lymphoid structures(mTLS).Forty-nine mTLSnegative STS patients were enrolled,including leiomyosarcoma(45%),synovial sarcoma(18%),and other subtypes.The objective response rate was 11.0%(95%CI:4.0%-22.0%),with median progression-free survival and overall survival of 1.8 months(95%CI,1.7-3.5 months)and 15.1 months,respectively.Frequent adverse events included grade 1 or 2 palmar-plantar erythrodysesthesia,fatigue,and diarrhea.On-treatment multiplex immunofluorescence analysis revealed significant increases in CD8+T cell and B cell infiltration and PD1 expression on immune cells.Plasma analysis indicated significant upregulation of soluble PD-L1(sPD-L1)levels and tryptophan consumption.Overall,these results indicate that anti-angiogenic therapy modulates the tumor microenvironment in patients with cold STS and highlight the need for complementary strategies to enhance the functional activity of immune cells in this particular setting.
文摘There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been established.SCM may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular(LV)dysfunction and/or right ventricular dysfunction.Physicians should consider this diagnosis in patients with sepsis-associated organ dysfunction,and particularly in cases of septic shock that require vasopres-sors.Echocardiography is currently the gold standard for diagnosis of SCM.Left ventricular ejection fraction is the most common parameter used to describe LV function in the literature,but its dependence on loading condi-tions,particularly afterload,limits its use as a measure of intrinsic myocardial contractility.Therefore,repeated echocardiography evaluation is mandatory.Evaluation of global longitudinal strain(GLS)may be more sensi-tive and specific for SCM than LV ejection fraction(LVEF).Standard management includes etiological treatment,adapted fluid resuscitation,use of vasopressors,and monitoring.Use of inotropes remains uncertain,and heart rate control could be an option in some patients.
文摘Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume overload.Obviously,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic monitoring.Hemodynamic monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical support.It is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient outcomes.In more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce mortality.In this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.
文摘Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not usable.Methods:We retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA.Results:Between 2002 and 2017,1,677 LT were performed in our institution among which 141(8.4%)with unusable recipient HA were analyzed.Four groups were defined according to the site of anastomosis:the splenic artery(SA group,n=26),coeliac trunk(CT group,n=12),aorta using or not the donor’s vessel(Ao group,n=91)and aorta using a vascular prosthesis(Ao-P group,n=12)as conduit.The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups(5,5,8.5 and 16 for SA,CT,Ao and Ao-P group respectively,P=0.002),as well as fresh frozen plasma(4.5,2.5,10,17 for the SA,CT,Ao and Ao-P groups respectively,P=0.001).Hospitalization duration was also significantly increased in the Ao and Ao-P groups(15,16,24,26.5 days for the SA,CT,Ao and Ao-P groups respectively,P<0.001).The occurrence of early allograft dysfunction(EAD)(P=0.07)or arterial complications(P=0.26)was not statistically different.Level of factor V,INR,bilirubin and creatinine during the 7th postoperative days(POD)was significantly improved in the SA group.No difference was observed regarding graft(P=0.18)and patient(P=0.16)survival.Conclusions:In case of unusable HA,intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.
文摘In intensive care units(ICUs),the decision to extubate is a critical one because mortality is particularly high in case of reintubation.Around 15%of patients ready to be weaned offa ventilator experience extubation failure leading to reintubation.The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation.High-flow nasal oxygen and non-invasive ventilation,may be used to prevent reintubation in patients with low(e.g.,patients without comorbidities and with short durations of mechanical ventilation)and high risk(e.g.,patients>65 years and those with underlying cardiac disease,chronic respiratory disorders,and/or hypercapnia at the time of extubation)of reintubation,respectively.However,non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation,and should therefore be used very carefully in this setting.The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs.Standard oxygen after a surgical procedure is adequate,even following major abdominal or cardio-thoracic surgery,but should probably be switched to high-flow nasal oxygen in patients with hypoxemic.Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects,it may actually improve the outcomes in postoperative patients with respiratory failure.This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.
文摘Background:We investigated the criteria that hospitalized patients in intensive care units(ICUs)deem important when designating relatives who are best qualified to interact with the caregiving staff.Methods:We conducted an exploratory,observational,prospective,multicenter study between March 1,2018,and October 31,2018,within two ICUs.A 12-item questionnaire was distributed to patients in the ICUs by the investigating physicians.Patients were considered eligible if they had a good understanding of the French language and if they had not officially designated surrogates before ICU admission.Results:Seventy-one patients whose average age was 63.9±17.3 years,of whom 21(29.5%)were females,completed the questionnaire.The average Charlson comorbidity score was 2.5±2.4,and the average Simplified Acute Physiology Score(SAPS II)was 39.8±16.5.The main etiology was respiratory infection(40.8%),followed by sepsis(23.9%).The most important criteria identified by patients when selecting reference persons were a good knowledge of the patient’s wishes and values,an emotional attachment to the patient,and being a family member.Conclusion:Our findings reveal that ICU patients considered the following criteria to be critical when designating reference persons:knowledge of their wishes and the existence of emotional and family attachments.
文摘Acute respiratory distress syndrome(ARDS)was reported for the first time in 1967 in 12 patients with sudden respiratory failure due to a non-cardiogenic pulmonary edema.[1]Even though these patients had no underlying pulmonary disease,they rapidly developed severe hypoxemia,stiff lungs,and pulmonary bilateral infiltrates within a few days after a precipitating factor.Autopsy revealed a characteristic histological pattern of diffuse alveolar damage involving hyaline membranes,edema,necrosis,and cell proliferation.[2,3]The definition of ARDS evolved markedly over time and the Berlin definition,which was proposed in 2012,is currently the most recent one.[4]First,acute onset of respiratory symptoms appearing or worsening within 7 days of a clinical insult,thereby excluding patients who develop respiratory failure over more prolonged periods due to idiopathic pulmonary fibrosis,non-specific interstitial pneumonitis,organizing pneumonia,or pulmonary vasculitis.
文摘Background:Healthcare pathways of patients with prostate cancer are heterogeneous and complex to apprehend using traditional descriptive statistics.Clustering and visualization methods can enhance their characterization.Methods:Patients with prostate cancer in 2014 were identified in the French National Healthcare database(Système National des Données de Santé—SNDS)and their data were extracted with up to 5 years of history and 4 years of follow‐up.Fifty‐one‐specific encounters constitutive of prostate cancer management were synthesized into four macro‐variables using a clustering approach.Their values over patient follow‐ups constituted healthcare pathways.Optimal matching was applied to calculate distances between pathways.Partitioning around medoids was then used to define consistent groups across four exclusive cohorts of incident prostate cancer patients:Hormone‐sensitive(HSPC),metastatic hormone‐sensitive(mHSPC),castration‐resistant(CRPC),and metastatic castration‐resistant(mCRPC).Index plots were used to represent pathways clusters.Results:The repartition of macro‐variables values—surveillance,local treatment,androgenic deprivation,and advanced treatment—appeared to be consistent with prostate cancer status.Two to five clusters of healthcare pathways were observed in each of the different cohorts,corresponding for most of them to relevant clinical patterns,although some heterogeneity remained.For instance,clustering allowed to distinguish patients undergoing active surveillance,or treated according to cancer progression risk in HSPC,and patients receiving treatment for potentially curative or palliative purposes in mHSPC and mCRPC.Conclusion:Visualization methods combined with a clustering approach enabled the identification of clinically relevant patterns of prostate cancer management.Characterization of these care pathways is an essential element for the comprehension and the robust assessment of healthcare technology effectiveness.
文摘Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.
基金supported by Institut National du Cancer(Grant No.9533)Fondation ARC(Grant No.PGA120150202302).
文摘Background:Populations of French Polynesia(FP),where France performed atmospheric tests between 1966 and 1974,experience a high incidence of differentiated thyroid cancer(DTC).However,up to now,no sufficiently large study of DTC genetic factors in this population has been performed to reach definitive conclusion.This research aimed to analyze the genetic factors of DTC risk among the native FP populations.Methods:We analyzed more than 300000 single nucleotide polymorphisms(SNPs)genotyped in 283 DTC cases and 418 matched controls born in FP,most being younger than 15 years old at the time of the first nuclear tests.We analyzed the genetic profile of our cohort to identify population subgroups.We then completed a genome-wide analysis study on the whole population.Results:We identified a specific genetic structure in the FP population reflecting admixture from Asian and European populations.We identified three regions associated with increased DTC risk at 6q24.3,10p12.2,and 17q21.32.The lead SNPs at these loci showed respective p-values of 1.66×10^(−7),2.39×10^(−7),and 7.19×10^(−7) and corresponding odds ratios of 2.02,1.89,and 2.37.Conclusion:Our study results suggest a role of the loci 6q24.3,10p12.2 and 17q21.32 in DTC risk.However,a whole genome sequencing approach would be better suited to characterize these factors than genotyping with microarray chip designed for the Caucasian population.Moreover,the functional impact of these three new loci needs to be further explored and validated.
