Psychometric properties of a Creole version of Medical Outcome Study – Short Form 36 among type II diabetes patients on Reunion Island

IntroductionHealth quality of life assessment is particularly important to measure the impact of chronic diseases. The aims of this study were to provide a cross-culturally adapted Creole-translation of the Medical Outcome Study Short-Form 36 (SF-36) and to assess psychometric performance of the Creole and French versions of the SF-36 among patients with type II diabetes in Reunion Island.Materials and methodsThe Creole translation and cross-cultural adaptation processes were based on the International Quality Of Life Assessment (IQOLA) methods. Internal consistency, test–retest reliability, convergent and discriminant validity using Multi-Trait-Multi-Method analysis and structural validity using exploratory factor analysis of the SF-36 for both versions were performed.ResultsIn the Creole version of the SF-36, Cronbach’s alpha exceeded 0.70 for all subscales except general health. In the French SF-36, Cronbach’s alpha exceeded 0.70 on all subscales except general health and bodily pain. In the Creole SF-36, intraclass correlation coefficient (ICC) for reproducibility was suboptimal. Multi-trait multi-method analysis showed that item-scale correlation exceeded 0.4 for all items except two general health items of the Creole SF-36 and one of the French SF-36. Factor analysis of 2 versions showed that the physical functioning, vitality, and mental health were each divided into two subscales.DiscussionOverall, our findings provided evidence that the SF-36 is adapted to Reunion Island in both Creole and French versions. However, further research could be conducted to investigate French–Creole differences in perceived health status and a cultural adaptation of the French version will be considered

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio

Epidemiology and outcome predictors in 450 patients with hanging-induced cardiac arrest: a retrospective study

BackgroundCardiac arrest is the most life-threatening complication of attempted suicide by hanging. However, data are scarce on its characteristics and outcome predictors.MethodsThis retrospective observational multicentre study in 31 hospitals included consecutive adults admitted after cardiac arrest induced by suicidal hanging. Factors associated with in-hospital mortality were identified by multivariate logistic regression with multiple imputations for missing data and adjusted to the temporal trends over the study period.ResultsOf 450 patients (350 men, median age, 43 [34–52] years), 305 (68%) had a psychiatric history, and 31 (6.9%) attempted hanging while hospitalized. The median time from unhanging to cardiopulmonary resuscitation was 0 [0–5] min, and the median time to return of spontaneous circulation (ROSC) was 20 [10–30] min. Seventy-nine (18%) patients survived to hospital discharge. Three variables were independently associated with higher in-hospital mortality: time from collapse or unhanging to ROSC&gt;20 min (odds ratio [OR], 4.71; 95% confidence intervals [95%CIs], 2.02–10.96; p = 0.0004); glycaemia &gt;1.4 g/L at admission (OR, 6.38; 95%CI, 2.60–15.66; p &lt; 0.0001); and lactate &gt;3.5 mmol/L at admission (OR, 6.08; 95%CI, 1.71–21.06; p = 0.005). A Glasgow Coma Scale (GCS) score of &gt;5 at admission was associated with lower in-hospital mortality (OR, 0.009; 95%CI, 0.02–0.37; p = 0.0009).ConclusionIn patients with hanging-induced cardiac arrest, time from collapse or unhanging to return of spontaneous circulation, glycaemia, arterial lactate, and coma depth at admission were independently associated with survival to hospital discharge. Knowledge of these risk factors may help guide treatment decisions in these patients at high risk of hospital mortality

Relation fidèle de la bravade de M. le Mis de Curton à Riom-ès-Montagnes (août 1687) / L. Lafarge

Appartient à l’ensemble documentaire : Auvergn

Acute Kidney Injury in Cancer Immunotherapy Recipients

Cancer immunotherapy has now entered clinical practice and has reshaped the standard of care for many cancer patients. With these new strategies, specific toxicities have emerged, and renal side effects have been described. In this review, we will describe the causes of acute kidney injury in CAR T cell, immune checkpoint inhibitors and other cancer immuno-therapy recipients. CAR T cell therapy and bispecific T cell engaging antibodies can lead to acute kidney injury as a consequence of cytokine release syndrome, tumor lysis syndrome, sepsis or specific CAR T cell infiltration. Immune checkpoint blockade most often results in acute tubular interstitial nephritis, but glomerular diseases have also been described. Although the pathophysiology remains mostly elusive, we will describe the mechanisms of renal damage in these contexts, its prognosis and treatment. As the place of immunotherapy in the anti-cancer armamentarium is exponentially increasing, close collaboration between nephrologists and oncologists is of utmost importance to provide the best standard of care for these patients

Increased Rice Susceptibility to Rice Blast Is Related to Post-Flowering Nitrogen Assimilation Efficiency

International audienceReducing nitrogen leaching and nitrous oxide emissions with the goal of more sustainability in agriculture implies better identification and characterization of the different patterns in nitrogen use efficiency by crops. However, a change in the ability of varieties to use nitrogen resources could also change the access to nutrient resources for a foliar pathogen such as rice blast and lead to an increase in the susceptibility of these varieties. This study focuses on the pre-and post-floral biomass accumulation and nitrogen uptake and utilization of ten temperate japonica rice genotypes grown in controlled conditions, and the relationship of these traits with molecular markers and susceptibility to rice blast disease. After flowering, the ten varieties displayed diversity in nitrogen uptake and remobilization. Surprisingly, post-floral nitrogen uptake was correlated with higher susceptibility to rice blast, particularly in plants fertilized with nitrogen. This increase in susceptibility is associated with a particular metabolite profile in the upper leavers of these varieties

Increased Rice Susceptibility to Rice Blast Is Related to Post-Flowering Nitrogen Assimilation Efficiency

International audienceReducing nitrogen leaching and nitrous oxide emissions with the goal of more sustainability in agriculture implies better identification and characterization of the different patterns in nitrogen use efficiency by crops. However, a change in the ability of varieties to use nitrogen resources could also change the access to nutrient resources for a foliar pathogen such as rice blast and lead to an increase in the susceptibility of these varieties. This study focuses on the pre-and post-floral biomass accumulation and nitrogen uptake and utilization of ten temperate japonica rice genotypes grown in controlled conditions, and the relationship of these traits with molecular markers and susceptibility to rice blast disease. After flowering, the ten varieties displayed diversity in nitrogen uptake and remobilization. Surprisingly, post-floral nitrogen uptake was correlated with higher susceptibility to rice blast, particularly in plants fertilized with nitrogen. This increase in susceptibility is associated with a particular metabolite profile in the upper leavers of these varieties

The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists

International audienceOver the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience affecting all aspects of our specialty. Critical care was put forward as a priority and managed to adapt to the influx of patients and the growing demand for beds, financial and material resources, thereby highlighting its flexibility and central role in the healthcare system. Intensivists assumed an essential and unprecedented role in public life, which was important when claiming for indispensable material and human investments. Physicians and researchers around the world worked hand-in-hand to advance research and better manage this disease by integrating a rapidly growing body of evidence into guidelines. Our daily ethical practices and communication with families were challenged by the massive influx of patients and restricted visitation policies, forcing us to improve our collaboration with other specialties and innovate with new communication channels. However, the picture was not all bright, and some of these achievements are already fading over time despite the ongoing pandemic and hospital crisis. In addition, the pandemic has demonstrated the need to improve the working conditions and well-being of critical care workers to cope with the current shortage of human resources. Despite the gloomy atmosphere, we remain optimistic. In this ten-key points review, we outline our vision on how to capitalize on the lasting impact of the pandemic to face future challenges and foster transformative changes of critical care for the better

Increased Rice Susceptibility to Rice Blast Is Related to Post-Flowering Nitrogen Assimilation Efficiency

Reducing nitrogen leaching and nitrous oxide emissions with the goal of more sustainability in agriculture implies better identification and characterization of the different patterns in nitrogen use efficiency by crops. However, a change in the ability of varieties to use nitrogen resources could also change the access to nutrient resources for a foliar pathogen such as rice blast and lead to an increase in the susceptibility of these varieties. This study focuses on the pre- and post-floral biomass accumulation and nitrogen uptake and utilization of ten temperate japonica rice genotypes grown in controlled conditions, and the relationship of these traits with molecular markers and susceptibility to rice blast disease. After flowering, the ten varieties displayed diversity in nitrogen uptake and remobilization. Surprisingly, post-floral nitrogen uptake was correlated with higher susceptibility to rice blast, particularly in plants fertilized with nitrogen. This increase in susceptibility is associated with a particular metabolite profile in the upper leavers of these varieties

Milk maturation temperature and time are key technological parameters to limit staphylococcal enterotoxin production during uncooked semi-hard cheese manufacture

International audienceThe influence of five technological parameters selected amongst uncooked semi-hard cheese-making practices, i. e. milk maturation temperature and time, stirring during maturation, curd stirring time and pressing time was examined on Staphylococcus aureus growth, enterotoxin gene expression and enterotoxin (SE) production during cheese manufacture. A fractional factorial experimental design was applied to perform 32 cheese batches independently inoculated at 103 cfu/ml of milk using four strains producing SEA, SEB, SEC or SED.The S. aureus population was found to exceed 105 cfu/g of cheese four hours after molding. SED was the only enterotoxin detected. It was produced in very low quantities that varied with the parameters studied. Early sed gene expression during cheese processing was correlated with SED detection in curd and cheese. Milk maturation temperature and time emerge as key technological parameters that control SED production. A response surface methodology was then carried out to further characterize the relationships between both factors and SE production in cheese and whey. Two SED-producing strains were used to perform two sets of ten cheese batches based on a central composite design of experiments at five levels. Predictive mathematical models were established.Increasing the temperature at the beginning of the cheese-making process was shown to increase SED production. Furthermore, we determined that the proportion of SED drained after molding from the curd in the whey depended only on the technological parameters. The two SED-producing strains showed similar trends of behavior but specific level of gene expression and enterotoxin production in response to the same set of milk maturation parameters