Impact d'une évaluation gériatrique sur l'orientation des personnes âgées au sein d'un service d'accueil des urgences (expérience au centre hospitalier de La Rochelle)

Introduction : L'évolution démographique entraîne une augmentation du nombre de personnes âgées aux urgences. Les patients fragiles sont à risque de décompensation et de pathologies en cascade qui peuvent aboutir à une perte d'autonomie. Pour faire face aux spécificités médico-psycho-sociales de cette population, une équipe de gériatrie (EGU) intervient aux urgences (SAU) de La Rochelle. Nous avons mené une étude pour décrire la population gériatrique admise aux Urgences et comparer l'orientation dans la filière de soins avec celle d'une population témoin antérieure qui était prise en charge par des urgentistes uniquement. Méthode : étude rétrospective portant sur 292 patients vus par l'équipe de gériatrie entre le 1er août et le 31 octobre 2012. Recueil des données socio-démographiques, d'un score de fragilité (ISAR) et de l'orientation au décours du passage aux urgences : unité d'hospitalisation de courte durée (UHCD, unité court séjour gériatrique (CSG) ou retour au domicile). Résultats : L'équipe de gériatrie a vu 87,5% des patients fragiles (score ISAR > 2), qui nécessitaient une évaluation gériatrique globale. Le taux de retour à domicile après l'UHCD était de 36,4% pour les patients pris en charge par l'EGU contre 12,5% pour ceux antérieurement vus par les urgentistes (p = 0,0005). Le taux d'admission vers le CSG à partir des urgences était de 50,4% pour les patients pris en charge par l'EGU contre 16,2 % (p = 0,001) auparavant. L'adéquation entre l'orientation souhaitée et l'orientation effective était significativement plus élevée, 77,1% contre 54% (p <0,0001) pour les patients pris en charge par l'EGU au SAU. Le taux de retour aux urgences des patients rentrés à domicile un mois après la consultation aux urgences était de 27,3% contre 9% pour l'EGU (p = 0,027). Discussion : Les orientations des patients semblaient plus adaptées à leur profil et à leur pathologie. Face à l'augmentation du nombre de personnes âgées, la filière gériatrique aux urgences devrait se développer pour permettre d'offrir une prise en charge médico-psycho-sociale adaptée à tous les patients de plus de 75 ans fragiles.POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Influence du stress sur la polarisation cytokinique de type 1 et de type 2 (conséquences possibles sur l'asthme ?)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

BF2 complexes of 1,3-diketones on the surface of phosphorus dendrimers: synthesis and study of the photoluminescence properties

International audienceDifluoroboron complexes of monomeric and dimeric diketones and of generations 0-4 of phosphorus dendrimers ended by diketone ligands are synthesized and characterized. Their photoluminescence properties are measured. All compounds exhibit an intense absorption band in the near UV region. Both model dimers and dendrimers show a marked hypsochromic shift of this absorption band compared with the monomeric difluoroboron complex. The fluorescence of the dioxaborine complex subunit in the multichromophoric dendritic architectures is quenched compared with the emission of the isolated monomeric fluorophore, presumably due to interactions between the terminal groups of dendrimers

Reproductive effort and oxidative stress

Data for the manuscript entitled 'Reproductive effort and oxidative stress: effects of offspring sex and number on the physiological state of a long-lived bird' by Merkling et al. published in Functional Ecolog

Reproductive effort and oxidative stress: effects of offspring sex and number on the physiological state of a long-lived bird

International audience1. Individuals must trade-off between energetically costly activities to maximize their fitness.However, the underlying physiological mechanism remains elusive. Oxidative stress, the imbalancebetween reactive oxygen species production and antioxidant and/or repair activities, hasbeen suggested to underlie life-history trade-offs: greater investment in reproduction supposedlygenerating higher oxidative damage, thus reducing life span.2. While most studies used natural or experimental variation in offspring number to examinehow reproduction affects oxidative stress, none studied the impact of offspring sex, although itcould influence physiological costs and fitness, if the sexes differ in terms of energetic cost.3. Here, we aim at further understanding how reproduction (in terms of offspring sex, experimentallymanipulated and number, not manipulated) influences oxidative stress in a wild seabird,where sons are energetically costlier than daughters. We did so by conducting a chickfostering experiment (to disentangle foster and produced sex ratio) and using four oxidativestress markers plus baseline corticosterone.4. First, the results suggest that individual physiological state before laying modulatesupcoming reproductive effort. Individuals with higher pre-laying baseline corticosterone andlower antioxidant activity, estimated by their superoxide dismutase activity, subsequentlyinvested more in reproduction, estimated by the cumulative number of days spent rearingchicks. Hence, it seems that only individuals that could afford to invest heavily in reproductiondid so.5. Then, we examined the effects of reproductive effort on individual physiological state atthe end of the breeding season. Higher reproductive effort seemed to imply higher physiologicalcosts. Oxidative stress, estimated by the ratio of oxidized over reduced glutathione,increased with more male-biased foster sex ratio among mothers but not among fathers,whereas baseline corticosterone did so in both sexes. Similarly, lipid oxidative damage tored blood cells increased with increasing cumulative number of days spent rearing chicks.6. Our study provides the first evidence that brood sex ratio variation can affect oxidative balance,potentially in a sex-specific way, although more studies are needed to understandwhether the observed physiological costs could lead to fitness costs. It also highlights the needto consider sex ratio in future studies investigating the role of oxidative stress in life-historytrade-off

Antigen recognition detains CD8+ T cells at the blood-brain barrier and contributes to its breakdown

Abstract Blood-brain barrier (BBB) breakdown and immune cell infiltration into the central nervous system (CNS) are early hallmarks of multiple sclerosis (MS). High numbers of CD8+ T cells are found in MS lesions, and antigen (Ag) presentation at the BBB has been proposed to promote CD8+ T cell entry into the CNS. Here, we show that brain endothelial cells process and cross-present Ag, leading to effector CD8+ T cell differentiation. Under physiological flow in vitro, endothelial Ag presentation prevented CD8+ T cell crawling and diapedesis resulting in brain endothelial cell apoptosis and BBB breakdown. Brain endothelial Ag presentation in vivo was limited due to Ag uptake by CNS-resident macrophages but still reduced motility of Ag-specific CD8+ T cells within CNS microvessels. MHC class I-restricted Ag presentation at the BBB during neuroinflammation thus prohibits CD8+ T cell entry into the CNS and triggers CD8+ T cell-mediated focal BBB breakdown

Tocopherol Derivative TFA-12 Promotes Myelin Repair in Experimental Models of Multiple Sclerosis

Multiple sclerosis (MS) is an inflammatory disease of the CNS that is associated with demyelination and axonal loss, resulting in severe neurological handicap. Current MS therapies mostly target neuroinflammation but have only a little impact on CNS myelin repair. Progress toward treatments that enhance remyelination would therefore represent major advances in MS treatment. Here, we examined the ability of TFA-12, a new synthetic compound belonging to tocopherol long-chain fatty alcohols, to promote oligodendrocyte regeneration and remyelination in experimental models of MS. We showed that TFA-12 significantly ameliorates neurological deficit and severity of myelin oligodendrocyte glycoprotein-induced experimental autoimmune encephalomyelitis (EAE) in mice. Histological evaluation of mouse EAE spinal cords showed that TFA-12 treatment reduces inflammation, astrogliosis, and myelin loss. Additionally, we demonstrated that TFA-12 accelerates remyelination of focal demyelinated lesions induced by lysolecithin injections.Wealso found that this compound induces the differentiation of oligodendrocyte precursor cells into mature oligodendrocytes through the inhibition of the Notch/Jagged1 signaling pathway. Altogether, our data provide important proof of principle indicating that TFA-12 could be a potential therapeutic compound for myelin repair in MS.Fil: Blanchard, Benoit. Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia; . Institut National de la Santé et de la Recherche Médicale; FranciaFil: Heurtaux, Tony. Université du Luxembourg. Faculté des Sciences, de la Technologie et de la Communication. Laboratoire de Neurobiologie. Life Sciences Research Unit; Luxemburgo;Fil: Garcia, Corina Ileana. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología. Cátedra de Química Medicinal; Argentina. Institut National de la Santé et de la Recherche Médicale; Francia. Universite Pierre et Marie Curie; Francia;Fil: Moll, Natalia M.. Institut National de la Santé et de la Recherche Médicale; . Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia;Fil: Caillava, Céline. Institut National de la Santé et de la Recherche Médicale; . Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia;Fil: Grandbarbe, Luc. Université du Luxembourg. Faculté des Sciences, de la Technologie et de la Communication. Laboratoire de Neurobiologie. Life Sciences Research Unit; Luxemburgo;Fil: Klosptein, Armelle. Institut National de la Santé et de la Recherche Médicale; . Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia;Fil: Kerninon, Christophe. Institut National de la Santé et de la Recherche Médicale; . Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia;Fil: Frah, Magali. Institut National de la Santé et de la Recherche Médicale; . Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia;Fil: Coowar, Djalil. AxoGlia Therapeutics; Luxemburgo;Fil: Baron-van Evercooren, Anne. Institut National de la Santé et de la Recherche Médicale; . Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia;Fil: Morga, Eleonora. Université du Luxembourg. Faculté des Sciences, de la Technologie et de la Communication. Laboratoire de Neurobiologie. Life Sciences Research Unit; Luxemburgo;Fil: Heuschling, Paul. Université du Luxembourg. Faculté des Sciences, de la Technologie et de la Communication. Laboratoire de Neurobiologie. Life Sciences Research Unit; Luxemburgo;Fil: Nait Oumesmar, Brahim. Institut National de la Santé et de la Recherche Médicale; . Universite Pierre et Marie Curie; Francia; . Centre National de la Recherche Scientifique. Unités Mixtes de Recherche; Francia

Resistance to Insulin in Patients with Gitelman Syndrome and a Subtle Intermediate Phenotype in Heterozygous Carriers: A Cross-Sectional Study

BACKGROUND: Gitelman syndrome is a salt-losing tubulopathy caused by mutations in the SLC12A3 gene, which encodes the thiazide-sensitive sodium-chloride cotransporter. Previous studies suggested an intermediate phenotype for heterozygous carriers. METHODS: To evaluate the phenotype of heterozygous carriers of pathogenic SLC12A3 mutations, we performed a cross-sectional study of patients with Gitelman syndrome, heterozygous carriers, and healthy noncarriers. Participants measured their BP at home for three consecutive days before hospital admission for blood and urine sampling and an oral glucose tolerance test. RESULTS: We enrolled 242 participants, aged 18-75 years, including 81 heterozygous carriers, 82 healthy noncarriers, and 79 patients with Gitelman syndrome. The three groups had similar age, sex ratio, and body mass index. Compared with healthy noncarriers, heterozygous carriers showed significantly higher serum calcium concentration (P=0.01) and a trend for higher plasma aldosterone (P=0.06), but measures of home BP, plasma and urine electrolytes, renin, parathyroid hormone, vitamin D, and response to oral glucose tolerance testing were similar. Patients with Gitelman syndrome had lower systolic BP and higher heart rate than noncarriers and heterozygote carriers; they also had significantly higher fasting serum glucose concentration, higher levels of markers of insulin resistance, and a three-fold higher sensitivity to overweight. According to oral glucose tolerance testing, approximately 14% of patients with Gitelman syndrome were prediabetic, compared with 5% of heterozygous carriers and 4% of healthy noncarriers. CONCLUSIONS: Heterozygous carriers had a weak intermediate phenotype, between that of healthy noncarriers and patients with Gitelman syndrome. Moreover, the latter are at risk for development of type 2 diabetes, indicating the heightened importance of body weight control in these patients

Fluid Intake in Critically Ill Patients: The “Save Useless Fluids For Intensive Resuscitation” Multicenter Prospective Cohort Study

International audienceObjectives: Patients at risk of adverse effects related to positive fluid balance could benefit from fluid intake optimization. Less attention is paid to nonresuscitation fluids. We aim to evaluate the heterogeneity of fluid intake at the initial phase of resuscitation. Design: Prospective multicenter cohort study. Setting: Thirty ICUs across France and one in Spain. Patients: Patients requiring vasopressors and/or invasive mechanical ventilation. Interventions: None. Measurements and Main Results: All fluids administered by vascular or enteral lines were recorded over 24 hours following admission and were classified in four main groups according to their predefined indication: fluids having a well-documented homeostasis goal (resuscitation fluids, rehydration, blood products, and nutrition), drug carriers, maintenance fluids, and fluids for technical needs. Models of regression were constructed to determine fluid intake predicted by patient characteristics. Centers were classified according to tertiles of fluid intake. The cohort included 296 patients. The median total volume of fluids was 3546 mL (interquartile range, 2441–4955 mL), with fluids indisputably required for body fluid homeostasis representing 36% of this total. Saline, glucose-containing high chloride crystalloids, and balanced crystalloids represented 43%, 27%, and 16% of total volume, respectively. Whatever the class of fluids, center of inclusion was the strongest factor associated with volumes. Compared with the first tertile, the difference between the volume predicted by patient characteristics and the volume given was +1.2 ± 2.0 L in tertile 2 and +3.0 ± 2.8 L in tertile 3. Conclusions: Fluids indisputably required for body fluid homeostasis represent the minority of fluid intake during the 24 hours after ICU admission. Center effect is the strongest factor associated with the volume of fluids. Heterogeneity in practices suggests that optimal strategies for volume and goals of common fluids administration need to be developed