Ketamine for pain management in France, an observational survey

International audienceContext: Before updating the French guidelines on postoperative pain treatment in 2015, the Pain Committee of the French Society of Anaesthesiology and Intensive Care (SFAR) conducted a survey on the medical use of ketamine in France. Methods: An online questionnaire was nationally distributed to members of SFAR, the French Pain Society (SFETD) and the French Society of Emergency Medicine (SFMU). The questionnaire included questions on demographic data, the type of patients for whom ketamine was prescribed, the doses used, the side effects and safety measures associated with the administration of ketamine. Results: A total of 1388 questionnaires were analysed. Ninety-two percent of the responders declared that they used ketamine. Ketamine was widely used as anti-hyperalgesic medication but the modalities of administration and the doses varied greatly and were not in accordance with the guidelines. Despite the lack of evidence and guidelines, ketamine has also been used to treat acute and chronic pain. Doses, duration and localization of the patients during administration have varied greatly. Psychedelic effects and hallucinations are the most feared side effects. In terms of monitoring during ketamine infusion, 15% of physicians declared that no monitoring was necessary while 59%, 55%, 59% and 77% monitored heart rate, SpO2, blood pressure and level of consciousness, respectively. Conclusion: Anaesthesiologists have integrated the benefit of ketamine in preventing hyperalgesia but there is no consensus on doses and duration. For other indications (acute and chronic pain treatment), toxicity and the absence of significant benefit call for guidelines from scientific societie

La réception de l’encyclique Fidei Donum dans l’Ouest de la France (1957-2003)

En 1957, le pape Pie XII publie l’encyclique Fidei Donum, qui lance aux évêques du monde entier « un grave appel en faveur des missions d’Afrique ». En 1961, le pape Jean XXIII élargit le cadre des envois en mission à l’Amérique latine. Depuis lors, des centaines de prêtres diocésains sont partis en mission, même si le courant s’est sensiblement amenuisé depuis les années soixante-dix. Ma recherche concerne les flux de missionnaires Fidei Donum dans l’Ouest de la France depuis une quarantaine d’années. Plusieurs sources ecclésiastiques ont été privilégiées : les Ordo, les Semaines Religieuses et les hebdomadaires catholiques régionaux. Trois interrogations ont orienté plus particulièrement mes recherches : Quels sont les temps forts de l’envoi en mission Fidei Donum dans l’ouest de 1957 à 1997 ? Qui sont les missionnaires Fidei Donum de l’Ouest ? (origines, âge, parcours…) Quelles sont les destinations choisies par les envoyés de l’Ouest ? Y a-t-il eu des évolutions dans le temps ? Les choix sont-ils atypiques par rapport à l’ensemble de la France ?In 1957, the pope Pie XII publishes the encyclical letter Fidei Donum, which appeals a request publicly on behalf of the missions of Africa. In 1961, the pope Jean XXIII widens the frame of the sending in mission in the Latin America. Since then, hundreds of diocesan priests left for mission, even if the current appreciably diminished since the seventies. My research study missionaries Fidei Donum originated from the West of France since about forty years. Several ecclesiastical sources were privileged: Ordo, the Semaines Religieuses and regional catholic weeklies. Three questioning directed more particularly my researches: What are the strong times of the sending in mission in the West from 1957 till 1997? Who are the western missionaries Fidei Donum? (Previous history, age, course…) What are the destinations chosen by the western missionaries? Were there evolutions in the time? Are choices atypical with regard to the whole France

Isolation and characterisation of Listeria monocytogenes from piggeries in France

Recent analyses of human listeriosis outbreaks showed that these were associated with consumption of delicatessen items or pork products from other sources

PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations

The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intra-operative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine

Technical specifications for the monitoring and reporting of VTEC on animals and food

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Chan-Vese based method to segment mouse brain MRI images: application to cerebral malformation analysis in trisomy 21

International audienceIn this paper, a semi automatic active contour method based on Chan-Vese model is proposed for the segmentation of mouse brain MR images. First, a 2 ½ D strategy is applied on the axial images to segment the 3D volume of interest. The method takes into account the special shape of the object to segment. Moreover, the user defines the limits where to search these contours and also provides an initial contour. This semi automatic method makes that human intervention is limited and the tedious manual handling is greatly reduced. Results have shown that the brain volumes estimated by the method are identical to expert manually estimated volumes. Last but not least, the new method was used in the analysis of the cerebral malformations linked to Trisomy 21: no significant difference of the brain volumes between Tri-somy 21 mice and the control ones were found

Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

BACKGROUND: Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs-paracetamol (P), nefopam (N), and ketoprofen (K)-for postoperative analgesia. METHODS: Patients from 10 hospitals were randomised to one of eight groups: control (C) received saline as placebo, P, N, K, PN, PK, NK, and PNK. Treatments were given intravenously four times a day during the first 48 h after surgery, and morphine patient-controlled analgesia was used as rescue analgesia. The outcome measures were morphine consumption, pain scores, and morphine-related side-effects evaluated 24 and 48 h after surgery. RESULTS: Two hundred and thirty-seven patients undergoing a major surgical procedure were included between July 2013 and November 2016. Despite a failure to reach a calculated sample size, 24 h morphine consumption [median (inter-quartile range)] was significantly reduced in the PNK group [5 (1-11) mg] compared with either the C group [27 (11-42) mg; P<0.05] or the N group [21 (12-29) mg; P<0.05]. Results were similar 48 h after surgery. Patients experienced less pain in the PNK group compared with the C, N, and P groups. No difference was observed in the incidence of morphine-related side-effects. CONCLUSIONS: Combining three NOAs with morphine allows a significant morphine sparing for 48 h after surgery associated with superior analgesia the first 24 h when compared with morphine alone. CLINICAL TRIAL REGISTRATION: EudraCT: 2012-004219-30; NCT01882530

An exploratory study about contamination of pens of finishing pigs by ubiquitous Salmonella

Salmonella is one of the most common food-borne pathogens transmitted to humans and human salmonellosis is primarily caused by contaminated food. Porcine products have been identified as important food vehicles in outbreaks of salmonellosis (I, 2, 3). In France, the majority of Salmonella infected pig herds are sub-clinically infected. S. Choleraesuis does not occur and only ubiquitous serotypes are isolated (4). Sub-clinically infection is characterized by intermittent shedding of small numbers of Salmonella. In these sub-clinically infected pig herds, an infectioncontamination-infection cycle is maintained with mainly an endemic house flora of Salmonella enterica (5). When contaminated batches from these farms are processed on the slaughter line, slaughtering practices contribute to Salmonella dissemination and carcass contamination. Within batches, there is a strong correlation between the proportion of animals with Salmonella spp. in their feces and the proportion of contaminated carcasses at the end of the line (6, 7). As a result of subclinical Salmonella infection in pig herds, Salmonella contamination of pork carcasses constitutes a threat to human health. The influence of a wide range of factors on subclinical Salmonella contamination of pig farms is not well known. A good understanding of risk factors for Salmonella contamination of pig herds is an essential stake in order to avoid Salmonella spread within herds and between herds and slaughterhouses. Thus, the aim of this study was to investigate potential risk factors for the presence of ubiquitous Salmonella in the finishing sheds of farrow-to-finish farms in France

KIT is required for hepatic function during mouse post-natal development

<p>Abstract</p> <p>Background</p> <p>The <it>Kit </it>gene encodes a receptor tyrosine kinase involved in various biological processes including melanogenesis, hematopoiesis and gametogenesis in mice and human. A large number of <it>Kit </it>mutants has been described so far showing the pleiotropic phenotypes associated with partial loss-of-function of the gene. Hypomorphic mutations can induce a light coat color phenotype while complete lack of KIT function interferes with embryogenesis. Interestingly several intermediate hypomorphic mutations induced in addition growth retardation and post-natal mortality.</p> <p>Results</p> <p>In this report we investigated the post-natal role of <it>Kit </it>by using a panel of chemically-induced hypomorphic mutations recently isolated in the mouse. We found that, in addition to the classical phenotypes, mutations of <it>Kit </it>induced juvenile steatosis, associated with the downregulation of the three genes, <it>VldlR</it>, <it>Lpin1 </it>and <it>Lpl</it>, controlling lipid metabolism in the post-natal liver. Hence, <it>Kit </it>loss-of-functions mimicked the inactivation of genes controlling the hepatic metabolism of triglycerides, the major source of energy from maternal milk, leading to growth and viability defects during neonatal development.</p> <p>Conclusion</p> <p>This is a first report involving KIT in the control of lipid metabolism in neonates and opening new perspectives for understanding juvenile steatosis. Moreover, it reinforces the role of Kit during development of the liver and underscores the caution that should be exerted in using KIT inhibitors during anti-cancer treatment.</p