IDEAL : un reseau supervise par un reseau de superviseurs

Communication a : EC2, AVIGNON'93, Avignon (France), 24-28 mai 1993Available at INIST (FR), Document Supply Service, under shelf-number : 22419, issue : a.1993 n.76 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

Does programmed intermittent epidural bolus improve childbirth conditions of nulliparous women compared with patient-controlled epidural analgesia?

International audienceBACKGROUND:Epidural analgesia may change the mechanics of childbirth. These changes are related to the concentration of the local anaesthetic used epidurally but probably also to its mode of delivery into the epidural space.OBJECTIVE:To determine whether the administration of programmed intermittent epidural boluses (PIEB) improves the mechanics of second-stage labour compared with patient-controlled epidural analgesia (PCEA) with a background infusion.DESIGN:A randomised, controlled, triple-blind study.SETTING:Multicentre study including four level III maternity units, January 2014 until June 2016.PATIENTS:A total of 298 nulliparous patients in spontaneous labour were randomised to a PIEB or PCEA group.INTERVENTION:After epidural initiation with 15 ml of 0.1% levobupivacaine containing 10 μg of sufentanil, patients received either an hourly bolus of 8 ml (PIEB) or a continuous rate infusion of 8 ml h (PCEA): the drug mixture used was levobupivacaine 0.1% and sufentanil 0.36 μg ml.MAIN OUTCOME MEASURES:The primary outcome was a composite endpoint of objective labour events: a posterior occiput position in the second stage, an occiput position at birth, waiting time at full cervical dilatation before active maternal pushing more than 3 h, maternal active pushing duration more than 40 min, and foetal heart rate alterations. Vaginal instrumental delivery rates, analgesia and motor blockade scores were also recorded.RESULTS:From the 298 patients randomised, data from 249 (124 PIEB, 125 PCEA) were analysed. No difference was found in the primary outcome: 48.0% (PIEB) and 45.5% (PCEA) of patients, P = 0.70. In addition, no difference was observed between the groups for each of the individual events of the composite endpoint, nor in the instrumental vaginal delivery rate, nor in the degree of motor blockade. Despite an equivalent volume of medication in the groups, a significantly higher analgesia score at full dilatation was observed in the PIEB group, odds-ratio = 1.9 (95% confidence interval, 1.0 to 3.5), P = 0.04.CONCLUSION:The mechanics of the second stage did not differ whether PIEB or PCEA was used. Analgesic conditions appeared to be superior with PIEB, especially at full dilation

No more hypoglycaemia on days with physical activity and unrestricted diet when using a closed‐loop system for 12 weeks: A post‐hoc secondary analysis of the multicentre randomized controlled Diabeloop WP7 trial

International audienceObjective: To investigate the efficacy of the Diabeloop Generation-1 (DBLG1) closed-loop system to control the hypoglycaemia induced by physical activity (PA) in real-life conditions.Methods: This was a post-hoc analysis of the Diabeloop WP7 multicentre randomized controlled trial. Glycaemic outcomes were compared between days with and without PA in 56 patients with type 1 diabetes (T1D) using DBLG1 for 12 weeks. After the patient announces a PA, DBLG1 reduces insulin delivery and, if necessary, calculates the amount of preventive carbohydrates (CHO).Results: Daily time spent in the interstitial glucose range <70 mg/dL was not significantly different between days with and without PA (2.0 ± 1.5% versus 2.2 ± 1.1%) and this regardless of the intensity or duration of the PA. Preventive CHO intake recommended by the system was significantly higher in days with PA (41.1 ± 35.5 versus 21.8 ± 28.5 g/day; P <0.0001), and insulin delivery was significantly lower (31.5 ± 10.5 versus 34.0 ± 10.5 U/day; P <0.0001). The time spent in hyperglycaemia and the glycaemic variation coefficient increased significantly on days with PA.Conclusions: In real-life conditions, the use of DBLG1 avoids PA-induced hypoglycaemia. Insulin adjustments and preventive CHO recommendation may explain this therapeutic benefit

A Small-Molecule Screen for Enhanced Homing of Systemically Infused Cells

Poor homing of systemically infused cells to disease sites may limit the success of exogenous cell-based therapy. In this study, we screened 9,000 signal-transduction modulators to identify hits that increase mesenchymal stromal cell (MSC) surface expression of homing ligands that bind to intercellular adhesion molecule 1 (ICAM-1), such as CD11a. Pretreatment of MSCs with Ro-31-8425, an identified hit from this screen, increased MSC firm adhesion to an ICAM-1-coated substrate in vitro and enabled targeted delivery of systemically administered MSCs to inflamed sites in vivo in a CD11a- (and other ICAM-1-binding domains)-dependent manner. This resulted in a heightened anti-inflammatory response. This represents a new strategy for engineering cell homing to enhance therapeutic efficacy and validates CD11a and ICAM-1 as potential targets. Altogether, this multi-step screening process may significantly improve clinical outcomes of cell-based therapies

An Unsafe/Safe Typology in People with Type 2 Diabetes: Bridging Patients’ Expectations, Personality Traits, Medication Adherence, and Clinical Outcomes

International audienceBackground: Support programs are provided to people with diabetes to help them manage their disease. However, adherence to and persistence in support programs are often low, making it difficult to demonstrate their effectiveness.Aim: To identify the determinants of patients' perceived interest in diabetes support programs because it may be a powerful determinant of effective participation in such programs.Patients and methods: An online study conducted in April 2021 in metropolitan France on 600 people with diabetes recruited from a consumer panel. A 64-item psychosocial questionnaire including a question asking to evaluate the helpfulness of a support program was used. Univariate, multivariate, and multiple correspondence analyses were performed.Results: The existence of a typology, known as Unsafe/Safe, was discovered, in which patients with type 2 diabetes respond in two distinct ways. Type U (unsafe) patients, who believe that a support program would be helpful, are more likely to be nonadherent to their treatment, have high hemoglobin A1c levels, have at least one diabetic complication, lack information regarding their disease and treatment, rate the burden of their disease and impairment of their quality of life as high, worry about their future, and are pessimistic. Type S (safe) patients have the opposite characteristics. Type U patients can be dichotomized into two broad classes: one in which they lack information regarding disease and treatment and the other in which alterations in the quality of life and burden of the disease predominate. Insulin-treated patients give more importance to the lack of information, whereas noninsulin-treated patients complain primarily about the burden of the disease and impairment of quality of life.Conclusion: This study describes this new U/S typology, proposes a simple method based on a nine-item questionnaire to identify type U patients by calculating a Program Helpfulness Score described herein, and clarifies the nature of the intervention to be provided to them. This novel approach could be applied to other chronic diseases

Le Roman du signe

Indices, traces, symptômes... Qu’est-ce qui fait signe dans le roman ? Quel rapport le roman du XIXe siècle entretient-il avec la question herméneutique ? Dans une société hantée par le spectre de l’opacité et de l’insignifiance, le déchiffrement et l’interprétation des signes offrent, en même temps qu’une traversée du réel, un accès véritable à la connaissance. Le présent ouvrage étudie les mille et une formes narratives prises au XIXe siècle par le « paradigme indiciaire » (Carlo Ginzburg), chez Stendhal comme chez Huysmans, chez Gautier comme chez Flaubert, dans la représentation des corps comme dans la conduite de l’intrigue

Prevalence of sleep apnoea in patients with type 1 diabetes and its association with comorbidities and diabetic complications: A French nationwide prospective study

International audienceAbstract Aim To investigate sleep apnoea prevalence, factors influencing severity, and associations between sleep apnoea severity and micro‐/macrovascular complications in a large population of patients with type 1 diabetes. Materials and methods This French multicentre prospective cohort study was conducted between July 2016 and June 2020. Adults with type 1 diabetes using an insulin pump were eligible. Home care provider nurses collected demographic and clinical data and set up oximetry to determine the oxygen desaturation index (ODI). No, mild–moderate and severe sleep apnoea were defined as ODI <15 events/h, 15 to <30 events/h and ≥30 events/h, respectively. Univariate and multivariate analyses were performed to identify factors associated with sleep apnoea, and associations between sleep apnoea severity and micro‐/macrovascular complications were determined using logistic regression. Results Of 769 participants, 12.4% and 3.4% had mild‐to‐moderate or severe sleep apnoea, respectively. Factors significantly associated with sleep apnoea on multivariate analysis were age, sex, body mass index (BMI) and hypertension. After adjustment for age, sex and BMI, presence of severe sleep apnoea was significantly associated with macrovascular complications (odds ratio vs. no sleep apnoea: 3.96 [95% confidence interval 1.43‐11.11]; P < 0.01), while mild‐to‐moderate sleep apnoea was significantly associated with presence of diabetic retinopathy (odds ratio 2.09 [95% confidence interval 1.10‐3.74]; P < 0.01). Conclusion Sleep apnoea is a significant comorbidity in patients with type 1 diabetes, especially with respect to diabetic complications. This highlights the need for sleep apnoea screening and management in these individuals

Prevalence of sleep apnea in patients with type 1 diabetes and its association with comorbidities and diabetic complications: A French nationwide prospective study

International audienceTo investigate sleep apnea prevalence, factors influencing severity, and associations between sleep apnea severity and micro-/macrovascular complications in a large population of patients with type 1 diabetes.</div