Corticotherapy for traumatic brain-injured Patients - The Corti-TC trial: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Traumatic brain injury (TBI) is a main cause of severe prolonged disability of young patients. Hospital acquired pneumonia (HAP) add to the morbidity and mortality of traumatic brain-injured patients. In one study, hydrocortisone for treatment of traumatic-induced corticosteroid insufficiency (CI) in multiple injured patients has prevented HAP, particularly in the sub-group of patients with severe TBI. Fludrocortisone is recommended in severe brain-injured patients suffering from acute subarachnoid hemorrhage. Whether an association of hydrocortisone with fludrocortisone protects from HAP and improves neurological recovery is uncertain. The aim of the current study is to compare corticotherapy to placebo for TBI patients with CI.</p> <p>Methods</p> <p>The CORTI-TC (Corticotherapy in traumatic brain-injured patients) trial is a multicenter, randomized, placebo controlled, double-blind, two-arms study. Three hundred and seventy six patients hospitalized in Intensive Care Unit with a severe traumatic brain injury (Glasgow Coma Scale ≤ 8) are randomized in the first 24 hours following trauma to hydrocortisone (200 mg.day^-1for 7 days, 100 mg on days 8-9 and 50 mg on day-10) with fludrocortisone (50 μg for 10 days) or double placebo. The treatment is stopped if patients have an appropriate adrenal response. The primary endpoint is HAP on day-28. The endpoint of the ancillary study is the neurological status on 6 and 12 months.</p> <p>Discussion</p> <p>The CORTI-TC trial is the first randomized controlled trial powered to investigate whether hydrocortisone with fludrocortisone in TBI patients with CI prevent HAP and improve long term recovery.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01093261">NCT01093261</a></p

CpG-ODN and MPLA Prevent Mortality in a Murine Model of Post-Hemorrhage-Staphyloccocus aureus Pneumonia

Infections are the most frequent cause of complications in trauma patients. Post-traumatic immune suppression (IS) exposes patients to pneumonia (PN). The main pathogen involved in PN is Methicillin Susceptible Staphylococcus aureus (MSSA). Dendritic cells () may be centrally involved in the IS. We assessed the consequences of hemorrhage on pneumonia outcomes and investigated its consequences on DCs functions. A murine model of hemorrhagic shock with a subsequent MSSA pneumonia was used. Hemorrhage decreased the survival rate of infected mice, increased systemic dissemination of sepsis and worsened inflammatory lung lesions. The mRNA expression of Tumor Necrosis Factor-alpha (TNF-α), Interferon-beta (IFN-β) and Interleukin (IL)-12p40 were mitigated for hemorrhaged-mice. The effects of hemorrhage on subsequent PN were apparent on the pDCs phenotype (reduced MHC class II, CD80, and CD86 molecule membrane expression). In addition, hemorrhage dramatically decreased CD8+ cDCs- and CD8- cDCs-induced allogeneic T-cell proliferation during PN compared with mice that did not undergo hemorrhage. In conclusion, hemorrhage increased morbidity and mortality associated with PN; induced severe phenotypic disturbances of the pDCs subset and functional alterations of the cDCs subset. After hemorrhage, a preventive treatment with CpG-ODN or Monophosphoryl Lipid A increased transcriptional activity in DCs (TNF-α, IFN-β and IL-12p40) and decreased mortality of post-hemorrhage MSSA pneumonia

Traumatic brain injury and peripheral immune suppression: primer and prospectus

Nosocomial infections are a common occurrence in patients following traumatic brain injury (TBI) and are associated with an increased risk of mortality, longer length of hospital stay and poor neurological outcome. Systemic immune suppression arising as a direct result of injury to the central nervous system (CNS) is considered to be primarily responsible for this increased incidence of infection, a view strengthened by recent studies that have reported novel changes in the composition and function of the innate and adaptive arms of the immune system post TBI. However, our knowledge of the mechanisms that underlie TBI-induced immune suppression is equivocal at best. Here, after summarising our current understanding of the impact of TBI on peripheral immunity and discussing CNS-mediated regulation of immune function, we propose roles for a series of novel mechanisms in driving the immune suppression that is observed post TBI. These mechanisms, which have never been considered before in the context of TBI-induced immune paresis include the CNS-driven emergence into the circulation of myeloid derived suppressor cells and suppressive neutrophil subsets, and the release from injured tissue of nuclear and mitochondria-derived damage associated molecular patterns. Moreover, in an effort to further our understanding of the mechanisms that underlie TBI-induced changes in immunity, we pose throughout the review a series of questions, which if answered would address a number of key issues such as establishing whether manipulating peripheral immune function has potential as a future therapeutic strategy by which to treat and/or prevent infections in the hospitalised TBI patient

Ignacy F. Dobrzynski: His Life and Contributions to Piano Pedagogy

Ignacy F. Dobrzyński was a Polish Romantic-era composer and pedagogue who had a considerable compositional output and received high acclaim during his lifetime, especially for his chamber and orchestral works. Unfortunately, the sociopolitical atmosphere of twentieth-century Poland ultimately led to the obscurity of this great composer. This essay is comprised of a chronicle of Dobrzyński&rsquo;s personal and professional events based on a biography written by his son, Bronisław, while contextualizing his output for the piano, as well as a detailed discussion of his piano compositions to reveal some of Dobrzyński&rsquo;s pedagogical predilections. As a native Polish speaker, the author provides the first translation of Dobrzyński&rsquo;s piano method book Szkoła na Fortepian in the appendix for the English reader&rsquo;s reference. The study seeks to present the pedagogical merit of Dobrzyński&rsquo;s piano compositions and how his works are suitable for preparing performers for more technically and harmonically demanding pieces by composers such as Chopin. Dobrzyński&rsquo;s connection to Chopin is also noteworthy, as both studied under the tutelage of J&oacute;zef Elsner in their formative years at the conservatory in Warsaw and composed works that reflect the Polish genres of music.</p

Enquête sur le portage de Staphylocoque doré résistant à la méticilline en salle de surveillance post-interventionnelle

Les salles de surveillance post-interventionnelles sont des structures en salle commune avec une charge de soins infirmiers importante pouvant être à l'origine de la transmission croisée du SARM.Dans cette étude prospective réalisée sur une période de 15 jours, nous avons recherché à évaluer la prévalence du portage de SARM parmi les patients de SSPI, les facteurs de risques de ce portage et le risque de transmission, évalue par le nombre de patients ayant été en contact au sein de la SSPI avec un patient porteur de SARM.Parmi les 255 patients étudiés, 7 patients, correspondant à 10 admissions, étaient porteurs de SARM. Les facteurs de risque retrouvés en analyse univariée d'un portage de SARM étaient une classe ASA et Altemeier supérieures à 2, la durée d'hospitalisation dans l'année et en pré-opératoire, une antibiothérapieedans l'année et la présence d'une sonde vésicale. Malgré une faible prévalence du portage de SARM(2.7%), prés d'un tiers de l'ensemble des patients a été en contact avec au moins un porteur de SARM. Ces résultats démontrent le risque potentiel important de transmission croisée et plaident pour l'application de mesures strictes d'hygiéne en SSPI.PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF