Troponine élevée avant une chirurgie non cardiaque réglée (fréquence et valeur pronostique)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Le bloc abdominal transverse continu au cours de la chirurgie programmée de l aorte abdominale par laparotomie latérale (essai prospectif, contrôlé, randomisé en double aveugle comparant la ropivacaïne 0.2% au placebo)

INTRODUCTION: La chirurgie de l aorte abdominale par laparotomie est une chirurgie douloureuse et prodiguée à des patients fragiles. Une prise en charge optimale de la douleur postopératoire a montré un bénéfice sur la morbi-mortalité. Le bloc abdominal transverse (TAP bloc) est une technique d anesthésie loco-régionale récente et efficace pour l analgésie de la paroi abdominale s incluant dans le concept d analgésie multimodale. Son utilisation en continu par la pose d un cathéter a peu été évaluée. MATERIELS ET METHODES: Lors d un essai prospectif, randomisé, en double aveugle (ropivacaïne 0,2% versus placebo), nous avons évalué au CHU de Dijon l efficacité du TAP bloc continu durant 48 heures en postopératoire de chirurgie programmée de l aorte abdominale par voie d abord rétropéritonéale. Le cathéter est placé par le chirurgien au moment de la fermeture de la paroi musculaire. Le critère de jugement principal est la consommation de morphine par PCA au cours des 24 premières heures. Les critères secondaires sont la consommation de morphine à 48 heures, les scores de douleur, la durée du séjour hospitalier, la survenue d épisodes de rétention aigue d urine, de nausées vomissements postopératoires et de retard de reprise du transit. RESULTATS: 25 patients ont été inclus dans chaque groupe du 1er septembre 2011 24 Août 2012. La consommation de morphine est inférieure dans le groupe ropivacaïne à 24 heures (30,7 +- 15,9 mg versus 40,7 +- 16,9 mg ; p = 0,019) et à 48 heures (42 +- 26,2 mg versus 63,8 +- 24,5 mg ; p = 0,003). Il n y a pas de différence significative entres les deux groupes sur les autres critères. Aucun incident lié à la technique n est relevé. CONCLUSIONS : Le TAP bloc en continu permet de réduire significativement la consommation de morphine en postopératoire de chirurgie programmée de l aorte abdominale par voie rétropéritonéale. Il doit faire partie de l arsenal analgésique au décours de ce type d intervention. Il se distingue par sa simplicité d apprentissage, de réalisation, de surveillance et son innocuité.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Chimiothérapie intrapleurale en hyperpression (étude de faisabilité en termes de retentissement hémodynamique chez le porc)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Specific post-translational modifications of soluble tau protein distinguishes Alzheimer’s disease and primary tauopathies

Abstract Tau protein aggregates in several neurodegenerative disorders, referred to as tauopathies. The tau isoforms observed in post mortem human brain aggregates is used to classify tauopathies. However, distinguishing tauopathies ante mortem remains challenging, potentially due to differences between insoluble tau in aggregates and soluble tau in body fluids. Here, we demonstrated that tau isoforms differ between tauopathies in insoluble aggregates, but not in soluble brain extracts. We therefore characterized post-translational modifications of both the aggregated and the soluble tau protein obtained from post mortem human brain tissue of patients with Alzheimer’s disease, cortico-basal degeneration, Pick’s disease, and frontotemporal lobe degeneration. We found specific soluble signatures for each tauopathy and its specific aggregated tau isoforms: including ubiquitination on Lysine 369 for cortico-basal degeneration and acetylation on Lysine 311 for Pick’s disease. These findings provide potential targets for future development of fluid-based biomarker assays able to distinguish tauopathies in vivo

Guidelines on perioperative optimization protocol for the adult patient 2023

International audienceObjective: The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. Design: A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. Methods: Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a “formalized expert recommendations” format. Results: The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. Conclusions: Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields

Epigenetic control of aquaporin 1 expression by the amyloid precursor protein.

Cellular processing of the amyloid precursor protein (APP) has been extensively studied, but its precise function remains elusive. The intracellular domain of APP has been proposed to regulate expression of several genes by mechanisms that are largely unknown. We report that APP regulates expression of the aquaporin 1 (AQP1) gene in mouse embryonic fibroblasts and in transgenic mice. AQP1 mRNA and protein were down-regulated in fibroblasts lacking APP or presenilin 2 in which AQP1 expression was restored by stable expression of full-length APP or presenilin 2 but not by APP deleted from its carboxy-terminal domain. The transcriptional activity of the AQP1 gene promoter and the stability of AQP1 mRNA were identical in fibroblasts expressing or not expressing APP. Control of AQP1 expression by APP was sensitive to trichostatin A, an histone deacetylase inhibitor, and histone deacetylase activity coimmunoprecipitated with APP. Altogether, these data show that a presenilin-2-dependent gamma-secretase activity releases the intracellular domain of APP involved in the epigenetic control of AQP1 expression. Since AQP1 is found in astrocytes surrounding senile plaques, this epigenetic control of AQP1 expression could have important implications in Alzheimer disease.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe