Low-dose hydrocortisone reduces norepinephrine duration in severe burn patients: a randomized clinical trial

INTRODUCTION: The aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn. METHODS: A placebo-controlled, double-blind, randomized clinical trial (RCT) was performed on two parallel groups in the burn intensive care unit (ICU). Patients were randomized to receive either low-dose corticosteroid therapy or placebo for seven days. A corticotropin test was performed at the time of randomization, before the administration of the treatment dose. Thirty-two severely burned patients with refractory shock (>0.5 μg/kg/min of norepinephrine) were prospectively included in the study. RESULTS: We included 12 patients in the hydrocortisone-treated group and 15 patients in the placebo group in the final analysis. Among these patients, 21 were nonresponders to the corticotropin test. Median norepinephrine treatment duration (primary objective) was significantly lower in the corticosteroid-treated versus the placebo group (57 hours versus 120 hours, P = 0.035). The number of patients without norepinephrine 72 hours after inclusion was significantly lower in the treated group (P = 0.003, log-rank test analysis). The total quantities of norepinephrine administered to patients were lower in the hydrocortisone-treated versus the placebo group (1,205 μg/kg (1,079 to 2,167) versus 1,971 μg/kg (1,535 to 3,893), P = 0.067). There was no difference in terms of ICU or hospital length of stay, sepsis incidence, cicatrization or mortality. CONCLUSIONS: In this placebo-controlled, randomized, double-blind clinical trial, we show for the first time that the administration of low-dose hydrocortisone in burn patients with severe shock reduces vasopressor administration. TRIAL REGISTRATION: Clinicaltrial.gov NCT00149123. Registered 6 September 2005. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0740-0) contains supplementary material, which is available to authorized users

Comment caractériser les femmes autistes à l'âge adulte?

International audienceAutism had predominantly be described and studied in males. On one hand, it is related to the thought that this condition would be essentially found in males; on the other hand, it comes from the idea that autistic symptoms would be similar in men and women. The later perspective tends to minimize some autistic specificities more common in women and, consequently, can conduct clinicians to miss women’s diagnosis. Yet, recent research demonstrated that autistic women sometimes slightly distinguish from males by specific phenotypic characteristics, despite similar core symptoms. Autistic females often appear to be more socially integrated and their verbal as well as nonverbal communication can be more efficient. Moreover, their specific interests usually seem to be less atypical. Nevertheless, all these domains are impaired in autistic female as compared to non-autistic population. Furthermore, they experienced executive function impairments, emotional distress, as well as specific women issues, for instance, specificities when experiencing maternity. Regarding every day professional and personal challenges autistic women have to face, there is a need to provide research findings to clinician in order to improve their knowledge and their ability to better identify, understand and support autistic women of all ages.L’autisme a majoritairement été décrit et étudié à partir de populations masculines. Cela tient d’une part à la croyance que cette condition se retrouve essentiellement chez les garçons et d’autre part, à une conception que les manifestations autistiques seraient identiques chez l’homme et la femme. Cette dernière approche a l’écueil de minimiser certaines caractéristiques propres aux femmes et, par voie de conséquence, de passer à côté du diagnostic d’autisme chez ces dernières. Or, les recherches récentes montrent que les femmes autistes, malgré des symptômes fondamentaux similaires aux hommes autistes, présentent parfois un phénotype qui se distingue sensiblement de celui de leurs pairs masculins. Il n’est pas rare que leur insertion sociale puisse sembler plus réussie et que leur communication verbale et non verbale soit plus adaptée. Par ailleurs, leurs intérêts paraissent souvent moins atypiques. Néanmoins, tous ces aspects restent une réelle source de difficultés chez elles, et à ceux-ci viennent s’ajouter des difficultés de fonctionnement exécutif, émotionnel et des problématiques liées à leur condition de femme, comme la maternité. Devant les nombreux défis que cette population a à relever quotidiennement tant d’un point de vue personnel que professionnel, il est primordial que les cliniciensaient une meilleure connaissance des caractéristiques des femmes autistes afin de mieux les repérer, les comprendre et les accompagner à tous les âges de la vie

Faire face aux nouveaux défis environnementaux Comment notre cerveau permet les changements de nos comportements ?

National audienc

Saccadic eye movements in adults with high-functioning autism spectrum disorder

International audienc

Liens entre spécificités sensorielles et sévérité des symptômes dans le trouble du spectre de l’autisme chez de jeunes enfants

International audienc

What can we learn by including autistic people in the scientific process?

International audienc

Effect of diffuse axonal lesions on working memory: a fMRI study

International audienc

fMRI study of problem-solving after severe traumatic brain injury.

International audienceOBJECTIVE: To assess the cerebral correlates of the dysexecutive syndrome after diffuse severe traumatic brain injury (TBI). METHODS: Ten patients with sub-acute/chronic severe TBI without detectable focal cortical contusion and 11 matched healthy subjects were included in a parametric fMRI study using a planning task, the Tower of London. RESULTS: Brain activation in the left Dorsolateral Pre-frontal Cortex (DLPFC) and the Anterior Cingulate Cortex (ACC) was closely related to performance. Patients with TBI who performed the task efficiently showed, like healthy controls who obtained a similar pattern of performance, a large activation in the left DLPFC and a small activation in the ACC. In contrast, poor performance was associated with a reduced activation in these both regions. CONCLUSION: Problem-solving deficits after severe diffuse TBI could be related to an impaired activation of the DLPFC and of the ACC