Early detection of Cheyne-Stokes breathing via ECG-derived respiration in patients with severe heart failure: a pilot study

International audienceWe present in this paper a preliminary study for detecting early pattern of Cheyne-Stokes Breathing using a single electrocardiogram signal in patients with severe heart failure. Two ECG-derived respiration signals, namely Heart-Rate and R-Wave Amplitude, are computed and jointly used to estimate different respiratory events, respiratory rate and amplitude modulation. Three patients whose respiration goes from normal to severe CSB are used to test our method. Results show good performance for the detection of breathing cycles compared with the ventilation signal and the final classification based on respiratory events, AHI, amplitude modulation reveals exact correlation with the expert

How the central domain of dystrophin acts to bridge F-actin to sarcolemmal lipids

Dystrophin is a large intracellular protein that prevents sarcolemmal ruptures by providing a mechanical link between the intracellular actin cytoskeleton and the transmembrane dystroglycan complex. Dystrophin deficiency leads to the severe muscle wasting disease Duchenne Muscular Dystrophy and the milder allelic variant, Becker Muscular Dystrophy (DMD and BMD). Previous work has shown that concomitant interaction of the actin binding domain 2 (ABD2) comprising spectrin like repeats 11 to 15 (R11-15) of the central domain of dystrophin, with both actin and membrane lipids, can greatly increase membrane stiffness. Based on a combination of SAXS and SANS measurements, mass spectrometry analysis of cross-linked complexes and interactive low-resolution simulations, we explored in vitro the molecular properties of dystrophin that allow the formation of ABD2-F-actin and ABD2-membrane model complexes. In dystrophin we identified two subdomains interacting with F-actin, one located in R11 and a neighbouring region in R12 and another one in R15, while a single lipid binding domain was identified at the C-terminal end of R12. Relative orientations of the dystrophin central domain with F-actin and a membrane model were obtained from docking simulation under experimental constraints. SAXS-based models were then built for an extended central subdomain from R4 to R19, including ABD2. Overall results are compatible with a potential F-actin/dystrophin/membrane lipids ternary complex. Our description of this selected part of the dystrophin associated complex bridging muscle cell membrane and cytoskeleton opens the way to a better understanding of how cell muscle scaffolding is maintained through this essential protein

Evaluating the feasibility and acceptability of an adapted fencing intervention in breast cancer surgery post-operative care: the RIPOSTE pilot randomized trial

BackgroundAdapted physical activity programs have shown promising results in reducing the physical, social and psychological side effects associated with breast cancer, but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the framework to guide the planning and evaluation of programs according to the 5 following keys: Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate a fencing program under the French acronym RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime) literally in English (Reconstruction, Self-Image, Posture, Oncology, Health, Therapy, Fencing). This program is an innovative intervention focused on improving the quality of life (QoL) of breast cancer surgery patients through fencing.MethodsA convergent mixed methods pilot study was conducted to preliminary evaluate the different RE-AIM dimension of the pilot program. Twenty-four participants who have just undergone surgery for invasive breast cancer were randomly allocated in two groups: one group started immediately after their inclusion (Early RIPOSTE group) and the other started 3 months following their inclusion (Delayed RIPOSTE group). Participants answered a questionnaire at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and physical activity.ResultsRIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of QoL, shoulder functional capacity, fatigue and anxiety-depression state, even without any significant differences between the Early RIPOSTE group and the Delayed RIPOSTE group.DiscussionsThe cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during school vacations were the main barriers. The intervention was moderately well implemented and adherence to the protocol was suitable.ConclusionRIPOSTE is an acceptable and effective program for involving breast cancer survivors in physical activity, that needs to be tested at a larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide

Using exoskeletons to assist medical staff during prone positioning of mechanically ventilated COVID-19 patients: a pilot study

International audienceWe conducted a pilot study to evaluate the potential and feasibility of back-support exoskeletons to help the caregivers in the Intensive Care Unit (ICU) of the University Hospital of Nancy (France) executing Prone Positioning (PP) maneuvers on patients suffering from severe COVID-19-related Acute Respiratory Distress Syndrome. After comparing four commercial exoskeletons, the Laevo passive exoskeleton was selected and used in the ICU in April 2020. The first volunteers using the Laevo reported very positive feedback and reduction of effort, confirmed by EMG and ECG analysis. Laevo has been since used to physically assist during PP in the ICU of the Hospital of Nancy, following the recrudescence of COVID-19, with an overall positive feedback

Confrontation anatomoclinique et survies comparées des tumeurs carcinoïdes typiques, atypiques et carcinomes neuroendocrines à grandes cellules, bronchopulmonaires selon la classification de l'OMS de 1999 (étude rétrospective de 49 cas nancéiens de 1989 à 2000)

NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude des mécanismes physiopathologiques impliqués dans les apnées centrales du sommeil associées à l'insuffisance cardiaque chronique : données expérimentales animales et applications à l'Homme

During sleep, control of breathing is greatly influenced by metabolic information. Whether this chemical control of ventilation is involved in the genesis of central sleep apneas with CheyneStokes respiration in severe congestive heart patients is unknown and the subject of our work. It includes three series of experiments in animal models to clarify the mechanisms involved in the hypocapnia-induced apneas, the anatomical structures mediating such a ventilatory response and the specific effects of heart failure on the control of breathing, leading to an increased susceptibility to central apneas. More specifically a sleeping dog model was used, allowing the study of periodic breathing induced by a transient hyperventilation, with and without any acute pulmonary vascular congestion. We were interested in conditions capable of changing the apneic threshold defined as the arterial or end-expiratory partial carbon dioxide pressure below which ventilation ceases. Two mechanisms possibly involved in human pathology were investigated : 1- changes in the activity of the peripheral chemoreceptors 2- pulmonary vascular congestion. Whereas the arterial chemoreceptors are involved in the genesis of hypocapnia-induced apneas and the cardio-respiratory structures activated by a pulmonary edema facilitate the occurrence of central apneas, these mechanisms were not able to fully explain the description of the Cheyne-Stokes respiration in Humans. The relevance of these results must be evaluated in Human and the role played by the non-chemical information of the control of breathing in the genesis of central apneas must be more precisely studied.La régulation chimique de la ventilation joue un rôle important durant le sommeil. Son implication possible dans la survenue d'apnées centrales du sommeil associées à la respiration périodique de Cheyne-Stokes dans l'insuffisance cardiaque sévère est l'objet de ce travail. Il comporte trois études expérimentales chez l'animal pour préciser comment une hypocapnie peut engendrer des apnées centrales, les structures anatomiques mises en jeu et les mécanismes physiopathologiques responsables d'une facilitation des apnées centrales en cas d'insuffisance cardiaque. Une préparation canine non anesthésiée, reproduisant une ventilation périodique par hyperventilation transitoire durant le sommeil a plus particulièrement été étudiée. Nous nous sommes intéressés aux conditions pouvant entraîner une modification du seuil d'apnée : pression partielle de CO2 au dessous de laquelle la ventilation s'arrête. Deux mécanismes, possiblement mis en jeu en pathologie humaine et aboutissant à une plus grande susceptibilité aux apnées centrales ont été étudiés: 1-la modification de l'activité des chémorécepteurs artériels 2- la congestion vasculaire pulmonaire. Si les chémorécepteurs artériels sont particulièrement impliqués la genèse des apnées centrales induites par l'hypocapnie et les structures cardio-respiratoires mises en jeu lors d'un d?ème pulmonaire peuvent favoriser la constitution d'une respiration périodique chez le chien, ils ne peuvent tout expliquer. La pertinence de ces résultats doit être évaluée chez l'Homme et l'implication d'informations non chimiosensibles dans la survenue d'apnées centrales du sommeil reste à étudier

Etude des mécanismes physiopathologiques impliqués dans les apnées centrales du sommeil associées à l'insuffisance cardiaque chronique : données expérimentales animales et applications à l'Homme

La régulation chimique de la ventilation joue un rôle important durant le sommeil. Son implication possible dans la survenue d'apnées centrales du sommeil associées à la respiration périodique de Cheyne-Stokes dans l'insuffisance cardiaque sévère est l'objet de ce travail. Il comporte trois études expérimentales chez l'animal pour préciser comment une hypocapnie peut engendrer des apnées centrales, les structures anatomiques mises en jeu et les mécanismes physiopathologiques responsables d'une facilitation des apnées centrales en cas d'insuffisance cardiaque. Une préparation canine non anesthésiée, reproduisant une ventilation périodique par hyperventilation transitoire durant le sommeil a plus particulièrement été étudiée. Nous nous sommes intéressés aux conditions pouvant entraîner une modification du seuil d'apnée : pression partielle de CO2 au dessous de laquelle la ventilation s'arrête. Deux mécanismes, possiblement mis en jeu en pathologie humaine et aboutissant à une plus grande susceptibilité aux apnées centrales ont été étudiés: 1-la modification de l'activité des chémorécepteurs artériels 2- la congestion vasculaire pulmonaire. Si les chémorécepteurs artériels sont particulièrement impliqués la genèse des apnées centrales induites par l'hypocapnie et les structures cardio-respiratoires mises en jeu lors d'un œdème pulmonaire peuvent favoriser la constitution d'une respiration périodique chez le chien, ils ne peuvent tout expliquer. La pertinence de ces résultats doit être évaluée chez l'Homme et l'implication d'informations non chimiosensibles dans la survenue d'apnées centrales du sommeil reste à étudier.During sleep, control of breathing is greatly influenced by metabolic information. Whether this chemical control of ventilation is involved in the genesis of central sleep apneas with CheyneStokes respiration in severe congestive heart patients is unknown and the subject of our work. It includes three series of experiments in animal models to clarify the mechanisms involved in the hypocapnia-induced apneas, the anatomical structures mediating such a ventilatory response and the specific effects of heart failure on the control of breathing, leading to an increased susceptibility to central apneas. More specifically a sleeping dog model was used, allowing the study of periodic breathing induced by a transient hyperventilation, with and without any acute pulmonary vascular congestion. We were interested in conditions capable of changing the apneic threshold defined as the arterial or end-expiratory partial carbon dioxide pressure below which ventilation ceases. Two mechanisms possibly involved in human pathology were investigated : 1- changes in the activity of the peripheral chemoreceptors 2- pulmonary vascular congestion. Whereas the arterial chemoreceptors are involved in the genesis of hypocapnia-induced apneas and the cardio-respiratory structures activated by a pulmonary edema facilitate the occurrence of central apneas, these mechanisms were not able to fully explain the description of the Cheyne-Stokes respiration in Humans. The relevance of these results must be evaluated in Human and the role played by the non-chemical information of the control of breathing in the genesis of central apneas must be more precisely studied.NANCY1-SCD Medecine (545472101) / SudocSudocFranceF

Description et intérêt du suivi médical du sportif de haut niveau (étude de 29 jeunes joueurs de tennis lorrains)

Le Sportif de Haut Niveau est un patient à part dans le sens où son objectif de santé ne se limite pas au classique état de bien être global comme le décrit l OMS mais va être également de repousser les limites physiologiques de son organisme pour pouvoir améliorer ses performances tout en évitant la survenue de blessure. Il est ainsi particulièrement exposé à de nombreux problèmes de santé sur le plan physique et mental. C est ici que réside l intérêt du suivi médical obligatoire que doivent subir ces athlètes. Cet ouvrage fait donc une description du monde du Sport de Haut Niveau ainsi que du contenu et des objectifs du suivi médical régulier qu il impose, allant de l examen clinique biannuel à l échocardiographie initiale ou encore à l épreuve d effort maximal réalisée tous les quatre ans. Une étude portant sur ces bilans médicaux répétés chez des jeunes joueurs de tennis lorrains suivis pendant plusieurs années vient illustrer ces propos et révèle quelques-unes des conséquences possibles d une pratique sportive intensive sur des organismes en croissance. La description de ces conséquences potentielles fait elle-même l objet d un chapitre spécifique. Cet ouvrage offre donc une vision globale du rôle du Médecin dans le Sport de Haut Niveau, partagé entre le désir d amélioration des performances que manifeste l athlète et la gestion des risques que celui-ci fait ainsi courir pour sa santé globaleNANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Réalité Virtuelle Immersive: Effets antalgiques et physiologiques

International audienc

Réalité Virtuelle Immersive: Effets antalgiques et physiologiques

International audienc