mHLA-DR dans l'évaluation de l'immunodépression et la prédiction des infections chez les polytraumatisés

LYON1-BU Santé (693882101) / SudocSudocFranceF

In canine bacterial pneumonia circulating granulocyte counts determine outcome from donor cells

BACKGROUND: In experimental canine septic shock, depressed circulating granulocyte counts were associated with a poor outcome and increasing counts with prophylactic granulocyte colony-stimulating factor (G-CSF) improved outcome. Therapeutic G-CSF, in contrast, did not improve circulating counts or outcome, and therefore investigation was undertaken to determine whether transfusing granulocytes therapeutically would improve outcome. STUDY DESIGN AND METHODS: Twenty-eight purpose-bred beagles underwent an intrabronchial Staphylococcus aureus challenge and 4 hours later were randomly assigned to granulocyte (40-100 × 109 cells) or plasma transfusion. RESULTS: Granulocyte transfusion significantly expanded the low circulating counts for hours compared to septic controls but was not associated with significant mortality benefit (1/14, 7% vs. 2/14, 14%, respectively; p = 0.29). Septic animals with higher granulocyte count at 4 hours (median [interquartile range] of 3.81 3.39-5.05] vs. 1.77 [1.25-2.50]) had significantly increased survival independent of whether they were transfused with granulocytes. In a subgroup analysis, animals with higher circulating granulocyte counts receiving donor granulocytes had worsened lung injury compared to septic controls. Conversely, donor granulocytes decreased lung injury in septic animals with lower counts. CONCLUSION: During bacterial pneumonia, circulating counts predict the outcome of transfusing granulocytes. With low but normal counts, transfusing granulocytes does not improve survival and injures the lung, whereas for animals with very low counts, but not absolute neutropenia, granulocyte transfusion improves lung function

Organisation de la réanimation « hors les murs » en salle de surveillance post-interventionnelle et au bloc opératoire en phase d’épidémie de COVID-19

International audienceWe report here the implementation and the use during 24 days of critical care beds beyond the walls during the COVID-19 outbreak in a teaching university hospital in Paris. These beds were settled in a 14-bed recovery room and two adjacent operating theatres leading to 20 additional critical care beds. The historical timeline, architectural elements, human resources, organisation and medical devices issues are presented. The benefits and limitations of this organisation are discussed.Nous rapportons la mise en place et l’utilisation pendant 24 jours de lits de réanimation « hors les murs » à l’occasion de l’épidémie de COVID-19 dans un hôpital universitaire parisien. Ces lits créés dans une salle de surveillance post-interventionnelle de 14 postes et dans deux blocs opératoires attenants ont permis l’ouverture de 20 lits supplémentaires de réanimation. Les aspects chronologiques, architecturaux, de ressources humaines, d’organisation et de matériel sont présentés. Les avantages et inconvénients de cette organisation sont discutés

Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study

International audienceBackgroundNeuromuscular blocking agents (NMBAs) are among the leading cause of perioperative anaphylaxis, and most of these reactions are IgE mediated. Allergic sensitisation induced by environmental exposure to other quaternary ammonium-containing compounds, such as pholcodine, has been suggested. The aim of this study was to assess the relationship between pholcodine exposure and NMBA-related anaphylaxis.MethodsALPHO was a multicentre case-control study, comparing pholcodine exposure within a year before anaesthesia between patients with NMBA-related perioperative anaphylaxis (cases) and control patients with uneventful anaesthesia in France. Each case was matched to two controls by age, sex, type of NMBA, geographic area, and season. Pholcodine exposure was assessed by a self-administered questionnaire and pharmaceutical history retrieved from pharmacy records. The diagnostic values of anti-pholcodine and anti-quaternary ammonium specific IgE (sIgE) were also evaluated.ResultsOverall, 167 cases were matched with 334 controls. NMBA-related anaphylaxis was significantly associated with pholcodine consumption (odds ratio 4.2; 95% confidence interval 2.3–7.0) and occupational exposure to quaternary ammonium compounds (odds ratio 6.1; 95% confidence interval 2.7–13.6), suggesting that apart from pholcodine, other environmental factors can also lead to sensitisation to NMBAs. Pholcodine and quaternary ammonium sIgEs had a high negative predictive value (99.9%) but a very low positive predictive value (<3%) for identifying NMBA-related reactions.ConclusionsPatients exposed to pholcodine 12 months before NMBA exposure have a significantly higher risk of an NMBA-related anaphylaxis. The low positive predictive values of pholcodine and quaternary ammonium sIgEs precludes their use to identify a population with a high risk of NMBA-related anaphylaxis

Comment choisir la question de son essai clinique ? Les conseils du Réseau Recherche de la SFAR

National audienceEvery research project begins with a question. As its nature will influence all subsequent steps, including the methodology, the question should be clear and well-defined from the outset. This is therefore a major step in carrying out a research project, which requires expertise and work. It is indeed clinical experience and previous research that lead to a good question. For it to be relevant, it is necessary to master existing literature on the subject, to be open to new ideas, new techniques, new methodologies, imagination and creativity, as well as to pay attention to mentorship and expert advice. This question must meet criteria for feasibility, interest, novelty, ethics, and relevance (the FINER criteria). It should be formulated in a structured way to ensure maximum clarity, for example following the PICOT framework. Therefore, defining the main question of your clinical trial is not just a semantic exercise.Tous les travaux de recherche commencent par une question. Cette question doit être claire et bien définie dès le départ, car sa nature influencera toutes les étapes suivantes, notamment la méthodologie. Il s’agit donc d’une étape majeure dans la réalisation d’un projet de recherche, qui demande de l’expertise et du travail. Une bonne question émerge en effet de l’expérience clinique et des recherches réalisées antérieurement. Elle nécessite pour être pertinente une maîtrise de la littérature existante sur le sujet, une ouverture à de nouvelles idées, de nouvelles techniques, de nouvelles méthodologies, de l’imagination et de la créativité, mais aussi une grande attention aux conseils de ses mentors et des experts établis. Cette question doit répondre à des critères de faisabilité, d’intérêt, de nouveauté, d’éthique et de pertinence (les critères FINER). Elle doit être formulée de manière structurée pour assurer un maximum de clarté, en suivant par exemple le cadre PICOT (pour population, intervention étudiée, contrôle, outcome et timeframe). Choisir et formuler la question principale de son essai clinique n’est donc pas un exercice purement sémantique

Active hydrothermal vents in the Woodlark Basin may act as dispersing centres for hydrothermal fauna

peer reviewedHere we report the discovery of a high-temperature hydrothermal vent field on the Woodlark Ridge, using ship-born multibeam echosounding and Remotely Operated Vehicle (ROV) exploration. La Scala Vent Field comprises two main active areas and several inactive zones dominated by variably altered basaltic rocks, indicating that an active and stable hydrothermal circulation has been maintained over a long period of time. The Pandora Site, at a depth of 3,380 m, is mainly composed of diffuse vents. The Corto site, at a depth of 3,360 m, is characterized by vigorous black smokers (temperature above 360°C). The striking features of this new vent field are the profusion of stalked barnacles Vulcanolepas sp. nov., the absence of mussels and the scarcity of the gastropod symbiotic fauna. We suggest that La Scala Vent Field may act as a dispersing centre 37 for hydrothermal fauna towards the nearby North Fiji, Lau and Manus basins