Adéquation thérapeutique et diagnostique entre le SMUR et la réanimation de l'hôpital de Saint-Germain-en-Laye

[Résumé français] Objectif : mesurer l'adéquation thérapeutique et diagnostique entre un Service Mobile d'Urgence et de Réanimation (SMUR) et le service de réanimation d'un même établissement (Saint-Germain-en-Laye). Méthode : 250 patients consécutifs, pris en charge par le SMUR et adressés directement dans le service de réanimation, pendant la période concernée, ont été inclus dans une étude rétrospective. Nous avons comparé, pour chaque patient, les traitements et diagnostics des deux unités fonctionnelles. Résultats : l'adéquation thérapeutique était égale à 88%, toutes classes médicamenteuses confondues. L'essentiel des discordances apparentes de prescription (94%) était expliqué par l'évolution clinique du patient (44%), par la suffisance du premier traitement (39%) ou par des précisions diagnostiques dues au plateau technique hospitalier (11%). Les inadéquations thérapeutiques avérées étaient limitées à 6% et concernaient principalement l'analgésie-sédation et les traitements anti-arythmiques. L'adéquation diagnostique entre le SMUR et la réanimation était supérieure à 80%. Conclusion : au total, il existe une étroite adéquation thérapeutique et diagnostique entre le SMUR et la réanimation polyvalente de l'établissement.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Synchrotron X-ray imaging of the onset of ultrasonic horn cavitation

High-power ultrasonic horns operating at low frequency are known to generate a cone-shaped cavitation bubble cloud beneath them. The exact physical processes resulting in the conical structure are still unclear mainly due to challenges associated with their visualization. Herein, we address the onset of the cavitation cloud by exploiting high-speed X-ray phase contrast imaging. It reveals that the cone formation is not immediate but results from a three-step phenomenology: (i) inception and oscillation of single bubbles, (ii) individual cloud formation under splitting or lens effects, and (iii) cloud merging leading to the formation of a bubble layer and, eventually, to the cone structure due to the radial pressure gradient on the horn tip.ISSN:1350-4177ISSN:1873-282

Safety Evaluation of All-Solid-State Batteries: An Innovative Methodology Using In Situ Synchrotron X-ray Radiography

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Does subthalamic nucleus stimulation affect the frontal limbic areas? A single-photon emission computed tomography study using a manual anatomical segmentation method.

International audienceAmong the basal ganglia nuclei, the subthalamic nucleus (STN) is considered to play a major role in output modulation. The STN represents a relay of the motor cortico-basal ganglia-thalamo-cortical circuit and has become the standard surgical target for treating Parkinson's patients with long-term motor fluctuations and dyskinesia. But chronic bilateral stimulation of the STN produces cognitive effects. According to animal and clinical studies, the STN also appears to have direct or indirect connections with the frontal associative and limbic areas. This prospective study was conducted to analyse regional cerebral blood flow changes in single-photon emission computed tomography imaging of six Parkinson's patients before and after STN stimulation. We particularly focused on the dorsolateral prefrontal cortex and the frontal limbic areas using a manual anatomical MRI segmentation method. We defined nine regions of interest, segmenting each MR slice to quantify the regional cerebral blood flow on pre- and postoperative SPECT images. We normalised the region-of-interest-based measurements to the entire brain volume. The patients showed increased activation during STN stimulation in the dorsolateral prefrontal cortex bilaterally and no change in the anterior cingulate and orbito-frontal cortices. In our study, STN stimulation induced activation of premotor and associative frontal areas. Further studies are needed to underline involvement of the STN with the so-called limbic system

Evaluation of methods to detect interhemispheric asymmetry on cerebral perfusion SPECT: application to epilepsy.

International audienceDetecting perfusion interhemispheric asymmetry in neurologic nuclear medicine imaging is an interesting approach to epilepsy. METHODS: This study compared 4 methods that detect interhemispheric asymmetries of brain perfusion in SPECT. The first (M1) was conventional side-by-side expert-based visual interpretation of SPECT. The second (M2) was visual interpretation assisted by an interhemispheric difference (IHD) volume. The last 2 were automatic methods: unsupervised analysis using volumes of interest (M3) and unsupervised analysis of the IHD volume (M4). Use of these methods to detect possible perfusion asymmetry was compared on 60 simulated SPECT datasets by controlling the presence and location of asymmetries. From the detection results, localization receiver operating characteristic curves were generated and areas under curves were estimated and compared. Finally, the methods were applied to analyze interictal SPECT datasets to localize the epileptogenic focus in temporal lobe epilepsies. RESULTS: This study showed an improvement in asymmetry detection on SPECT images with the methods using IHD volume (M2 and M4), in comparison with the other methods (M1 and M3). However, the most useful method for analyzing clinical SPECT datasets appeared to be visual inspection assisted by the IHD volume, since the automatic method using the IHD volume was less specific. CONCLUSION: The use of quantitative methods can improve performance in detection of perfusion asymmetry over visual inspection alone

Evaluation of methods to detect interhemispheric asymmetry on cerebral perfusion SPECT: application to epilepsy.

International audienceDetecting perfusion interhemispheric asymmetry in neurologic nuclear medicine imaging is an interesting approach to epilepsy. METHODS: This study compared 4 methods that detect interhemispheric asymmetries of brain perfusion in SPECT. The first (M1) was conventional side-by-side expert-based visual interpretation of SPECT. The second (M2) was visual interpretation assisted by an interhemispheric difference (IHD) volume. The last 2 were automatic methods: unsupervised analysis using volumes of interest (M3) and unsupervised analysis of the IHD volume (M4). Use of these methods to detect possible perfusion asymmetry was compared on 60 simulated SPECT datasets by controlling the presence and location of asymmetries. From the detection results, localization receiver operating characteristic curves were generated and areas under curves were estimated and compared. Finally, the methods were applied to analyze interictal SPECT datasets to localize the epileptogenic focus in temporal lobe epilepsies. RESULTS: This study showed an improvement in asymmetry detection on SPECT images with the methods using IHD volume (M2 and M4), in comparison with the other methods (M1 and M3). However, the most useful method for analyzing clinical SPECT datasets appeared to be visual inspection assisted by the IHD volume, since the automatic method using the IHD volume was less specific. CONCLUSION: The use of quantitative methods can improve performance in detection of perfusion asymmetry over visual inspection alone

Effect of the AutoPulse automated band chest compression device on hemodynamics in out-of-hospital cardiac arrest resuscitation.

International audiencePURPOSE: Guidelines for advanced life support of cardiac arrest (CA) emphasize continuous and effective chest compressions as one of the main factors of cardiopulmonary resuscitation (CPR) success. The use of an automated load distributing chest compression device for CPR is promising but initial studies on survival show contradictory results. The aim of this study was to evaluate the effects of AutoPulse on blood pressure (BP) in out-of-hospital CA patients. METHODS: This prospective study included adult patients presenting with in refractory out-of-hospital CA. Invasive arterial BP produced by AutoPulse was compared to BP generated by manual CPR (Active Compression Decompression). Systolic, diastolic and mean BP and end-tidal carbon dioxide were recorded before and after initiating the automated band device for each patient. The comparison of diastolic BP produced by manual CPR versus automated chest compressions was the primary end point. RESULTS: Hemodynamics in 29 patients are reported and analyzed. Median diastolic BP increased after starting AutoPulse from 17[11-25] mmHg to 23[18-28] mmHg (P < 0.001). Median systolic BP increased from 72[55-105] mmHg to 106[78-135] mmHg (P = 0.02). Mean BP increased from 29[25-38] mmHg to 36[30-15] mmHg (P = 0.002). On the other hand, End-Tidal CO(2) did not increase significantly with AutoPulse (21[13-36] vs. 22[12-35] mmHg, P = 0.80). CONCLUSIONS: In patients with out-of-hospital CA, the use of AutoPulse is associated with an increased diastolic BP compared to manual chest compressions. While its benefit to survival has yet to be demonstrated, the increase in diastolic and mean BP is a promising outcome for AutoPulse use

Mitochondrial Protein UCP2 Controls Pancreas Development

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Role of cardiac troponin in the diagnosis of acute myocardial infarction in comatose patients resuscitated from out-of-hospital cardiac arrest

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Two interacting PPR proteins are major Arabidopsis editing factors in plastid and mitochondria

RNA editing is converting hundreds of cytosines into uridines during organelle gene expression of land plants. The pentatricopeptide repeat (PPR) proteins are at the core of this posttranscriptional RNA modification. Even if a PPR protein defines the editing site, a DYW domain of the same or another PPR protein is believed to catalyze the deamination. To give insight into the organelle RNA editosome, we performed tandem affinity purification of the plastidial CHLOROPLAST BIOGENESIS 19 (CLB19) PPR editing factor. Two PPR proteins, dually targeted to mitochondria and chloroplasts, were identified as potential partners of CLB19. These two proteins, a P-type PPR and a member of a small PPR-DYW subfamily, were shown to interact in yeast. Insertional mutations resulted in embryo lethality that could be rescued by embryo-specific complementation. A transcriptome analysis of these complemented plants showed major editing defects in both organelles with a very high PPR type specificity, indicating that the two proteins are core members of E+-type PPR editosomes