Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study

IntroductionHip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery.MethodA population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization.ResultsA total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1–27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23–2.74; p = 0.003).ConclusionOnly POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home

The effect of universal leukodepletion of packed red blood cells on postoperative infections in high-risk patients undergoing abdominal aortic surgery.

We evaluated, by using a before-and-after study, the influence of leukoreduction by filtration on postoperative infections and adverse outcomes in patients undergoing elective major aortic surgery. From January 1995 to October 2000, all patients who underwent elective abdominal aortic surgery were included in the analysis. Before the introduction of systematic leukodepletion of packed red blood cells (RBCs), on April 1, 1998, 192 patients received standard or buffy-coat-depleted packed RBCs. Then, 195 patients were transfused with exclusively filtered leukodepleted packed RBCs. No major significant difference was observed between the groups of patients with regard to preoperative cardiac and pulmonary status, anesthetic and surgical techniques, or transfusion policy. No significant difference in mortality was observed between the two groups. The incidence of postoperative infections was 31% (95% confidence interval, 25%--38%) in the Control group versus 27% (95% confidence interval, 21%--33%) in the Leukodepleted group; severe infectious complications and pneumonia were not significantly different between the two groups of patients. Cardiovascular and respiratory outcomes were not significantly different between the groups. Data from this study suggest that the effect of using leukodepleted RBC on postoperative infections is not of obvious importance. IMPLICATIONS: We evaluated the influence of leukocyte reduction by filtration of packed red blood cells (RBC) on postoperative infections and adverse outcomes in patients undergoing elective major aortic surgery by comparing two epochs with and without filtration. Data from this study suggest that the effect of using filtered RBC on postoperative infections is not of obvious importance

Etude de l'activité et de la composition des communautés microbiennes dans l'eau non précipitante de la troposphere libre: approches moléculaires

Communication oral

The Adipose Microenvironment Dysregulates the Mammary Myoepithelial Cells and Could Participate to the Progression of Breast Cancer

International audienceBreast cancer is the most common cancer among women worldwide. Overweight and obesity are now recognized as established risk factors for this pathology in postmenopausal women. These conditions are also believed to be responsible for higher recurrence and mortality rates. Reciprocal interactions have been described between adipose and cancer cells. An adipose microenvironment favors a greater proliferation of cancer cells, their invasion and even resistance to anti-cancer treatments. In addition, the chronic low-grade inflammation observed in obese individuals is believed to amplify these processes. Among the cell types present in the breast, myoepithelial cells (MECs), located at the interface of the epithelial cells and the stroma, are considered "tumor suppressor" cells. During the transition from ductal carcinoma in situ to invasive cancer, disorganization or even the disappearance of MECs is observed, thereby enhancing the ability of the cancer cells to migrate. As the adipose microenvironment is now considered as a central actor in the progression of breast cancer, our objective was to evaluate if it could be involved in MEC functional modifications, leading to the transition of in situ to invasive carcinoma, particularly in obese patients. Through a co-culture model, we investigated the impact of human adipose stem cells from women of normal weight and obese women, differentiated or not into mature adipocytes, on the functionality of the MECs by measuring changes in viability, apoptosis, gene, and miRNA expressions. We found that adipose cells (precursors and differentiated adipocytes) could decrease the viability of the MECs, regardless of the original BMI. The adipose cells could also disrupt the expression of the genes involved in the maintenance of the extracellular matrix and to amplify the expression of leptin and inflammatory markers. miR-122-5p and miR-132-3p could also be considered as targets for adipose cells. The metabolite analyses revealed specific profiles that may be involved in the growth of neoplastic cells. All of these perturbations could thus be responsible for the loss of tumor suppressor status of MECs and promote the transition from in situ to invasive carcinoma

Xanthine Oxidase Inhibitors from Filipendula ulmaria (L.) Maxim. and Their Efficient Detections by HPTLC and HPLC Analyses

International audienceFilipendula ulmaria is a plant commonly used for the treatment of several pathologies, such as diarrhoea, ulcers, pain, stomach aches, fevers, and gout. Our study focused on the use of F. ulmaria for the treatment of gout disease. We first studied the chemical composition of a methanolic extract of the aerial parts and demonstrated its xanthine oxidase (XO) inhibitory activity. Then, we performed a fractionation and evaluated the most XO inhibitory active fractions by UV measurement. Purification of some fractions allowed the determination of the inhibitory activity of pure compounds. We demonstrated that spiraeoside, a glycosylated flavonoid, possesses an activity around 25 times higher than allopurinol, used as a reference in the treatment of gout disease. In order to easily and quickly identify potent inhibitors in complex matrix, we developed a complementary strategy based on an HPLC method and an Effect Directed Assay (EDA) method combining HPTLC and biochemical assays. The HPLC method, capable of determining compounds exhibiting interactions with the enzyme, could be an efficient strategy for evaluating potent enzyme inhibitors in a complex mixture. This strategy could be applied for quantitative assays using LC/MS experiments

Magnetic Resonance Imaging of Parotid Gland Tumors

International audienceThe aim of the study was to evaluate dynamic contrast-enhanced magnetic resonance (MR) imaging in the characterization of parotid gland tumors

Les animaux malades

“Quand les animaux meurent, les hommes sont malades”. Cette formule lapidaire recèle toute la richesse du thème ici abordé. Depuis les peurs ancestrales de la contagion entre les espèces, jusqu’aux lourdes pertes subies lors des épisodes brutaux des pandémies animales, l’homme est touché dans ses intérêts matériels mais aussi dans ses rapports personnels avec les animaux qu’il a domestiqués. Comment les épizooties se répandent-elles ? Quand les états ont-il pris conscience de la nécessité de lutter contre la propagation, de prévenir les maladies animales ? Les écoles vétérinaires mais aussi la vaccination ont trouvé là leurs premiers terrains d’application. Soigner les uns, c’est guérir les autres. Les questions de l’évaluation du préjudice, ainsi que de sa réparation, des indemnisations - déjà ! - sont aussi abordées dans cette réflexion

Colonization of non-biodegradable and biodegradable plastics by marine microorganisms

article 1571International audiencePlastics are ubiquitous in the oceans and constitute suitable matrices for bacterial attachment and growth. Understanding biofouling mechanisms is a key issue to assessing the ecological impacts and fate of plastics in marine environment. In this study, we investigated the different steps of plastic colonization of polyolefin-based plastics, on the first one hand, including conventional low-density polyethylene (PE), additivated PE with pro-oxidant (OXO), and artificially aged OXO (AA-OXO); and of a polyester, poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), on the other hand. We combined measurements of physical surface properties of polymers (hydrophobicity and roughness) with microbiological characterization of the biofilm (cell counts, taxonomic composition, and heterotrophic activity) using a wide range of techniques, with some of them used for the first time on plastics. Our experimental setup using aquariums with natural circulating seawater during 6 weeks allowed us to characterize the successive phases of primo-colonization, growing, and maturation of the biofilms. We highlighted different trends between polymer types with distinct surface properties and composition, the biodegradable AA-OXO and PHBV presenting higher colonization by active and specific bacteria compared to non-biodegradable polymers (PE and OXO). Succession of bacterial population occurred during the three colonization phases, with hydrocarbonoclastic bacteria being highly abundant on all plastic types. This study brings original data that provide new insights on the colonization of non-biodegradable and biodegradable polymers by marine microorganisms

Comparaison de l’activité immunomodulatrice de 3 plantes issues de la flore auvergnate à celle de plantes médicinales reconnues (harpagophyton et reine des prés)

National audienceIntroduction : Relativement sous-exploité, le potentiel d’innovation lié aux activités biologiques des métabolites secondaires des végétaux est pourtant considérable. Aussi, nous nous sommes intéressés à la flore d’Auvergne, reconnue pour sa richesse et sa diversité, qui possède de nombreuses plantes encore peu étudiées et valorisables (projet PLANTINAUV 2017-2020). L’objectif de l’étude présentée est de comparer l’action sur différents médiateurs de l’inflammation de trois extraits méthanoliques (ExM) de plantes locales (nommées A, B et C), à celle d’ExM de reine des prés (Filipendula ulmaria, ExM/Fil) et d’harpagophyton (Harpagophytum procumbens, ExM/Harp), reconnus pour leur potentiel anti-inflammatoire.. Matériels et méthodes : i/ les leucocytes totaux, obtenus après hémolyse du sang de volontaires sains (VS, n=6), ont été mis en culture avec les ExM (0 ou 50 µg/ml), et de la dihydrorhodamine 123, en présence ou non de phorbol 12-myristate 13-acetate (PMA 1µM) afin de suivre leur production de radicaux libres oxygénés intracellulaires (RLO) durant 60 min (Fluoroskan Ascent Fl®). ii/ les cellules mononuclées du sang périphérique (PBMCs, ie monocytes et lymphocytes) ont été isolées sur Ficoll à partir de sang de VS (n=2) et cultivées avec les ExM (0 ou 50 µg/ml) en présence ou non de LPS (1 µg/ml, 24h) afin d’évaluer la concentration de PGE2 dans les surnageants de culture (ELISA). iii/ un double gradient de Ficoll a permis de collecter à partir du sang de VS (n=3) d’une part, les PBMCs et, d’autre part, les polynucléaires neutrophiles (PNNs). Les PBMCs ont été cultivées en présence d’ExM (0 ou 50 µg/ml, 24h) avec ou sans phytohémagglutinine (PHA, 5 µg/ml) afin d’évaluer un panel de 14 cytokines dans les surnageants de culture grâce à un kit Milliplex®. Le chimiotactisme des PNNs a été déterminé en présence d’ExM (0 ou 50 µg/ml) et d’un chimio-attractant (fMLP, 0,1µM) sur gel d’agarose à l’aide d’un oculaire micrométrique. Résultats : Pour les cellules cultivées sans agent stimulant, on observe que i/ la production de RLO est augmentée en présence d’ExM/Fil (+48%, p=0.01), stable pour l’ExM/B et diminuée pour les autres (notamment pour les ExM/Harp et A) ; ii/ l’ExM/Fil augmente la production d’IL-4 (+400%, p<0.01), de même que les ExM/B et C (tendance, 0,05<p<0,1) ; iii/ tous les ExM augmentent significativement la migration des PNNs vers le chimio-attractant, l’ExM/Harp étant le plus efficace, iv/ la production de PGE2 est également augmentée pour tous les ExM, sauf l’ExM/B. Pour les cellules cultivées avec un agent stimulant, i/ la production de RLO est stable en présence d’ExM/Fil, diminuée par les ExM/A, C et l’ExM/Harp de 39%, 20% et 18%, respectivement ; ii/ l’ExM/A diminue significativement la production d’IFNγ, d’IL-2 et d’IL-10. Conclusions : L’augmentation de la production de RLO, du chimiotactisme et de l’IL-4 est bénéfique pour aider à la résolution rapide de la première, tandis qu’une baisse des RLO, de la prolifération et des cytokines pro-inflammatoires sera plus indiquée pour la seconde. Ainsi, il serait intéressant d’étudier plus en détail les effets de l’ExM/B qui semble pouvoir égaler l’ExM/Fil en situation d’inflammation considérée comme aigüe. En inflammation chronique, l’étude de l’ExM/A mérite d’être approfondie car il se révèle plus efficace que les ExM des plantes de référence Fil et Harp

Cancer du sein et obésité : Impact du Rooibos sur le microenvironnement adipeux inflammatoire au cours du traitement par hormonothérapie

International audienc