Intérêt de la lidocaïne en administration intraveineuse ou intrapéritonéale dans la prévention de la réponse hémodynamique à un pneumopéritoine au CO2 (une étude expérimentale chez le porcelet)

MONTPELLIER-BU Médecine (341722104) / SudocMONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt de la rachi-analgésie à la morphine dans la chirurgie colique

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Agents anesthésiques et tonus artériel coronaire (implication d'un courant sodique ?)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

A Web App Based-music Intervention (MUSIC-CARE) Reduces Sedative Requirement and Anxiety During Coronary Angioplasty

Coronary angiography is a procedure in which patients tend to present with a moderately high level of stress and anxiety. The present investigation sought to examine the impact of a patient controlled music listening intervention by mobile application (Music-Care) on sedative consumption as primary endpoint, and on pain, anxiety and satisfaction levels. This is a prospective non-randomized controlled clinical study. Patients scheduled to undergo coronary angioplasty under local anesthesia and sedation were recruited. A 76 patients were included, 54 were assigned under the music arm and 22 under the control arm. Medication intake during the procedure has been reported as well as anxiety as measured by numeric rating score and APAIS, pain and satisfaction scores. Music group was administered U sequence during the procedure. Patients under music took significantly less midazolam medication (median 1 vs 3 mg in control, p\u3c0.01). Additionally, there was a significant difference (p\u3c0.01) on anxiety (Mmusic = 2.9, Mcontrol = 4.2, p \u3c0.01) but not in pain score. Almost all of the patients from the music group (98%) were satisfied (score ≥ 4) vs 91% in control group. Music-Care program application provides a 2/3 reduction in midazolam sedation during coronary angiography under local anesthesia and sedation. Furthermore, cardiologists appreciated this technique and suggested it to assist with their procedure in ambulatory practice

L'industrie française au milieu du 19e siècle : les enquêtes de la statistique générale de la France

Recherches d'histoire et de sciences sociales ; 86National audienceA deux reprises, en 1839-1847, puis en 1860-1865, les pouvoirs publics français ont lancé des vastes enquêtes sur l'industrie nationale, riches en données sur les branches d'activité répertoriées par circonscription administrative et jusqu'au niveau de l'entreprise. Ces enquêtes devaient permettre de mieux connaître l'état de l'économie. La masse d'informations, des milliers de données, qui en est issue, a été publiée dans la "Statistique de la France". L'essentiel est rendu public grâce au CD-Rom joint à l'ouvrage. La qualité du travail des statisticiens français du siècle dernier a été vérifiée et mise en perspective par les auteurs. Il en ressort qu'à condition de faire preuve de discernement et de prudence, les enquêtes du milieu du 19e siècle méritent d'être considérées comme fiables

005 ST-elevation myocardial infarction admission during “ON-” versus “OFF-” hours: is there an impact on outcome for primary PCI?

BackgroundIt has been suggested that delays, quality and outcome of reperfusion therapy provided to ST-Elevation Myocardial Infarction (STEMI) patients during OFF-hours (nights and weekend) are worse than during ON-hours (day working hours).MethodsWe studied 736 consecutive STEMI patients transferred for primary percutaneous intervention (PCI) to a single large volume urban Primary PCI center. Characteristics and clinical outcome of patients admitted during ON-hours (Monday through Friday 8 am-6 pm) were compared to OFF-hours patients (admitted during night shifts and weekends). Clinical outcome was 1 year death and death or MI.ResultsSTEMI patients undergoing primary PCI were admitted more frequently during OFF-hours (n = 449; 61.1%) than ON-hours (n = 287; 38.9%), with no major differences in characteristics or treatment between the two groups. Use of radial approach and the rate of stenting during PCI was 83.3% and 86.1% in ON-hours patients vs. 88.2%.and 88.1% in OFF-hours patients. There was no impact of time of admission on in-hospital mortality before or after adjustment for baseline characteristics OR 1.54; CI [0.71–3.35]. Time from symptom onset to first medical contact was shorter during OFF-hours than ON-hours (105 min [50–225] vs. 114 min [60–367]; p = 0.06). Time from first medical contact to sheath insertion was also identical between the 2 groups (101 min [80–155] and 105 min [78–155]; p = 0.61 respectively). Time to TIMI 3 flow and duration of procedure were also similar. At one year, all cause mortality and the composite end point of death or MI was 8.3% and 12.2% for OFF-hours patients vs. 7.0% and 10,8% in ON-hours patients, p = 0.4 and p = 0.3 respectively.ConclusionIn a well-organized urban STEMI network, were 61% of patients referred for primary PCI are admitted during “OFF” hours, admission time does not impact quality of care or outcomes.Death or MI after one year of follow-u

\textbfPlatelet Reactivity in Human Immunodeficiency Virus \textbf Infected Patients on Dual Antiplatelet Therapy for an Acute Coronary Syndrome: The \textbfEVERE\textbf \textbf\textsubscript2\textbf \textbfST-HIV\textbf Study

International audienc

Lipoprotein(a): Pathophysiology, measurement, indication and treatment in cardiovascular disease. A consensus statement from the Nouvelle Société Francophone d’Athérosclérose (NSFA)

International audienceLipoprotein(a) is an apolipoprotein B100-containing low-density lipoprotein-like particle that is rich in cholesterol, and is associated with a second major protein, apolipoprotein(a). Apolipoprotein(a) possesses structural similarity to plasminogen but lacks fibrinolytic activity. As a consequence of its composite structure, lipoprotein(a) may: (1) elicit a prothrombotic/antifibrinolytic action favouring clot stability; and (2) enhance atherosclerosis progression via its propensity for retention in the arterial intima, with deposition of its cholesterol load at sites of plaque formation. Equally, lipoprotein(a) may induce inflammation and calcification in the aortic leaflet valve interstitium, leading to calcific aortic valve stenosis. Experimental, epidemiological and genetic evidence support the contention that elevated concentrations of lipoprotein(a) are causally related to atherothrombotic risk and equally to calcific aortic valve stenosis. The plasma concentration of lipoprotein(a) is principally determined by genetic factors, is not influenced by dietary habits, remains essentially constant over the lifetime of a given individual and is the most powerful variable for prediction of lipoprotein(a)-associated cardiovascular risk. However, major interindividual variations (up to 1000-fold) are characteristic of lipoprotein(a) concentrations. In this context, lipoprotein(a) assays, although currently insufficiently standardized, are of considerable interest, not only in stratifying cardiovascular risk, but equally in the clinical follow-up of patients treated with novel lipid-lowering therapies targeted at lipoprotein(a) (e.g. antiapolipoprotein(a) antisense oligonucleotides and small interfering ribonucleic acids) that markedly reduce circulating lipoprotein(a) concentrations. We recommend that lipoprotein(a) be measured once in subjects at high cardiovascular risk with premature coronary heart disease, in familial hypercholesterolaemia, in those with a family history of coronary heart disease and in those with recurrent coronary heart disease despite lipid-lowering treatment. Because of its clinical relevance, the cost of lipoprotein(a) testing should be covered by social security and health authorities

Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial

International audienceBackground: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI.Methods: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290.Findings: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070).Interpretation: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.Funding: ACTION Study Group and AstraZeneca