Dopexamine and norepinephrine versus epinephrine on gastric perfusion in patients with septic shock: a randomized study [NCT00134212]

INTRODUCTION: Microcirculatory blood flow, and notably gut perfusion, is important in the development of multiple organ failure in septic shock. We compared the effects of dopexamine and norepinephrine (noradrenaline) with those of epinephrine (adrenaline) on gastric mucosal blood flow (GMBF) in patients with septic shock. The effects of these drugs on oxidative stress were also assessed. METHODS: This was a prospective randomized study performed in a surgical intensive care unit among adults fulfilling usual criteria for septic shock. Systemic and pulmonary hemodynamics, GMBF (laser-Doppler) and malondialdehyde were assessed just before catecholamine infusion (T(0)), as soon as mean arterial pressure (MAP) reached 70 to 80 mmHg (T(1)), and 2 hours (T(2)) and 6 hours (T(3)) after T(1). Drugs were titrated from 0.2 μg kg(-1 )min(-1 )with 0.2 μg kg(-1 )min(-1 )increments every 3 minutes for epinephrine and norepinephrine, and from 0.5 μg kg(-1 )min(-1 )with 0.5 μg kg(-1 )min(-1 )increments every 3 minutes for dopexamine. RESULTS: Twenty-two patients were included (10 receiving epinephrine, 12 receiving dopexamine–norepinephrine). There was no significant difference between groups on MAP at T(0), T(1), T(2), and T(3). Heart rate and cardiac output increased significantly more with epinephrine than with dopexamine–norepinephrine, whereas. GMBF increased significantly more with dopexamine–norepinephrine than with epinephrine between T(1 )and T(3 )(median values 106, 137, 133, and 165 versus 76, 91, 90, and 125 units of relative flux at T(0), T(1), T(2 )and T(3), respectively). Malondialdehyde similarly increased in both groups between T(1 )and T(3). CONCLUSION: In septic shock, at doses that induced the same effect on MAP, dopexamine–norepinephrine enhanced GMBF more than epinephrine did. No difference was observed on oxidative stress

Multifragmentation and phase transition for hot nuclei

5 pages, Proceedings of NN2009, August 17-21, Beijing (China)Recent important progress on the knowledge of multifragmentation and phase transition for hot nuclei, thanks to the high detection quality of the INDRA array, is reported. It concerns i) the radial collective energies involved in hot fragmenting nuclei/sources produced in central and semi- peripheral collisions and their influence on the observed fragment partitions, ii) a better knowledge of freeze-out properties obtained by means of a simulation based on all the available experimental information and iii) the quantitative study of the bimodal behaviour of the heaviest fragment distribution for fragmenting hot heavy quasi-projectiles which allows the extraction, for the first time, of an estimate of the latent heat of the phase transition

Multicenter randomized phase II study of two schedules of docetaxel, estramustine, and prednisone versus mitoxantrone plus prednisone in patients with metastatic hormone-refractory prostate cancer

A B S T R A C T Purpose Mitoxantrone-corticosteroid is currently the standard palliative treatment in hormone-refractory prostate cancer (HRPC) patients. Recent clinical trials documented the high activity of the docetaxel-estramustine combination. We conducted a randomized phase II study to evaluate prostate-specific antigen (PSA) response (primary end point) and safety of two docetaxelestramustine-prednisone (DEP) regimens and mitoxantrone-prednisone (MP). Patients and Methods One hundred thirty metastatic HRPC patients were randomly assigned to receive docetaxel (70 mg/m 2 on day 2 or 35 mg/m 2 on days 2 and 9 of each 21-day cycle) and estramustine (280 mg PO tid on days 1 through 5 and 8 through 12) or mitoxantrone 12 mg/m 2 every 3 weeks; all patients received prednisone (10 mg daily). Results One hundred twenty-seven patients were assessable for PSA response and safety. A Ն 50% PSA decline was found in a greater percentage of patients in the docetaxel arms (67% and 63%) compared with MP (18%; P ϭ .0001). Median time to PSA progression was five times longer with DEP than with MP (8.8 and 9.3 v 1.7 months, respectively; P ϭ .000001). Overall survival was better in the docetaxel arms (18.6 and 18.4 months) compared with the MP arm (13.4 months), but not significantly so (P ϭ .3). Crossover rates differed significantly among treatment arms (16%, 10%, and 48% in arms A, B, and C, respectively; P ϭ .00001). Treatment-related toxicities were mild and mainly hematologic. Conclusion The results of this randomized phase II study showed significantly higher PSA decline Յ 50% and longer times to progression in HRPC patients receiving DEP-based chemotherapy than MP, and that DEP could be proposed in this setting

Convergence of marine megafauna movement patterns in coastal and open oceans

Author Posting. © The Author(s), 2017. This is the author's version of the work. It is posted here for personal use, not for redistribution. The definitive version was published in Proceedings of the National Academy of Sciences of the United States of America 115 (2018): 3072-3077, doi:10.1073/pnas.1716137115.The extent of increasing anthropogenic impacts on large marine vertebrates partly depends on the animals’ movement patterns. Effective conservation requires identification of the key drivers of movement including intrinsic properties and extrinsic constraints associated with the dynamic nature of the environments the animals inhabit. However, the relative importance of intrinsic versus extrinsic factors remains elusive. We analyse a global dataset of 2.8 million locations from > 2,600 tracked individuals across 50 marine vertebrates evolutionarily separated by millions of years and using different locomotion modes (fly, swim, walk/paddle). Strikingly, movement patterns show a remarkable convergence, being strongly conserved across species and independent of body length and mass, despite these traits ranging over 10 orders of magnitude among the species studied. This represents a fundamental difference between marine and terrestrial vertebrates not previously identified, likely linked to the reduced costs of locomotion in water. Movement patterns were primarily explained by the interaction between species-specific traits and the habitat(s) they move through, resulting in complex movement patterns when moving close to coasts compared to more predictable patterns when moving in open oceans. This distinct difference may be associated with greater complexity within coastal micro-habitats, highlighting a critical role of preferred habitat in shaping marine vertebrate global movements. Efforts to develop understanding of the characteristics of vertebrate movement should consider the habitat(s) through which they move to identify how movement patterns will alter with forecasted severe ocean changes, such as reduced Arctic sea ice cover, sea level rise and declining oxygen content.Workshops funding granted by the UWA Oceans Institute, AIMS, and KAUST. AMMS was supported by an ARC Grant DE170100841 and an IOMRC (UWA, AIMS, CSIRO) fellowship; JPR by MEDC (FPU program, Spain); DWS by UK NERC and Save Our Seas Foundation; NQ by FCT (Portugal); MMCM by a CAPES fellowship (Ministry of Education)

Ductus: a software package for the study of handwriting production.

International audienceDuctus is a software tool designed to analyze and aid understanding of the processes underlying handwriting production. Ductus is a digitizer-based device that provides online information on the handwriting process. It consists of two distinct modules that operate independently. The first module concerns stimulus presentation. It is particularly suited to experiments with children and patients presenting handwriting pathologies. The second module is devoted to data analysis. Apart from the geometrical aspects of handwriting, such as trajectory formation, Ductus provides a wide range of kinematic information, such as velocity, duration, fluency, and pauses, linked to the mastery of the movement itself. Ductus is available free from the authors. It works on a Windows platform with Wacom digitizers

Mass casualty events: a decision making tool for home health care to discharge conventional hospitals

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Projet HRP2 (Hôpitaux : Regroupement, Partage, Pilotage

8 pagesInternational audienceLa mise en place de la tarification à l'activité dans les établissements de soins publics et privés, associée à un contexte de raréfaction des ressources humaines qualifiées (médecins, infirmiers) incitent les hôpitaux à remettre en cause leurs pratiques. Cette remise en cause s'opère notamment dans le secteur chirurgical par la modification des organisations et l'intégration physique de plateaux médico-techniques afin de réduire les coûts d'exploitation et d'augmenter l'efficience des systèmes. La mutualisation des ressources humaines et matérielles ainsi réalisée assure un meilleur partage de celles-ci et autorise des possibilités d'économie d'échelle. D'autre part, la démographie médicale actuelle et le désir de mieux vivre des personnels renforcent l'urgence des redistributions. Cette nouvelle mutation lourde d'investissements, pose la problématique du diagnostic, de l'évaluation de la performance des organisations, et de l'objectivation de la pratique. Elle pose aussi la problématique des outils d'aide à la décision pour la gestion prévisionnelle et opérationnelle. La recherche d'optimalité est multicritère, elle doit prendre en compte les aspects économiques de productivité mais aussi les aspects de qualité et de gestion des risques pour les patients, les infirmiers et les praticiens. Elle pose enfin la problématique d'une démarche et des outils de la conduite de cette mutation. Des outils qui permettront l'évaluation et la validation des choix stratégiques en termes de nouvelles infrastructures et d'organisations humaines et matérielles qui devront être mises en place. Notre ambition est d'une part d'offrir à tous ceux qui ont en charge la conduite d'un projet de transformation ou de conception d'une nouvelle structure hospitalière, une démarche instrumentalisée d'aide à la décision, de validation et d'évaluation des conséquences de chaque choix, et d'autre part de donner un référentiel d'outils qui amènent les bonnes pratiques en gestion prévisionnelle et opérationnelle

Internalisation et externalisation de la fonction médicale en HAD

International audienceL’hospitalisation à domicile initialement pensée autour d’intervenants librement choisis par le patient (c.-à-d. son médecin traitant, son médecin hospitalier, son officine pharmaceutique de proximité et son infirmier référent), a de plus en plus de mal à justifier sa pertinence humaine et économique. Deux raisons à ce constat : (1) L’HAD est un établissement hospitalier, à ce titre, elle est soumise aux exigences réglementaires des centres hospitaliers en termes de qualité, de continuité des soins, de sécurisation du parcours patient, … Ces objectifs ne peuvent être raisonnablement atteints que si l’HAD maitrise et pilote son fonctionnement. (2) L’HAD doit maîtriser ses coûts et la qualité de ses services. Pour cela, elle doit d’une part optimiser la prescription et la délivrance de ses actes et d’autre part optimiser ses flux logistiques. Dans ce papier nous présentons le rôle des différents médecins qui interviennent en HAD dans l’organisation actuelle, plus particulièrement la place du médecin traitant et du médecin coordonnateur. Nous analysons, l’incidence de leurs rôles sur la prise de décision, le fonctionnement opérationnel et l’efficience de la prise en charge. De ces constats, nous proposons la définition de nouveaux rôles plus en adéquation avec les attentes des patients et des tutelles

Hospitalisation à domicile : Internalisation/externalisation de la fonction médicale

National audienceL’hospitalisation à domicile a de plus en plus de mal à justifier sa pertinence humaine et économique. Elle est en effet soumise aux exigences réglementaires des centres hospitaliers en termes de qualité, de continuité des soins, de sécurisation du parcours patient… Des objectifs qui ne peuvent être raisonnablement atteints que si l’HAD maîtrise et pilote son fonctionnement. De plus, pour maîtriser ses coûts et la qualité de ses services, elle doit optimiser la prescription et la délivrance de ses actes, ainsi que ses flux logistiques. Les auteurs analysent le rôle des différents médecins qui interviennent en HAD dans l’organisation actuelle, en particulier le médecin traitant et le médecin coordonnateur, l’incidence sur la prise de décision, le fonctionnement opérationnel et l’efficience de la prise en charge. À partir de ces constats, ils proposent la définition de nouveaux rôles plus en adéquation avec les attentes des patients et des tutelles