Etat des connaissances et pratiques des médecins généralistes face à la douleur liée à la vaccination des nourrissons

Introduction : La vaccination est l une des douleurs iatrogène les plus fréquemment rencontré dans l enfance. Cette douleur peut être traumatisante et mener a une phobie des aiguilles ou à un comportement d évitement des soins, or des moyens simples existent pour y lutter. Notre objectif était d évaluer les connaissances et l utilisation de ces moyens au cours de la vaccination des nourrissons. Matériel et méthodes : Il s agissait d une enquête quantitative par envoie de questionnaire à 200 médecins généralistes de Picardie. Résultats : Le taux de réponse était de 30%. Sur les 60 médecins répondeurs, 92% considéraient ce geste comme douloureux et 80 % utilisaient un moyen antalgique lors de la vaccination. 62% d entre eux employaient le patch Emla®, alors que les autres moyens: distraction, succion et association succion-solution sucrée, étaient très peu cités. En post-injection 67% prescrivaient du paracétamol. Discussion : L utilisation de moyens antalgiques n était pas généralisée lors de la vaccination malgré une littérature scientifique profuse en leur faveur. Par ailleurs il était trop prescrit de paracétamol en post-injection alors que l on sait désormais que cela réduit la réponse immunitaire du vaccin. Une meilleur information des médecins est nécessaire. Conclusion : Il ressort de cette étude, un manque de connaissances des recommandations actuelles concernant les moyens de lutte contre la douleur lors de la vaccination des nourrissons. Et même si cette douleur n est pas insupportable, elle est intolérable car elle pourrait être évitée, et l amélioration de sa prise en charge pourrait permettre une meilleure adhésion aux soins, véritable problème de santé publique.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Assignment of autogenous bone grafts for reconstruction of the alveolar ridge before implant placement

Introduction: Autologous bone is considered to be the “gold standard” for the reconstruction of the reabsorbed alveolar ridges. For small defects, autologous bone samples can be harvested from intraoral donor sites. However, extraoral donor sites are the first choice for any extensive augmentation of the alveolar ridges. The resorption of the bone grafts depends on several factors, including the recipient sites, the donor sites, volume of the bone grafts and whether or not the patient smokes. The aim of this study was to investigate the rate of autologous bone graft resorption, 4 months after the surgical reconstruction, according to their sites of origin, parietal or ramus, according to the grafted site, mandible or maxilla and according to the surgical indications. Patients and methods: 22 patients had 51 reconstructions of alveolar ridges with ramic or parietal onlay bone grafts. The increase of bone volume was assessed with computed tomography, immediately after augmentation (V0) and 4 months after the procedure (V1), before the placement of dental implants. Results: The mean rate of bone resorption was 26% for the parietal bone grafts and 27% for the ramus bone grafts after 4 months (p: ns). This rate was 26% for maxillary grafts and 25% for mandibular grafts (p: ns). This rate varies from 22% to 33% according to the etiology of the bone defect but these variations are not significant and ultimately, this rate of bone resorption was unaffected by the gender of patients. Conclusion: Based on these findings, the resorption of onlay grafts doesnʼt seems to be affected by the recipient and donor sites nor by the etiology of the bone defects. Parietal and ramic bone grafts showed limited resorption rates for the pre-implant reconstruction of alveolar ridges

Hypoxic preconditioning in renal ischaemia–reperfusion injury: a review in pre-clinical models

International audienceAbstract Ischaemia–reperfusion injury (IRI) is a major cause of acute kidney injury (AKI) and chronic kidney disease, which consists of cellular damage and renal dysfunction. AKI is a major complication that is of particular concern after cardiac surgery and to a lesser degree following organ transplantation in the immediate post-transplantation period, leading to delayed graft function. Because effective therapies are still unavailable, several recent studies have explored the potential benefit of hypoxic preconditioning (HPC) on IRI. HPC refers to the acquisition of increased organ tolerance to subsequent ischaemic or severe hypoxic injury, and experimental evidences suggest a potential benefit of HPC. There are three experimental forms of HPC, and, for better clarity, we named them as follows: physical HPC, HPC via treated-cell administration and stabilised hypoxia-inducible factor (HIF)-1α HPC, or mimicked HPC. The purpose of this review is to present the latest developments in the literature on HPC in the context of renal IRI in pre-clinical models. The data we compiled suggest that preconditional activation of hypoxia pathways protects against renal IRI, suggesting that HPC could be used in the treatment of renal IRI in transplantation

Correlation between low adenosine A2A receptor expression and hypercholesterolemia: A new component of the cardiovascular risk?

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Adenosine Receptors Profile in Fibromuscular Dysplasia

International audienceFibromuscular dysplasia (FMD) is a non-inflammatory vascular disease that is characterized by unexplained systemic hypertension occurring in young people, associated with arterial stenosis, aneurysm rupture, intracranial/renal infarction, and stroke. Although the gold standard for the diagnosis remains catheter-angiography, biological markers would be helpful due to the delay from first symptom to diagnosis. Adenosine is an ATP derivative, that may be implicated in FMD pathophysiology. We hypothesized that changes in adenosine blood level (ABL) and production of adenosine receptors may be associated with FMD. Using peripheral blood mononuclear cells, we evaluated A1, A2A, and A2B receptor production by Western blot, in 67 patients (17 men and 50 women, mean (range) age 55 (29–77) years and 40 controls, 10 men and 30 women, mean (range) age 56 (37–70)). ABL was evaluated by liquid chromatography, mass spectrometry. ABL was significantly higher in patients vs. controls, mean (range): 1.7 (0.7–3) µmol/L vs. controls 0.6 (0.4–0.8) µmol/L (+180%) p < 0.001. While A1R and A2AR production did not differ in patients and controls, we found an over-production of A2BR in patients: 1.70 (0.90–2.40; arbitrary units) vs. controls = 1.03 (0.70–1.40), mean + 65% (p < 0.001). A2BR production with a cut off of 1.3 arbitrary units, gives a good sensitivity and specificity for the diagnosis. Production measurement of A2BR on monocytes and ABL could help in the diagnosis, especially in atypical or with poor symptoms

Adenosine and Its Receptors: An Expected Tool for the Diagnosis and Treatment of Coronary Artery and Ischemic Heart Diseases

International audienceAdenosine is an endogenous nucleoside which strongly impacts the cardiovascular system. Adenosine is released mostly by endothelial cells and myocytes during ischemia or hypoxia and greatly regulates the cardiovascular system via four specific G-protein-coupled receptors named A1R, A2AR, A2BR, and A3R. Among them, A2 subtypes are strongly expressed in coronary tissues, and their activation increases coronary blood flow via the production of cAMP in smooth muscle cells. A2A receptor modulators are an opportunity for intense research by the pharmaceutical industry to develop new cardiovascular therapies. Most innovative therapies are mediated by the modulation of adenosine release and/or the activation of the A2A receptor subtypes. This review aims to focus on the specific exploration of the adenosine plasma level and its relationship with the A2A receptor, which seems a promising biomarker for a diagnostic and/or a therapeutic tool for the screening and management of coronary artery disease. Finally, a recent class of selective adenosine receptor ligands has emerged, and A2A receptor agonists/antagonists are useful tools to improve the management of patients suffering from coronary artery disease

Characterization of adenosine A 2 receptors of peripheral blood mononuclear cells of patients with fibromuscular dysplasia

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A2 Adenosine Receptor Subtypes Overproduction in Atria of Perioperative Atrial Fibrillation Patients Undergoing Cardiac Surgery: A Pilot Study

International audienceObjective: Although atrial fibrillation is a common cardiac arrhythmia in humans, the mechanism that leads to the onset of this condition is poorly elucidated. Adenosine is suspected to be implicated in the trigger of atrial fibrillation (AF) through the activation of its membrane receptors, mainly adenosine receptor (AR) subtypes A 1 R and A 2 R. In this study, we compared blood adenosine concentration (BAC), and A 1 R, A 2A R, and A 2B R production in right (RA) and left atrium (LA), and on peripheral blood mononuclear cells (PBMCs) in patients with underlying structural heart disease undergoing cardiac surgery with or without peri-operative AF (PeOpAF). Methods: The study group consisted of 39 patients (30 men and 9 women, mean age, range 65 [40–82] years) undergoing cardiac surgery and 20 healthy patients (8 women and 12 men; mean age, range 60 [39–72] years) as controls were included. Among patients, 15 exhibited PeOpAF. Results: Blood adenosine concentration was higher in patients with PeOpAF than others. A 2A R and A 2B R production was higher in PBMCs of patients compared with controls and was higher in PeOpAF patients than other patients. In LA and RA, the production of A 2A R and A 2B R was higher in patients with PeOpAF than in other patients. Both A 2A R and A 2B R production were higher in LA vs. RA. A 1 R production was unchanged in all situations. Finally, we observed a correlation between A 1 R, A 2A R, and A 2B R production evaluated on PBMCs and those evaluated in LA and RA. Conclusions: Perioperative AF was associated with high BAC and high A 2A R and A 2B R expression, especially in the LA, after cardiac surgery in patients with underlying structural heart disease. Whether these increases the favor in triggering the AF in this patient population needs further investigation

Adenosine plasma level in patients with paroxysmal or persistent atrial fibrillation and normal heart during ablation procedure and/or cardioversion

International audienceThe mechanism of atrial fibrillation (AF) in patients with normal heart remains unclear. While exogenous adenosine can trigger AF, nothing is known about the behavior of endogenous adenosine plasma level (APL) at the onset of AF and during ablation procedure. Ninety-one patients (68 with paroxysmal AF: 40 males, 66 ± 16 years; 23 with persistent AF: 14 males, 69 ± 11 years) and 18 controls were included. Among paroxysmal patients: i) medical therapy alone was performed in 45 cases and ablation procedure in 23. AF was spontaneously resolutive in 6 cases; ii) 23 underwent ablation procedure and blood was collected simultaneously in a brachial vein and in the left atrium; 17 were spontaneously in sinus rhythm while 6 were in sinus rhythm after direct current cardioversion. Among persistent patients: i) in 17 patients, blood samples were collected in a brachial vein before and after direct current cardioversion; ii) in 6 patients, blood samples were collected simultaneously in a brachial vein and in left atrium before and after cardioversion during ablation procedure. CV-APL was higher in patients with persistent AF vs patients with paroxysmal AF (median [range]: 0.9[0.6-1.1] vs 0.7[0.4-1.1] μM; p < 0.001). In patients with paroxysmal AF, LA-APL increased during the AF episode (0.95[0.85-1.4] vs 2.7[1.5-7] μM; p = 0.03) and normalized in sinus rhythm after DCCV. In patients with persistent AF, LA-APL was higher than CV-APL (1.2[0.7-1.8] vs 0.9[0.6-1.1] μM; p < 0.001), and both normalized in sinus rhythm (CV-APL: 0.8[0.6-1.1] vs 0.75[0.4-1] μM; p = 0.03), (LA-APL: 1.95[1.3-3] vs 1[0.5-1.15] μM; p = 0.03). The occurrence of AF is associated with a strong increase of APL in the atrium. The cause of this increase needs further investigations