Long-term outcome of severe herpes simplex encephalitis: a population-based observational study

Literature review for adult case reports and series of patients undergoing decompressive hemicraniectomy for severe herpes simplex encephalitis. (PDF 57 kb

Thymic Program Directing the Functional Development of γδT17 Cells

γδT cells comprise a unique T cell sublineage endowed with a wide functional repertoire, which allow them to play important—sometimes opposite—roles in many immune responses associated with infection, cancer, and inflammatory processes. This is largely dependent on the existence of pre-programmed discrete functional subsets that differentiate within the thymus at specific temporal windows of life. Since they represent a major early source of interleukin-17A in many models of immune responses, the γδT17 cell population has recently gained considerable interest. Thus, a better dissection of the developmental program of this effector γδT subset appears critical in understanding their associated immune functions. Several recent reports have provided new exciting insights into the developmental mechanisms that control γδT cell lineage commitment and differentiation. Here, we review the importance of thymic cues and intrinsic factors that shape the developmental program of γδT17 cells. We also discuss the potential future areas of research in γδT17 cell development especially in regards to the recently provided data from deep RNA sequencing technology. Pursuing our understanding into this complex mechanism will undoubtedly provide important clues into the biology of this particular T cell sublineage

Pneumonies sévères et syndrome de détresse respiratoire aiguë : implication des lymphocytes T non conventionnels

International audienc

Le syndrome post-réanimation

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Lung compartmentalization of inflammatory biomarkers in COVID-19-related ARDS

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Preoperative Chemerin Level Is Predictive of Inflammatory Status 1 Year After Bariatric Surgery

Background Obesity is associated with chronic low-grade inflammation, which has been linked to increased morbidity. However, inflammation variably and unpredictably improves after bariatric surgery. This study aimed at (1) evaluating the relationship between amplitude of weight loss and variation of inflammatory parameters after bariatric surgery, and (2) identifying, among clinical and biological baseline parameters, predictive factors of variation in inflammatory parameters. Methods In a prospective cohort of patients who underwent bariatric surgery, serum concentrations of interleukin (IL)-6, IL-10, resistin, leptin, adiponectin chemerin, and C-reactive protein (CRP) were measured preoperatively and 1 year after surgery, and routine clinical and biochemical parameters were retrieved. Univariate and multivariate analyses (partial least square method) were performed to assess how parameters were associated with weight loss and to predict improvement of inflammatory parameters. Results Eighty-seven patients were included (mean weight +/- SD 136.3 +/- 3.2 kg, 35 gastric bypasses, 52 sleeve gastrectomies). In parallel with weight loss (39.5 +/- 13.8 kg), pro-inflammatory markers (IL-6, CRP, leptin, resistin) significantly decreased, and anti-inflammatory markers (IL-10, adiponectin) increased. Multivariate analysis revealed a significant association between weight loss and improvement in inflammatory parameters. Among all the clinical and biological preoperative parameters, baseline chemerin level was the only parameter that was significantly associated with global improvement of the inflammatory status after surgery. Conclusion The amplitude of weight loss 1 year after bariatric surgery was strongly correlated with improvement of inflammatory profile, which could be predicted by baseline plasma level of chemerin. This suggests a key role of chemerin in obesity-driven inflammation, and a potential use as a biomarker

Thymic Program Directing the Functional Development of γδT17 Cells

International audienceγδT cells comprise a unique T cell sublineage endowed with a wide functional repertoire, which allow them to play important-sometimes opposite-roles in many immune responses associated with infection, cancer, and inflammatory processes. This is largely dependent on the existence of pre-programmed discrete functional subsets that differentiate within the thymus at specific temporal windows of life. Since they represent a major early source of interleukin-17A in many models of immune responses, the γδT17 cell population has recently gained considerable interest. Thus, a better dissection of the developmental program of this effector γδT subset appears critical in understanding their associated immune functions. Several recent reports have provided new exciting insights into the developmental mechanisms that control γδT cell lineage commitment and differentiation. Here, we review the importance of thymic cues and intrinsic factors that shape the developmental program of γδT17 cells. We also discuss the potential future areas of research in γδT17 cell development especially in regards to the recently provided data from deep RNA sequencing technology. Pursuing our understanding into this complex mechanism will undoubtedly provide important clues into the biology of this particular T cell sublineage

Long-term outcome of severe herpes simplex encephalitis: a population-based observational study

AbstractIntroduction: Herpes simplex encephalitis (HSE) is a rare disease with a poor prognosis. No recent evaluation ofhospital incidence, acute mortality and morbidity is available. In particular, decompressive craniectomy has rarely beenproposed in cases of life-threatening HSE with temporal herniation, in the absence of evidence. This study aimed toassess the hospital incidence and mortality of HSE, and to evaluate the characteristics, management, the potentialvalue of decompressive craniectomy and the outcome of patients with HSE admitted to intensive care units (ICUs).Methods: Epidemiological study: we used the hospital medical and administrative discharge database to identify hospitalstays, deaths and ICU admissions relating to HSE in 39 hospitals, from 2010 to 2013. Retrospective monocentric cohort: allpatients with HSE admitted to the ICU of the university hospital during the study were included. The use of decompressivecraniectomy and long-term outcome were analyzed. The initial brain images were analyzed blind to outcome.Results: The hospital incidence of HSE was 1.2/100,000 inhabitants per year, 32 % of the patients were admitted toICUs and 17 % were mechanically ventilated. Hospital mortality was 5.5 % overall, but was as high as 11.9 % in ICUs. Inthe monocentric cohort, 87 % of the patients were still alive after one year but half of them had moderate to severedisability. Three patients had a high intracranial pressure (ICP) with brain herniation and eventually underwentdecompressive hemicraniectomy. The one-year outcome of these patients did not seem to be different from that ofthe other patients. It was not possible to predict brain herniation reliably from the initial brain images.Conclusions: HSE appears to be more frequent than historically reported. The high incidence we observed probablyreflects improvements in diagnostic performance (routine use of PCR). Mortality during the acute phase and long-termdisability appear to be stable. High ICP and brain herniation are rare, but must be monitored carefully, as initial brainimaging is not useful for identifying high-risk patients. Decompressive craniectomy may be a useful salvage procedurein cases of intractable high ICP

Lack of impact of iodinated contrast media on kidney cell-cycle arrest biomarkers in critically ill patients

Abstract Background Iodinated contrast media may contribute to acute kidney injury. However, several recent works suggest that this toxicity is minimal in the clinical setting. Recently, urinary G1 cell-cycle arrest proteins tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin like growth factor binding protein 7 (IGFBP-7) were identified as highly sensitive and specific biomarkers for early detection of kidney aggression. The impact of contrast administration on those biomarkers has not been specifically evaluated but could provide clues about the toxicity of contrast media. This study aimed at measuring changes in TIMP-2 and IGFBP-7 urinary concentrations before and after a contrast-enhanced computed tomography in critically ill patients. Methods 77 patients were included in a prospective observational cohort study. Urinary [TIMP -2]·[IGFBP-7] was measured before, 6 and 24 h after contrast infusion. Urine output and serum creatinine were followed 3 days. Results Median [TIMP-2]·[IGFBP-7] was 0.06 [interquartile range 0.04;0.26], 0.07 [0.03;0.34] and 0.10 [0.04;0.37] (ng/mL)2/1000 respectively before, 6 and 24 h after contrast infusion. Individual changes from baseline were − 0.01 [− 0.11;0.11] and 0.00 [− 0.10;0.09] (ng/ml)2/1000 at 6 and 24 h. These changes were not higher among the patients increasing their Kidney Disease Improving Global Outcome (KDIGO) classification within 3 days after contrast infusion (n = 14 [18%] based on creatinine criterion only, n = 42 [55%] based on creatinine and urine output). Conclusions Changes in [TIMP-2]·[IGFBP-7] urinary concentration after contrast-enhanced computed tomography were insignificant, suggesting minimal kidney aggression by modern iodinated contrast media

Critically ill SARS-CoV-2-infected patients are not stratified as sepsis by the qSOFA

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