129 research outputs found
Anaesth Crit Care Pain Med
PURPOSE: To provide recommendations for the anaesthetic and peri-operative management for thrombectomy procedure in stroke patients DESIGN: A consensus committee of 15 experts issued from the French Society of Anaesthesia and Intensive Care Medicine (SociĂ©tĂ© Française d'AnesthĂ©sie et RĂ©animation, SFAR), the Association of French-language Neuro-Anaesthetists (Association des Neuro-AnesthĂ©sistes RĂ©animateurs de Langue Francaise, ANARLF), the French Neuro-Vascular Society (SociĂ©tĂ© Francaise de Neuro-Vasculaire, SFNV), the French Neuro-Radiology Society (SociĂ©tĂ© Francaise de Neuro-Radiologie, SFNR) and the French Study Group on Haemostasis and Thrombosis (Groupe Français d'Ătudes sur l'HĂ©mostase et la Thrombose, GFHT) was convened, under the supervision of two expert coordinators from the SFAR and the ANARLF. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were required to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. METHODS: Four fields were defined prior to the literature search: (1) Peri-procedural management, (2) Prevention and management of secondary brain injuries, (3) Management of antiplatelet and anticoagulant treatments, (4) Post-procedural management and orientation of the patient. Questions were formulated using the PICO format (Population, Intervention, Comparison, and Outcomes) and updated as needed. Analysis of the literature was then conducted and the recommendations were formulated according to the GRADE methodology. RESULTS: The SFAR/ANARLF/SFNV/SFNR/GFHT guideline panel drew up 18 recommendations regarding anaesthetic management of mechanical thrombectomy procedures. Due to a lack of data in the literature allowing to conclude with high certainty on relevant clinical outcomes, the experts decided to formulate these guidelines as "Professional Practice Recommendations" (PPR) rather than "Formalized Expert Recommendations". After two rounds of rating and several amendments, a strong agreement was reached on 100% of the recommendations. No recommendation could be formulated for two questions. CONCLUSIONS: Strong agreement among experts was reached to provide a sizable number of recommendations aimed at optimising anaesthetic management for thrombectomy in patients suffering from stroke
Khresmoi Professional: Multilingual Semantic Search for Medical Professionals
There is increasing interest in and need for innovative solutions to medical search. In this paper we present the EU funded Khresmoi medical search and access system, currently in year 3 of 4 of development across 12 partners . The Khresmoi system uses a component based architecture housed in the cloud to allow for the development of several innovative applications to support target users medical information needs. The Khresmoi search systems based on this architecture have been designed to support the multilingual and multimod al information needs of three target groups the general public, general practitioners and consultant
radiologists. In this paper we focus on the presentation of the systems to support the latter two groups using semantic, multilingual text and image based (including 2D and 3D radiology images) search
Skeletal muscle oxygenation in severe trauma patients during haemorrhagic shock resuscitation
Muscle squelettique et ischémie-reperfusion expérimentale des membres : mécanismes impliqués dans la protection ou les effets délétÚres de la cyclosporine et facteurs limitant les conditionnements pharmacologique et ischémique
Peripheral arterial disease and many surgical procedures (requiring vascular clamping or tourniquet application) induce severe skeletal muscle ischemia-reperfusion (IR) injuries. As a result, using experimental hind limb ischemia-reperfusion models, our goals were: ° To test a pharmacologic substitute to ischemic postconditioning by using cyclosporine A, that acts on a very downstream step of IR injury cascade by binding to cyclophilin D and inhibiting mitochondrial transition pore opening. We wondered if cyclosporine could alleviate mitochondrial dysfunction and reduce ROS production in skeletal muscles submitted to IR. ° To determine how diabetes and senescence would influence cyclosporine A protective effects. In conclusion, the protective effects of pharmacologic postconditioning with cyclosporine A seem to critically depend on the model under study. A variable and narrow dose-effect relationship is likely and makes it necessary to perform a dose finding study in every pathologic model. Considering the narrow relationships between mitochondrial protection and oxidative stress, combing cyclosporine A postconditioning with antioxidant therapy may restore a more robust protective effect but this hypothesis has to be validated.Le muscle striĂ© squelettique subit de graves lĂ©sions dâischĂ©mie-reperfusion (IR) au cours de la progression de lâartĂ©riopathie oblitĂ©rante des membres infĂ©rieurs et lors dâinterventions chirurgicales qui nĂ©cessitent lâinterruption transitoire du flux sanguin dans les artĂšres des membres. Dans ce contexte, nos objectifs Ă©taient de mettre Ă profit deux modĂšles expĂ©rimentaux dâIR des membres infĂ©rieurs par clampage aortique et garrotage unilatĂ©ral pour : ° tester lâefficacitĂ© dâune alternative mĂ©dicamenteuse au postconditionnement ischĂ©mique par lâutilisation de la cyclosporine A (CsA). En se liant Ă la cyclophiline D, la CsA empĂȘche lâouverture du pore de transition mitochondrial (mPTP) Ă un niveau trĂšs distal de la cascade dâĂ©vĂšnements qui conduit Ă la nĂ©crose aprĂšs IR. ° dĂ©terminer de quelle façon deux comorbiditĂ©s frĂ©quemment retrouvĂ©es chez des patients souffrant dâatteinte artĂ©rielle (le diabĂšte et lâĂąge) influencent lâeffet de la cyclosporine. Avec les protocoles de conditionnement et aux doses que nous avons utilisĂ©es, la cyclosporine a des effets diffĂ©rents sur les consĂ©quences musculaires de lâischĂ©mie-reperfusion des membres infĂ©rieurs, dĂ©pendant de la pathologie sous-jacente des animaux Ă©tudiĂ©s. Il semble intĂ©ressant dâĂ©tudier lâeffet dose-rĂ©ponse de la cyclosporine A pour dĂ©terminer lâintervalle thĂ©rapeutique optimal, celui-ci pouvant ĂȘtre diffĂ©rent chez lâanimal sain et pathologique. Dâautre part, Ă©tant donnĂ© lâimportance considĂ©rable du stress oxydant chez les animaux diabĂ©tiques et sĂ©nescents, la co-administration de cyclosporine et dâun antioxydant au moment de la reperfusion pourrait rĂ©tablir une protection
Atteintes microcirculatoires et dysfonctions mitochondriales au cours des phénomÚnes d'ischemie-reperfusion et des altérations de la perfusion tissulaire
Sciences de la vie et de la sant
Skeletal muscle and experimental ischemia-reperfusion members : mechanisms involved in the protective effects of cyclosporine and the limiting factors of pharmacologic and ischemic postconditioning
Le muscle striĂ© squelettique subit de graves lĂ©sions dâischĂ©mie-reperfusion (IR) au cours de la progression de lâartĂ©riopathie oblitĂ©rante des membres infĂ©rieurs et lors dâinterventions chirurgicales qui nĂ©cessitent lâinterruption transitoire du flux sanguin dans les artĂšres des membres. Dans ce contexte, nos objectifs Ă©taient de mettre Ă profit deux modĂšles expĂ©rimentaux dâIR des membres infĂ©rieurs par clampage aortique et garrotage unilatĂ©ral pour : ° tester lâefficacitĂ© dâune alternative mĂ©dicamenteuse au postconditionnement ischĂ©mique par lâutilisation de la cyclosporine A (CsA). En se liant Ă la cyclophiline D, la CsA empĂȘche lâouverture du pore de transition mitochondrial (mPTP) Ă un niveau trĂšs distal de la cascade dâĂ©vĂšnements qui conduit Ă la nĂ©crose aprĂšs IR. ° dĂ©terminer de quelle façon deux comorbiditĂ©s frĂ©quemment retrouvĂ©es chez des patients souffrant dâatteinte artĂ©rielle (le diabĂšte et lâĂąge) influencent lâeffet de la cyclosporine. Avec les protocoles de conditionnement et aux doses que nous avons utilisĂ©es, la cyclosporine a des effets diffĂ©rents sur les consĂ©quences musculaires de lâischĂ©mie-reperfusion des membres infĂ©rieurs, dĂ©pendant de la pathologie sous-jacente des animaux Ă©tudiĂ©s. Il semble intĂ©ressant dâĂ©tudier lâeffet dose-rĂ©ponse de la cyclosporine A pour dĂ©terminer lâintervalle thĂ©rapeutique optimal, celui-ci pouvant ĂȘtre diffĂ©rent chez lâanimal sain et pathologique. Dâautre part, Ă©tant donnĂ© lâimportance considĂ©rable du stress oxydant chez les animaux diabĂ©tiques et sĂ©nescents, la co-administration de cyclosporine et dâun antioxydant au moment de la reperfusion pourrait rĂ©tablir une protection.Peripheral arterial disease and many surgical procedures (requiring vascular clamping or tourniquet application) induce severe skeletal muscle ischemia-reperfusion (IR) injuries. As a result, using experimental hind limb ischemia-reperfusion models, our goals were: ° To test a pharmacologic substitute to ischemic postconditioning by using cyclosporine A, that acts on a very downstream step of IR injury cascade by binding to cyclophilin D and inhibiting mitochondrial transition pore opening. We wondered if cyclosporine could alleviate mitochondrial dysfunction and reduce ROS production in skeletal muscles submitted to IR. ° To determine how diabetes and senescence would influence cyclosporine A protective effects. In conclusion, the protective effects of pharmacologic postconditioning with cyclosporine A seem to critically depend on the model under study. A variable and narrow dose-effect relationship is likely and makes it necessary to perform a dose finding study in every pathologic model. Considering the narrow relationships between mitochondrial protection and oxidative stress, combing cyclosporine A postconditioning with antioxidant therapy may restore a more robust protective effect but this hypothesis has to be validated
Skeletal muscle and experimental ischemia-reperfusion members : mechanisms involved in the protective effects of cyclosporine and the limiting factors of pharmacologic and ischemic postconditioning
Le muscle striĂ© squelettique subit de graves lĂ©sions dâischĂ©mie-reperfusion (IR) au cours de la progression de lâartĂ©riopathie oblitĂ©rante des membres infĂ©rieurs et lors dâinterventions chirurgicales qui nĂ©cessitent lâinterruption transitoire du flux sanguin dans les artĂšres des membres. Dans ce contexte, nos objectifs Ă©taient de mettre Ă profit deux modĂšles expĂ©rimentaux dâIR des membres infĂ©rieurs par clampage aortique et garrotage unilatĂ©ral pour : ° tester lâefficacitĂ© dâune alternative mĂ©dicamenteuse au postconditionnement ischĂ©mique par lâutilisation de la cyclosporine A (CsA). En se liant Ă la cyclophiline D, la CsA empĂȘche lâouverture du pore de transition mitochondrial (mPTP) Ă un niveau trĂšs distal de la cascade dâĂ©vĂšnements qui conduit Ă la nĂ©crose aprĂšs IR. ° dĂ©terminer de quelle façon deux comorbiditĂ©s frĂ©quemment retrouvĂ©es chez des patients souffrant dâatteinte artĂ©rielle (le diabĂšte et lâĂąge) influencent lâeffet de la cyclosporine. Avec les protocoles de conditionnement et aux doses que nous avons utilisĂ©es, la cyclosporine a des effets diffĂ©rents sur les consĂ©quences musculaires de lâischĂ©mie-reperfusion des membres infĂ©rieurs, dĂ©pendant de la pathologie sous-jacente des animaux Ă©tudiĂ©s. Il semble intĂ©ressant dâĂ©tudier lâeffet dose-rĂ©ponse de la cyclosporine A pour dĂ©terminer lâintervalle thĂ©rapeutique optimal, celui-ci pouvant ĂȘtre diffĂ©rent chez lâanimal sain et pathologique. Dâautre part, Ă©tant donnĂ© lâimportance considĂ©rable du stress oxydant chez les animaux diabĂ©tiques et sĂ©nescents, la co-administration de cyclosporine et dâun antioxydant au moment de la reperfusion pourrait rĂ©tablir une protection.Peripheral arterial disease and many surgical procedures (requiring vascular clamping or tourniquet application) induce severe skeletal muscle ischemia-reperfusion (IR) injuries. As a result, using experimental hind limb ischemia-reperfusion models, our goals were: ° To test a pharmacologic substitute to ischemic postconditioning by using cyclosporine A, that acts on a very downstream step of IR injury cascade by binding to cyclophilin D and inhibiting mitochondrial transition pore opening. We wondered if cyclosporine could alleviate mitochondrial dysfunction and reduce ROS production in skeletal muscles submitted to IR. ° To determine how diabetes and senescence would influence cyclosporine A protective effects. In conclusion, the protective effects of pharmacologic postconditioning with cyclosporine A seem to critically depend on the model under study. A variable and narrow dose-effect relationship is likely and makes it necessary to perform a dose finding study in every pathologic model. Considering the narrow relationships between mitochondrial protection and oxidative stress, combing cyclosporine A postconditioning with antioxidant therapy may restore a more robust protective effect but this hypothesis has to be validated
Evaluation de la microcirculation sublingale par spectroscopie orthogonale polarisée au cours du choc hémorragique et de sa réanimation dans un modÚle porcin de choc hémorragique à pression contrÎlée.
STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Valeur prédictive du gradient de saturation cérébro-musculaire en oxygÚne comme témoin précoce d'hypoperfusion périphérique chez le patient de chirurgie cardiaque
STRASBOURG-Medecine (674822101) / SudocSudocFranceF
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