Diaphragm function in patients with sepsis and septic shock: A longitudinal ultrasound study.

[en] BACKGROUND: Previous literature on the determinants of diaphragm dysfunction in septic patients is limited. The goal of this study is to assess diaphragm dysfunction in terms of its prevalence and its potential associated factors in septic intensive care unit (ICU) patients. METHODS: This prospective and observational study was conducted between June 2015 and July 2019. Ultrasound measures of diaphragm thickness were performed daily on septic patients. The primary outcome was the prevalence of diaphragm dysfunction at baseline and during the ICU stay. The secondary outcome was the diaphragm thickness. Possible associated factors were prospectively recorded. RESULTS: Fifty patients were enrolled in the study. The prevalence of diaphragm dysfunction was 58%. No diaphragm atrophy was found during the ICU stay. Diaphragm dysfunction was associated with the alteration of consciousness, intra-abdominal sepsis, hypnotics and opioids, and mechanical ventilation. Administration of hypnotics, opioids, and steroids was associated with a decreased diaphragm thickening fraction. Diaphragm dysfunction had no impact on patient outcomes. CONCLUSIONS: Our data reveal a high prevalence of diaphragm dysfunction in septic patients at the onset of sepsis. Administration of hypnotics, opioids, and steroids was associated with the alteration of diaphragm function as well as intra-abdominal sepsis

Endothelial Cells Activated by Extracellular Histones Promote Foxp3+ Suppressive Treg Cells In Vitro

International audienceHistones are widely recognized as pro-inflammatory mediators upon their release from the nucleus into the extracellular space. However, their impact on endothelial cell immunogenicity is unknown. Endothelial cells, Human Microvascular Endothelial cells 1 (HMEC1), have been exposed to recombinant histones in order to study their effect on the endothelial phenotype. We then studied the differentiation of CD4+-T lymphocytes subpopulations after three days of interaction with endothelial cells in vitro and observed that histone-treated endothelial cells differentiate a suppressive FoxP3+ T regulator subpopulation that expressed Human Leucocyte Antigen DR (HLA-DR) and Cytotoxic T-Lymphocyte-Associated protein 4 (CTLA4). Toll-Like Receptor 4 (TLR4) inhibition significantly decreased the expansion of these Treg cells. Moreover, blockade of Interleukin (IL)-6 and Intercellular Adhesion Molecule (ICAM)-1 in cocultures significantly decreased the expansion of Tregs, suggesting an IL-6 and ICAM-1 dependent pathway. Thus, beyond their inflammatory effects, extracellular histones may induce an increase of immunosuppressive Treg population via their action on endothelial cells. Further studies are needed to evaluate the impact on immunosuppression of an increase of peripheral suppressive Treg via endothelial cell activation by histones in vivo

A Virtual Caregiver for Assisted Daily Living of Pre-Frail Users

As Europe sees its population aging dramatically, Assisted Daily Living for the elderly becomes a more and more important and relevant research topic. The Movecare Project focuses on this topic by integrating a robotic platform, an IoT system, and an activity center to provide assistance, suggestions of activities and transparent monitoring to users at home. In this paper, we describe the Virtual Caregiver, a software component of the Movecare platform, that is responsible for analyzing the data from the various modules and generating suggestions tailored to the user’s state and needs. A preliminary study has been carried on over 2 months with 15 users. This study suggests that the presence of the Virtual Caregiver encourages people to use the Movecare platform more consistently, which in turn could result in better monitoring and prevention of cognitive and physical decline

User feedback and remote supervision for assisted living with mobile robots: A field study in long-term autonomy

In an ageing society, the at-home use of Socially Assistive Robots (SARs) could provide remote monitoring of their users' well-being, together with physical and psychological support. However, private home environments are particularly challenging for SARs, due to their unstructured and dynamic nature which often contributes to robots' failures. For this reason, even though several prototypes of SARs for elderly care have been developed, their commercialisation and wide-spread at-home use are yet to be effective. In this paper, we analyse how including the end users' feedback impacts the SARs reliability and acceptance. To do so, we introduce a Monitoring and Logging System (MLS) for remote supervision, which increases the explainability of SAR-based systems deployed in older adults' apartments, while also allowing the exchange of feedback between caregivers, technicians, and older adults. We then present an extensive field study showing how long-term deployment of autonomous SARs can be accomplished by relying on such a feedback loop to address any potential issue. To this end, we provide the results obtained in a 130-week long study where autonomous SARs were deployed in the apartments of 10 older adults, with the aim of possibly serving and assisting future practitioners, with the knowledge collected from this extensive experimental campaign, to fill the gap that currently exists for the widespread adoption of SARs. (c) 2022 Elsevier B.V. All rights reserved

Exploring the Viability of Socially Assistive Robots for At-Home Cognitive Monitoring:Potential and Limitations

The early detection of mild cognitive impairment, a condition of increasing impact in our aging society, is a challenging task with no established answer. One promising solution is the deployment of robotic systems and ambient assisted living technology in the houses of older adults for monitoring and assistance. In this work, we address and discuss a qualitative analysis on the feasibility and acceptability of a socially assistive robot (SAR) deployed in prospective users’ houses to monitor their cognitive capabilities through a set of digitalised neuropsychological tests and spot questions conveniently integrated within the robotic assistant’s daily tasks. We do this by describing an experimental campaign where a robotic system, integrated with a larger framework, was installed in the house of 10 users for a duration of at least 10 weeks, during which their cognitive capabilities were monitored by the robot. Concretely, the robots supervised the users during the completion of the tests and transparently monitored them by asking questions interleaved in their everyday activities. Results show a general acceptance of such technology, being able to carry out the intended tasks without being too invasive, paving the way for an impactful at-home use of SARs.</p