Secretion mechanisms of volatile organic compounds in specialized cells of aromatic plants

The present review focuses on cells secreting volatile odorant compounds. This cell type is found in a wide variety of plants, grouped under the term aromatic plants. Such secreting cells are very diverse in morphology, from highly specialized trichomes to nonspecialized cells, including the secretory epidermal cells of petals and osmophores. In these various types of cell, the biosynthetic pathways of three main groups of volatile organic compounds are recognized: isoprenoids, fatty acid derivatives and aromatic compounds. The precise cellular localization of these pathways has not yet been elucidated in all cases, though many of the enzymes involved have already been cloned. These have been found to be frequently located in plastids but also in endoplasmic reticulum or even cytosol. Two alternative mechanisms of secretion termed granulocrine and eccrine have been postulated to exist. Recent studies support the fact that both mechanisms could exist for different compounds and different plants. This review will discuss also the route by which secreted molecules make their way through the cell wall and cuticle

Overview of the current use of levosimendan in France: a prospective observational cohort study

Abstract Background Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. Method The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. Results The patients included ( n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock ( n = 250, 41.5%), decompensated heart failure ( n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment ( n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation ( n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. Conclusions We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied

Place du Levosimendan chez les patients en insuffisance cardiaque aiguë et en bas débit péri-opératoire de chirurgie cardiaque adulte et pédiatrique (expérience du CHU de Bordeaux)

INTRODUCTION : Le traitement de l'Insuffisance Cardiaque Aiguë (ICA) par les inotropes conventionnels est parfois associé dans la littérature à un pronostic défavorable. Le levosimendan, "nouvel" inotrope vasodilatateur et carfio-protecteur, a intégré les recommandations et nos pratiques, mais ses bénéfices sont discutés. Nous avons analysé l'évolution de nos patients traités par levosimendan, particulièrement en cas de choc cardiogénique réfractaire. PATIENTS ET METHODE : Nous avons étudié rétrospectivement l'évolution clinique et biologique de 138 patients traités entre 2008 et 2011. Notre hypothèse était qu'il favorise le sevrage en assistance circulatoire et en inotropes. Nous avons comparé l'évolution des patients en choc cardiogénique et réfractaire sous Extra-Corporeal Life Support (ECLS) avec ou sans levosimendan (37 et 43 patients). RESULTATS : Le levosimendan participe à une évolution favorable clinique (SOFA, sevrage d'inotropes) et biologique. Parmi 28 patients traités pour éviter ou pour supporter l'attente de thérapeutiques invasives, cinq ont récupéré sans assistance ni transplantation cardiaque, et deux sont décédés en refus de traitement. Chez les 21 derniers patients, le temps gagné avant la mise sous assistance ou la transplantation était de 28 [18 - 75] jours. Chez les patients avec ECLS, le levosimendan était associé à une mortalité inférieure à 30 et 90 jours (24 contre 56 % et 38 contre 63 % ; p < 0,05), ainsi qu'à une amélioration significative des durées de vie sans thérapeutiques de réanimation (ECLS, inotropes, ventilation invasive) et hors de l'hôpital. CONCLUSION : Intégré au traitement de l'ICA, le levosimendan semble participer à une évolution clinique favorable chez nos patients. Dans les états de choc cardiogénique, il permet parfois d'éviter le recours à une assistance circulatoire, et sous ECLS, son administration est associé à un meilleur pronostic. Ces bénéfices restent à confirmer par des études prospectives.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Severe Neonatal Pertussis Treated by Leukodepletion and Early Extra Corporeal Membrane Oxygenation.

We report the case of a 17-day-old infant with severe pertussis for whom the early initiation of veno-arterial extra corporeal membrane oxygenation and leukodepletion strategies (exchange transfusion and leukofiltration) allowed to reduce leukocytosis and pulmonary hypertension, thus leading to survival. These invasive techniques can be considered when severe pulmonary hypertension complicates hyperleukocytosis in neonates

Ann Intensive Care

Grown-up congenital heart (GUCH) patients represent a growing population with a high morbidity risk when undergoing reparative surgery. A main preoperative feature is right ventricular failure, which represents a risk factor for postoperative low cardiac output syndrome. Levosimendan has a potentially beneficial effect. This retrospective study included consecutive GUCH patients with surgeries in a tertiary cardiothoracic centre between 01-01-2013 and 01-10-2017, to test the hypothesis that the postoperative use of levosimendan might be associated with shorter time of mechanical ventilation, when compared with the use of milrinone. To adjust for bias related to the probability of treatment assignment, it uses the inverse propensity score weighting methodology. Overall 363 patients had GUCH surgeries during the study period, their mean age was 31.39 ± 15.31 years, 87 patients were eligible for analysis in the Levosimendan group and 117 in the Milrinone group. The propensity score used pre- and intraoperative variables and resulted in a good balance between covariates. The Levosimendan group included patients with higher preoperative risk scores, a higher prevalence of left and right ventricular failure, who required more often the addition of epinephrine, renal replacement therapy, prolonged mechanical ventilation and intensive care stay. However, after propensity score weighting, patients in the Levosimendan group had shorter durations of mechanical ventilation (average treatment effect - 37.59 h IQR [- 138.85 to - 19.13], p = 0.01) and intensive care stay (average treatment effect - 3.11 days IQR [- 10.03 to - 1.48], p = 0.009). The number of days of additional epinephrine support was shorter and the vasoactive inotropic scores lower. We report a beneficial effect in terms of duration of mechanical ventilation and intensive care stay, and on inotropic requirements of the use of levosimendan following GUCH surgeries. The use of levosimendan in this setting requires validation at a larger scale

Neurally adjusted ventilatory assist for children on veno-venous ECMO.

peer reviewedNAVA may improve veno-venous ECMO weaning in children. This is a retrospective small series, describing for the first time proof-of-principle for the use of NAVA in children on VV ECMO. Six patients (age 1-48 months) needed veno-venous ECMO. Controlled conventional ventilation was replaced with assisted ventilation as soon as lung compliance improved, and could trigger initiation and termination of ventilation. NAVA was then initiated when diaphragmatic electrical activity (EAdi) allowed for triggering. NAVA was possible in all patients. Proportionate to EAdi (1.8-26 μV), initial peak inspiratory pressures ranged from 21 to 34 cm H(2)O, and the tidal volume (Vt) from 3 to 7 ml/kg. During weaning, peak pressures increased proportionally to EAdi increase (5.2-41 μV), with tidal volumes ranging from 6.6 to 8.6 ml/kg. ECMO was weaned after a median time of 1.75 days on NAVA. Following ECMO weaning, the median duration of mechanical ventilation, and intensive care unit stay were 4.5 days, and 13.5 days, respectively. Survival to hospital discharge was 100%. In conclusion, combining NAVA to ECMO in paediatric respiratory failure is safe and feasible, and may help in a smoother ECMO weaning, since NAVA allows the patient to drive the ventilator and regulate Vt according to needs

300: Perioperative assessment of patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement?

PurposePulmonary valve replacement (PVR) is commonly performed in aduts with repaired TOF to avoid late complications related to severe pulmonary regurgitation. However, few data are available concerning perioperative complications. The aim of this study was to evaluate the perioperative complications and to determine predictive factors of the Low Cardiac Output Syndrome (LCOS) in patients undergoing PVR.Methods and Results30 patients with TOF who underwent PVR between 2008 and 2009 were retrospectivelly enrolled. Mean age at valve surgery was 29.5 (range: 6.5–56.5). PVR was conducted with beating heart using a normothermic CPB (77+/−25min) in 16 pts. 14 pts underwent additional surgery requiring aortic cross clamp (CPB mean time was 113+/−21min). Survival rate was 97% at 90 days. Post operative complications were uncommon (VT in 6%, Mechanical Ventilation> 24 hours in 6%, renal dysfunction in 10%) except for the LCOS (46%). Prolonged CPB duration> 80min (p<0.01) and aortic cross-clamp (p=0.03) increased LCOS (OR33 and 6). Age, RV or LV volumes and function, and preoperative additionnal lesion were not significatively predictive of perioperative complications.ConclusionThese data underline the major role of myocardial protection during PVR in TOF patients. Short beating heart normothermic CPB leads to a decrease LCOS