Low parathyroid hormone status induced by high dialysate calcium is an independent risk factor for cardiovascular death in hemodialysis patients

Here we studied a possible association between low parathyroid hormone (PTH) status and mortality in incident patients undergoing hemodialysis . A total of 1983 patients were included at baseline and prospectively followed for 24 months. Patients were classified according to their Kidney Disease: Improving Global Outcomes PTH status at baseline and at 12 months, and mortality evaluated at 12 to 24 months using adjusted Cox analysis. Factors potentially involved in PTH status variability between baseline and 12 months were analyzed. A decrease in serum PTH from normal or high to low values between baseline and 12 months was associated with significantly increased cardiovascular mortality at 12 to 24 months (hazard ratio, 2.03; 95% confidence interval, 1.22–3.36). For patients with high or normal baseline PTH levels, the main independent factor at 6 months for a decrease to low PTH levels at 12 months was high dialysate calcium (1.75 mmol/L), whereas prescription of non–calcium-based phosphate binders was associated with a lower risk of PTH decrease. In the high cardiovascular (CV) mortality risk subgroup of patients who acquired a low PTH status at 12 months, the main independent factor at 12 months associated with significant 12- to 24-month CV mortality was high dialysate calcium (odds ratio, 5.44; 95% CI, 2.52–11.75). Thus, patients with a serum PTH decrease to low values after 1 year of hemodialysis treatment are at high risk of short-term CV death. High dialysate calcium was an important contributor to PTH oversuppression, and continued use was associated with increased CV mortality

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Insuffisance rénale aiguë en réanimation chirurgicale (intérêt de la mesure de l'index de résistivité par le Doppler rénal pour le diagnostic étiologique précoce)

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

PTH basse et morbi-mortalité des patients hémodialysés chroniques (étude nationale observationnelle prospective menée sur 2164 patients)

Les patients hémodialysés chroniques sont particulièrement à risque de mortalité et notamment d origine cardiovasculaire (CV). Alors que l imputabilité des troubles du métabolisme minéral et osseux dans le processus de calcification vasculaire à été bien démontrée, les conséquences d une parathormone (PTH) basse (< 2N selon les recommandations KDIGO) ne sont pas clairement établies. Cette étude recherche une éventuelle association entre une PTH basse et la morbi-mortalité des patients hémodialysés et tente de définir les facteurs associés à ce statut. Dans cette étude nationale observationnelle prospective, 2164 patients incidents en dialyse ont été suivis entre Octobre 2010 et Octobre 2012. On observe qu une PTH basse au 12e mois (M12) est associée à une surmortalité d origine CV l année suivante (entre M12 et M24). Plus précisément, les patients présentant une PTH normale ou haute à l incidence (M0) et devenant basse à M12 sont particulièrement à risque de décès CV entre M12 et M24, indépendamment de l âge, des antécédents CV et des marqueurs nutritionnels et inflammatoires. Les facteurs associés à ce profil de variabilité de la PTH entre M0 et M12 sont une albuminémie basse et un dialysat enrichi en calcium (1,75 mmol/l) au 6e mois (M6). Cette étude montre également que les patients ayant une PTH basse dès M0 et restant basse à M12 présentent une surmortalité d origine non CV entre M12 et M24, dépendante d une hémoglobinémie basse. Ces patients s avèrent être plus âgés, dénutris et inflammatoires. L utilisation d un dialysat enrichi en calcium se révèle être le facteur de risque principal de la baisse anormale de la PTH entre M0 et M12, conduisant à une surmortalité CV des patients l année suivante. Ces résultats suggèrent une restriction d utilisation d un dialysat enrichi en calcium afin de réduire le risque CV des patients hémodialysés et devraient être confirmer dans d autres étudesMaintenance dialysis patients present a high risk of death and particularly cardiovascular deaths. Although mineral and bone metabolism has been well related to calcification process, consequences of low parathyroid hormone (PTH) (<2N according to K/DIGO recommendations) on arterial calcifications have not been proved. Our study tries to evaluate the association between low PTH status and short term morbi-mortality in hemodialysis patients and find associated factors to this status. This national, prospective study followed 2164 incident hemodialysis patients from October 2010 to October 2012. Patients with low PTH at M12 was associated with increased cardiovascular mortality between M12 and M24 and particularly patients with a PTH level decreasing between M0 and M12 after adjusting on age, cardiovascular disease, nutritional and inflammation factors. Predictive factors for M0 to M12 decreased PTH level were hypoalbuminemia and a high dialysate calcium concentration use at M6. Moreover, patients with low PTH from M0 to M12 had a higher risk of non-cardiovascular mortality, linked to anemia. These patients were more likely older, malnourished and with a higher inflammation status. High dialysate calcium concentration strongly participated to the decrease of PTH level between incidence and one year of follow up, leading to higher cardiovascular mortality the year after. These results suggest to restrict high dialysate calcium concentration use in order to reduce cardiovascular risk in hemodialysis patients and should be confirmed in other studies.ST QUENTIN EN YVELINES-BU (782972101) / SudocSudocFranceF

Quelles possibilités pour les intellectuels engagés ?

Jilin Xu, Tran Emilie, Merle Aurore. Quelles possibilités pour les intellectuels engagés ?. In: Perspectives chinoises, n°81, 2004. pp. 16-31

Raman and infrared spectra of doped La8+xSr2-y(SiO4)6O2+d compounds compared to the ab initio obtained spectroscopic characteristics of fully stoichiometric La8Sr2(SiO4)6O2

International audienceVibrational spectroscopy data were used to gain insight into the possible locations of extra oxygen ions introduced into La8+xSr2−y(SiO4)6O2+δ compounds to raise their ionic conductivity. Perturbations observed in the Raman and infrared spectra of these compounds with increasing δ were explained by using the ab initio calculation results for the fully stoichiometric (x = y = δ = 0) lattice. This allowed the inference that the extra oxygen ions are incorporated into La–O tunnel-like fragments inherent in the studied structures

Les inondations remarquables en France au XXe siècle : premiers éléments d’analyse issus de l'enquête EPRI 2011

Significant French floods events during the XXth century from 2011 preliminary flood risk assessment of the European Flood directive. An inventory of about 2000 French flood events has been achieved in 2011, in the framework of the Preliminary Flood Risk Assessment of the European Flood Directive. In collaboration with local authorities, a set of about 300 significant past floods has been documented with a short presentation (1 to 2 pages) of the hydro-meteorological conditions and the adverse consequences. The paper presents the methodological framework for data collection and significant flood selection. Then ten extreme flood events are presented : 1910, 1930, 1940, 1947-48, 1959, 1980, 1999, 2000-01, 2001 and 2010. Some perspectives are addressed to improve the knowledge of past floods.Un recensement de près de 2000 inondations a été réalisé en 2011 sur l’ensemble du territoire français dans le cadre de l’Evaluation Préliminaire des Risques d’Inondation (EPRI), première phase de la Directive européenne sur les Inondations. En collaboration étroite avec les services de l’Etat concernés, un choix d’environ 300 événements remarquables a ensuite été établi, pour lesquels une description courte (1 à 2 pages) a passé en revue la genèse de l’inondation et ses conséquences. L’article décrit le mode opératoire suivi pour la collecte des données et la sélection des événements puis présente à titre d’illustration dix inondations remarquables (1910, 1930, 1940, 1947-48, 1959, 1980, 1999, 2000-01, 2001 et 2010). Il se termine par les perspectives de valorisation de cette enquête 2011.Lang Michel, Coeur Denis, Bard Antoine, Bacq Bruno, Becker Timothée, Bignon Emilie, Blanchard Raphaël, Bruckmann Laurent, Delserieys Mathieu, Edelblutte Charlotte, Merle Caroline. Les inondations remarquables en France au XXe siècle : premiers éléments d’analyse issus de l'enquête EPRI 2011. In: Evénements extrêmes fluviaux et maritimes. Leurs variabilités spatiales et chronologiques dans l'ouest de l’Europe. 34èmes journées de l’hydraulique Paris, 1 et 2 février 2012. 2012