Du concept à la réalisation d'un logiciel d'évaluation de l'état nutitionnel et d'aide à la prescription de nutrition artificielle en réanimation

La dénutrition hospitalière, et plus particulièrement en réanimation est un problème majeur. Sa prise en charge est nécessaire mais, malgré de multiples recommandations, sa prescription reste le plus souvent inadaptée. L'objectif principal de cette étude est de mettre au point un logiciel fonctionnel permettant de guider la prescription de nutrition artificielle en réanimation et d'en évaluer l'efficacité. Cette réalisation s'inscrit dans une démarche d'amélioration de la qualité des soins. Nous avons, après recherches bibliographiques, élaboré un algorithme, socle du logiciel. Ce dernier se module en fonction du motif d'hospitalisation, des pathologies associées. Il propose, en outre, une évaluation régulière de l'état nutritionnel avec une interprétation des résultats. Le proof of concept par programmation orientée objet, en langage PHP dans sa version 5 a été réalisé. Il est disponible sur serveur et est accessible via un navigateur internet. Ce proof of concept n'est pas pleinement fonctionnel. Il reste en effet des heures de programmation à effectuer pour ajouter les niveaux de sécurité qui en permettront une utilisation étendue. Cependant, la concrétisation du projet, au travers de ce logiciel, montre que celui-ci est réalisable. Suites aux recherches bibliographiques ayant étoffé ce travail, nous pouvons nous poser la question de la spécificité des apports nutritionnels en fonction des différentes pathologies. Il faut garder à l'esprit qu'aucun logiciel ne parviendra à prémunir un médecin contre des erreurs de prescription. La prescription informatisée doit être clairement comprise comme un outil performant de prescription, et non comme un substitut à la décision thérapeutique.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

L'admission différée en réanimation médicale (étude de pratique au CHU de Rouen et impact sur la mortalité)

Les sollicitations pour une admission en réanimation sont nombreuses et les ressources limitées. Les réanimateurs sont conduits à refuser des patients faute de place, du fait du refus du patient ou parce qu'ils les jugent trop ou pas assez graves. Cette décision n'est cependant pas toujours prise d'emblée, le réanimateur pouvant la temporiser lors d'une période de stand-by. Notre objectif était de caractériser cette période en déterminant les facteurs intervenant dans le processus de décision et évaluer l'effet sur la mortalité des patients mis en stand-by comparés aux patients admis ou refusés d'emblée. Nous avons réalisé une étude prospective observationnelle monocentrique sur un an de l'ensemble des sollicitations pour une admission. Les critères démographiques, les caractéristiques des sollicitations et la mortalité à 28 jours, le recours à des suppléances d'organes, ont été étudiés. Sur les 1815 patients analysés, 845 patients (46,6%) ont été admis d'emblée, 579 (31,9%) refusés d'emblée, 341 (18,8 %) mis en stand-by et 50 (27,5%) réorientés. Il n'existe pas de différence de mortalité à 28 jours entre les patients admis après stand-by et les patients admis d'emblée. A l'inverse, les patients refusés d'emblée ont un taux de mortalité significativement plus important que les patients en stand-by (p<0.0001). Des facteurs organisationnels (contact téléphonique, provenance et horaire de l'appel) influent dans la décision de temporisation. Le recours à la ventilation mécanique est plus important chez les patients admis d'emblée. Nous retrouvons donc que temporiser la prise de décision d'admission en réanimation médicale n'est pas associée à une augmentation de la mortalité.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Formation Mechanism of the Ga 13 Keggin Ion: A Combined EXAFS and NMR Study

International audienc

Influence of Tetrahedral Layer Charge on the Organization of Interlayer Water and Ions in Synthetic Na-Saturated Smectites

International audienceSmectite hydration strongly influences dynamical properties of interlayercations and thus the fate of H2O and pollutants in surficial systems where smectite-basedmaterials are often used as a major barrier component. Smectite crystal chemistry is knownto rule its hydration, although the influence of specific parameters such as the amount andlocation of layer charge deficit remains poorly understood. A set of tetrahedrally chargedtrioctahedral smectites, with a common structural formula inter[Nax]oct[Mg6]tet[Si8.0−xAlx]-O20(OH,F)4 and a layer charge (x) varying from 0.8 to 3.0, were thus synthesized to assessthe influence of layer charge on smectite hydration and interlayer structure. Both hydroxylatedand fluorinated samples were synthesized because of the increasing use of the lattervarieties in recent spectroscopic studies aiming at the determination of interlayer H2Odynamical properties. The distribution of charge-compensating cations and of associatedH2O molecules was determined both experimentally from the modeling of X-ray diffractionpatterns and numerically from Monte Carlo molecular simulations performed in the grandcanonical ensemble. The consistency of both approaches for hydroxylated samples allowed gaining insights into the specificinfluence of smectite crystal chemistry. For a given hydration state, H2O content is about constant in hydroxylated saponites,independent of layer charge, whereas smectite layer-to-layer distance decreases with increasing layer charge because of theenhanced cation-layer electrostatic attraction. As a result, positional disorder of interlayer H2O molecules is reduced because ofstronger steric constraints and of the increased density of electronegative sites at the surface of the clay layer. Fluorinefor-hydroxyl isomorphic substitutions likely increase further electronegativity of the clay layer surface leading to further reductionof the interlayer H2O content and to the formation of Na+ inner sphere complexes at the clay layer surface. When normalized tothe number of interlayer cations, the number of interlayer H2O molecules decreases with increasing layer charge, and theproportion of these H2O molecules hydrating interlayer cations increases, thus increasing the stability of most hydrated statestoward lower relative humidity conditions. Smectite hydration evolution appears as a steady process with no tendency tointerlayer cation ordering at the smectite-to-vermiculite limit of ∼1.3 charge per O20(OH,F)4

Invasive Geotrichum clavatum Fungal Infection in an Acute Myeloid Leukaemia Patient: A Case Report and Review

International audienceInvasive Geotrichum clavatum fungal infections are extremely rare and unusual, occurring nearly exclusively in patients experiencing prolonged neutropenia during the treatment for acute myeloid leukaemia. Several groups of cases of fatal G. clavatum infection were reported in France between 2011 and 2012, but the ecological niche has not yet been identified. We report a case of a 32-year-old patient with acute myeloid leukaemia who developed G. clavatum sepsis with primary peritonitis, hepatic nodular lesions, and multivisceral failure during apla-sia after induction followed by salvage chemotherapy. He was treated with voriconazole and is still alive 1 year after with controlled disease. We then discuss the epidemiological, clinical, and therapeutic features of these serious fungal infections compared to the published data

New pigments based on carminic acid and smectites: A molecular investigation

International audienceHybrid materials based on montmorillonite, a cationic polymer and carminic acid were prepared. The surface charge of montmorillonite was inversed thanks to the cationic polymer, polydiallyldimethylammonium chloride. Samples were characterized by a set of different techniques including Infrared (IR) and Nuclear Magnetic Resonance (NMR) spectroscopies to highlight the nature of the interactions between the organic and inorganic parts. The photo-stability of the samples was tested for different durations, and L*a*b* parameters were measured. It was possible to propose an approach for the degradation mechanism of the supported dye thanks to EPR (electron paramagnetic resonance) spectroscopy. The experimental data were in agreement with the theoretical periodic DFT calculations where a molecular scheme of the adsorption complex was proposed, and the importance of hydration on the stability of the adsorption complex highlighted

Additional file 1 of ROX index performance to predict high-flow nasal oxygen outcome in Covid-19 related hypoxemic acute respiratory failure

Additional file 1: Figure S1. Receiver operating characteristic curves for HFNO failure within 28 days at different times after HFNO initiation. HFNO: high-flow nasal oxygen therapy; ROC: receiver operating characteristic; H0: ROC curve at the time of HFNO initiation; H12:12 hours after HFNO initiation; H18: 18 hours after HFNO initiation; H24:24 hours after HFNO initiation. Figure S2. Rox index performance to predict the risk of HFNO failure at different times after HFNO initiation. HFNO: high-flow nasal oxygen therapy; red line gives proportion of patients in the HFNO failure group with a ROX index ≤ a chosen cut-off value; black line gives proportion of patients in the HFNO success group with a ROX index ≤ a chosen cut-off value. For example: at H6, using a Rox index of ≤8.50 as cut-off would identify 90% of patients with HFNO failure after H6, whereas this cut-off would identify only 38% of patients with HFNO success after H6, avoiding intubation. Figure S3. Incidence of HFNO failure within 7 days after HFNO initiation. HFNO: high-flow nasal oxygen therapy. Table S4. Conditions of intubation and clinical respiratory parameters in all intubated patients and according to hemodynamic status. HFNO: high-flow nasal oxygen therapy; FiO2: fraction of inspired oxygen; SpO2: pulse oxygen saturation; RR: respiratory rate; values are expressed as n (%) or median (Q1-Q3). Table S5. Rox index at H0, HFNO outcome and duration according to each ICU center. HFNO: high-flow nasal oxygen therapy; ICU: intensive care unit; values are expressed as n (%) or median (Q1-Q3); *= logistic regression unless stated otherwise; **= Kruskall-Wallis’s test

Association of both Langerhans cell histiocytosis and Erdheim-Chester disease linked to the BRAFV600E mutation

Comment in "A common progenitor cell in LCH and ECD. [Blood. 2014]"International audienceHistiocytoses are a group of heterogeneous diseases that mostly comprise Langerhans cell histiocytosis (LCH) and non-LCH. The association of LCH with non-LCH is exceptional. We report 23 patients with biopsy-proven LCH associated with Erdheim-Chester disease (ECD) (mixed histiocytosis) and discuss the significance of this association. We compare the clinical phenotypes of these patients with those of 56 patients with isolated LCH and 53 patients with isolated ECD. The average age at diagnosis was 43 years. ECD followed (n = 12) or was diagnosed simultaneously with (n = 11) but never preceded LCH. Although heterogeneous, the phenotype of patients with mixed histiocytosis was closer to that of isolated ECD than to that of isolated LCH (principal component analysis). LCH and ECD improved in response to interferon alpha-2a treatment in only 50% of patients (8 of 16). We found the BRAF(V600E) mutation in 11 (69%) of 16 LCH lesions and in 9 (82%) of 11 ECD lesions. Eight patients had mutations in both ECD and LCH biopsies. Our findings indicate that the association of LCH and ECD is not fortuitous and suggest a link between these diseases involving the BRAF(V600E) mutation