Effets de l'application d'un stretch cyclique sur un modèle isolé de bronche humaine : étude fonctionnelle, pharmacologique et immuno−génétique

The tracheo-bronchial tree is a true immunologic sentinel related to the huge interface with the external environment. Moreover, it is submitted to variable physical strains (tidal ventilation and variation in pressure) and an excessive response leads to the genesis of some pathology as hyperresponsiveness. The aim of this work on an isolated organ model was to characterize the human bronchial response to a single or repetitive and physiological stretch as observed during mechanical ventilation. From a functional perspective, a single strain or a cyclic stretch significantly increased the basal tone of the human bronchus with a two-step response: the early response appears during cycling and the delayed after the stretch has ceased. The early response is robust then no pre-treatment and especially epithelial removal totally inhibits it. This response implies NO synthase and Rho-A kinase pathway with a reduction of the developed basal tone with these inhibitors. As it concerns the late response, it involved epithelium and NO synthase suggesting a prominent action of NO. Inflammatory mediators are not directly involved in the rise of basal tone because stretch-induced secretion as detected with ELISA is very low. Genomic approach transiently activates transcription of genes for MMP-9, involved in the collagen production and consequently in the support tissue of the bronchial tree. As a conclusion, cyclic stretch enhances bronchoconstriction by inhibition of the NO-synthase pathway and mechanotransduction.L’arbre bronchique constitue une large interface avec le milieu extérieur ce qui en fait notamment une sentinelle immunologique. Par ailleurs, il est soumis à de multiples contraintes physiques (variation de pressions lors du cycle ventilatoire) avec le développement de pathologies lorsque la réponse à ces contraintes est inadaptée. Au cours de ce travail, nous avons essayé de caractériser la réponse bronchique des voies aériennes distales à partir d’un modèle isolé de bronche humaine soumis à l’application d’un stretch unique ou cyclique tel qu’il est généré lors de la ventilation mécanique. D’un point de vue fonctionnel, le stretch unique ou cyclique s’accompagne d’une modification significative du tonus basal de la bronche avec deux étapes : l’une précoce apparaît au cours de l’exposition même des variations de tension pariétale, l’autre est tardive et apparaît à l’arrêt de l’étirement. Concernant l’étape précoce, elle se révèle robuste car aucun pré-traitement et particulièrement l’abrasion de l’épithélium ne la supprime totalement. La caractérisation de cette réponse implique notamment la voie des NO synthases et des Rho-A kinase. La réponse tardive fait quant à elle intervenir l’épithélium ainsi que la voie des NO-synthase suggérant un rôle prépondérant du NO. Par contre, ces modifications de force au repos sont indépendantes de la sécrétion de médiateurs inflammatoires détectés par ELISA. L’approche génétique renforce par contre le rôle du tissu de soutien bronchique en activant la synthèse de collagène (MMP-9). Au total l'application d'une contrainte cyclique renforce la bronchoconstriction par inhibition de la voie des NOsynthases et de la mécanotransduction

Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial

Background: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring. Methods: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting >30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping. Results: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P < .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P < .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P < .0001) identified using continuous oximetry and capnography monitoring. Conclusions: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor

Social Class

Discussion of class structure in fifth-century Athens, historical constitution of theater audiences, and the changes in the comic representation of class antagonism from Aristophanes to Menander

Upregulation of PPARβ/δ Is Associated with Structural and Functional Changes in the Type I Diabetes Rat Diaphragm

Diabetes mellitus is associated with alterations in peripheral striated muscles and cardiomyopathy. We examined diaphragmatic function and fiber composition and identified the role of peroxisome proliferator-activated receptors (PPAR alpha and beta/delta) as a factor involved in diaphragm muscle plasticity in response to type I diabetes.Streptozotocin-treated rats were studied after 8 weeks and compared with their controls. Diaphragmatic strips were stimulated in vitro and mechanical and energetic variables were measured, cross bridge kinetics assessed, and the effects of fatigue and hypoxia evaluated. Morphometry, myosin heavy chain isoforms, PPAR alpha and beta/delta gene and protein expression were also assessed. Diabetes induced a decrease in maximum velocity of shortening (-14%, P<0.05) associated with a decrease in myosin ATPase activity (-49%, P<0.05), and an increase in force (+20%, P<0.05) associated with an increase in the number of cross bridges (+14%, P<0.05). These modifications were in agreement with a shift towards slow myosin heavy chain fibers and were associated with an upregulation of PPARbeta/delta (+314% increase in gene and +190% increase in protein expression, P<0.05). In addition, greater resistances to fatigue and hypoxia were observed in diabetic rats.Type I diabetes induced complex mechanical and energetic changes in the rat diaphragm and was associated with an up-regulation of PPARbeta/delta that could improve resistance to fatigue and hypoxia and favour the shift towards slow myosin heavy chain isoforms

Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial.

BACKGROUND: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring. METHODS: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting \u3e30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping. RESULTS: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P \u3c .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P \u3c .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P \u3c .0001) identified using continuous oximetry and capnography monitoring. CONCLUSIONS: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor

Dark Matter Searches with the ANTARES Neutrino Telescope

[EN] The MOSCAB experiment (Materia OSCura A Bolle) uses the Geyser technique for dark matter search. The results of the first 0.5 kg mass prototype detector using superheated C3F8 liquid were very encouraging, achieving a 5 keV nuclear recoil threshold with high insensitivity to gamma radiation. Additionally, the technique seems to be easily scalable to higher masses for both in terms of complexity and costs, resulting in a very competitive technique for direct dark matter search, especially for the spin dependent case. Here, we report as well in the construction and commissioning of the big detector of 40 kg at the Milano-Bicocca University. The detector, the calibration tests and the evaluation of the background will be presented. Once demonstrated the functionality of the detector, it will be operated at the Gran Sasso National Laboratory in 2015.We acknowledge the financial support of the Spanish Ministerio de Ciencia e Innovación (MICINN) and Ministerio de Economía y Competitividad (MINECO), Grants FPA2012-37528-C02-02, and Consolider MultiDark CSD2009-00064, and of the Generalitat Valenciana, Grants ACOMP/2014/153 and PrometeoII/2014/079.Ardid Ramírez, M. (2016). Dark Matter Searches with the ANTARES Neutrino Telescope. Nuclear and Particle Physics Proceedings. 273:378-382. https://doi.org/10.1016/j.nuclphysbps.2015.09.054S37838227