Le rôle infirmier dans l’accompagnement des proches des patients en état de mort cérébrale aux soins intensifs lors d’un processus de don d’organes: une revue de littérature

Problématique : l’annonce du diagnostic de mort cérébrale ainsi que la question du don d’organes provoquent un état de choc chez les proches et cela rend la situation difficile et éprouvante à vivre. A ce moment-là, le rôle de l’infirmier consiste à donner des informations aux proches mais également à les accompagner et à les soutenir. But : identifier les facteurs qui améliorent l’accompagnement des proches de patients en état de mort cérébrale aux soins intensifs, par les infirmiers, lors d’un processus de don d’organes. Méthode : revue de littérature regroupant neuf études quantitatives et qualitatives, identifiées sur les bases de données CINAHL et PUBMED. Ces articles ont été analysés à l’aide de grilles de résumé et de lecture critique. Résultats : le manque de connaissance des professionnels sur la mort cérébrale et le don d’organes impactent la qualité des informations données et la compréhension des proches. Les attitudes et les comportements des infirmiers influenceraient la prise de décision des proches quant au don d’organes. Le temps accordé ainsi que les informations claires et honnêtes données aux proches sont des éléments clés pour aborder la question du don. Pour les proches, le don doit être dissocié de la perte, car même si celui-ci permet de sauver une/des vie(s), il ne remplacera jamais l’être cher. Conclusion : les concepts majeurs de la théorie du Patient Family Centered Care complètent les résultats. Le respect, la dignité, le partage d’informations, les informations transmises ainsi que la collaboration avec les proches sont des éléments essentiels à intégrer dans l’accompagnement de ces derniers

CD29 identifies IFN-γ-producing human CD8+ T cells with an increased cytotoxic potential

Cytotoxic CD8+ T cells can effectively kill target cells by producing cytokines, chemokines, and granzymes. Expression of these effector molecules is however highly divergent, and tools that identify and preselect CD8+ T cells with a cytotoxic expression profile are lacking. Human CD8+ T cells can be divided into IFN-γ- and IL-2-producing cells. Unbiased transcriptomics and proteomics analysis on cytokine-producing fixed CD8+ T cells revealed that IL-2+ cells produce helper cytokines, and that IFN-γ+ cells produce cytotoxic molecules. IFN-γ+ T cells expressed the surface marker CD29 already prior to stimulation. CD29 also marked T cells with cytotoxic gene expression from different tissues in single-cell RNA-sequencing data. Notably, CD29+ T cells maintained the cytotoxic phenotype during cell culture, suggesting a stable phenotype. Preselecting CD29-expressing MART1 TCR-engineered T cells potentiated the killing of target cells. We therefore propose that CD29 expression can help evaluate and select for potent therapeutic T cell products

CD29 identifies IFN-γ-producing human CD8+ T cells with an increased cytotoxic potential

Cytotoxic CD8+ T cells can effectively kill target cells by producing cytokines, chemokines, and granzymes. Expression of these effector molecules is however highly divergent, and tools that identify and preselect CD8+ T cells with a cytotoxic expression profile are lacking. Human CD8+ T cells can be divided into IFN-γ- and IL-2-producing cells. Unbiased transcriptomics and proteomics analysis on cytokine-producing fixed CD8+ T cells revealed that IL-2+ cells produce helper cytokines, and that IFN-γ+ cells produce cytotoxic molecules. IFN-γ+ T cells expressed the surface marker CD29 already prior to stimulation. CD29 also marked T cells with cytotoxic gene expression from different tissues in single-cell RNA-sequencing data. Notably, CD29+ T cells maintained the cytotoxic phenotype during cell culture, suggesting a stable phenotype. Preselecting CD29-expressing MART1 TCR-engineered T cells potentiated the killing of target cells. We therefore propose that CD29 expression can help evaluate and select for potent therapeutic T cell products

The two enantiomers of 2-hydroxyglutarate differentially regulate cytotoxic T cell function

2-Hydroxyglutarate (2HG) is a byproduct of the tricarboxylic acid (TCA) cycle and is readily detected in the tissues of healthy individuals. 2HG is found in two enantiomeric forms: S-2HG and R-2HG. Here, we investigate the differential roles of these two enantiomers in cluster of differentiation (CD)8+ T cell biology, where we find they have highly divergent effects on proliferation, differentiation, and T cell function. We show here an analysis of structural determinants that likely underlie these differential effects on specific a-ketoglutarate (aKG)-dependent enzymes. Treatment of CD8+ T cells with exogenous S-2HG, but not R-2HG, increased CD8+ T cell fitness in vivo and enhanced anti-tumor activity. These data show that S-2HG and R-2HG should be considered as two distinct and important actors in the regulation of T cell function

Polyfunctional tumor-reactive T cells are effectively expanded from non-small cell lung cancers, and correlate with an immune-engaged T cell profile

Non-small cell lung cancer (NSCLC) is the second most prevalent type of cancer. With the current treatment regimens, the mortality rate remains high. Therefore, better therapeutic approaches are necessary. NSCLCs generally possess many genetic mutations and are well infiltrated by T cells (TIL), making TIL therapy an attractive option. Here we show that T cells from treatment naive, stage I-IVa NSCLC tumors can effectively be isolated and expanded, with similar efficiency as from normal lung tissue. Importantly, 76% (13/17) of tested TIL products isolated from NSCLC lesions exhibited clear reactivity against primary tumor digests, with 0.5%-30% of T cells producing the inflammatory cytokine Interferon (IFN)-γ. Both CD4+ and CD8+ T cells displayed tumor reactivity. The cytokine production correlated well with CD137 and CD40L expression. Furthermore, almost half (7/17) of the TIL products contained polyfunctional T cells that produced Tumor Necrosis Factor (TNF)-α and/or IL-2 in addition to IFN-γ, a hallmark of effective immune responses. Tumor-reactivity in the TIL products correlated with high percentages of CD103+CD69+CD8+ T cell infiltrates in the tumor lesions, with PD-1hiCD4+ T cells, and with FoxP3+CD25+CD4+ regulatory T cell infiltrates, suggesting that the composition of T cell infiltrates may predict the level of tumor reactivity. In conclusion, the effective generation of tumor-reactive and polyfunctional TIL products implies that TIL therapy will be a successful treatment regimen for NSCLC patients

Supplemental material for Risk factors and outcomes of infected pancreatic necrosis: Retrospective cohort of 148 patients admitted to the ICU for acute pancreatitis

<p>Supplemental material for Risk factors and outcomes of infected pancreatic necrosis: Retrospective cohort of 148 patients admitted to the ICU for acute pancreatitis by Charlotte Garret, Matthieu Péron, Jean Reignier, Aurélie Le Thuaut, Jean-Baptiste Lascarrou, Frédéric Douane, Marc Lerhun, Isabelle Archambeaud, Noëlle Brulé, Cédric Bretonnière, Olivier Zambon, Laurent Nicolet, Nicolas Regenet, Christophe Guitton and Emmanuel Coron in United European Gastroenterology Journal</p

Table1_Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN).docx

ContextLaryngoscopy is frequently required in neonatal intensive care. Awake laryngoscopy has deleterious effects but practice remains heterogeneous regarding premedication use. The goal of this statement was to provide evidence-based good practice guidance for clinicians regarding premedication before tracheal intubation, less invasive surfactant administration (LISA) and laryngeal mask insertion in neonates.MethodsA group of experts brought together by the French Society of Neonatology (SFN) addressed 4 fields related to premedication before upper airway access in neonates: (1) tracheal intubation; (2) less invasive surfactant administration; (3) laryngeal mask insertion; (4) use of atropine for the 3 previous procedures. Evidence was gathered and assessed on predefined questions related to these fields. Consensual statements were issued using the GRADE methodology.ResultsAmong the 15 formalized good practice statements, 2 were strong recommendations to do (Grade 1+) or not to do (Grade 1−), and 4 were discretionary recommendations to do (Grade 2+). For 9 good practice statements, the GRADE method could not be applied, resulting in an expert opinion. For tracheal intubation premedication was considered mandatory except for life-threatening situations (Grade 1+). Recommended premedications were a combination of opioid + muscle blocker (Grade 2+) or propofol in the absence of hemodynamic compromise or hypotension (Grade 2+) while the use of a sole opioid was discouraged (Grade 1−). Statements regarding other molecules before tracheal intubation were expert opinions. For LISA premedication was recommended (Grade 2+) with the use of propofol (Grade 2+). Statements regarding other molecules before LISA were expert opinions. For laryngeal mask insertion and atropine use, no specific data was found and expert opinions were provided.ConclusionThis statement should help clinical decision regarding premedication before neonatal upper airway access and favor standardization of practices.</p