Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France

Background The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). Methods This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. Results Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002). Conclusions In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF

Laparoscopic versus open splenectomy for nontraumatic diseases

BACKGROUND: Laparoscopic splenectomy (LS) is the standard procedure for normal size or moderately enlarged spleens; open splenectomy (OS) is preferred in cases of splenomegaly. In this study, indications for and complications of open and laparoscopic splenectomy were analyzed, with the aim to identify patients who will benefit from either technique. METHOD: A consecutive series of 52 patients undergoing elective open or laparoscopic splenectomy between January 2001 and December 2006 was analyzed. Spleen volume was calculated as length x width x depth from the pathologist's measurements. RESULTS: LS was performed in 25 patients with a median age of 41 years (range = 24-65). OS was performed in 27 patients with a median age of 60 years (range = 24-86) (p < 0.001). Conversion to OS was necessary in two patients (8%). Operation time was significantly shorter in LS (p < 0.05). Spleen volume was significantly greater in patients who underwent open (median = 2520 ml, range = 150-16,800 ml) versus laparoscopic (median = 648 ml, range = 150-4860 ml) splenectomy (p = 0.001). In 36% of all laparoscopic procedures, spleen volume exceeded 1000 ml. The underlying disease was mainly immunothrombocytopenia in LS patients and lymphoma and osteomyelofibrosis in OS patients. Five patients died after OS. Significantly more patients were hospitalized longer than 7 days following OS than following LS (p < 0.05). Overall complication rate was higher after OS (LS, 8; OS, 13 patients; p < 0.05). CONCLUSIONS: LS was preferred in younger patients with moderate splenomegaly, while massive splenomegaly mostly led to OS. In view of the absence of technique-related differences, LS can primarily be attempted in all patients

Luz Long et Jesse Owens, les amis de 36

Dans le contexte des JO de Berlin en 1936, évoque la complicité entre deux athlètes, l'un aryen et ressortissant du IIIe Reich, l'autre noir américain. Dans les coulisses des JO, l'article évoque cette amitié dans un contexte de racisme et de ségrégation, avec en toile de fond une sinistre mascarade du Reich pour camoufler ses méfaits et apparaître acceptable à la communauté internationale

Alain Giresse 99e [quatre-vingt-dix-neuvième]

L'écrivain Pierre-Louis Basse se souvient, avec la nostalgie de l'adolescent qu'il fut, de la demi-finale de la Coupe du monde de football à Séville en 1982, opposant la France à la RFA

Effect of short non-ionic amphiphiles derived from ethylene and propylene glycol alkyl ethers on the CMC of SDS

The effect of the short non-ionic amphiphiles: n-alc. (n = 3-6), polypropylene glycol alkyl ether (CnPOm, for n = 3, 4; m = 1-3) and polyethylene glycol (CnEOm, for n = 3; m = 1 and n = 4; m = 1-3) on the crit. micellar concn. (CMC) of SDS in aq. solns. at 25° was detd. exptl. by measuring the elec. conductance. There is a linear relation between the no. of propylene glycol and ethylene glycol groups and the slope of the CMC decrease with amphiphile concn. The propylene glycol group appears to be more efficient in lowering the CMC than the ethylene glycol group which is less hydrophobic. Considering the polypropylene glycol alkyl ethers as the condensation of an n-alc. and a certain no. of propylene glycol groups it was possible to classify these amphiphiles according to their efficiency to decrease the CMC of SDS: C4PO3 > C6PO0 > C4PO2 > C3PO3 > C4PO1 > C3PO2 > C5PO0 > C3PO1 > C4PO0 > C3PO0. This trend is different from the series of hydrophobicity of these compds., inferred recently from water/CnPOm binary phase diagrams: C6PO0 > C5PO0 > C4PO4 > C4PO3 > C4PO1 > C4PO0 > C3PO3 > C3PO2 > C3PO1 > C3PO0. The hydrophobicity of these compds. increases much more with the addn. of 1 C in the alkyl chain than with the addn. of one propylene glycol group. The co-surfactant behavior of some of these mols. is also discussed and compared in terms of the topol. of their ternary phase diagrams SDS/water/co-surfactant. Some striking differences in the co-surfactant behavior of the studied amphiphiles are found between their CMC decrease property and the topol. of their corresponding ternary systems

Management of cutaneous toxicities under amivantamab (anti MET and anti EGFR bispecific antibody) in patients with metastatic non-small cell lung cancer harboring EGFR Exon20ins: towards a proactive, multidisciplinary approach

International audienceContexte. The Epidermal Growth Factor Receptor (EGFR) is mutated in 10–15% of patients with lung adenocarcinoma. At metastatic stage EGFR tyrosine kinase inhibitors (TKIs) are used front line for patients harboring targetable mutations. Novel anti-EGFR therapies are being developed. Amivantamab is a bispecific anti-EGFR and anti-MET antibody with expected skin toxicities. Objective: We developed here guidelines for prevention and treatment of cutaneous toxicities under amivantamab according to our experience at Institut Curie. Materiel & Method: The first patients with metastatic lung cancer harboring EGFR Exon20ins mutation, included in the phase 1 CHRYSALIS trial and cured at Institute Curie from November 1st 2019 until December 31st 2021 were selected for this work. Retrospectively, all cutaneous adverse events were registered and classified according to the CTCAE 6.0 classification, and actions we implemented to minimize and treat these adverse events were collected. We then developed guidelines based on these datas. Results: A total of seven patients started amivantamab as monotherapy. The two most frequent dermatological adverse events were: acneiform rash and paronychia (100 % of patients). Other adverse events presented by the patients were reported: modification of hair growth with hypertrichosis in 50 % of men (n = 1/2) and hirsutism in 80 % of women (n = 4/5); skin abrasion of the scalp in 71 % (n = 5/7); and skin fissure in 57 % (n = 4/7). We recommend first a rigorous inspection of the skin and teguments to determine the risk rate to have dryer skin under treatment; second a prevention of paronychia/acneiform rash/and skin fissures with prophylactic tetracycline, skin moisturizing, and hygienic measures starting at least 14 days before treatment initiation; third a particular attention to the psychological impact of skin toxicities with access to psychological support. Conclusion: We propose here guidelines for the management of dermatological toxicities under amivantamab with a multidisciplinary approach for the proactive management of cutaneous toxicities with a focus on preventive actions

The respiratory syncytial virus non-structural protein 1 and its interaction with the MED25 sub-unit of the mediator complex

National audienc

A mechanism for transcriptional regulation of innate immune response genes by RSV NS1 protein

International audienc

A mechanism for transcriptional regulation of innate immune response genes by RSV NS1 protein

International audienc