Prediction of Hip Failure Load: In Vitro Study of 80 Femurs Using Three Imaging Methods and Finite Element Models-The European Fracture Study (EFFECT).

Purpose To evaluate the performance of three imaging methods (radiography, dual-energy x-ray absorptiometry DXA, and quantitative computed tomography CT) and that of a numerical analysis with finite element modeling (FEM) in the prediction of failure load of the proximal femur and to identify the best densitometric or geometric predictors of hip failure load.Supported by the European Commission “Quality of Life And Management of Living Resources Program” (QLK6-CT-2002-02440-3DQCT)

Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

Anaesth Crit Care Pain Med

PURPOSE: To provide recommendations for the anaesthetic and peri-operative management for thrombectomy procedure in stroke patients DESIGN: A consensus committee of 15 experts issued from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation, SFAR), the Association of French-language Neuro-Anaesthetists (Association des Neuro-Anesthésistes Réanimateurs de Langue Francaise, ANARLF), the French Neuro-Vascular Society (Société Francaise de Neuro-Vasculaire, SFNV), the French Neuro-Radiology Society (Société Francaise de Neuro-Radiologie, SFNR) and the French Study Group on Haemostasis and Thrombosis (Groupe Français d'Études sur l'Hémostase et la Thrombose, GFHT) was convened, under the supervision of two expert coordinators from the SFAR and the ANARLF. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were required to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. METHODS: Four fields were defined prior to the literature search: (1) Peri-procedural management, (2) Prevention and management of secondary brain injuries, (3) Management of antiplatelet and anticoagulant treatments, (4) Post-procedural management and orientation of the patient. Questions were formulated using the PICO format (Population, Intervention, Comparison, and Outcomes) and updated as needed. Analysis of the literature was then conducted and the recommendations were formulated according to the GRADE methodology. RESULTS: The SFAR/ANARLF/SFNV/SFNR/GFHT guideline panel drew up 18 recommendations regarding anaesthetic management of mechanical thrombectomy procedures. Due to a lack of data in the literature allowing to conclude with high certainty on relevant clinical outcomes, the experts decided to formulate these guidelines as "Professional Practice Recommendations" (PPR) rather than "Formalized Expert Recommendations". After two rounds of rating and several amendments, a strong agreement was reached on 100% of the recommendations. No recommendation could be formulated for two questions. CONCLUSIONS: Strong agreement among experts was reached to provide a sizable number of recommendations aimed at optimising anaesthetic management for thrombectomy in patients suffering from stroke

Paraparesis Revealing Tophaceous Gout

International audienceA 77-year-old man with a history of intermittent inflammatory arthritis of the feet was hospitalized for a 6-month progressive paraparesis resulting in severe gait impairment. Magnetic resonance imaging revealed a 4cm extradural mass lesion at the T10 level, compressing the spinal cord, with heterogeneous peripheral enhancement after gadolinium

Gout misdiagnosis due to dual-energy computed tomography artefact

International audienceA dual-energy CT (DECT) gout protocol (Fig. 1A) was performed for suspicion of gout of the left knee arthritis in 74-year-old woman with no monosodium urate crystals on initial SF analysis. DECT reconstructions revealed uric acid deposition automatically coloured in green (Fig. 1B, arrows) at the posterior surface of the femoral condyles. However, the localization of crystals deposition was unusual and the arthritis was not improved by colchicine. A new DECT was performed with flexion of the contralateral prosthetic knee (Fig. 1C) and did not show any green pixilation suggestive of gout, thus confirming a metal artefact due..

Muscle squelettique et ischémie-reperfusion expérimentale des membres (mécanismes impliqués dans la protection ou les effets délétères de la cyclosporine et facteurs limitant les conditionnements pharmacologique et ischémique)

Le muscle strié squelettique subit de graves lésions d ischémie-reperfusion (IR) au cours de la progression de l artériopathie oblitérante des membres inférieurs et lors d interventions chirurgicales qui nécessitent l interruption transitoire du flux sanguin dans les artères des membres. Dans ce contexte, nos objectifs étaient de mettre à profit deux modèles expérimentaux d IR des membres inférieurs par clampage aortique et garrotage unilatéral pour : tester l efficacité d une alternative médicamenteuse au postconditionnement ischémique par l utilisation de la cyclosporine A (CsA). En se liant à la cyclophiline D, la CsA empêche l ouverture du pore de transition mitochondrial (mPTP) à un niveau très distal de la cascade d évènements qui conduit à la nécrose après IR. déterminer de quelle façon deux comorbidités fréquemment retrouvées chez des patients souffrant d atteinte artérielle (le diabète et l âge) influencent l effet de la cyclosporine. Avec les protocoles de conditionnement et aux doses que nous avons utilisées, la cyclosporine a des effets différents sur les conséquences musculaires de l ischémie-reperfusion des membres inférieurs, dépendant de la pathologie sous-jacente des animaux étudiés. Il semble intéressant d étudier l effet dose-réponse de la cyclosporine A pour déterminer l intervalle thérapeutique optimal, celui-ci pouvant être différent chez l animal sain et pathologique. D autre part, étant donné l importance considérable du stress oxydant chez les animaux diabétiques et sénescents, la co-administration de cyclosporine et d un antioxydant au moment de la reperfusion pourrait rétablir une protection.Peripheral arterial disease and many surgical procedures (requiring vascular clamping or tourniquet application) induce severe skeletal muscle ischemia-reperfusion (IR) injuries. As a result, using experimental hind limb ischemia-reperfusion models, our goals were: To test a pharmacologic substitute to ischemic postconditioning by using cyclosporine A, that acts on a very downstream step of IR injury cascade by binding to cyclophilin D and inhibiting mitochondrial transition pore opening. We wondered if cyclosporine could alleviate mitochondrial dysfunction and reduce ROS production in skeletal muscles submitted to IR. To determine how diabetes and senescence would influence cyclosporine A protective effects. In conclusion, the protective effects of pharmacologic postconditioning with cyclosporine A seem to critically depend on the model under study. A variable and narrow dose-effect relationship is likely and makes it necessary to perform a dose finding study in every pathologic model. Considering the narrow relationships between mitochondrial protection and oxidative stress, combing cyclosporine A postconditioning with antioxidant therapy may restore a more robust protective effect but this hypothesis has to be validated.STRASBOURG-Bib.electronique 063 (674829902) / SudocSudocFranceF

Burned to the Bone

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Reply: Which is the Best Chemotherapeutic Agent for Transarterial Chemoembolization of Hepatocellular Carcinoma?

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