303 research outputs found
Bénéfices de l'administration précoce pré hospitaliÚre d'acide tranexamique dans la prise en charge du traumatisé sévÚre
Introduction : L hĂ©morragie est la seconde cause de mortalitĂ© prĂ©coce chez les traumatisĂ©s sĂ©vĂšres, et la coagulopathie fait partie avec l acidose et l hypothermie de la triade lĂ©tale. Elle implique les voies de la fibrinolyse. L Ă©tude CRASH 2 s est intĂ©ressĂ©e au potentiel de l acide tranexamique, dans la prise en charge du traumatisĂ© sĂ©vĂšre avec un rĂ©sultat positif en terme de mortalitĂ©. L objectif est d Ă©valuer les consĂ©quences circulatoires et thromboemboliques de l administration prĂ©coce de cette molĂ©cule. MatĂ©riel et mĂ©thode : Une Ă©tude avant/aprĂšs l introduction de l acide tranexamique, a Ă©tĂ© menĂ©e sur une population de traumatisĂ©s sĂ©vĂšres prise en charge par le SMUR et amenĂ©e au dĂ©choquage du CHRA sur une mĂȘme pĂ©riode (Ă©tĂ© 2011 et Ă©tĂ© 2012). Les critĂšres de jugements principaux sont le volume de remplissage administrĂ©, le recours Ă la transfusion ou Ă l administration d amines. Les critĂšres de jugement secondaires sont la survenue d Ă©vĂšnements thromboemboliques et l adhĂ©sion au protocole par les mĂ©decins du SMUR. RĂ©sultats : Les groupes Ă©tudiĂ©s comportent 28 et 35 traumatisĂ©s sĂ©vĂšres. Le groupe de patient acide tranexamique a reçu en moyenne 1900 ml de remplissage contre 2400 ml dans l autre et 1,17 culots globulaires contre 1,46. Le recours aux amines est similaire dans les deux groupes (46,4% et 48,6%). Le taux de complications thromboemboliques est de 18,2% dans le groupe acide tranexamique contre 7,1%.L administration prĂ© hospitaliĂšre a lieu dans 31,4% des cas avec un dĂ©lai moyen de 40 minutes. Conclusion : L utilisation de l acide tranexamique montre une tendance en terme d Ă©pargne transfusionnelle et de remplissage vasculaire au cours des 24 premiĂšres heures de prise en charge. Ce traitement doit ĂȘtre considĂ©rĂ© comme un traitement de choix dans la prise en charge d un traumatisĂ© sĂ©vĂšre.GRENOBLE1-BU MĂ©decine pharm. (385162101) / SudocSudocFranceF
En situation de catabolisme musculaire, les protĂ©ines de lactosĂ©rum permettent bien de restaurer un anabolisme musculaire post prandial mais dâune durĂ©e trĂšs transitoire probablement insuffisante pour limiter la fonte musculaire
En situation de catabolisme musculaire, les protĂ©ines de lactosĂ©rum permettent bien de restaurer un anabolisme musculaire post prandial mais dâune durĂ©e trĂšs transitoire probablement insuffisante pour limiter la fonte musculair
Whey proteins promote post prandial positive nitrogen balance in a muscle wasting situation but probably for a too short period of time to translate into muscle sparing
Background and aims: Muscle wasting occurred by an imbalance of muscle protein metabolism. Most of catabolic states are characterized by both an insulin and amino acid resistance which result into a food intake inefficiency to promote positive nitrogen balance during the post prandial period. So far, fast digested proteins (i.e whey) have been shown to be more efficient than casein to promote a stimulation of muscle protein synthesis (PS) in such situations; however, muscle mass is rarely improved. Our hypothesis is that this stimulation occurs only for a short period of time in the fed state, which remains insufficient to induce a significant increase in muscle mass. To address this point, a PS and proteolysis (PRO) kinetic study at the muscle level is required.Methods: Adult mini pigs were catheterized into both the femoral artery and vein and infused with 13C Phe to assess continuously) muscle PS and PRO in the hindlimb by the substrate and tracer arterio-venous difference method (every 30min before (PA) and after food intake). The catabolic state was induced by glucocorticoid treatment (8d); both casein and whey effects on PS and PRO were tested over time for 6.5 h.Results: After glucocorticoids, animals were in negative nitrogen balance at PA and casein intake had no effect on both PS and PRO and animals remained in negative nitrogen balance during the whole postprandial period. With whey, treated animals are able to generate a positive nitrogen balance for 120min after food intake (PS:+40% and PRO:-20%) which decreased thereafter along the postprandial period. Glucocorticoids were associated with insulin resistance (postprandial period: increased insulin/glycaemia). When fed whey, animals still presented hyperinsulinemia but normalized postprandial glycaemia.Conclusions. Whey are more efficient to generate positive muscle nitrogen balance in catabolic states but it remained only for a short period of time which may limit their efficiency on muscle wasting. Nutritional strategies have to be studied to optimize the duration of whey efficiency in the catabolic states. By contrast, whey are interesting to control post prandial hyperglycaemia in muscle protein wasting situations
Performance of LHC Main Dipoles for Beam Operation
At present about 90% of the main dipoles for the LHC have been manufactured and one of the three cold mass assemblers has already completed the production. 85% of the 1232 dipoles needed for the tunnel have been tested and accepted. In this paper we mainly deal with the performance results: the quench behaviour, the magnetic field quality, the electrical integrity quality and the geometry features will be summarized
Proceedings of the Fifth Italian Conference on Computational Linguistics CLiC-it 2018
On behalf of the Program Committee, a very warm welcome to the Fifth Italian Conference on Computational Linguistics (CLiC-Ââit 2018). This edition of the conference is held in Torino. The conference is locally organised by the University of Torino and hosted into its prestigious main lecture hall âCavallerizza Realeâ. The CLiC-Ââit conference series is an initiative of the Italian Association for Computational Linguistics (AILC) which, after five years of activity, has clearly established itself as the premier national forum for research and development in the fields of Computational Linguistics and Natural Language Processing, where leading researchers and practitioners from academia and industry meet to share their research results, experiences, and challenges
Food, Nutrition and Agrobiodiversity Under Global Climate Change
Available evidence and predictions suggest overall negative effects on agricultural production as a result of climate change, especially when more food is required by a growing population. Information on the effects of global warming on pests and pathogens affecting agricultural crops is limited, though cropâpest models could offer means to predict changes in pest dynamics, and help design sound plant health management practices. Host-plant resistance should continue to receive high priority as global warming may favor emergence of new pest epidemics. There is increased risk, due to climate change, to food and feed contaminated by mycotoxin-producing fungi. Mycotoxin biosynthesis gene-specific microarray is being used to identify food-born fungi and associated mycotoxins, and investigate the influence of environmental parameters and their interactions for control of mycotoxin in food crops. Some crop wild relatives are threatened plant species and efforts should be made for their in situ conservation to ensure evolution of new variants, which may contribute to addressing new challenges to agricultural production. There should be more emphasis on germplasm enhancement to develop intermediate products with specific characteristics to support plant breeding. Abiotic stress response is routinely dissected to component physiological traits. Use of transgene(s) has led to the development of transgenic events, which could provide enhanced adaptation to abiotic stresses that are exacerbated by climate change. Global warming is also associated with declining nutritional quality of food crops. Micronutrient-dense cultivars have been released in selected areas of the developing world, while various nutritionally enhanced lines are in the release pipeline. The high-throughput phenomic platforms are allowing researchers to accurately measure plant growth and development, analyze nutritional traits, and assess response to stresses on large sets of individuals. Analogs for tomorrowâs agriculture offer a virtual natural laboratory to innovate and test technological options to develop climate resilience production systems. Increased use of agrobiodiversity is crucial to coping with adverse impacts of global warming on food and feed production and quality. No one solution will suffice to adapt to climate change and its variability. Suits of technological innovations, including climate-resilient crop cultivars, will be needed to feed 9 billion people who will be living in the Earth by the middle of the twenty-first century
Cardiac arrest registry : a public health tool?
Introduction : L'arrĂȘt cardiaque (AC) est considĂ©rĂ© comme un problĂšme majeur de santĂ© publique. Il reprĂ©sente la plus extrĂȘme des urgences et nâest dĂ©sormais plus considĂ©rĂ© comme irrĂ©versible. Les progrĂšs en matiĂšre de prise en charge et lâamĂ©lioration de la chaĂźne de survie, en particulier sont donc essentiels. La survie Ă lâAC demeurant encore trĂšs faible, il existe de nombreuses mesures dâamĂ©lioration parmi lesquelles la crĂ©ation dâun registre des AC figure au premier rang. L'objectif de cette thĂšse consiste Ă montrer la place essentielle dâun registre dâĂ©valuation dans lâamĂ©lioration de la prise en charge des patients en AC Ă lâextĂ©rieur de lâhĂŽpital. A partir des donnĂ©es du registre des AC du RĂ©seau Nord Alpin des Urgences (RENAU), nous nous sommes en particulier intĂ©ressĂ©s Ă lâAC dâorigine traumatique (ACT) et avons analysĂ©s lâimpact de la prise en charge des causes rĂ©versibles sur la survie des victimes. PrĂ©alablement Ă ce travail, une analyse rigoureuse de lâexhaustivitĂ© de ce registre a Ă©tĂ© menĂ©e. MatĂ©riel et MĂ©thodes : Nous avons Ă©tudiĂ© les donnĂ©es dâAC du dĂ©partement de la Haute-Savoie, un des trois dĂ©partements participant au RENAU. Les donnĂ©es relatives aux AC ont Ă©tĂ© extraites du registre du RENAU-AC. Pour mesurer lâexhaustivitĂ© de ce registre nous avons dans un premier temps utiliser un diagramme proportionnel de Venn en comparant les cas inclus dans le RENAU-AC sur une pĂ©riode de 4 mois avec ceux prĂ©sent dans 2 bases indĂ©pendantes, celle du SAMU et de la sĂ©curitĂ© civile. Puis nous avons mesurĂ© dans 2 SMUR de ce dĂ©partement lâimpact sur la survie des mesures spĂ©cifiques effectuĂ©es dans le cadre de la rĂ©animation les ACT, en explorant lâinfluence de la mise en oeuvre de recommandations et de formations professionnelles dans une Ă©tude avant-aprĂšs. Le critĂšre d'Ă©valuation principal Ă©tait le taux de survie Ă J30 avec un bon Ă©tat neurologique (score de performance cĂ©rĂ©brale 1 & 2). RĂ©sultats et Discussion : Nous avons Ă©tudiĂ© 287 ACT entre 2004 et 2017 Ă partir du RENAU-AC dont lâexhaustivitĂ© a Ă©tĂ© estimĂ©e Ă 81,8%. Les mesures spĂ©cifiques compilĂ©es regroupaient 262 remplissages vasculaires, 41 stabilisations pelviennes Ă lâaide dâune ceinture de contention, 5 poses de garrot tourniquet et 175 thoracotomies bilatĂ©rales (incluant 44 pneumothorax compressifs). La rĂ©alisation dâune thoracostomie bilatĂ©rale et l'application d'un garrot sur une hĂ©morragie de membre amĂ©liorent la survie des ATC. Cependant un Ă©chantillon plus important pour montrer lâintĂ©rĂȘt de la stabilisation pelvienne est nĂ©cessaire. La mise en oeuvre de recommandations professionnelles et le suivi de formations entre 2008 et 2011 a permis dâaugmenter de façon significative la rĂ©alisation des mesures spĂ©cifiques avec une augmentation de 16% des expansions vasculaires, de 75% des thoracostomies bilatĂ©rales et de 25% des stabilisations pelviennes entre la pĂ©riode avant et aprĂšs. Pour autant, ces actions nâont pas permis dâamĂ©liorer la survie globale des ACT. Grace Ă ce registre exhaustif, lâĂ©tude du traitement des causes curables des ACT montre que si la performance de la gestion des ACT passe par le traitement de ces causes curables, le taux de rĂ©alisation de ces actions ne permet pas de capturer de maniĂšre adĂ©quate les performances prĂ© hospitaliĂšres sur la survie globale. Conclusion : Cette Ă©tude rĂ©vĂšle lâimportance dâun registre dâAC dans lâĂ©valuation des pratiques des multiples acteurs de la chaine de survie. Câest un outil qui permet de rĂ©pondre Ă des questions de recherche pour peu quâil soit rigoureux dans sa structuration et dans son exhaustivitĂ©.Introduction: Cardiac arrest (CA) is a major public health issue. CA stands as the most extreme emergency though no longer considered irreversible. Progress in care and improving the chain of survival especially, therefore becomes essential. Survival after cardiac arrest is still very low. Top on proposed ways to improve this survival rate is the creation of a cardiac arrest register. The objective of this thesis lies in the essential place of an evaluation register to improve on the care for Cardiac Arrest outpatients. Based on data from the CA register of the Northern Alpine Emergency Network (RENAU), this research is interested in Traumatic CA based on an analysis of the impact of care administered following reversible causes on survival. Prior to this work, a detailed analysis of the exhaustivity of this register was carried out and two other examples for illustrations of interest of (Covid and workplace) Tools and methodology : We studied CA data from the Haute-Savoie department, one of the three member departments of the RENAU. Data on cardiac arrest were collected from the RENAU-AC register. To assess the exhaustivity of this register, we first used a proportional Venn diagram by comparing the cases included in the register over a period 4 months with those present in 2 independent databases, that of the SAMU and firefighters. Then, we assessed the impact of the specific measures implemented in the Traumatic CAson survival, in 2 advanced life support services of this department, through the exploration of the scope of implementation of recommendations and training in a before-after study using Utstein guidelines. The primary assessment variable was the 30-day survival rate with good neurological status (brain performance score 1 & 2). RĂ©sultats et Discussion : We studied 287 Traumatic CAs between 2004 and 2017 from RENAU-AC, the completeness of which was estimated at 81.8% and considered excellent. Specific measures compiled included 262 fluid expansions, 41 pelvic stabilizations, 5 tourniquets, and 175 bilateral thoracotomies (including 44 tension pneumothorax). Performing a bilateral thoracostomy, and applying a tourniquet improves survival. A larger sample to show the benefit of pelvic stabilization is needed. The implementation of recommendations and training between 2008 and 2011 allow significant increase in the number of specific measures with a 16% increase in vascular expansion, 75% in bilateral thoracostomies and 25% in pelvic stabilization between the period before and after. However, these actions have not made it possible to improve the overall survival of Traumatic CAs. Using this exhaustive register, the study showed that if the performance of Traumatic AC care involves the treatment of these curable causes, the rate of realization of these actions does not make it possible to adequately capture the pre-hospital performance on survival. Furthermore, two other examples, Covid or workplace, confirmed the interest of the registers as a public health tool. Conclusion : This study reveals the importance of CA registry in assessing the practices of multiple actors in the chain of survival in case of trauma as well as the other two examples. Itâs a tool that makes it possible to answer research questions as long as it is smartly structured and exhaustiv
Prise en charge prehospitaliÚre des syndromes coronariens aigus sans sus de décalage (registre réalisé au SMUR d'Annecy)
L objectif de notre travail a Ă©tĂ© d Ă©valuer la prise en charge prĂ©hospitaliĂšre des SCA ST- au SMUR d Annecy. Nous avons rĂ©alisĂ© une Ă©tude observationnelle, unicentrique, prospective Ă partir d un registre temporaire de tous les patients pris en charge en prĂ©hospitalier souffrant soit d un SCA ST- diagnostiquĂ© dĂšs la prise en charge initiale, soit d une douleur thoracique diagnostiquĂ©e secondairement SCAT ST-. 133 patients ont Ă©tĂ© inclus entre le 01/10/04 et le 31/09/05. Concernant l orientation, 73% des patients ont Ă©tĂ© hospitalisĂ© en USIC. Concernant le traitement, 7,7% des patients ont reçu un traitement antalgique, 11,7% des bĂȘtabloquants, 60,9% une hĂ©parine et 85,7% de l aspirine. Aucune diffĂ©rence significative n a Ă©tĂ© relevĂ©e en fonction du score de stratification (Ă©tabli Ă posteriori). La sensibilitĂ© du diagnostic SMUR est de 0,86, sa spĂ©cificitĂ© de 0,67. Nos rĂ©sultats concorde au registre Toscane et montrent des possibilitĂ©s d amĂ©lioration de notre prise en charge prĂ©hospitaliĂšre.GRENOBLE1-BU MĂ©decine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Evolution en 2003 des accidents de parapentes sur le bassin annecien
Devant un sentiment d'augmentation du nombre d'interventions auprÚs des parapentistes, victimes d'accidents de parapente dans le bassin annecien en 2003, nous avons réalisé une étude qui montre une augmentation significative d'accidents et surtout l'apparition de collision entre parapentistes. Afin d'éviter de voir se généraliser ce type de situation dans les années à venir, nous avons averti le centre de veille sanitaire.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Faut-il encore rĂ©animer les arrĂȘts cardiaques traumatiques prĂ©hospitaliers?
Objectif : dĂ©crire l Ă©pidĂ©miologie des arrĂȘts cardiaques (AC) traumatiques prĂ©hospitaliers, Ă©valuer leur survie et les possibilitĂ©s de prĂ©lĂšvement d organes. MĂ©thode : les AC bĂ©nĂ©ficiant d une rĂ©animation prĂ©hospitaliĂšre sont dĂ©crits selon le style d Utstein dans le registre prospectif rĂ©gional multicentrique du RĂ©seau Nord Alpin des Urgences. Nous avons Ă©tudiĂ© les AC traumatiques en Ă©valuant les circonstances du traumatisme, le bilan initial et les procĂ©dures de prĂ©lĂšvement d organes entreprises. RĂ©sultats : 1552 victimes d AC ont Ă©tĂ© pris en charge par les Ă©quipes mĂ©dicalisĂ©es prĂ©hospitaliĂšres entre le 01/01/2004 et le 31/12/2005. Pour 129 d entre eux (soit 8,3%) l AC est traumatique. L Ăąge moyen est de 47,1 an ; il s agit d hommes dans 74,4% des cas. 80,7% des AC surviennent devant tĂ©moins. Le rythme cardiaque initial est une asystolie dans 88,4% des cas. Le taux de reprise d activitĂ© circulatoire spontanĂ©e (RACS) est de 24,8%, la survie Ă l admission Ă l hĂŽpital est de 18,6% ; 1 seul patient est en vie Ă la sortie de l hĂŽpital, il n a pas de sĂ©quelle Ă un an. Le traumatisme responsable de l AC est non pĂ©nĂ©trant dans 94,6% des cas; l AC est dĂ» Ă une lĂ©sion neurologique isolĂ©e pour 22 patients (17%), dont 40,9% survivent Ă l admission Ă l hĂŽpital et 13% bĂ©nĂ©ficient d une procĂ©dure de prĂ©lĂšvement d organes. Conclusion : la survie aprĂšs un AC traumatique prĂ©hospitalier est catastrophique, sans diffĂ©rence significative avec celle des victimes d AC non traumatiques. Nous avons individualisĂ© un groupe de patients victimes d AC traumatique par lĂ©sion neurologique isolĂ©e pour lesquels la rĂ©animation doit ĂȘtre motivĂ©e par les possibilitĂ©s de prĂ©lĂšvements d organes.GRENOBLE1-BU MĂ©decine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
- âŠ