La Révolution française dans l’espace médiatique

Origines du projet Lorsque survient en Tunisie au début de l’année 2011 une révolte brutale et profonde contre les pouvoirs en place, révolte qui provoque la chute du gouvernement Ben Ali, la tentation a été forte chez les intellectuels français, et, singulièrement, parmi les historiens de la Révolution française, d’observer les événements en cours avec les lunettes de leur savoir académique et de leurs convictions de citoyens. L’un des premiers à écrire sur ce sujet a été Jean Tulard, le 18 ..

Systematic overdosing of oxa- and cloxacillin in severe infections treated in ICU: risk factors and side effects

Additional file 1: Figure S1. Flowchart of patients included between 2012 and 2014

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

BACKGROUND Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. METHODS In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1). Patients with contraindications to anticoagulants or to PFO closure were randomly assigned to the alternative noncontraindicated treatment or to antiplatelet therapy (randomization groups 2 and 3). The primary outcome was occurrence of stroke. The comparison of PFO closure plus antiplatelet therapy with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 2, and the comparison of oral anticoagulation with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 3. RESULTS A total of 663 patients underwent randomization and were followed for a mean (+/- SD) of 5.3 +/- 2.0 years. In the analysis of randomization groups 1 and 2, no stroke occurred among the 238 patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet-only group (hazard ratio, 0.03; 95% confidence interval, 0 to 0.26; P<0.001). Procedural complications from PFO closure occurred in 14 patients (5.9%). The rate of atrial fibrillation was higher in the PFO closure group than in the antiplatelet-only group (4.6% vs. 0.9%, P = 0.02). The number of serious adverse events did not differ significantly between the treatment groups (P = 0.56). In the analysis of randomization groups 1 and 3, stroke occurred in 3 of 187 patients assigned to oral anticoagulants and in 7 of 174 patients assigned to antiplatelet therapy alone. CONCLUSIONS Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation

La Révolution française dans l’espace médiatique: Entretien avec Annie Duprat, Aurore Chery, Cécile Guérin, Pascal Guimier, Emmanuel Laurentin, Pierre Serna, Roland Timsit

traduit en anglais sur le portail Cairn international ; traduit en portugais dans une revue brésilienneInternational audienc

Discussion. Première journée

DISCUSSION — 1st day. The International Seminar on Administrative Research in Europe, organized by Mr. Lesage was held on November 15-17, 1973, in the Conference Hall of the French National Center for Scientific Research (C.N.R.S.). Both Eastern and Western European countries were largely and brilliantly represented: Belgium, Bulgaria, Czechoslovakia, Federal Germany, Hungary, Poland, Rumania, U.K., U.S.S.R. and Yugoslavia. French specialists, mostly Jurists, but including civil servants, political representatives, and Sociologists were also numerous. The initial presentations were made by the organizers of the seminar, and the first work session was subsequently opened under the presidency of Mr. Brai- bant on the theme "Interdisciplinarity in Administrative Research". The two reporters, despite the divergence in systems, often presented similar problems and solutions. The interventions, which in the course of the day were enflamed and often caustic but always enriching, converged around three themes: the present situation of Administrative Science and concrete experiments in interdisciplinarity; the aims of interdisciplinarity and the methods to employ; and the nature of Administrative Science itself. Where is Administrative Science? At present there is juxtaposition of the different sciences pertaining to administration, but a need for broader conceptualization and a more interdisciplinarity approach is felt. This gives rise to certain problems. Epistomological obstacles were brought up by two reporters. The difficulty of decoding concepts and transcoding must not hamper research. Having underlined the imbrication of scientific activities such as Planning, Economics, Administrative Law, Sociology, Psychology, Computer techniques, participants of the seminar related concrete experiments in interdisciplinary research conducted in their respective countries, describing difficulties encountered, the first reflex of self-defense, the need for strict methodology and finally the break through. They all agree that interdisciplinarity is an unquestionable contribution. Interdisciplinarity also comes up against other obstacles of an institutional nature, compartmentation within faculties, in the administration and even within the National Center for Scientific Research. International teams should be created so that problems may be invested with an international dimension. Research should also be conducted in different countries by mixed teams or based on a common subject. The methodology to adopt was the subject of much debate. Methods must differ when they serve different points of view or when they apply to different objects. Certain considered that collaboration between two teams, each having its own program, is perhaps less difficult. Others favored research on administration via mixed teams. The Aims of Interdisciplinarity In any case research work which answers the need of enlightenment concerning concrete phenomena should lead to conclusions having a theoretical character. Administrative Science must be endowed with conceptual and methodological unity. The second aim of interdisciplinarity is to permit the exploration of fronteer regions. The problem of the existence of one Science or many, the favorable or unfavorable consequences of "hybridism" were issues for heated discussion. In a successful effort to clarify the debate, the President remarked that, "starting with research on interdisciplinarity we have arrived at the problem of the very existence and necessity of Administrative Science." The Very Nature of Administrative Science and its object was the focal point of several interventions, certain considering that Administrative Science has no epistemological statute. For several participants, set on defining its object, Administration is an instrument of the political apparatus, a bureaucracy, an organism for political representation of a certain clientele. Its role is to organize, therefore innovate. Administration must prepare solutions for the future bearing the social conscience in mind. Interdisciplinary or pluridisciplinary research, Administrative Science or sciences? If no agreement was reached as to the nature of administrative research, the debates evidenced a common will to cooperate; the participants insisted on the need of establishing interdisciplinary or pluridisciplinary research, to be carried out by international teams or several national teams on a given subject. Lucette KHAIATde la recherche administrative, les débats ont témoigné d'une volonté commune de coopérer ; les participants ont tous insisté sur la nécessité de mettre sur pied des recherches interdisciplinaires — ou pluridisciplinaires — qui seraient effectuées par des équipes internationales ou par plusieurs équipes nationales sur un sujet commun. Lucette KHAIATTimsit Gérard, Braibant Guy, Dupuis Georges, Nizard Lucien, Sfez Lucien, De Baecque Francis, Tikhomirov Jurij A., Drago Roland, Eisenmann Charles, Zaleski Eugène, Stjepanovic Nikola, Borkowski Janusz, Kostadinov M. G., Kovacs Istvan, Mond Georges H., Loschak Danièle, Molitor André, Starosciak Jerzy. Discussion. Première journée. In: Revue d'études comparatives Est-Ouest, vol. 6, 1975, n°3. La recherche administrative en Europe. pp. 57-130

Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial

International audienceCONTEXT: Corticosteroid therapy induces potentially detrimental hyperglycemia in septic shock. In addition, the benefit of adding fludrocortisone in this setting is unclear. OBJECTIVES: To test the efficacy of intensive insulin therapy in patients whose septic shock was treated with hydrocortisone and to assess, as a secondary objective, the benefit of fludrocortisone. DESIGN, SETTING, AND PATIENTS: A multicenter, 2 x 2 factorial, randomized trial, involving 509 adults with septic shock who presented with multiple organ dysfunction, as defined by a Sequential Organ Failure Assessment score of 8 or more, and who had received hydrocortisone treatment was conducted from January 2006 to January 2009 in 11 intensive care units in France. INTERVENTIONS: Patients were randomly assigned to 1 of 4 groups: continuous intravenous insulin infusion with hydrocortisone alone, continuous intravenous insulin infusion with hydrocortisone plus fludrocortisone, conventional insulin therapy with hydrocortisone alone, or conventional insulin therapy with intravenous hydrocortisone plus fludrocortisone. Hydrocortisone was administered in a 50-mg bolus every 6 hours, and fludrocortisone was administered orally in 50-microg tablets once a day, each for 7 days. MAIN OUTCOME MEASURE: In-hospital mortality. RESULTS: Of the 255 patients treated with intensive insulin, 117 (45.9%), and 109 of 254 (42.9%) treated with conventional insulin therapy died (relative risk [RR], 1.07; 95% confidence interval [CI], 0.88-1.30; P = .50). Patients treated with intensive insulin experienced significantly more episodes of severe hypoglycemia (<40 mg/dL) than those in the conventional-treatment group, with a difference in mean number of episodes per patient of 0.15 (95% CI, 0.02-0.28; P = .003). At hospital discharge, 105 of 245 patients treated with fludrocortisone (42.9%) died and 121 of 264 (45.8%) in the control group died (RR, 0.94; 95% CI, 0.77-1.14; P = .50). CONCLUSIONS: Compared with conventional insulin therapy, intensive insulin therapy did not improve in-hospital mortality among patients who were treated with hydrocortisone for septic shock. The addition of oral fludrocortisone did not result in a statistically significant improvement in in-hospital mortality. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00320099

Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia

International audienceAbstractBackgroundMultiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), although their clinical impact remains uncertain.MethodsAmong consecutive adult patients who had undergone a mPCR within 72 hours following their admission to one intensive care unit (ICU), we retrospectively included those with a final diagnosis of CAP. Four etiology groups were clustered: bacterial, viral, mixed (viral-bacterial) and no etiology. A composite criterion of complicated course (hospital death or mechanical ventilation > 7 days) was used. A subgroup analysis compared patients with bacterial and viral-bacterial CAP matched on the bacterial pathogens.ResultsAmong 174 patients (132 men [76 %], age 63 [53–75] years, SAPSII 38 [27;55], median PSI score 106 [78;130]), bacterial, viral, mixed and no etiology groups gathered 46 (26 %), 53 (31 %), 45 (26 %) and 30 (17 %) patients, respectively. Virus-infected patients displayed a high creatine kinase serum level, a low platelet count, and a trend toward more frequent alveolar-interstitial infiltrates. A complicated course was more frequent in the mixed group (31/45, 69 %), as compared to bacterial (18/46, 39 %), viral (15/53, 28 %) and no etiology (12/30, 40 %) groups (p < 0.01). In multivariate analysis, the mixed (viral-bacterial) infection was independently associated with complicated course (reference: bacterial pneumonia; OR, 3.58; CI 95 %, 1.16–11; p = 0.03). The subgroup analysis of bacteria-matched patients confirmed these findings.ConclusionsViral-bacterial coinfection during severe CAP in adults is associated with an impaired presentation and a complicated course

Correction to: Changes in the clinical presentation and outcomes of patients treated for severe malaria in a referral French university intensive care unit from 2004 to 2017

International audienceAfter publication of the original article [1], we were notified that family names have been exchanged with the first names for all authors. Below the name are tagged correctly

Recombinant human activated protein C for adults with septic shock.

International audienceRationale: A decade after drotrecogin alfa (activated) (DAA) was released on the market worldwide, its benefit-to-risk ratio remains a matter of debate. Objectives: The current investigator-led trial was designed to evaluate the efficacy and safety of DAA, in combination with low-dose steroids, in adults with persistent septic shock. Methods: This was a multicenter (24 intensive care units), placebo-controlled, double-blind, 2 × 2 factorial design trial in which adults with persistent septic shock and no contraindication to DAA were randomly assigned to DAA alone (24 μg/kg/h for 96 h), hydrocortisone and fludrocortisone alone, their respective combinations, or their respective placebos. Primary outcome was mortality rate on Day 90. Measurements and Main Results: On October 25, 2011, the trial was suspended after the withdrawal from the market of DAA. The Scientific Committee decided to continue the trial according to a two parallel group design comparing low-dose steroids with their placebos and to analyze the effects of DAA on patients included before trial suspension. At the time trial was suspended, 411 patients had been recruited, 208 had received DAA, and 203 had received its placebo. There was no significant interaction between DAA and low-dose steroids (P = 0.47). On Day 90, there were 99 deaths (47.6%) among the 208 patients receiving DAA and 94 deaths (46.3%) among the 203 patients receiving placebo (P = 0.79). There was no evidence of a difference between DAA and its placebo for any secondary outcomes or serious adverse events. Conclusions: In adults with established and severe septic shock, DAA showed no evidence of benefit or harm. Clinical trial registered with www.clinicaltrials.gov (NCT00625209)