Hypoxia-inducible factor (HIF1α) gene expression in human shock states.

International audienceABSTRACT: INTRODUCTION: Hypoxia-inducible factor-1 (HIF1) controls the expression of genes involved in the cellular response to hypoxia. No information is available on its expression in critically ill patients. Thus, we designed the first clinical study in order to evaluate the role of HIF1α as a prognosis marker in patients suffering from shock. METHODS: Fifty consecutive adult patients with shock and 11 healthy volunteers were prospectively enrolled in the study. RNA was extracted from whole blood samples and expression of HIF1α was assessed over the first four hours of shock. The primary objective was to assess HIF1α as a prognostic marker in shock. Secondary objectives were to evaluate the role of HIF1α as a diagnostic and follow-up marker. Patient survival was evaluated at day 28. RESULTS: The causes of shock were sepsis (78%), hemorrhage (18%), and cardiac dysfunction (4%). HIF1α expression was significantly higher in the shock patients than in the healthy volunteers (121 (range: 72-168) versus 48 (range: 38-54) normalized copies, P <0.01), whatever the measured isoforms. It was similar in non-survivors and survivors (108 (range 84-183) versus 121(range 72-185) normalized copies, P = 0.92), and did not significantly change within the study period. CONCLUSIONS: The present study is the first to demonstrate an increased expression of HIF1α in patients with shock. Further studies are needed to clarify the potential association with outcome. Our findings reinforce the value of monitoring plasma lactate levels to guide the treatment of shock

Sommeil et état de vigilance chez les médecins anesthésistes-réanimateurs français

INTRODUCTION: Dans le cadre du travail en horaires atypiques, les troubles du sommeil et de la vigilance peuvent avoir des conséquences d'une part, sur la santé des praticiens et d'autre part, sur celles des patients (erreur médicale). L'objectif principale de cette étude était de déterminer la prévalence des troubles du sommeil et de la vigilance chez les médecins anesthésistes réanimateurs (MAR) français. MATERIELS ET METHODES: Nous avons réalisé une étude transversale sur une période de 2 mois (questionnaire internet). La qualité du sommeil était évalué par l'Index de Qualité du Sommeil de Pittsburgh (PSQI). L'échelle de somnolence d'Epworth (score ESS) permettait d'évaluer le degré de somnolence diurne excessive (SDE). RESULTATS: 13% des MAR (1504) ont participé à notre étude. 45% des MAR présentaient des troubles du sommeil (PSQI>5). En analyse multivariée, les facteurs indépendants significativement associés à un score PSQI>5 étaient: déclare avoir des troubles du sommeil (OR 12,4 [8,889-16,46]), un temps de sommeil 10). En analyse multivariée, les facteurs indépendants significativement associés à la SDE étaient: le sexe féminin (OR 1,86 [1,49-2,34]), la consommation de thé (OR 1,47 [1,14-1,91]), faire la sieste (OR 1,68 [1,34-2,09]), le stress à la maison (OR 131 [1,02-1,68]), avoir plus de 4 gardes par mois (OR 1,25 [1,01-1,56]) et avoir des troubles du sommeil (PSQI> 5) (OR 1,73 [1,31-2,29]). [ ] CONCLUSION: Au vu de nos résultats, nous préconisons un dépistage systématique par la médecine du travail, avec instauration d'une surveillance médicale renforcée (consultation spécialisée). Dépistage, information et formation représentent le trépied stratégique de lutte contre ces troubles.INTRODUCTION: As part of th shiftwork, sleep disorders and impaired alertness can affect the one hand physician's health and an other hand patient's health (medical errors). The main objective of this study is to determine the prevalence of sleep disorders and impaired alertness among French anesthetists and ICU physicians (AICUP). MATERIALS AND METHODS: We performed a cross-sectional study over a period of 2 months (internet survey). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The Epworth Sleepiness Scale (ESS score) was used to assess the degree of excessive daytime sleepiness (EDS). RESULTS: 13% of AICUP (1504) contributed to this study. 45% of AICUP presented sleep disturbances (PSQI> 5). In multivariate analysis, the independent factors significantly associated with a PSQI score> 5 were: report having sleep disorder (OR 12.4 [8.889 to 16.46]), sleep time 10). In multivariate analysis, the independent factors significantly associated with EDS were: female sex (OR 1.86 [1.49 to 2.34]), tea consumption (OR 1.47 [1.14 to 1.91 ]), nap (OR 1.68 [1.34 to 2.09]), stress at home (OR 131 [1.02 to 1.68]), more than 4 extended work shift (24h) per month (OR 1.25 [1.01 to 1.56]) and having sleep disorders (PSQI> 5) (OR 1.73 [1.31 to 2.29]). [...] CONCLUSION: Given our results, we recommend routine screening by occupational medicine, with the implementation of increased medical observation (specialist). Screening, information and training are strategic keustone against these disorders.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Impact de la réanimation sur la fonction rénale après transplantation

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

About baclofen withdrawal syndrome

International audienceno abstrac

The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection—a case series

International audienceAcute pancreatitis after liver resection is a rare but serious complication, and few cases have been described in the literature. Extended lymphadenectomy, and long ischemia due to the Pringle maneuver could be responsible of post-liver resection acute pancreatitis, but the exact causes of AP after hepatectomy remain unclear. Cases presentation We report here three cases of AP after hepatectomy and we strongly hypothesize that this is due to the bile leakage white test. 502 hepatectomy were performed at our center and 3 patients (0.6%) experienced acute pancreatitis after LR and all of these three patients underwent the white test at the end of the liver resection. None underwent additionally lymphadenectomy to the liver resection. All patient had a white-test during the liver surgery. We identified distal implantation of the cystic duct in these three patients as a potential cause for acute pancreatitis. Conclusion The white test is useful for detection of bile leakage after liver resection, but we do not recommend a systematic use after LR, because severe acute pancreatitis can be lethal for the patient, especially in case of distal cystic implantation which may facilitate reflux in the main pancreatic duct

Peri-operative risk factors of chronic kidney disease after liver transplantation

International audienc

Two-Dimensional-Strain Echocardiography in Intensive Care Unit Patients: ă A Prospective, Observational Study

International audiencePurpose. Two-dimensional-strain echocardiography (2D-strain) is a ă promising technique for the early detection of myocardial dysfunction. ă Our study was aimed to assess its feasibility in the intensive care unit ă (ICU). Our secondary goal was to determine if 2D-strain could predict ă the patient's outcome. ă Methods. Conventional echocardiography and 2D-strain were performed on ă 64 consecutive patients admitted to our ICU. Using 2D-strain, the ă longitudinal deformation of the left ventricle was assessed. Feasibility ă of 2D-strain, diagnosis performance, and 28-day mortality prediction ă were determined. ă Results. 2D-strain measurements could be performed in 77% of our ă patients. All 2D-strain variables related to ventricular performance ă were significantly impaired in the patients who died compared with those ă who survived. Strain global medium was the only independent ă echocardiographic variable predictor of 28-day mortality rate (odds ă ratio 0.60; 95% confidence interval 0.43-0.80, p = 0.002). ă Conclusions. 2D-strain measurement is feasible in ICU patients, enabling ă identifying early left ventricle dysfunction. Strain global medium is an ă independent predictor of 28-day mortality. (C) 2016 Wiley Periodicals, ă Inc