PLoS One

Quantitative analysis of the vascular network anatomy is critical for the understanding of the vasculature structure and function. In this study, we have combined microcomputed tomography (microCT) and computational analysis to provide quantitative three-dimensional geometrical and topological characterization of the normal kidney vasculature, and to investigate how 2 core genes of the Wnt/planar cell polarity, Frizzled4 and Frizzled6, affect vascular network morphogenesis. Experiments were performed on frizzled4 (Fzd4-/-) and frizzled6 (Fzd6-/-) deleted mice and littermate controls (WT) perfused with a contrast medium after euthanasia and exsanguination. The kidneys were scanned with a high-resolution (16 μm) microCT imaging system, followed by 3D reconstruction of the arterial vasculature. Computational treatment includes decomposition of 3D networks based on Diameter-Defined Strahler Order (DDSO). We have calculated quantitative (i) Global scale parameters, such as the volume of the vasculature and its fractal dimension (ii) Structural parameters depending on the DDSO hierarchical levels such as hierarchical ordering, diameter, length and branching angles of the vessel segments, and (iii) Functional parameters such as estimated resistance to blood flow alongside the vascular tree and average density of terminal arterioles. In normal kidneys, fractal dimension was 2.07±0.11 (n = 7), and was significantly lower in Fzd4-/- (1.71±0.04; n = 4), and Fzd6-/- (1.54±0.09; n = 3) kidneys. The DDSO number was 5 in WT and Fzd4-/-, and only 4 in Fzd6-/-. Scaling characteristics such as diameter and length of vessel segments were altered in mutants, whereas bifurcation angles were not different from WT. Fzd4 and Fzd6 deletion increased vessel resistance, calculated using the Hagen-Poiseuille equation, for each DDSO, and decreased the density and the homogeneity of the distal vessel segments. Our results show that our methodology is suitable for 3D quantitative characterization of vascular networks, and that Fzd4 and Fzd6 genes have a deep patterning effect on arterial vessel morphogenesis that may determine its functional efficiency

Evaluation de la prise en charge de l'infarctus du myocarde par angioplastie sous enoxaparine aux soins intensifs de l'hôpital du Haut Lévêque (suivi à 1 an)

GOAL : 30 day and 1 year follow up of a STEMI poopulation homogeneiously treated with pre hospital enoxaparin who underwent angioplasty. POPULATION AND METHODS : 203 patients were included from june 2007 to june 2008, 61 for the fibrinolysis group and 142 for the PPCI group. RESULTS : 1 month mortality is 4,4 % and 1 year mortality 5,9 %. IIb/IIIa GPI have 81 % prescription rate. There is no significant difference in term of events between the PPCI group and the fibrinolysis group in an univariate analysis. Shock, severe bleedings, longer ischemia times are predictive for events in the follow up. CONCLUSION : On a "real life" STEMI population, enoxaparin use shows very similar results to the one observed in studies and registry with enoxaparin use in term of ischemic and hemorragic events. Thus, our enoxaparin protocol provide adequate anticoagulation simple to provide in pre hospital settings indifferently of the reperfusion treatment used.OBJECTIF : Suivi à 30 jours et 1 an d'une population de STEMI avec prise en charge homogène pré hospitalière par enoxaparine et ayant bénéficié d'une angioplastie. POOPULATION ET METHODES : 203 patients inclus de juin 2007 à juin 2008, 61 dans le groupe fibrinolyse et 142 dans le groupe angioplastie primaire (PPCI). RESULTATS : La mortalité à 1 mois est de 4,4 %, à 1 an de 5,9 %. Les patients bénéficiaient à 81 % d'antiGPIIb/IIIa. Il n'existe pas de différence significative sur la survenue d'événements entre le groupe PPCI et fibrinolyse. Dans la population sont prédictifs en analyse univariée d'événements : l'âge, la présence d'un choc, une hémorragie grave, un temps d'ischémie plus long. CONCLUSION : Sur une population de STEMI de la "vie réelle", l'utilisation d'enoxaparine permet d'obtenir des résultats équivalents ou supérieurs à ceux des registres et études utilisant l'enoxaparine comme anticoagulant en terme d'événements ischémiques ou hémorragiques. Ainsi, notre protocole pré hospitalier procure une anticoagulation adéquate, simple à administrer notamment en préhospitalier, indépendamment du traitement de reperfusion ensuite effectuée.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Toxic thrombocytopenia during Nerium oleander poisoning.

Article cliniqu

Brain imaging determinants of functional prognosis after severe endocarditis: a multicenter observational study

International audienceObjective We developed a detailed imaging phenotype of the cerebral complications in critically ill patients with infective endocarditis (IE) and determine whether any specific imaging pattern could impact prognostic information. Methods One hundred ninety-two patients admitted to the intensive care units of seven tertiary centers with severe, definite left IE and neurological complications were included. All underwent cerebral imaging few days after admission to define the types of lesions, their volumes, and their locations using voxel-based lesion-symptom mapping (VLSM). We employed uni- and multi-variate logistic regression analyses to explore the associations among imaging features and other prognostic variables and the 6-month modified Rankin Scale (mRS) score. Results Ischemic lesions were the most common lesions (75%; mean volume, 15.3 +/- 33 mL) followed by microbleeds (50%; mean number, 4 +/- 7.5), subarachnoidal hemorrhages (20%), hemorrhagic strokes (16%; mean volume, 14.6 +/- 21 mL), and hemorrhagic transformations (10%; mean volume, 5.6 +/- 11 mL). The volume of hemorrhagic transformations, the severity of leukopathy, and the compromises of certain locations on the motor pathway from the VLSM were associated with a poor 6-month mRS score on univariate analyses. However, upon multivariate analyses, no such specific imaging pattern independently predicted the mRS; this was instead influenced principally by age (OR = 1.03 [1.004-1.06]) and cardiac surgery status (OR = 0.06 [0.02-0.16]) in the entire cohort, and by age (OR= 1.04 [1.01-1.08]) and Staphylococcus aureus status (OR= 2.86 [1.19-6.89]) in operated patients. Conclusions In a cohort of severely ill IE patients with neurological complications, no specific imaging pattern could be highlighted as a reliable predictor of prognosis

Glycaemic Variability and Hyperglycaemia as Prognostic Markers of Major Cardiovascular Events in Diabetic Patients Hospitalised in Cardiology Intensive Care Unit for Acute Heart Failure.

(1) Background: Hyperglycaemia and hypoglycaemia are both emerging risk factors for cardiovascular disease. Nevertheless, the potential effect of glycaemic variability (GV) on mid-term major cardiovascular events (MACE) in diabetic patients presenting with acute heart failure (AHF) remains unclear. This study investigates the prognostic value of GV in diabetic patients presenting with acute heart failure (AHF). (2) Methods: this was an observational study including consecutive patients with diabetes and AHF between January 2015 and November 2016. GV was calculated using standard deviation of glycaemia values during initial hospitalisation in the intensive cardiac care unit. MACE, including recurrent AHF, new-onset myocardial infarction, ischaemic stroke and cardiac death, were recorded. The predictive effects of GV on patient outcomes were analysed with respect to baseline characteristics and cardiac status. (3) Results: In total, 392 patients with diabetes and AHF were enrolled. During follow-up (median (interquartile range) 29 (6-51) months), MACE occurred in 227 patients (57.9%). In total, 92 patients died of cardiac causes (23.5%), 107 were hospitalised for heart failure (27.3%), 19 had new-onset myocardial infarction (4.8%) and 9 (2.3%) had an ischaemic stroke. Multivariable logistic regression analysis showed that GV > 50 mg/dL (2.70 mmol/L), age > 75 years, reduced left ventricular ejection fraction (LVEF < 30%) and female gender were independent predictors of MACE: hazard ratios (HR) of 3.16 (2.25-4.43; < 0.001), 1.54 (1.14-2.08; = 0.005), 1.47 (1.06-2.07; = 0.02) and 1.43 (1.05-1.94; = 0.03), respectively. (4) Conclusions: among other well-known factors of HF, a GV cut-off value of >50 mg/dL was the strongest independent predictive factor for mid-term MACE in patients with diabetes and AHF

Diameter and length distribution.

<p>A, B, C. Log-log plots of absolute (A) and relative (B) diameter distributions, and the average diameters in individual Strahler Orders (DDSO) (C). D, E, F. Log-log plots of absolute (D) and relative (E) vessel segment length distribution and average vessel segment lengths of individual Strahler Orders (F) for WT (black), <i>Fzd4</i>^-/-(blue) and <i>Fzd6</i>^-/-(red) phenotypes. Error bars stand for the SD.</p

Morphofunctional characteristics of vascular networks.

<p>Number of vessel segments (A), estimation of vessel resistance <i>R</i>_DDSO (B), shortest distance between terminal elements (C) and its frequency distribution (D) for the three sub-populations. In the box chart diagrams (C) the boxes determinate the interval within the 25th and 75th percentiles and whiskers denote the interval within the 5th and 95th percentiles, lines within the boxes indicate the medians, and the small squares stand for the average value. Black: WT, blue: <i>Fzd4</i>^-/-, red: <i>Fzd6</i>^-/-. The error bars in panels A and B stand for the SD.</p