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Mazeraud A, Turc G, Sivanandamoorthy S, Porcher R, Stoclin A, Antona M, Polito A, Righy C, Bozza FAB, Siami S, Sharshar T. Association of Lack of Fear of Dying With New Organ Failure: Results of a Multicenter Prospective Cohort Study. Am J Crit Care 2024; 33:36-44. [PMID: 38161174 DOI: 10.4037/ajcc2024517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patients' anxiety on intensive care unit (ICU) admission is associated with subsequent deterioration. OBJECTIVE To assess whether patients' fears/anxiety are predictive of new organ failure within 7 days of ICU admission. METHODS In a prospective 3-center cohort study of non-comatose patients without delirium or invasive mechanical ventilation, 9 specific fears were evaluated through yes/no questions. Illness severity was assessed using the Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA). Intensity of acute and chronic anxiety was assessed with the state and trait components of the State-Trait Anxiety Inventory (STAI). Patients were followed up for 7 days. RESULTS From April 2014 to December 2017, 373 patients (median [IQR] age, 63 [48-74] years; 152 [40.8%] women; median (IQR) SAPS II, 27 [19-37]) were included. Feelings of vulnerability and fear of dying were reported by 203 (54.4%) and 172 (46.1%) patients, respectively. The STAI-State score was 40 or greater in 192 patients (51.5%). Ninety-four patients (25.2%) had new organ failure. Feelings of vulnerability (odds ratio, 1.96 [95% CI, 1.12-3.43]; P=.02) and absence of fear of dying (odds ratio, 2.38 [95% CI, 1.37-4.17]; P=.002) were associated with new organ failure after adjustment for STAI-State score (≥40), SAPS II, and SOFA score. CONCLUSION Absence of fear of dying is associated with new organ failure within the first 7 days after ICU admission. Fear of dying may protect against subsequent deterioration by mobilizing patients' homeostatic resources. ClinicalTrials.gov Identifier: NCT02355626.
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Affiliation(s)
- Aurélien Mazeraud
- Aurélien Mazeraud is an intensivist/anesthesiologist, GHU Paris Psychiatrie et Neurosciences Pole Neuro-Anesthesiology and Intensive Care and Université de Paris, Paris, France
| | - Guillaume Turc
- Guillaume Turc is a professor, Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France; research director, INSERM U1266; and member of the FHU NeuroVasc
| | - Sivanthiny Sivanandamoorthy
- Sivanthiny Sivanandamoorthy is an intensivist, General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Raphaël Porcher
- Raphaël Porcher is a professor of biostatistics, Center for Clinical Epidemiology, Assistance Publique Hôpitaux de Paris, Hôtel Dieu Hospital, Université de Paris, Paris, France
| | - Annabelle Stoclin
- Annabelle Stoclin is an intensivist, General Intensive Care Unit, Institut Gustave Roussy Hospital, Villejuif, France
| | - Marion Antona
- Marion Antona is an intensivist/anesthesiologist, General Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Université de Paris Saclay, Garches, France
| | - Andrea Polito
- Andrea Polito is an intensivist/anesthesiologist, General Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Université de Paris Saclay, Garches, France
| | - Cassia Righy
- Cassia Righy is an intensivist and internal medicine practitioner, D'Or Institute of Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Fernando A B Bozza
- Fernando A. B. Bozza is an internist and research director, D'Or Institute of Research and Education (IDOR) and Laboratory of Critical Care, National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Brazil
| | - Shidasp Siami
- Shidasp Siami is an intensivist, General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Tarek Sharshar
- Tarek Sharshar is a professor of intensive care medicine, GHU Paris Psychiatrie et Neurosciences, Pole Neuro-Anesthesiology and Intensive Care and Université de Paris, Paris, France
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Grignoli N, Petrocchi S, Polito A, Gagliano V, Sallusto F, Uguccioni M, Gabutti L. The interplay between previous infection and mental health condition on antibody response to COVID-19 mRNA vaccination. Brain Behav Immun Health 2023; 33:100677. [PMID: 37701787 PMCID: PMC10493882 DOI: 10.1016/j.bbih.2023.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
Increasing evidence has been pointing towards the existence of a bi-directional interplay between mental health condition and immunity. Data collected during the COVID-19 outbreak suggest that depressive symptoms may impact the production of antibodies against SARS-CoV-2, while a previous infection could affect the immune response and cause neuropsychological disturbances. A prospective observational study was designed to investigate the association between mental health conditions and immune response over time. We analyzed the mental health at baseline and the antibodies before and after immunization with the COVID-19 mRNA vaccine in a cohort of healthcare professionals in southern Switzerland. One-hundred and six subjects were enrolled. Anxiety, distress and depression correlated to each other. There were no correlations between the mentioned variables and the vaccine induced IgG antibodies against the receptor binding domain (RBD) of the spike protein. For those who had a previous COVID-19 infection, the antibodies increased according to the grade of depression. For those who did not, the anti-RBD IgG levels remained similar when comparing presence or absence of depression symptoms. Our results show that previous SARS-CoV-2 natural infection in subjects with mental health conditions enhances the immune response to COVID-19 mRNA vaccination. The correlation between immune response to COVID-19 vaccination, a previous exposure to the virus, and symptoms of mood disorders, makes it necessary to explore the direction of the causality between immune response and depressive symptoms.
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Affiliation(s)
- Nicola Grignoli
- Department of Internal Medicine, Regional Hospital of Bellinzona and Valleys, Ente Ospedaliero Cantonale, Bellinzona and Università della Svizzera italiana, Lugano, Switzerland
- Cantonal Sociopsychiatric Organisation, Public Health Division, Department of Health and Social Care, Repubblica e Cantone Ticino, Mendrisio, Switzerland
| | - Serena Petrocchi
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Andrea Polito
- Department of Anesthesiology, Regional Hospital of Mendrisio and Università della Svizzera italiana, Lugano, Switzerland
| | - Vanessa Gagliano
- Department of Internal Medicine, Regional Hospital of Bellinzona and Valleys, Ente Ospedaliero Cantonale, Bellinzona and Università della Svizzera italiana, Lugano, Switzerland
| | - Federica Sallusto
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | - Mariagrazia Uguccioni
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Gabutti
- Department of Internal Medicine, Regional Hospital of Bellinzona and Valleys, Ente Ospedaliero Cantonale, Bellinzona and Università della Svizzera italiana, Lugano, Switzerland
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Dowse G, Perkins E, Stein H, Chidini G, Danhaive O, Elsayed Y, Carvalho W, AlNaqeeb N, Rooze S, Cetinkaya M, Vetter-Laracy S, Pilar-Orive F, Torpiano P, Gonçalves Ferri W, Buonsenso D, Rogdo B, Medina A, Polito A, Brouwer C, Kneyber M, De Luca D, Tingay D. Born into an isolating world: family-centred care for babies born to mothers with COVID-19. EClinicalMedicine 2023; 56:101822. [PMID: 36846297 PMCID: PMC9941883 DOI: 10.1016/j.eclinm.2022.101822] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. METHODS Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. FINDINGS 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. INTERPRETATION This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed. FUNDING The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children's Hospital Foundation: Grant ID 2019-1155 (EJP), Victorian Government Operational Infrastructure Support Program.
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Affiliation(s)
- G. Dowse
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Corresponding author. Neonatal Research, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, 3052, Victoria, Australia.
| | - E.J. Perkins
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
| | - H.M. Stein
- Department of Pediatrics, Division of Neonatology, Promedica Ebied Children's Hospital, Toledo, OH, USA
| | - G. Chidini
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - O. Danhaive
- Division of Neonatology (Pediatrics), Catholic University of Louvain, Brussels, Belgium
- Division of Neonatology (Pediatrics), University of California San Francisco, California, USA
| | - Y.N. Elsayed
- Pediatrics, University of Manitoba, Winnipeg, Canada
| | - W.B. Carvalho
- Pediatric Intensive Care/Neonatology of the Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - N. AlNaqeeb
- Neonatal Department, AL-Adan Hospital, Ahmadi Area, Kuwait
| | - S. Rooze
- Unités de Soins Intensifs, Hôpital Universitaire des Enfants Reine Fabiola, Laeken, Belgium
| | - M. Cetinkaya
- Health Sciences University, Department of Neonatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - S. Vetter-Laracy
- Division of Neonatology (Pediatrics), University Hospital Son Espases / Balearic Island Health Research Institute IdISBa, Palma, Spain
| | - F.J. Pilar-Orive
- Pediatrics Department, PICU, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - P. Torpiano
- Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - W.A. Gonçalves Ferri
- Department of Pediatrics, Ribeirão Preto Medical School - University of São Paulo, São Paulo State, Ribeirão Preto, Brazil
| | - D. Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B. Rogdo
- NICU/PICU, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - A. Medina
- Pediatric Intensive Care Unit, University Hospital Central de Asturias, Oviedo, Spain
| | - A. Polito
- Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - C.N.M. Brouwer
- Pediatric Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - M.C.J. Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, Groningen, the Netherlands
- Critical Care, Anesthesiology, Peri-operative & Emergency Medicine (CAPE), University Medical Center Groningen, the Netherlands
| | - D. De Luca
- Division of Pediatrics and Neonatal Critical Care, “A.Béclère” Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - D.G. Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Vanhelst J, Béghin L, Labreuche J, Michels N, Miguel-Berges M, Polito A, Barnaba L, Moreno L, De Henauw S, Gottrand F. Évolution de l’activité physique quotidienne de l’adolescence à l’âge adulte : l’étude BELINDA. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Morcel J, Béghin L, Mitchels N, Vanhelst J, Labreuche J, Drumez E, Polito A, Ferrari M, De Henauwn S, Miguel Berges M, Moreno L, Gottrand F. Risque cardiovasculaire chez le jeune adulte (étude BELINDA) : design et objectifs. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kwak J, Polito A, Majewski M, Adams W, Burcar K, Oftadeh M, Haske M, LeVan P. Comparison of Left Atrial Measurements Using 2- and 3-Dimensional Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2019; 33:1518-1526. [PMID: 30876767 DOI: 10.1053/j.jvca.2019.01.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the correlation between left atrial measurements using 2- and 3-dimensional transesophageal echocardiography. DESIGN Prospective, observational study. SETTING Single, tertiary care, academic medical center. PARTICIPANTS The study comprised 63 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass and intraoperative transesophageal echocardiography. INTERVENTIONS In addition to the standard comprehensive intraoperative transesophageal examination, study images were obtained by designated anesthesiologists from the study team. MEASUREMENTS AND MAIN RESULTS The 2-dimensional transesophageal echocardiography views included 4-chamber, 2-chamber, aortic valve short axis, and aortic valve long axis. For the 3-dimensional images, full-volume (90 × 90) data sets were acquired from 4-chamber and aortic valve short-axis views over 4 beats with apnea. Left atrial height, mediolateral length, anteroposterior length, and area were measured in 2- and 3-dimensional images. Left atrial length in the short- and long-axis views of the aortic valve also were measured in 2- and 3-dimensional images. Results indicate that for all patients in this study, the 2- and 3-dimensional measurements correlate well and the 2 observers were in agreement with each other. CONCLUSIONS Two- and 3-dimensional measurements of the left atrium correlated well. Measurements made using 3-dimensional transesophageal echocardiography were subject to similar limitations as those made using 2-dimensional echocardiography. The benefits of 3-dimensional transesophageal echocardiography and multiplanar reconstruction could be expanded by improvements in ultrasound technology and software.
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Affiliation(s)
- Jenny Kwak
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL.
| | - Andrea Polito
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Michael Majewski
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
| | - William Adams
- Clinical Research Office Biostatistics Core, Loyola University Chicago Health Sciences Division, Maywood, IL
| | - Kimberly Burcar
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
| | - Mina Oftadeh
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
| | - Michael Haske
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
| | - Pierre LeVan
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
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Nardi O, Zavala E, Martin C, Nanas S, Scheeren T, Polito A, Borrat X, Annane D. Targeting skeletal muscle tissue oxygenation (StO 2) in adults with severe sepsis and septic shock: a randomised controlled trial (OTO-StS Study). BMJ Open 2018; 8:e017581. [PMID: 29555789 PMCID: PMC5875667 DOI: 10.1136/bmjopen-2017-017581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Evaluation of the ratio of oxyhaemoglobin to total haemoglobin in skeletal muscle (StO2) using near-infrared spectroscopy may aid in the monitoring of patients with sepsis. This study assessed the benefits and risks of targeting StO2 in adults with severe sepsis or septic shock. DESIGN A European randomised controlled trial was performed on two parallel groups. SETTING Five intensive care units (ICU) in France, Greece, Spain and Germany were used for the study. PARTICIPANTS A total of 103 adults with severe sepsis or septic shock on ICU admission were randomised (54 subjects in the experimental arm and 49 subjects in the control arm). INTERVENTIONS Haemodynamic management using an algorithm that was adapted from the 2004 Surviving Sepsis Campaign guidelines with (experimental arm) or without (control arm) targeting an StO2 value greater than 80% at a minimum of two different sites. OUTCOMES The primary outcome was a composite: 7-day all-cause mortality or worsening of organ function, defined as a positive difference in Sepsis-related Organ Failure Assessment (SOFA) score between day 7 and randomisation (ie, delta SOFA >0). Secondary endpoints: 30-day mortality, duration of mechanical ventilation and vasopressor therapy up to 30 days from randomisation. RESULTS The study ended prematurely due to lack of funding after enrolment of 103/190 patients. Eighteen patients (33.3%) in the experimental arm and 14 (28.6%, P=0.67) in the control arm died or exhibited delta SOFA >0 on day 7. The mean number of days on mechanical ventilation was 12.2±10.6 in the experimental group and 7.6±7.9 in the control group (P=0.03). Thirty-one (57%) patients in the experimental arm and 14 (29%) patients in the control arm received red cells by day 7 (P=0.01). CONCLUSION Despite the limitation related to premature termination, this study provides no data to support the routine implementation of resuscitation protocols incorporating StO2 >80% at two or more muscle sites as a target. StO2-guided therapy may be associated with prolonged use of mechanical ventilation and an increased number of red blood cell transfusions. TRIAL REGISTRATION NUMBER NCT00167596; Results.
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Affiliation(s)
- Olivier Nardi
- Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique Hôpitaux de Paris and Laboratory of Inflammation and Infection UMR 1173, University of Versailles SQY and INSERM, Garches, France
| | - Elizabeth Zavala
- Department of Anesthesiology and Intensive Care Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Claude Martin
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, University of the Mediterranean, Marseille, France
| | - Serafim Nanas
- Critical Care Department, Evangelismos General Hospital, Athens, Greece
| | - Thomas Scheeren
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Rostock, Rostock, Germany
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrea Polito
- Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique Hôpitaux de Paris and Laboratory of Inflammation and Infection UMR 1173, University of Versailles SQY and INSERM, Garches, France
| | - Xavi Borrat
- Department of Anesthesiology and Intensive Care Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique Hôpitaux de Paris and Laboratory of Inflammation and Infection UMR 1173, University of Versailles SQY and INSERM, Garches, France
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Ricci Z, Polito A, Giorni C, Di Chiara L, Ronco C, Picardo S. Continuous Hemofiltration dose Calculation in a Newborn Patient with Congenital Heart Disease and Preoperative Renal Failure. Int J Artif Organs 2018; 30:258-61. [PMID: 17417766 DOI: 10.1177/039139880703000312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To report a case of a newborn patient with renal failure due to polycystic kidneys requiring renal replacement therapy, and total anomalous pulmonary venous return requiring major cardiosurgical intervention. Setting Pediatric cardiosurgery operatory room and pediatric cardiologic intensive care. Patient: A 6-day-old newborn child weighing 3.1 kg. Results Renal function (creatinine value and urine output) was monitored during the course of the operation and intraoperative renal replacement therapy was not initiated. Serum creatinine concentration decreased from 4.4 to 3 mg/dL at cardiopulmonary bypass (CPB) start and to 1.5 at the end of surgery: the creatinine decrease was provided by the dilutional effect of CPB priming and the infusion of fresh blood from transfusions together with an adequate filtration rate (800 m/L in about 120 minutes). After the operation, extracorporeal membrane oxygenation (ECMO) for ventricular dysfunction and continuous hemofiltration for anuria refractory to medical therapy were prescribed. The hemofiltration machine was set in parallel with the ECMO machine at a blood flow rate of 60 ml/min and a predilution replacement solution infusion of 600 ml/h (4.5 ml/min of creatinine clearance once adjusted on extracorporeal circuits; 3000 mL/m2 hemofiltration): after a single hemofiltration session lasting 96 hours, serum creatinine reached optimal steady state levels around 0.5 mg/dL on postoperative day 2 and 3. Conclusion Administration of intraoperative continuous hemofiltration is not mandatory in the case of a 3-kg newborn patient with established renal failure needing major cardiosurgery: hemodilution secondary to CPB, transfusion of hemoderivates, and optimal UF rate appear to be effective methods for achieving solute removal. If postoperative continuous hemofiltration is started, however, a “dialytic dose” of 4.5 ml/min allows an adequate creatinine clearance, quick achievement of a steady state of serum creatinine concentration and an eventual acceptable rate of inflammatory mediator removal.
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Affiliation(s)
- Z Ricci
- Department of Pediatric Cardiosurgery, Bambino Gesù Hospital, Rome, Italy.
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Van der Poel C, Bresters D, Reesink H, Plaisier A, Schaasberg W, Leentvaar-Kuypers A, Choo QL, Quan S, Polito A, Houghton M, Kuo G, Lelie P, Cuypers H. Early Antihepatitis C Virus Response with Second- Generation C200/C22 ELISA. Vox Sang 2017. [DOI: 10.1159/000462203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Azabou E, Rohaut B, Heming N, Magalhaes E, Morizot-Koutlidis R, Kandelman S, Allary J, Moneger G, Polito A, Maxime V, Annane D, Lofaso F, Chrétien F, Mantz J, Porcher R, Sharshar T. Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study. Ann Intensive Care 2017; 7:63. [PMID: 28608136 PMCID: PMC5468361 DOI: 10.1186/s13613-017-0290-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/02/2017] [Indexed: 12/21/2022] Open
Abstract
Background Somatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP’s ICCT and/or BAEP’s IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients. Methods SSEP by stimulation of the median nerve and BAEP were assessed in critically ill patients receiving deep sedation on day 3 following ICU admission. Deep sedation was defined by a Richmond Assessment sedation Scale (RASS) <−3. Mean left- and right-side ICCT and IPCT were measured for each patient. Primary and secondary outcomes were, respectively, in-ICU mortality and AMS defined as the occurrence of delirium and/or delayed awakening after discontinuation of sedation. Results Eighty-six patients were studied of which 49 (57%) were non-brain-injured and 37 (43%) were brain-injured. Impaired ICCT was a predictor of in-ICU mortality after adjustment on the global Sequential Organ Failure Assessment score (SOFA) [OR (95% CI) = 2.69 (1.05–6.85); p = 0.039] and on the non-neurological SOFA components [2.67 (1.05–6.81); p = 0.040]. IPCT was more frequently delayed in the subgroup of patients who developed post-sedation AMS (24%) compared those without AMS (0%). However, this difference did not reach statistical significance (p = 0.053). Impairment rates of ICCT and IPCT were not found to be significantly different between non-brain- and brain-injured subgroups of patients. Conclusion In critically ill patients receiving deep sedation, early ICCT impairment was associated with mortality. Somatosensory and brainstem auditory evoked potentials may be useful early warning indicators of brain dysfunction as well as prognostic markers in deeply sedated critically ill patients.
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Affiliation(s)
- Eric Azabou
- Department of Physiology - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1179, University of Versailles Saint-Quentin en Yvelines, Garches, France.,General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Benjamin Rohaut
- Department of Neurology, Intensive Care Unit, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,UPMC Univ. Paris 06, Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, Paris, France
| | - Nicholas Heming
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Eric Magalhaes
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Régine Morizot-Koutlidis
- Department of Neurology, Intensive Care Unit, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,UPMC Univ. Paris 06, Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, Paris, France
| | - Stanislas Kandelman
- Department of Anesthesiology and Intensive Care Medicine - Beaujon Hospital, University of Denis Diderot, Clichy, France
| | - Jeremy Allary
- Department of Anesthesiology and Intensive Care Medicine - Beaujon Hospital, University of Denis Diderot, Clichy, France
| | - Guy Moneger
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Andrea Polito
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Virginie Maxime
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Djillali Annane
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Frederic Lofaso
- Department of Physiology - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1179, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Fabrice Chrétien
- Laboratory of Human Histopathology and Animal Models, Institut Pasteur, 28, rue du Dr Roux, 75015, Paris, France
| | - Jean Mantz
- Laboratory of Human Histopathology and Animal Models, Institut Pasteur, 28, rue du Dr Roux, 75015, Paris, France.,Department of Anesthesiology and Intensive Care Medicine - European Hospital Georges Pompidou, Paris Descartes University, Paris, France
| | - Raphael Porcher
- Center for Clinical Epidemiology - Assistance Publique Hôpitaux de Paris, Hotel Dieu Hospital, INSERM U1153, University Paris Descartes, Paris, France
| | - Tarek Sharshar
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1173, University of Versailles Saint-Quentin en Yvelines, Garches, France. .,Laboratory of Human Histopathology and Animal Models, Institut Pasteur, 28, rue du Dr Roux, 75015, Paris, France. .,General Intensive Care Medicine, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, 104, Boulevard Raymond Poincaré, 92380, Garches, France.
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11
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Madden JR, Evans A, Hemenway M, Stark E, Kissell E, Polito A, Batson D, Stark M, Dhall G, Garvin JH, Foreman NK, Vibhakar R. Vincristine and Vinblastine: Is checking bilirubin mandatory in children with Brain Tumors? Pediatr Blood Cancer 2017; 64. [PMID: 27808466 DOI: 10.1002/pbc.26329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/28/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Jennifer R Madden
- Children's Hospital Colorado, University of Colorado, School of Medicine, Aurora, Colorado
| | - Anna Evans
- Children's Hospital Los Angeles, Los Angeles, California
| | - Molly Hemenway
- Children's Hospital Colorado, University of Colorado, School of Medicine, Aurora, Colorado
| | - Eileen Stark
- Columbia University/New York-Presbyterian Children's Hospital, New York, New York
| | - Erin Kissell
- Children's Hospital Colorado, University of Colorado, School of Medicine, Aurora, Colorado
| | - Andrea Polito
- Children's Hospital Colorado, University of Colorado, School of Medicine, Aurora, Colorado
| | - Deborah Batson
- Children's Hospital Colorado, University of Colorado, School of Medicine, Aurora, Colorado
| | - Marianne Stark
- Columbia University/New York-Presbyterian Children's Hospital, New York, New York
| | - Girish Dhall
- Children's Hospital Los Angeles, Los Angeles, California
| | - James H Garvin
- Columbia University/New York-Presbyterian Children's Hospital, New York, New York
| | - Nicholas K Foreman
- Children's Hospital Colorado, University of Colorado, School of Medicine, Aurora, Colorado
| | - Rajeev Vibhakar
- Children's Hospital Colorado, University of Colorado, School of Medicine, Aurora, Colorado
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12
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Michelon H, Bouchand F, Polito A, Clair B, Annane D. Fatal tramadol-induced multiple organ failure. Therapie 2016; 71:435-7. [DOI: 10.1016/j.therap.2016.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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13
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Polito A, Hamitouche N, Ribot M, Polito A, Laviolle B, Bellissant E, Annane D, Alvarez JC. Pharmacokinetics of oral fludrocortisone in septic shock. Br J Clin Pharmacol 2016; 82:1509-1516. [PMID: 27416887 DOI: 10.1111/bcp.13065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 06/28/2016] [Accepted: 07/10/2016] [Indexed: 01/06/2023] Open
Abstract
AIM The combination of hydrocortisone and fludrocortisone improved outcomes in septic shock. However, the specific role of fludrocortisone remains controversial and its pharmacokinetics (PK) has never been investigated in septic shock. This study aimed at characterizing the PK of fludrocortisone in septic shock. METHODS This was a single-centre ancillary PK study of a large multinational trial of crystalloids versus colloids for acute hypovolemia in intensive care unit (ICU) patients. In 21 adults with septic shock, fludrocortisone plasma concentrations were measured by liquid chromatography-mass spectrometry tandem analysis, before and repeatedly until 18 h after an oral dose of 50 μg. PK parameters were estimated using a nonlinear mixed-effects modelling. RESULTS Undetectable plasma concentrations were observed in 7 out of 21 patients. In the remaining 14 patients, plasma fludrocortisone concentrations were best described by a one-compartmental model with first-order absorption, a lag time (Tlag ) before the absorption phase, and first-order elimination. Severity of illness, as quantified by Simplified Acute Physiology Score II, significantly increased Tlag and apparent clearance. There was a large inter-individual variability in PK parameters. The population estimates of PK parameters (inter-individual variability) were: Tlag 0.65 h (98%), apparent clearance 40 l h-1 (49%) and apparent volume of distribution 78 l (75%). Plasma half-life was estimated at 1.35 h (95% CI, 0.84-2.03) and area under the curve of plasma concentrations was estimated at 1.25 μg h l-1 (95% CI, 1.09-1.46). CONCLUSIONS A single oral dose of fludrocortisone yielded undetectable plasma concentrations in one-third of adults with septic shock. Fludrocortisone PK showed a short plasma elimination half-life and a large inter-individual variability.
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Affiliation(s)
- Andrea Polito
- Department of Intensive Care, Raymond Poincaré Hospital (AP-HP), Garches, France.,Laboratory of Cell Death, Inflammation and Infection, INSERM UMR 1173 University of Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Noureddine Hamitouche
- INSERM 1414 Clinical Investigation Centre, Rennes, France.,Department of Pharmacology, Rennes 1 University, Rennes, France
| | - Mégane Ribot
- Laboratory of Cell Death, Inflammation and Infection, INSERM UMR 1173 University of Versailles Saint-Quentin-en-Yvelines, Garches, France.,Department of Pharmacology, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Angelo Polito
- Department of Cardiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Bruno Laviolle
- INSERM 1414 Clinical Investigation Centre, Rennes, France.,Department of Pharmacology, Rennes 1 University, Rennes, France
| | - Eric Bellissant
- INSERM 1414 Clinical Investigation Centre, Rennes, France.,Department of Pharmacology, Rennes 1 University, Rennes, France
| | - Djillali Annane
- Department of Intensive Care, Raymond Poincaré Hospital (AP-HP), Garches, France.,Laboratory of Cell Death, Inflammation and Infection, INSERM UMR 1173 University of Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Jean-Claude Alvarez
- Laboratory of Cell Death, Inflammation and Infection, INSERM UMR 1173 University of Versailles Saint-Quentin-en-Yvelines, Garches, France.,Department of Pharmacology, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin-en-Yvelines, Garches, France
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14
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15
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Madden J, Hemenway M, Kissell E, Batson D, Polito A, Evans A, Stark E. NU-21VINCRISTINE AND VINBLASTINE: IS CHECKING BILIRUBIN MANDATORY? Neuro Oncol 2016. [DOI: 10.1093/neuonc/now079.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Mazeraud A, Polito A, Annane D. Experimental and clinical evidences for glucose control in intensive care: is infused glucose the key point for study interpretation? Crit Care 2014; 18:232. [PMID: 25177798 PMCID: PMC4220093 DOI: 10.1186/cc13998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Stress-induced hyperglycemia has been considered an adaptive mechanism to stress up to the first intensive insulin therapy trial, which showed a 34% reduction in relative risk of in-hospital mortality when normalizing blood glucose levels. Further trials had conflicting results and, at present, stress-induced hyperglycemia management remains non-consensual. These findings could be explained by discrepancies in trials, notably regarding the approach to treat hyperglycemia: high versus restrictive caloric intake. Stress-induced hyperglycemia is a frequent complication during intensive care unit stay and is associated with a higher mortality. It results from an imbalance between insulin and counter-regulatory hormones, increased neoglucogenesis, and the cytokine-induced insulin-resistant state of tissues. In this review, we summarize detrimental effects of hyperglycemia on organs in the critically ill (peripheric and central nervous, liver, immune system, kidney, and cardiovascular system). Finally, we show clinical and experimental evidence of potential benefits from glucose and insulin administration, notably on metabolism, immunity, and the cardiovascular system.
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17
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Venneria E, Intorre F, Foddai MS, Azzini E, Palomba L, Raguzzini A, Polito A, Ciarapica D, Zaccaria M, Toti E, Catasta G, Maiani G. Antioxidant effect of zinc supplementation on both plasma and cellular red-ox status markers in a group of elderly Italian population. J Nutr Health Aging 2014; 18:345-50. [PMID: 24676313 DOI: 10.1007/s12603-014-0005-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this work was to evaluate the effect of long term supplementation with two moderate dose of Zn on plasma and cellular red-ox status markers in elderly volunteers. DESIGN, SETTING AND SUBJECTS In a double blind study 108 healthy volunteers, aged 70-85 years, were enrolled. They were randomly divided in 3 groups of treatment, receiving placebo, 15 mg/day and 30 mg/day of Zn for 6 months. Red-ox status markers were assessed at baseline and after 6 months evaluating carotenoids, vitamin A and E in plasma; glutathione (GSH), thiol groups (RSH), malondialdehyde (MDA), percentage of haemolysis and methemoglobin in erythrocytes. RESULTS Zn supplementation had no significant effects on red-ox status markers except for vitamin A levels (from 1.94±0.44 to 2.18±0.48 μM in volunteers receiving 15 mg of Zn and from 1.95±0.46 to 2.26±0.56 μM in volunteers receiving 30 mg of Zn), which increased proportionally to zinc dose. CONCLUSIONS It appears that, differently from unhealthy populations, long-term supplementation with two moderate doses of Zn in a healthy elderly population, with an adequate Zn nutritive status and macro and micronutrients intakes in the range of normality, is an inefficient way to increase antioxidant defences.
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Affiliation(s)
- E Venneria
- E. Venneria, Agricultural Research Council - Research Centre on Food and Nutrition (CRA-NUT), Rome, Italy. Via Ardeatina 546, 00178 Rome, Italy, phone number: 0039 06 51494553,
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18
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Durazzo A, Carcea M, Adlercreutz H, Azzini E, Polito A, Olivieri L, Zaccaria M, Meneghini C, Maiani F, Bausano G, Martiri F, Samaletdin A, Fumagalli A, Raguzzini A, Venneria E, Foddai MS, Ciarapica D, Mauro B, Volpe F, Maiani G. Effects of consumption of whole grain foods rich in lignans in healthy postmenopausal women with moderate serum cholesterol: a pilot study. Int J Food Sci Nutr 2014; 65:637-45. [PMID: 24611636 DOI: 10.3109/09637486.2014.893283] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aims at investigating the effect of an experimental period of intake of whole grain foods rich in lignans as part of an habitual diet on the plasma and urinary excretion of enterolignans, the biomarkers of lipid metabolism and the immunological and antioxidant status in a group of postmenopausal women with moderate serum cholesterol. A randomized double-blind crossover study was completed on 13 subjects in 12-weeks after protocol approval of an ethical committee. The subjects consumed whole grain foods high in lignans (30 g/d of breakfast cereals or biscuits, etc., 80 g/d of whole grain pasta) or refined grain foods for 4 weeks, separated by a 2-weeks wash-out period. A modest hypocholesterolemic effect (p < 0.05) of the whole grain diet was observed and the intake of whole grain products rich in lignans was also associated with an increase in urinary enterodiol excretion (p < 0.05).
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Affiliation(s)
- A Durazzo
- Agricultural Research Council-Food and Nutrition Research Centre (CRA-NUT) , Rome , Italy
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Siami S, Polito A, Porcher R, Hissem T, Blanchard A, Boucly C, Carlier R, Annane D, Haymann JP, Sharshar T. Thirst perception and osmoregulation of vasopressin secretion are altered during recovery from septic shock. PLoS One 2013; 8:e80190. [PMID: 24223220 PMCID: PMC3819281 DOI: 10.1371/journal.pone.0080190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 10/01/2013] [Indexed: 11/19/2022] Open
Abstract
Objective Vasopressin (AVP) secretion during an osmotic challenge is frequently altered in the immediate post-acute phase of septic shock. We sought to determine if this response is still altered in patients recovering from septic shock. Design Prospective interventional study Setting Intensive care unit (ICU) at Raymond Poincaré and Etampes Hospitals. Patients Normonatremic patients at least 5 days post discontinuation of catecholamines given for a septic shock. Intervention Osmotic challenge involved infusing 500 mL of hypertonic saline solution (with cumulative amount of sodium not exceeding 24 g) over 120 minutes. Measurements and main results Plasma AVP levels were measured 15 minutes before the infusion and then every 30 minutes for two hours. Non-responders were defined as those with a slope of the relation between AVP and plasma sodium levels less than < 0.5 ng/mEq. Among the 30 included patients, 18 (60%) were non-responders. Blood pressure and plasma sodium and brain natriuretic peptide levels were similar in both responders and non-responders during the course of the test. Critical illness severity, hemodynamic alteration, electrolyte disturbances, treatment and outcome did not differ between the two groups. Responders had more severe gas exchange abnormality. Thirst perception was significantly diminished in non-responders. The osmotic challenge was repeated in 4 non-responders several months after discharge and the abnormal response persisted. Conclusion More than half of patients recovering from septic shock have an alteration of osmoregulation characterised by a dramatic decrease in vasopressin secretion and thirst perception during osmotic challenge. The mechanisms of this alteration but also of the relationship between haematosis and normal response remain to be elucidated.
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Affiliation(s)
- Shidasp Siami
- Department of Intensive Care Medicine, Sud Essonne Hospital, Etampes, France
| | - Andrea Polito
- General Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Raphael Porcher
- Biostatistics and Medical Computer Science Department, Saint-Louis Teaching Hospital, Paris, France
| | - Tarik Hissem
- Department of Intensive Care Medicine, Sud Essonne Hospital, Etampes, France
| | - Anne Blanchard
- Clinical Investigation Centre, Assistance Publique Hôpitaux de Paris, European Georges Pompidou Teaching Hospital, University René Descartes and INSERM CIC9201, Paris, France
| | - Catherine Boucly
- Department of Biochemistry, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Robert Carlier
- Department of Radiology, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Djillali Annane
- General Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Jean-Philippe Haymann
- Department of Functional Investigations, Assistance Publique Hôpitaux de Paris, Tenon Teaching Hospital, University of Pierre et Marie Curie-Paris 6 and INSERM U702, Paris, France
| | - Tarek Sharshar
- General Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
- * E-mail:
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20
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Rey-López JP, Bel-Serrat S, Santaliestra-Pasías A, de Moraes AC, Vicente-Rodríguez G, Ruiz JR, Artero EG, Martínez-Gómez D, Gottrand F, De Henauw S, Huybrechts I, Polito A, Molnar D, Manios Y, Moreno LA. Sedentary behaviour and clustered metabolic risk in adolescents: the HELENA study. Nutr Metab Cardiovasc Dis 2013; 23:1017-1024. [PMID: 22906564 DOI: 10.1016/j.numecd.2012.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 06/25/2012] [Accepted: 06/27/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Although sedentary behaviours are linked with mortality for cardiovascular reasons, it is not clear whether they are negatively related with cardio-metabolic risk factors. The aim was to examine the association between time engaged in television (TV) viewing or playing with videogames and a clustered cardio-metabolic risk in adolescents. METHODS AND RESULTS Sedentary behaviours and physical activity were assessed in 769 adolescents (376 boys, aged 12.5-17.5 years) from the HELENA-CSS study. We measured systolic blood pressure, HOMA index, triglycerides, TC/HDL-c, VO₂max and the sum of four skinfolds, and a clustered metabolic risk index was computed. A multilevel regression model (by Poisson) was performed to calculate the prevalence ratio of having a clustered metabolic risk. In boys, playing >4 h/day with videogames (weekend) and moderate to vigorous PA (MVPA) was associated with cardio-metabolic risk after adjustment for age, maternal education and MVPA. In contrast, TV viewing was not associated with the presence of cardio-metabolic risk. CONCLUSION In boys, playing with videogames may impair cardio-metabolic health during the adolescence. Adolescents should be encouraged to increase their participation in physical activity of at least moderate intensity to obtain a more favourable risk factor profile.
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Affiliation(s)
- J P Rey-López
- GENUD Research Group, University of Zaragoza, C/Corona de Aragon, 42, Zaragoza E-50009, Spain.
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21
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Polito A, Eischwald F, Maho AL, Polito A, Azabou E, Annane D, Chrétien F, Stevens RD, Carlier R, Sharshar T. Pattern of brain injury in the acute setting of human septic shock. Crit Care 2013; 17:R204. [PMID: 24047502 PMCID: PMC4057119 DOI: 10.1186/cc12899] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 09/18/2013] [Indexed: 02/06/2023]
Abstract
Background Sepsis-associated brain dysfunction has been linked to white matter lesions (leukoencephalopathy) and ischemic stroke. Our objective was to assess the prevalence of brain lesions in septic shock patients requiring magnetic resonance imaging (MRI) for an acute neurologic change. Method Seventy-one septic shock patients were included in a prospective observational study. Patients underwent daily neurological examination. Brain MRI was obtained in patients who developed focal neurological deficit, seizure, coma, or delirium. Electroencephalogy was performed in case of coma, delirium, or seizure. Leukoencephalopathy was graded and considered present when white matter lesions were either confluent or diffuse. Patient outcome was evaluated at 6 months with the Glasgow Outcome Scale (GOS). Results We included 71 patients with median age of 65 years (56 to 76) and SAPS II at admission of 49 (38 to 60). MRI was indicated on focal neurological sign in 13 (18%), seizure in 7 (10%), coma in 33 (46%), and delirium in 35 (49%). MRI was normal in 37 patients (52%) and showed cerebral infarcts in 21 (29%), leukoencephalopathy in 15 (21%), and mixed lesions in 6 (8%). EEG malignant pattern was more frequent in patients with ischemic stroke or leukoencephalopathy. Ischemic stroke was independently associated with disseminated intravascular coagulation (DIC), focal neurologic signs, increased mortality, and worse GOS at 6 months. Conclusions Brain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality.
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22
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Nardi O, Polito A, Aboab J, Colin G, Maxime V, Clair B, Friedman D, Orlikowski D, Sharshar T, Annane D. StO2 guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial. J Clin Monit Comput 2013; 27:215-21. [DOI: 10.1007/s10877-013-9432-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/12/2013] [Indexed: 12/23/2022]
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23
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Angelini F, Corrente S, Romiti M, Moschese V, Polito A, Chiocchi M, Monteferrario E, Masala S, Chini L. Lack of Systemic Side Effects of Long-Term Inhaled Fluticasone Propionate Use in a Cohort of Asthmatic Children. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inhaled corticosteroids (ICS) are established as first-line therapy for persistent asthma in children. Fluticasone propionate (FP) has been used because it has equivalent efficacy when used at half-dose of older-generation ICS and has a comparable safety profile. However, concerns persist about the potential risk of adverse effects of long-term FP therapy on childhood growth, bone, adrenal function and immune system. To evaluate the potential adverse effects of FP, we analyzed growth, glucidic metabolism, hypothalamic-pituitary-adrenal axis, bone metabolism, bone mass density and immune system in a cohort of 19 children (average 102±18 months), with asthma who were in treatment with FP (average duration: 14 months, range: 11–17 months). Of these, 11 children homogenous for control of asthma symptoms, and compliance to therapy, were selected for a prospective study during which they were treated with FP250 mg/day for further 6 months (total period of treatment average duration: 22 months, range: 18–23 months). In all children, no alterations of growth, glucidic metabolism, hypothalamic-pituitary-adrenal axis, bone metabolism, bone mass density, immune system nor severe exacerbation of the disease were observed. Our study, showing that FP was able to control the symptoms of asthma and confirming the lack of systemic side effects at the recommended doses, supports its long-term use in children with asthma.
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Affiliation(s)
- F. Angelini
- Division of Pediatrics, University of Rome “Tor Vergata”, Rome, Italy
- Immunology, Allergy and Rheumatology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - S. Corrente
- Division of Pediatrics, University of Rome “Tor Vergata”, Rome, Italy
- Pediatric Allergology and Immunology Division, Policlinico Tor Vergata, University of Rome “Tor Vergata”, Rome, Italy
| | - M.L. Romiti
- Division of Pediatrics, University of Rome “Tor Vergata”, Rome, Italy
| | - V. Moschese
- Division of Pediatrics, University of Rome “Tor Vergata”, Rome, Italy
- Pediatric Allergology and Immunology Division, Policlinico Tor Vergata, University of Rome “Tor Vergata”, Rome, Italy
| | - A. Polito
- Pediatric Allergology and Immunology Division, Policlinico Tor Vergata, University of Rome “Tor Vergata”, Rome, Italy
| | - M. Chiocchi
- Department of Radiology, Policlinico Tor Vergata, University of Rome “Tor Vergata”, Rome, Italy
| | - E. Monteferrario
- Pediatric Allergology and Immunology Division, Policlinico Tor Vergata, University of Rome “Tor Vergata”, Rome, Italy
| | - S. Masala
- Department of Radiology, Policlinico Tor Vergata, University of Rome “Tor Vergata”, Rome, Italy
| | - L. Chini
- Division of Pediatrics, University of Rome “Tor Vergata”, Rome, Italy
- Pediatric Allergology and Immunology Division, Policlinico Tor Vergata, University of Rome “Tor Vergata”, Rome, Italy
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Ribot M, Polito A, Grassin-Delyle S, Annane D, Alvarez JC. Human plasma quantification of fludrocortisone using liquid chromatography coupled with atmospheric pressure chemical ionization mass spectrometry after low-dosage administration. Clin Chim Acta 2012; 420:109-13. [PMID: 23228845 DOI: 10.1016/j.cca.2012.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fludrocortisone acetate is given at very low dosage (50 μg) to patients suffering from septic shock with controversial clinical results. However, it is not clear if absorption is effective in these patients. METHODS An analytical method based upon liquid chromatography coupled to triple quadrupole spectrometry detection with atmospheric pressure chemical ionization interface has been developed for the identification and quantification of fludrocortisone, the active molecule circulating in human plasma. A solid phase extraction of plasma was used after addition of fludrocortisone-D2 as internal standard. Compounds were separated on a C18 column with a gradient of methanol-formate buffer. The ion transitions used to monitor analytes were m/z 381→239 and m/z 381→181 for fludrocortisone and m/z 383→239 and m/z 383→181 for fludrocortisone-D2. RESULTS Retention times were 4.0 min for both compounds. Calibration curves were linear for fludrocortisone in the 0.1-25 ng/ml range. The limits of detection and quantification were 0.05 ng/ml and 0.1 ng/ml, respectively. The intra- and inter-assay precisions were lower than 10.9% and the recovery was 101.8%. A slight matrix effect by about 10% was observed. Application of the method to a patient in septic shock treated with one 50-μg dose of fludrocortisone acetate has shown a maximal plasma concentration of 0.36 ng/ml obtained after 2h. CONCLUSION This method allows fludrocortisone pharmacokinetic/pharmacodynamic studies when given at low dosage in an intensive care unit in case of adrenal insufficiency during a septic shock.
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Affiliation(s)
- Mégane Ribot
- Laboratoire de Pharmacologie-Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, 92380 Garches et Université Versailles Saint-Quentin, France
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Sonneville R, den Hertog HM, Güiza F, Gunst J, Derese I, Wouters PJ, Brouland JP, Polito A, Gray F, Chrétien F, Charlier P, Annane D, Sharshar T, Van den Berghe G, Vanhorebeek I. Impact of hyperglycemia on neuropathological alterations during critical illness. J Clin Endocrinol Metab 2012; 97:2113-23. [PMID: 22442271 DOI: 10.1210/jc.2011-2971] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although preventing excessive hyperglycemia during critical illness may provide clinical neuroprotection, it remains debated whether normoglycemia is without risk for the brain. OBJECTIVE To address this question, we compared the neuropathological alterations in microglia, astrocytes, and neurons, with uncontrolled hyperglycemia, moderately controlled hyperglycemia, and normoglycemia during human critical illness. We further investigated the time course in an animal model. DESIGN AND SETTING We analyzed brain specimens from patients who died in the intensive care unit and from critically ill rabbits randomized to hyper- or normoglycemia. PATIENTS/OTHER PARTICIPANTS: We compared 10 critically ill patients randomized to normoglycemia (104 ±9 mg/dl) or moderate hyperglycemia (173 ±32 mg/dl), and five patients with uncontrolled hyperglycemia (254 ±83 mg/dl) with 16 controls (out of hospital sudden deaths). Critically ill rabbits were randomized to hyperglycemia (315 ±32 mg/dl) or normoglycemia (85 ±13 mg/dl) and studied after 3 and 7 d. INTERVENTIONS Insulin was infused to control blood glucose. MAIN OUTCOME MEASURES AND RESULTS Patients with uncontrolled hyperglycemia showed 3.7-6-fold increased microglial activation, 54-95% reduced number and activation of astrocytes, more than 9-fold increased neuronal and glial apoptosis, and a 1.5-2-fold increase in damaged neurons in hippocampus and frontal cortex (all P ≤ 0.05). Most of these abnormalities were attenuated with moderate hyperglycemia and virtually absent with normoglycemia. Frontal cortex of hyperglycemic rabbits that had been critically ill for 3 d only revealed microglial activation, followed after 7 d by astrocyte and neuronal abnormalities similar to those observed in patients, all prevented by normoglycemia. CONCLUSIONS Preventing hyperglycemia with insulin during critical illness reduced neuropathological abnormalities, with microglial activation being the earliest preventable event. Whether these pathological findings associate with neurological outcome remains unknown.
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Affiliation(s)
- Romain Sonneville
- Laboratory of Intensive Care Medicine, Katholieke Universiteit Leuven, Herestraat 49, B 3000 Leuven, Belgium
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Perri G, Polito A, Esposito C, Albanese SB, Francalanci P, Pongiglione G, Carotti A. Early and late failure of tissue-engineered pulmonary valve conduits used for right ventricular outflow tract reconstruction in patients with congenital heart disease. Eur J Cardiothorac Surg 2012; 41:1320-5. [DOI: 10.1093/ejcts/ezr221] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sharshar T, Polito A, Porcher R, Merhbene T, Blanc M, Antona M, Durand MC, Friedman D, Orlikowski D, Annane D, Marcadet MH. Relevance of anxiety in clinical practice of Guillain-Barre syndrome: a cohort study. BMJ Open 2012; 2:bmjopen-2012-000893. [PMID: 22923622 PMCID: PMC3432836 DOI: 10.1136/bmjopen-2012-000893] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Illness is often associated with anxiety, but few data exist about the prognostic significance of this phenomenon. To address this issue, we assessed whether patient anxiety is associated with subsequent need for intubation in Guillain-Barré syndrome (GBS). DESIGN Incident case-cohort study. SETTING Acute secondary care in a teaching hospital (France) from 2006 to 2010. PARTICIPANTS 110 adult GBS patients. Either language barrier or cognitive decline that precluded understanding was considered as exclusion criteria. PRIMARY OUTCOME Acute respiratory failure. INTERVENTIONS At admission, anxiety and clinical factors (including known predictors of respiratory failure: delay between GBS onset and admission, inability to lift head, vital capacity (VC)) were assessed and related to subsequent need for mechanical ventilation (MV). Anxiety was assessed using a Visual Analogical Scale (VAS), the State Anxiety Inventory form Y1 (STAI-Y1) score and a novel-specific questionnaire, evaluating fears potentially triggered by GBS. Patients were asked to choose which they found most stressful from weakness, pain, breathlessness and uncertainty. RESULTS 23 (22%) were subsequently ventilated. Mean STAI-Y1 was 47.2 (range 22-77) and anxiety VAS 5.2 (range 0-10). STAI was above 60/80 in 22 (21%) patients and anxiety VAS above 7/10 in 28 (27%) patients. Fear of remaining paralysed, uncertainty as to how the disease would progress and fear of intubation were the most stressful. Factors significantly associated with anxiety were weakness and bulbar dysfunction. STAI-Y1 was higher and uncertainty more frequent in subsequently ventilated patients, who had shorter onset-admission delay and greater weakness but not a lower VC. Uncertainty was independently associated with subsequent MV. CONCLUSIONS Early management of patients with GBS should evaluate anxiety and assess its causes both to adjust psychological support and to anticipate subsequent deterioration.
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Affiliation(s)
- Tarek Sharshar
- Medical Intensive Care Unit, Raymond Poincaré Teaching Hospital, Garches, France
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Polito A, Sonneville R, Guidoux C, Barrett L, Viltart O, Mattot V, Siami S, Lorin de la Grandmaison G, Chrétien F, Singer M, Gray F, Annane D, Brouland JP, Sharshar T. Changes in CRH and ACTH synthesis during experimental and human septic shock. PLoS One 2011; 6:e25905. [PMID: 22073145 PMCID: PMC3207830 DOI: 10.1371/journal.pone.0025905] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 09/13/2011] [Indexed: 01/26/2023] Open
Abstract
CONTEXT The mechanisms of septic shock-associated adrenal insufficiency remain unclear. This study aimed at investigating the synthesis of corticotropin-releasing hormone (CRH) and vasopressin (AVP) by parvocellular neurons and the antehypophyseal expression of ACTH in human septic shock and in an experimental model of sepsis. OBJECTIVE To test the hypothesis that ACTH secretion is decreased secondarily to alteration of CRH or AVP synthesis, we undertook a neuropathological study of the antehypophyseal system in patients who had died from septic shock and rats with experimental faecal peritonitis. METHODS Brains obtained in 9 septic shock patients were compared to 10 nonseptic patients (controls). Parvocellular expression of AVP and CRH mRNA were evaluated by in situ hybridization. Antehypophyseal expression of ACTH, vasopressin V1b and CRH R1 receptors and parvocellular expression of iNOS in the PVN were evaluated by immunohistochemistry. The same experiments were carried out in a fecal peritonitis-induced model of sepsis. Data from septic rats with (n = 6) or without (n = 10) early death were compared to sham-operated (n = 8) animals. RESULTS In patients and rats, septic shock was associated with a decreased expression of ACTH, unchanged expression of V1B receptor, CRHR1 and AVP mRNA, and increased expression of parvocellular iNOS compared to controls. Septic shock was also characterized by an increased expression of CRH mRNA in rats but not in patients, who notably had a greater duration of septic shock. CONCLUSION The present study suggests that in humans and in rats, septic shock is associated with decreased ACTH synthesis that is not compensated by its two natural secretagogues, AVP and CRH. One underlying mechanism might be increased expression of iNOS in hypothalamic parvocellular neurons.
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Affiliation(s)
- Andrea Polito
- Department of Intensive Care, Raymond Poincaré Hospital, Garches, France
- Laboratory of Neuroendocrin Response to Sepsis, EA4342, University Versailles Saint-Quentin en Yvelines, Garches, France
| | - Romain Sonneville
- Department of Pathology, Lariboisière Hospital, Paris, France
- Department of Infection and Epidemiology, HISTO (Human hISTOpathology and animal models), Pasteur Institute, Paris, France
| | - Céline Guidoux
- Department of Pathology, Lariboisière Hospital, Paris, France
| | - Lucinda Barrett
- Department of Intensive Care, University College, London, United Kingdom
| | - Odile Viltart
- Department of Biology, CNRS-UMR8161, Pasteur Institute of Lille, Lille, France
| | - Virginie Mattot
- Department of Plasticity of the Postnatal Brain, INSERM U837, University of Nord de France, Lille, France
| | - Shidasp Siami
- Department of Intensive Care, Raymond Poincaré Hospital, Garches, France
- Laboratory of Neuroendocrin Response to Sepsis, EA4342, University Versailles Saint-Quentin en Yvelines, Garches, France
| | | | - Fabrice Chrétien
- Department of Infection and Epidemiology, HISTO (Human hISTOpathology and animal models), Pasteur Institute, Paris, France
| | - Mervyn Singer
- Departement of Medicine, University College, London, United Kingdom
| | - Françoise Gray
- Department of Pathology, Lariboisière Hospital, Paris, France
| | - Djillali Annane
- Department of Intensive Care, Raymond Poincaré Hospital, Garches, France
- Laboratory of Neuroendocrin Response to Sepsis, EA4342, University Versailles Saint-Quentin en Yvelines, Garches, France
| | | | - Tarek Sharshar
- Department of Intensive Care, Raymond Poincaré Hospital, Garches, France
- Laboratory of Neuroendocrin Response to Sepsis, EA4342, University Versailles Saint-Quentin en Yvelines, Garches, France
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Polito A, Brouland JP, Porcher R, Sonneville R, Siami S, Stevens RD, Guidoux C, Maxime V, de la Grandmaison GL, Chrétien FC, Gray F, Annane D, Sharshar T. Hyperglycaemia and apoptosis of microglial cells in human septic shock. Crit Care 2011; 15:R131. [PMID: 21612615 PMCID: PMC3218997 DOI: 10.1186/cc10244] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/03/2011] [Accepted: 05/25/2011] [Indexed: 02/22/2023] Open
Abstract
Introduction The effect of hyperglycaemia on the brain cells of septic shock patients is unknown. The objective of this study was to evaluate the relationship between hyperglycaemia and apoptosis in the brains of septic shock patients. Methods In a prospective study of 17 patients who died from septic shock, hippocampal tissue was assessed for neuronal ischaemia, neuronal and microglial apoptosis, neuronal Glucose Transporter (GLUT) 4, endothelial inducible Nitric Oxide Synthase (iNOS), microglial GLUT5 expression, microglial and astrocyte activation. Blood glucose (BG) was recorded five times a day from ICU admission to death. Hyperglycaemia was defined as a BG 200 mg/dL g/l and the area under the BG curve (AUBGC) > 2 g/l was assessed. Results Median BG over ICU stay was 2.2 g/l. Neuronal apoptosis was correlated with endothelial iNOS expression (rho = 0.68, P = 0.04), while microglial apoptosis was associated with AUBGC > 2 g/l (rho = 0.70; P = 0.002). Neuronal and microglial apoptosis correlated with each other (rho = 0.69, P = 0.006), but neither correlated with the duration of septic shock, nor with GLUT4 and 5 expression. Neuronal apoptosis and ischaemia tended to correlate with duration of hypotension. Conclusions In patients with septic shock, neuronal apoptosis is rather associated with iNOS expression and microglial apoptosis with hyperglycaemia, possibly because GLUT5 is not downregulated. These data provide a mechanistic basis for understanding the neuroprotective effects of glycemic control.
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Affiliation(s)
- Andrea Polito
- General Intensive Care Medicine, Raymond Poincaré Hospital, University of Versailles Saint Quentin en Yvelines, 104 boulevard R. Poincaré, Garches, France
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Sharshar T, Bastuji-Garin S, Polito A, De Jonghe B, Stevens RD, Maxime V, Rodriguez P, Cerf C, Outin H, Touraine P, Laborde K. Hormonal status in protracted critical illness and in-hospital mortality. Crit Care 2011; 15:R47. [PMID: 21291516 PMCID: PMC3221977 DOI: 10.1186/cc10010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/06/2010] [Accepted: 02/03/2011] [Indexed: 01/04/2023]
Abstract
Introduction The aim of this study was to determine the relationship between hormonal status and mortality in patients with protracted critical illness. Methods We conducted a prospective observational study in four medical and surgical intensive care units (ICUs). ICU patients who regained consciousness after 7 days of mechanical ventilation were included. Plasma levels of insulin-like growth factor 1 (IGF-1), prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS) and cortisol were measured on the first day patients were awake and cooperative (day 1). Mean blood glucose from admission to day 1 was calculated. Results We studied 102 patients: 65 men and 37 women (29 of the women were postmenopausal). Twenty-four patients (24%) died in the hospital. The IGF-1 levels were higher and the cortisol levels were lower in survivors. Mean blood glucose was lower in women who survived, and DHEA and DHEAS were higher in men who survived. Conclusions These results suggest that, on the basis of sex, some endocrine or metabolic markers measured in the postacute phase of critical illness might have a prognostic value.
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Affiliation(s)
- Tarek Sharshar
- Department of Intensive Care Medicine, AP-HP, Raymond Poincaré Hospital, University Versailles Saint-Quentin en Yvelines, 104 bd Raymond Poincaré, Garches F-92380, France.
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Polito A, Parisini E, Ricci Z, Picardo S, Annne D. Vasopressin for the treatment of vasodilatory shock: an ESICM systematic review and a meta-analysis. Crit Care 2011. [PMCID: PMC3061722 DOI: 10.1186/cc9512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Sepsis-associated encephalopathy (SAE) is defined as a diffuse cerebral dysfunction resulting from the systemic inflammatory response to an infection without direct infestation of the CNS. Although the pathophysiology of SAE is as yet unknown, some mechanisms have been suggested that involve BBB disruption as a consequence of proinflammatory mediators’ effects on endothelial cells. This leads to an increased passage of neurotoxic and proinflammatory mediators into the brain parenchyma, as well as an impairment of the movements of oxygen and metabolites through the BBB. Both neurons and glial cells are affected, resulting in neural functioning and neurotransmission impairment. The clinical translation of this process is an alteration of consciousness and awareness. SAE is a frequent condition in septic patients. Despite being considered reversible, SAE appears to be associated with long-term cognitive impairment. Detection and diagnosis can be challenging; it requires daily neurological assessment with the assistance of clinical scores. Use of biomarkers and neurophysiological testing is discussed. The aim of this article is to provide practical tools for detection of SAE, as well as an updated overview of its pathophysiology and therapeutic perspectives.
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Affiliation(s)
- Anthony Checinski
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - Andrea Polito
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - Diane Friedman
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - Shidasp Siami
- Department of Intensive Care Medicine, Hospital of Sud Essonne, Etampes, France
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
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Abstract
Sepsis-associated encephalopathy is associated with increased mortality and morbidity. Its pathophysiology remains insufficiently elucidated, although there is evidence for a neuroinflammatory process sequentially involving endothelial activation, blood-brain barrier alteration and cellular dysfunction and alteration in neurotransmission. Experimental studies have shown that microcirculatory dysfunction, a consequence of endothelial activation, is an early pathogenic step. To date, we do not know whether it is present in septic patients, whether it accounts for clinical features and whether it is treatable.
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Affiliation(s)
- Tarek Sharshar
- Department of Intensive Care Medicine, Raymond Poincaré teaching Hospital and University of Versailles Saint-Quentin en Yvelines, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
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Polito A, Lorin de la Grandmaison G, Mansart A, Louiset E, Lefebvre H, Sharshar T, Annane D. Human and experimental septic shock are characterized by depletion of lipid droplets in the adrenals. Intensive Care Med 2010; 36:1852-8. [DOI: 10.1007/s00134-010-1987-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 04/27/2010] [Indexed: 12/21/2022]
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Polito A, Cereda M, Romanelli F, Pertile G. Macular translocation with 360 retinotomy for management of retinal pigment epithelial tear: long-term results. Br J Ophthalmol 2010; 95:74-8. [DOI: 10.1136/bjo.2009.170381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sharshar T, Bastuji-Garin S, De Jonghe B, Stevens RD, Polito A, Maxime V, Rodriguez P, Cerf C, Outin H, Touraine P, Laborde K. Hormonal status and ICU-acquired paresis in critically ill patients. Intensive Care Med 2010; 36:1318-26. [PMID: 20333354 DOI: 10.1007/s00134-010-1840-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 12/11/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND The pathogenesis of intensive care unit-acquired paresis (ICUAP), a frequent and severe complication of critical illness, is poorly understood. Since ICUAP has been associated with female gender in some studies, we hypothesized that hormonal dysfunction might contribute to ICUAP. OBJECTIVE To determine the relationship between hormonal status, ICUAP and mortality in patients with protracted critical illness. DESIGN Prospective observational study. SETTING Four medical and surgical ICUs. PATIENTS ICU patients mechanically ventilated for >7 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Plasma levels of insulin growth factor-1 (IgF1), prolactin, thyroid stimulating hormone (TSH), follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and cortisol were measured on the first day patients were awake (day 1). Mean blood glucose from admission to day 1 was calculated. ICUAP was defined as Medical Research Council sum score <48/60 on day 7. RESULTS We studied 102 patients (65 men and 37 women, 29 post-menopausal), of whom 24 (24%) died during hospitalization. Among the 86 patients tested at day 7, 39 (49%) had ICUAP, which was more frequent in women (63% versus men 36%, p = 0.02). Mean blood glucose was higher in patients with ICUAP. Estradiol/testosterone ratio was greater in men with ICUAP. CONCLUSION ICUAP 7 days after awakening was associated with increased blood glucose and with biological evidence of hypogonadism in men, while an association with hormonal dysfunction was not detected in women.
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Affiliation(s)
- Tarek Sharshar
- Department of Intensive Care Medicine, AP-HP, Raymond Poincare Hospital, University Versailles Saint-Quentin en Yvelines, 104 Boulevard Raymond Poincaré, 92380, Garches, France.
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Ciarapica D, Mauro B, Zaccaria M, Cannella C, Polito A. Validity of self-reported body weight and height among women including patients with eating disorders. Eat Weight Disord 2010; 15:e74-80. [PMID: 20571324 DOI: 10.1007/bf03325282] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The main objective of this study was to evaluate the accuracy of self-reported weight and height among women with eating disorders. The study sample consisted of 271 women aged 18-50 yrs: 73 anorexic patients (AN) with a body mass index (BMI) of <18.50 kg/m2, 54 normal weight bulimic or rehabilitated patients (BU/RE: 18.5<BMI<25), 38 overweight/ obese women (OW/OB: BMI> or =25 kg/m2) and 106 normal weight women without an eating disorder (NW: 18.5<BMI<25). Their self-reported body weight (BW) and height were recorded during an interview, and measured using standard procedures, and their self-reported and measured BMI was calculated (kg/m2). In comparison with the measured data, the AN patients tended to overestimate their body weight by 0.48+/-2.05 kg (p<0.05), whereas the OW/OB and BU/RE patients underestimated it (OW/OB: -1.52+/-3.21 kg, p=0.006; BU/RE: -1.12+/-2.60 kg, p=0.003). All of the groups overestimated height by at least 1 cm, and the OW/OB group overestimated it by 2.31+/-2.94 (p=0.00000). These differences were reflected in the significant underestimate of BMI by all groups except the AN patients. Pearson's correlation coefficients between the self-reported and measured variables ranged from 0.95 to 0.98. The results of a Bland & Altman analysis showed that the underestimates of weight and BMI were related to the magnitude of the values (BW: r=-0.24, p<0.000078; BMI: r=-0.37, p<0.00000), the differences being greater with increasing values of weight and BMI; sensitivity as greater for the AN patients. The self-reported data led to a significant misclassification of body mass categories, especially among the BU/RE and OW/OB subjects. Our results show that the over-reporting of height and under-reporting of body weight led to significant underestimates of BMI. The AN subjects seemed to know their weight quite well, whereas the BU/RE and OW/OB women significantly underestimated it. On the basis of these findings, measured weight and height should always be preferred to self-reported values.
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Affiliation(s)
- D Ciarapica
- Food and Nutrition National Research Institute, Via Ardeatina 546, 00178 Rome, Italy
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Sonneville R, Guidoux C, Barrett L, Viltart O, Mattot V, Polito A, Siami S, de la Grandmaison GL, Blanchard A, Singer M, Annane D, Gray F, Brouland JP, Sharshar T. Vasopressin synthesis by the magnocellular neurons is different in the supraoptic nucleus and in the paraventricular nucleus in human and experimental septic shock. Brain Pathol 2009; 20:613-22. [PMID: 20015289 DOI: 10.1111/j.1750-3639.2009.00355.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Impaired arginine vasopressin (AVP) synthesis and release by the neurohypophyseal system, which includes the neurohypophysis and magnocellular neurons of the paraventricular and supraoptic nuclei, have been postulated in septic shock, but changes in this system have never been assessed in human septic shock, and only partially experimentally. We investigated AVP synthesis and release by the neurohypophyseal system in 9 patients who died from septic shock and 10 controls, and in 20 rats with fecal peritonitis-induced sepsis and 8 sham-operation controls. Ten rats died spontaneously from septic shock, and the others were sacrificed. In patients with septic shock, as in rats that died spontaneously following sepsis induction, AVP immunohistochemical expression was decreased in the neurohypophysis and supraoptic magnocellular neurons, whereas it was increased in the paraventricular magnocellular neurons. No significant change was observed in AVP messenger RiboNucleic Acid (mRNA) expression assessed by in situ hybridization in either paraventricular or supraoptic magnocellular cells. This study shows that both in human and experimental septic shock, AVP posttranscriptional synthesis and transport are differently modified in the magnocellular neurons of the supraoptic and paraventricular nuclei. This may account for the inappropriate AVP release in septic shock and suggests that distinct pathogenic mechanisms operate in these nuclei.
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Affiliation(s)
- Romain Sonneville
- Department of Pathology, Lariboisière Hospital (AP-HP), Paris Cedex 10, University Denis-Diderot Paris 7, Paris, France
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Abstract
PURPOSE to propose and describe a new classification of diabetic macular edema (DME) based on its etiopathogenetic features and to present efficacy and safety data on medical and laser treatments currently used and under investigation. METHODS available literature on DME has been reviewed and information provided by contact lens biomicroscopy, fluorescein angiography and optical coherence tomomography has been combined; published data from trials and reports investigating effectiveness of medical and laser treatments were also analyzed. RESULTS DME was classified according to its main etiopathogenetic components: prevalently retinovascular, tractional and with taut attached posterior hyaloid, each of them having peculiar aspects on fundus, angiographic and tomographic examination. Focal laser treatment remains the only effective intervention, as shown by a large randomized controlled trial, but new less-invasive photocoagulation strategies (i.e., light laser photocoagulation and subthreshold micropulse diode laser) as well as pharmacological approaches (i.e., antioxidants, PKC inhibitors, aldose-reductase and AGE inhibitors, VEGF inhibitors, intravitreal triamcinolone) are emerging. CONCLUSIONS based on our review a classification of DME was developed that may prove useful in making the appropriate treatment decision; the new laser and pharmacological treatments currently investigated are promising and need to be confirmed by large, controlled clinical trials.
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Affiliation(s)
- F Bandello
- Department of Ophthalmology, University of Udine, 33100 Udine, Italy.
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Ortega FB, Artero EG, Ruiz JR, Vicente-Rodriguez G, Bergman P, Hagströmer M, Ottevaere C, Nagy E, Konsta O, Rey-López JP, Polito A, Dietrich S, Plada M, Béghin L, Manios Y, Sjöström M, Castillo MJ. Reliability of health-related physical fitness tests in European adolescents. The HELENA Study. Int J Obes (Lond) 2009; 32 Suppl 5:S49-57. [PMID: 19011654 DOI: 10.1038/ijo.2008.183] [Citation(s) in RCA: 206] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the reliability of a set of health-related physical fitness tests used in the European Union-funded Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study on lifestyle and nutrition among adolescents. DESIGN A set of physical fitness tests was performed twice in a study sample, 2 weeks apart, by the same researchers. PARTICIPANTS A total of 123 adolescents (69 males and 54 females, aged 13.6+/-0.8 years) from 10 European cities participated in the study. MEASUREMENTS Flexibility, muscular fitness, speed/agility and aerobic capacity were tested using the back-saver sit and reach, handgrip, standing broad jump, Bosco jumps (squat jump, counter movement jump and Abalakov jump), bent arm hang, 4 x 10 m shuttle run, and 20-m shuttle run tests. RESULTS The ANOVA analysis showed that neither systematic bias nor sex differences were found for any of the studied tests, except for the back-saver sit and reach test, in which a borderline significant sex difference was observed (P=0.044). The Bland-Altman plots graphically showed the reliability patterns, in terms of systematic errors (bias) and random error (95% limits of agreement), of the physical fitness tests studied. The observed systematic error for all the fitness assessment tests was nearly 0. CONCLUSIONS Neither a learning nor a fatigue effect was found for any of the physical fitness tests when repeated. The results also suggest that reliability did not differ between male and female adolescents. Collectively, it can be stated that the reliability of the set of physical fitness tests examined in this study is acceptable. The data provided contribute to a better understanding of physical fitness assessment in young people.
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Affiliation(s)
- F B Ortega
- Department of Physiology, School of Medicine, University of Granada, Granada, Spain.
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Polito A, Siami S, Sharshar T. Encephalopathy in Sepsis. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Siami S, Polito A, Sharshar T. Sepsis-associated Encephalopathy. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marcellini F, Giuli C, Papa R, Tirabassi G, Faloia E, Boscaro M, Polito A, Ciarapica D, Zaccaria M, Mocchegiani E. OBESITY AND BODY MASS INDEX (BMI) IN RELATION TO LIFE-STYLE AND PSYCHO-SOCIAL ASPECTS. Arch Gerontol Geriatr 2009; 49 Suppl 1:195-206. [DOI: 10.1016/j.archger.2009.09.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Akrout N, Polito A, Annane D, Orlikowski D. [Anesthetic management of patients with muscular disease?]. Rev Prat 2008; 58:2265-2271. [PMID: 19209658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The past two decades has been characterized by important advances in symptomatic care to the muscular patient. In particular, the development of home mechanical ventilation was associated by a substantial improvement in life expectancy. The presence of a muscular disease is less frequently a contra-indication of surgery and subsequently the issue of anesthetizing these patients has become a routine question. A growing number of muscular disorders have been subjected to specific guidelines for anesthetic procedures.
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Affiliation(s)
- Najla Akrout
- Service de réanimation, centre de référence des maladies neuromusculaires, CIC-IT 805 (Inserm), hôpital Raymond-Poincard, AP-HP, Université de Versailles SOY (PRES UniverSud), 92380 Garches Cedex, France
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Parienti JJ, Thirion M, Mégarbane B, Souweine B, Ouchikhe A, Polito A, Forel JM, Marqué S, Misset B, Airapetian N, Daurel C, Mira JP, Ramakers M, du Cheyron D, Le Coutour X, Daubin C, Charbonneau P. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 2008; 299:2413-22. [PMID: 18505951 DOI: 10.1001/jama.299.20.2413] [Citation(s) in RCA: 289] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis vascular access. OBJECTIVE To determine whether jugular catheterization decreases the risk of nosocomial complications compared with femoral catheterization. DESIGN, SETTING, AND PATIENTS A concealed, randomized, multicenter, evaluator-blinded, parallel-group trial (the Cathedia Study) of 750 patients from a network of 9 tertiary care university medical centers and 3 general hospitals in France conducted between May 2004 and May 2007. The severely ill, bed-bound adults had a body mass index (BMI) of less than 45 and required a first catheter insertion for renal replacement therapy. INTERVENTION Patients were randomized to receive jugular or femoral vein catheterization by operators experienced in placement at both sites. MAIN OUTCOME MEASURES Rates of infectious complications, defined as catheter colonization on removal (primary end point), and catheter-related bloodstream infection. RESULTS Patient and catheter characteristics, including duration of catheterization, were similar in both groups. More hematomas occurred in the jugular group than in the femoral group (13/366 patients [3.6%] vs 4/370 patients [1.1%], respectively; P = .03). The risk of catheter colonization at removal did not differ significantly between the femoral and jugular groups (incidence of 40.8 vs 35.7 per 1000 catheter-days; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.62-1.16; P = .31). A prespecified subgroup analysis demonstrated significant qualitative heterogeneity by BMI (P for the interaction term < .001). Jugular catheterization significantly increased incidence of catheter colonization vs femoral catheterization (45.4 vs 23.7 per 1000 catheter-days; HR, 2.10; 95% CI, 1.13-3.91; P = .017) in the lowest tercile (BMI <24.2), whereas jugular catheterization significantly decreased this incidence (24.5 vs 50.9 per 1000 catheter-days; HR, 0.40; 95% CI, 0.23-0.69; P < .001) in the highest tercile (BMI >28.4). The rate of catheter-related bloodstream infection was similar in both groups (2.3 vs 1.5 per 1000 catheter-days, respectively; P = .42). CONCLUSION Jugular venous catheterization access does not appear to reduce the risk of infection compared with femoral access, except among adults with a high BMI, and may have a higher risk of hematoma. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00277888.
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Affiliation(s)
- Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, Côte de Nacre University Hospital Center, Ave de la Côte de Nacre, 14033 Caen CEDEX, France.
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Kloeckner M, Gallet de Saint-Aurin R, Polito A, Aboab J, Annane D. [Corticotropic axis in septic shock]. Ann Endocrinol (Paris) 2007; 68:281-9. [PMID: 17689480 DOI: 10.1016/j.ando.2007.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- M Kloeckner
- Service de réanimation médicale, hôpital Raymond-Poincaré, université de Versailles-Saint-Quentin, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Intorre F, Polito A, Andriollo-Sanchez M, Azzini E, Raguzzini A, Toti E, Zaccaria M, Catasta G, Meunier N, Ducros V, O'Connor JM, Coudray C, Roussel AM, Maiani G. Effect of zinc supplementation on vitamin status of middle-aged and older European adults: the ZENITH study. Eur J Clin Nutr 2007; 62:1215-23. [PMID: 17622255 DOI: 10.1038/sj.ejcn.1602844] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the effects of zinc supplementation on vitamin status in middle-aged and older volunteers. SUBJECTS/METHODS Three hundred and eighty-seven healthy middle-aged (55-70 years) and older (70-85 years) men and women, randomly allocated to three groups to receive 15 or 30 mg Zn/day or placebo for 6 months. Dietary intake was assessed by means of a validated 4-day recall record. Fasting blood samples were simultaneously analysed for levels of plasma retinol and alpha-tocopherol by high-performance liquid chromatography. Erythrocyte folates were measured by a competitive immunoassay with direct chemiluminescence detection on an automatized immunoanalyser. Biochemical measurements were performed at baseline and after 3 and 6 months of zinc supplementation. RESULTS Plasma vitamin A levels were significantly increased proportionally with zinc dose and period of treatment, particularly at 6 months (for 15 mg Zn/day, P<0.05; for 30 mg Zn/day, P<0.0001); no significant changes were observed in the placebo group. There was no effect of zinc supplementation on vitamin E/cholesterol ratio and erythrocyte folates. CONCLUSIONS Our results show that a long-term zinc supplementation increases plasma vitamin A levels in middle-aged and older people of similar characteristics to those involved in this study. Moreover, supplementation influences serum zinc levels but does not affect erythrocyte zinc concentration and both plasma vitamin E and erythrocyte folate status.
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Affiliation(s)
- F Intorre
- Human Nutrition Unit, National Institute for Research on Food and Nutrition, Via Ardeatina 546, Rome, Italy.
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Intorre F, Maiani G, Cuzzolaro M, Simpson EEA, Catasta G, Ciarapica D, Mauro B, Toti E, Zaccaria M, Coudray C, Corelli S, Palomba L, Polito A. Descriptive data on lifestyle, anthropometric status and mental health in italian elderly people. J Nutr Health Aging 2007; 11:165-74. [PMID: 17435958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE The objective of this paper is to provide descriptive information on anthropometric status, pathological conditions, cognitive impairment and lifestyle in apparently healthy elderly Italian people. DESIGN, SETTING AND SUBJECTS In order to recruit the volunteers for the ZENITH study, 359 Italian participants (167 men and 192 women), aged between 70 and 85 years, free living in Rome, were selected. Volunteers underwent a full clinical examination, anthropometric measurements (height, weight), a lifestyle questionnaire and mental health assessment (cognitive impairment and depression). RESULTS The prevalence of overweight and obesity was high (57% and 22% in men; 43% and 27% in women). Obesity was associated with low socio-economic profile in about 40% of participants. Although the sample was selected by family doctors and was apparently healthy, after medical screening the presence of several pathologies, particularly diabetes in 21% of participants was observed. There was a low prevalence of cognitive impairment in 4% of men and 7% of women and possible depression in 9% of men and 19% of women. The lifestyle questionnaire showed that most of their time was spent in light activities such as reading, watching TV or playing cards and significant differences between sex and BMI categories were observed (P=0.000). CONCLUSION The results confirm the increasingly sedentary lifestyle of modern populations and demonstrate the need for sensitive and individualised strategies to design appropriate health promotion and disease prevention programs for older adults.
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Affiliation(s)
- F Intorre
- National Institute for Research on Food and Nutrition, Human Nutrition Unit, Rome, Italy.
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Polito A, Aboab J, Annane D. The hypothalamic pituitary adrenal axis in sepsis. Novartis Found Symp 2007; 280:182-99; discussion 199-203. [PMID: 17380795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
At the beginning of the 20th century, observations of apoplectic adrenal glands in fatal meningococcemia underlined their key role in host defence against infection. Thirty years later, cortisone was discovered and rapidly proven to have numerous and diversified physiological functions in the host response to stress. Corticosteroids were introduced in the treatment of severe infection as early as in the 1940s. Several 'negative' randomized controlled trials of high-dose of glucocorticoids given for a short period of time in the early course of severe sepsis or acute respiratory distress syndrome raised serious doubts as to the benefit of this treatment. Recently, a link between septic shock and adrenal insufficiency, or systemic inflammation-induced glucocorticoid receptor resistance has been established. This finding prompted renewed interest in a replacement therapy with low doses of corticosteroids during longer periods. We will review the key role of the hypothalamic-pituitary-adrenal axis in the host response to stress.
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Affiliation(s)
- Andrea Polito
- Hospital Raymond Poincaré (AP-HP), University of Versailles SQY, 104 Boulevard Raymond Poincaré, Garches 92380
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