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Lee B, Park J, Voshall A, Maury E, Kang Y, Kim YJ, Lee JY, Shim HR, Kim HJ, Lee JW, Jung MH, Kim SC, Chu HBK, Kim DW, Kim M, Choi EJ, Hwang OK, Lee HW, Ha K, Choi JK, Kim Y, Choi Y, Park WY, Lee EA. Pan-cancer analysis reveals multifaceted roles of retrotransposon-fusion RNAs. bioRxiv 2023:2023.10.16.562422. [PMID: 37905014 PMCID: PMC10614793 DOI: 10.1101/2023.10.16.562422] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Transposon-derived transcripts are abundant in RNA sequences, yet their landscape and function, especially for fusion transcripts derived from unannotated or somatically acquired transposons, remains underexplored. Here, we developed a new bioinformatic tool to detect transposon-fusion transcripts in RNA-sequencing data and performed a pan-cancer analysis of 10,257 cancer samples across 34 cancer types as well as 3,088 normal tissue samples. We identified 52,277 cancer-specific fusions with ~30 events per cancer and hotspot loci within transposons vulnerable to fusion formation. Exonization of intronic transposons was the most prevalent genic fusions, while somatic L1 insertions constituted a small fraction of cancer-specific fusions. Source L1s and HERVs, but not Alus showed decreased DNA methylation in cancer upon fusion formation. Overall cancer-specific L1 fusions were enriched in tumor suppressors while Alu fusions were enriched in oncogenes, including recurrent Alu fusions in EZH2 predictive of patient survival. We also demonstrated that transposon-derived peptides triggered CD8+ T-cell activation to the extent comparable to EBV viruses. Our findings reveal distinct epigenetic and tumorigenic mechanisms underlying transposon fusions across different families and highlight transposons as novel therapeutic targets and the source of potent neoantigens.
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Affiliation(s)
- Boram Lee
- Samsung Genome Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junseok Park
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Adam Voshall
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Eduardo Maury
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Bioinformatics and Integrative Genomics Program; Harvard/MIT MD-PhD Program, Harvard Medical School, Boston, MA, USA
| | - Yeeok Kang
- Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea
| | - Yoen Jeong Kim
- Samsung Genome Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin-Young Lee
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Hye-Ran Shim
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Hyo-Ju Kim
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Jung-Woo Lee
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Min-Hyeok Jung
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Si-Cho Kim
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Hoang Bao Khanh Chu
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Da-Won Kim
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Minjeong Kim
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Eun-Ji Choi
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Ok Kyung Hwang
- New Drug Development Center, KBiohealth, Cheongju-Si, Chungbuk, Republic of Korea
| | - Ho Won Lee
- New Drug Development Center, KBiohealth, Cheongju-Si, Chungbuk, Republic of Korea
| | - Kyungsoo Ha
- New Drug Development Center, KBiohealth, Cheongju-Si, Chungbuk, Republic of Korea
| | - Jung Kyoon Choi
- Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea
| | - Yongjoon Kim
- Cancer Genome Research Center (CGRC), Yonsei University, Seoul, Republic of Korea
| | - Yoonjoo Choi
- Combinatorial Tumor Immunotherapy MRC, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Eunjung Alice Lee
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Shin T, Song JH, Kosicki M, Kenny C, Beck SG, Kelley L, Qian X, Bonacina J, Papandile F, Antony I, Gonzalez D, Scotellaro J, Bushinsky EM, Andersen RE, Maury E, Pennacchio LA, Doan RN, Walsh CA. Rare variation in noncoding regions with evolutionary signatures contributes to autism spectrum disorder risk. medRxiv 2023:2023.09.19.23295780. [PMID: 37790480 PMCID: PMC10543033 DOI: 10.1101/2023.09.19.23295780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Little is known about the role of noncoding regions in the etiology of autism spectrum disorder (ASD). We examined three classes of noncoding regions: Human Accelerated Regions (HARs), which show signatures of positive selection in humans; experimentally validated neural Vista Enhancers (VEs); and conserved regions predicted to act as neural enhancers (CNEs). Targeted and whole genome analysis of >16,600 samples and >4900 ASD probands revealed that likely recessive, rare, inherited variants in HARs, VEs, and CNEs substantially contribute to ASD risk in probands whose parents share ancestry, which enriches for recessive contributions, but modestly, if at all, in simplex family structures. We identified multiple patient variants in HARs near IL1RAPL1 and in a VE near SIM1 and showed that they change enhancer activity. Our results implicate both human-evolved and evolutionarily conserved noncoding regions in ASD risk and suggest potential mechanisms of how changes in regulatory regions can modulate social behavior.
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Affiliation(s)
- Taehwan Shin
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Janet H.T. Song
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Michael Kosicki
- Environmental Genomics & Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Connor Kenny
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Samantha G. Beck
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Lily Kelley
- Division of Genetics and Genomics, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School; Allen Discovery Center for Human Brain Evolution, Boston, MA, 02115, USA
| | - Xuyu Qian
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Julieta Bonacina
- Division of Genetics and Genomics, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School; Allen Discovery Center for Human Brain Evolution, Boston, MA, 02115, USA
| | - Frances Papandile
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Irene Antony
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Dilenny Gonzalez
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Julia Scotellaro
- Division of Genetics and Genomics, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School; Allen Discovery Center for Human Brain Evolution, Boston, MA, 02115, USA
| | - Evan M. Bushinsky
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Rebecca E. Andersen
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Eduardo Maury
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Len A. Pennacchio
- Environmental Genomics & Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Ryan N. Doan
- Division of Genetics and Genomics, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School; Allen Discovery Center for Human Brain Evolution, Boston, MA, 02115, USA
| | - Christopher A. Walsh
- Division of Genetics and Genomics, Boston Children’s Hospital; Departments of Pediatrics and Neurology, Harvard Medical School; Allen Discovery Center for Human Brain Evolution; Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, 02115, USA
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Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
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Urbina T, Chauvet M, Lacombe K, Maury E. COVID-19-associated Multi-Inflammatory Syndrome in Adults (MIS-A): look into the eyes! Intensive Care Med 2022; 48:947-948. [PMID: 35286406 PMCID: PMC8919687 DOI: 10.1007/s00134-022-06667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/05/2022]
Affiliation(s)
- T Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75012, Paris, France.
| | - M Chauvet
- Service de Cardiologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - K Lacombe
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - E Maury
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75012, Paris, France.,Sorbonne Université, Paris, France
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Vigneron C, Baudel J, Pras-Landre V, Joffre J, Marjot F, Ait-Oufella H, Bige N, Maury E, Guidet B, Fain O, Mekinian A. Transfusion-related acute lung injury (TRALI) après immunoglobulines intraveineuses : étude multicentrique et revue de la littérature. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.013] [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: 11/17/2022]
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Tankovic J, Dahoumane R, Brissot E, Veziris N, Guidet B, Ait Oufella H, Maury E, Baudel J. Identification et antibiogramme rapides par technique Accelerate pour les bactériémies des patients d’hématologie et de réanimation médicale. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.052] [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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Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, Levraut J, Maury E, Oberlin M, Terzi N, Viglino D, Yordanov Y, Claret PG, Bigé N. Diagnostic et Prise en Charge de l’Acidose Métabolique Recommandations formalisées d’experts communes Société de réanimation de langue française (SRLF) – Société française de médecine d’urgence (SFMU). Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
L’acidose métabolique est un trouble fréquemment rencontré en médecine d’urgence et en médecine intensive réanimation. La littérature s’étant enrichie de nouvelles données concernant la prise en charge de l’acidose métabolique, la Société de Réanimation de Langue Française (SRLF) et la Société Française de Médecine d’Urgence (SFMU) ont élaboré des recommandations formalisées d’experts selon la méthodologie GRADE. Les champs de la stratégie diagnostique, de l’orientation et de la prise en charge thérapeutique ont été traités et vingt-neuf recommandations ont été formulées : quatre recommandations fortes (Grade 1), dix recommandations faibles (Grade 2) et quinze avis d’experts. Toutes ont obtenu un accord fort. L’application des méthodes d’Henderson-Hasselbalch et de Stewart pour le diagnostic du mécanisme de l’acidose métabolique est discutée et un algorithme diagnostique est proposé. L’utilisation de la cétonémie et des lactatémies veineuse et capillaire est également traitée. L’intérêt du pH, de la lactatémie et de sa cinétique pour l’orientation des patients en pré-hospitalier et aux urgences est envisagé. Enfin, les modalités de l’insulinothérapie au cours de l’acidocétose diabétique, les indications de la perfusion de bicarbonate de sodium et de l’épuration extra-rénale ainsi que les modalités de la ventilation mécanique au cours des acidoses métaboliques sévères sont traitées dans la prise en charge thérapeutique.
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Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, Pirracchio R, Aissaoui N, Karam N, Deye N, Sideris G, Beganton F, Jost D, Cariou A, Jouven X, Adnet F, Agostinucci JM, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Benhamou D, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Crahes M, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Dhonneur G, Diehl JL, Dinanian S, Domanski L, Dreyfuss D, Duboc D, Dubois-Rande JL, Dumas F, Empana JP, Extramiana F, Fartoukh M, Fieux F, Gabbas M, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Hidden Lucet F, Jabre P, Jacob L, Joseph L, Jost D, Jouven X, Karam N, Kassim H, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt CE, Maltret A, Mansencal N, Mansouri N, Marijon E, Marty J, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira JP, Monnet X, Narayanan K, Ngoyi N, Perier MC, Piot O, Pirracchio R, Plaisance P, Plu I, Raux M, Revaux F, Ricard JD, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharifzadehgan A, Sideris G, Spaulding C, Teboul JL, Timsit JF, Tourtier JP, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J 2019; 41:1961-1971. [DOI: 10.1093/eurheartj/ehz753] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [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] [Received: 12/28/2018] [Revised: 03/26/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.
Methods and results
We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002).
Conclusions
In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.
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Affiliation(s)
- Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Pierre Carli
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Romain Pirracchio
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Surgical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nadia Aissaoui
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicolas Deye
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Medical ICU, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Georgios Sideris
- Cardiology Department, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Brigade de Sapeurs Pompiers de Paris (BSPP), 1 Place Jules Renard, 75017 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical Intensive Care Unit, Cochin Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
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Augy JL, Aissaoui N, Richard C, Maury E, Fartoukh M, Mekontso-Dessap A, Paulet R, Anguel N, Blayau C, Cohen Y, Chiche JD, Gaudry S, Voicu S, Demoule A, Combes A, Megarbane B, Charpentier E, Haghighat S, Panczer M, Diehl JL. A 2-year multicenter, observational, prospective, cohort study on extracorporeal CO 2 removal in a large metropolis area. J Intensive Care 2019; 7:45. [PMID: 31452899 PMCID: PMC6701003 DOI: 10.1186/s40560-019-0399-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Extracorporeal carbon dioxide removal (ECCO2R) is a promising technique for the management of acute respiratory failure, but with a limited level of evidence to support its use outside clinical trials and/or data collection initiatives. We report a collaborative initiative in a large metropolis. Methods To assess on a structural basis the rate of utilization as well as efficacy and safety parameters of 2 ECCO2R devices in 10 intensive care units (ICU) during a 2-year period. Results Seventy patients were recruited in 10 voluntary and specifically trained centers. The median utilization rate was 0.19 patient/month/center (min 0.04; max 1.20). ECCO2R was started under invasive mechanical ventilation (IMV) in 59 patients and non-invasive ventilation in 11 patients. The Hemolung Respiratory Assist System (Alung) was used in 53 patients and the iLA Activve iLA kit (Xenios Novalung) in 17 patients. Main indications were ultraprotective ventilation for ARDS patients (n = 24), shortening the duration of IMV in COPD patients (n = 21), preventing intubation in COPD patients (n = 9), and controlling hypercapnia and dynamic hyperinflation in mechanically ventilated patients with severe acute asthma (n = 6). A reduction in median VT was observed in ARDS patients from 5.9 to 4.1 ml/kg (p <0.001). A reduction in PaCO2 values was observed in AE-COPD patients from 67.5 to 51 mmHg (p< 0.001). Median duration of ECCO2R was 5 days (IQR 3–8). Reasons for ECCO2R discontinuation were improvement (n = 33), ECCO2R-related complications (n = 18), limitation of life-sustaining therapies or measures decision (n = 10), and death (n = 9). Main adverse events were hemolysis (n = 21), bleeding (n = 17), and lung membrane clotting (n = 11), with different profiles between the devices. Thirty-five deaths occurred during the ICU stay, 3 of which being ECCO2R-related. Conclusions Based on a registry, we report a low rate of ECCO2R device utilization, mainly in severe COPD and ARDS patients. Physiological efficacy was confirmed in these two populations. We confirmed safety concerns such as hemolysis, bleeding, and thrombosis, with different profiles between the devices. Such results could help to design future studies aiming to enhance safety, to demonstrate a still-lacking strong clinical benefit of ECCO2R, and to guide the choice between different devices. Trial registration ClinicalTrials.gov: Identifier: NCT02965079 retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02965079
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Affiliation(s)
- J L Augy
- 1Service de Médecine Intensive Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - N Aissaoui
- 1Service de Médecine Intensive Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - C Richard
- 2Service de Médecine Intensive Réanimation, AP-HP, Hôpital de Bicètre, Le Kremlin Bicètre, France
| | - E Maury
- 3Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - M Fartoukh
- Service de Réanimation Polyvalente, AP-HP, Hôpital Tenon, Paris, France
| | - A Mekontso-Dessap
- 5Service de Médecine Intensive Réanimation, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - R Paulet
- Service de Réanimation Polyvalente, Centre Hospitalier de Longjumeau, Longjumeau, France
| | - N Anguel
- 2Service de Médecine Intensive Réanimation, AP-HP, Hôpital de Bicètre, Le Kremlin Bicètre, France
| | - C Blayau
- Service de Réanimation Polyvalente, AP-HP, Hôpital Tenon, Paris, France
| | - Y Cohen
- 7Service de Réanimation Polyvalente, AP-HP, Hôpital Avicenne, Bobigny, France
| | - J D Chiche
- 8Service de Médecine Intensive Réanimation, AP-HP, Hôpital Cochin, Paris, France
| | - S Gaudry
- 9Service de Réanimation Polyvalente, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - S Voicu
- 10Service de Médecine Intensive Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - A Demoule
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - A Combes
- 12Service de Médecine Intensive Réanimation, AP-HP, Hôpital Pitié-Salpétrière, Institut de Cardiologie, Paris, France
| | - B Megarbane
- 10Service de Médecine Intensive Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - E Charpentier
- 13AP-HP, Office du Transfert de Technologie et des Partenariats Industriels, Paris, France
| | - S Haghighat
- 14AP-HP, Agence Générale des Equipements et des Produits de Santé, Paris, France
| | - M Panczer
- 14AP-HP, Agence Générale des Equipements et des Produits de Santé, Paris, France
| | - J L Diehl
- 1Service de Médecine Intensive Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,15Faculty of Pharmacy, INSERM UMR-S1140, Paris Descartes University, Paris, France
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10
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Mayo PH, Copetti R, Feller-Kopman D, Mathis G, Maury E, Mongodi S, Mojoli F, Volpicelli G, Zanobetti M. Thoracic ultrasonography: a narrative review. Intensive Care Med 2019; 45:1200-1211. [PMID: 31418060 DOI: 10.1007/s00134-019-05725-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/30/2019] [Indexed: 01/18/2023]
Abstract
This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pulmonary embolism, pneumonia, interstitial processes, and the patient on mechanical ventilatory support. Mastery of lung and pleural ultrasonography allows the intensivist to rapidly diagnose and guide the management of a wide variety of disease processes that are common features of critical illness. Its ease of use, rapidity, repeatability, and reliability make thoracic ultrasonography the "go to" modality for imaging the lung and pleura in an efficient, cost effective, and safe manner, such that it can largely replace chest imaging in critical care practice. It is best used in conjunction with other components of critical care ultrasonography to yield a comprehensive evaluation of the critically ill patient at point of care.
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Affiliation(s)
- P H Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, Hempstead, NY, 11549, USA.
| | - R Copetti
- Department of Emergency Medicine, Latisana Hospital, 33053, Latisana, Italy
| | - D Feller-Kopman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7-125, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - G Mathis
- 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830, Rankweil, Austria
| | - E Maury
- 7 Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Saint-Antoine, Paris, France
- 8 INSERM U 1136, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, 75012, Paris, France
- 9 Sorbonne University, UPMC Univ Paris 06, Paris, France
| | - S Mongodi
- Anesthesia and Intensive Care, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - F Mojoli
- Anesthesia and Intensive Care, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, 10043, Turin, Italy
| | - M Zanobetti
- Emergency Department, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
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11
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Maury E. Georges Offenstadt (1944–2019) Un humaniste sans préjugé au service de la réanimation. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0104] [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: 11/20/2022]
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12
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Coppo P, Maury E, Azoulay E, Augusto J, Dossier A, Halimi J, Barbet C, Seguin A, Hamidou M, Malot S, Veyradier A, Poullin P. PTT acquis : Premières données de vie réelle du traitement par caplacizumab de la cohorte française suivie par le centre national de référence (CNR-MAT). Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.053] [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: 11/24/2022]
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13
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Hariri G, Joffre J, Dumas G, Lavillegrand JR, Bigé N, Baudel JL, Guidet B, Maury E, Ait-Oufella H. Exploration de la perfusion tissulaire microcirculatoire au cours du choc septique. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2018-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Au cours des infections graves, les travaux chez l’animal et chez l’homme ont mis en évidence une altération de la perfusion microcirculatoire à l’origine des défaillances viscérales et potentiellement du décès. La sévérité des anomalies microcirculatoires ainsi que leur persistance sont des facteurs prédictifs de mortalité indépendamment du débit cardiaque ou de la pression artérielle. Il est donc indispensable de développer des outils permettant d’évaluer la perfusion microcirculatoire au lit du malade. De nombreux travaux au cours du sepsis suggèrent que l’analyse de la perfusion cutanée au travers de sa température (et/ou du gradient), du temps de recoloration cutané, de l’étendue des marbrures et de l’indice de perfusion périphérique constitue un outil simple qui permet au réanimateur une évaluation rapide des anomalies microcirculatoires.
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14
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Placais L, Mekinian A, Bornes M, Poujol-Robert A, Bige N, Adedjouma A, Maury E, Fain O. Adult's onset Still disease occurring during pregnancy: Case report and literature review. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.190] [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: 11/16/2022]
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15
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Quintard H, l’Her E, Pottecher J, Adnet F, Constantin JM, De Jong A, Diemunsch P, Fesseau R, Freynet A, Girault C, Guitton C, Hamonic Y, Maury E, Mekontso-Dessap A, Michel F, Nolent P, Perbet S, Prat G, Roquilly A, Tazarourte K, Terzi N, Thille A, Alves M, Gayat E, Donetti L. Intubation and extubation of the ICU patient. Anaesth Crit Care Pain Med 2017; 36:327-341. [DOI: 10.1016/j.accpm.2017.09.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Nicholls SB, DeVos SL, Commins C, Nobuhara C, Bennett RE, Corjuc DL, Maury E, Eftekharzadeh B, Akingbade O, Fan Z, Roe AD, Takeda S, Wegmann S, Hyman BT. Characterization of TauC3 antibody and demonstration of its potential to block tau propagation. PLoS One 2017; 12:e0177914. [PMID: 28531180 PMCID: PMC5439699 DOI: 10.1371/journal.pone.0177914] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/05/2017] [Indexed: 11/21/2022] Open
Abstract
The spread of neurofibrillary tangle (NFT) pathology through the human brain is a hallmark of Alzheimer’s disease (AD), which is thought to be caused by the propagation of “seeding” competent soluble misfolded tau. “TauC3”, a C-terminally truncated form of tau that is generated by caspase-3 cleavage at D421, has previously been observed in NFTs and has been implicated in tau toxicity. Here we show that TauC3 is found in the seeding competent high molecular weight (HMW) protein fraction of human AD brain. Using a specific TauC3 antibody, we were able to substantially block the HMW tau seeding activity of human AD brain extracts in an in vitro tau seeding FRET assay. We propose that TauC3 could contribute to the templated tau misfolding that leads to NFT spread in AD brains.
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Affiliation(s)
- Samantha B. Nicholls
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Sarah L. DeVos
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Caitlin Commins
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Chloe Nobuhara
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Rachel E. Bennett
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Diana L. Corjuc
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Eduardo Maury
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Bahareh Eftekharzadeh
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Ololade Akingbade
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Zhanyun Fan
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Allyson D. Roe
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Shuko Takeda
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Susanne Wegmann
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
| | - Bradley T. Hyman
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts, United States of America
- * E-mail:
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17
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Rajaobelina K, Farges B, Nov S, Maury E, Cephise-Velayoudom FL, Gin H, Helmer C, Rigalleau V. Skin autofluorescence and peripheral neuropathy four years later in type 1 diabetes. Diabetes Metab Res Rev 2017; 33. [PMID: 27235334 DOI: 10.1002/dmrr.2832] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Received: 01/15/2016] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Advanced glycation end products (AGEs) are involved in diabetes complications. We aimed to investigate whether the accumulation of AGEs measured by skin autofluorescence (sAF) was associated with signs of diabetic peripheral neuropathy and to sensitivity, pain, motor and autonomic function 4 years later in patients with type 1 diabetes. METHODS At baseline, 188 patients (age 51 years, diabetes duration 22 years) underwent skin autofluorescence measurement using the AGE Reader. Four years later, signs of diabetic peripheral neuropathy were defined as the presence of neuropathic pain and/or feet sensory loss or foot ulceration. Neurological tests were systematically performed: vibration perception threshold by neuroesthesiometry, neuropathic pain by the Douleur Neuropathique en 4 Questions score, muscle strength by dynamometry and electrochemical skin conductance. Multivariate analyses were adjusted by age, sex, height, body mass index, tobacco, HbA1c , diabetes duration, estimated glomerular filtration rate and albumin excretion rate. RESULTS At the 4-year follow-up, 13.8% of patients had signs of diabetic peripheral neuropathy. The baseline sAF was higher in those with signs of diabetic peripheral neuropathy (2.5 ± 0.7 vs 2.1 ± 0.5 arbitrary units (AU), p < 0.0005). In the multivariate analysis, a 1 SD higher skin autofluorescence at baseline was associated with an increased risk of signs of neuropathy (OR = 2.68, p = 0.01). All of the neurological tests were significantly altered in the highest quartile of the baseline sAF (>2.4 AU) compared with the lowest quartiles after multivariate adjustment. CONCLUSION This non-invasive measurement of skin autofluorescence may have a value for diabetic peripheral neuropathy in type 1 diabetes and a potential clinical utility for detection of diabetic peripheral neuropathy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- K Rajaobelina
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - B Farges
- Nutrition-Diabetology Department, Haut-Lévêque Hospital, Pessac, France
| | - S Nov
- Nutrition-Diabetology Department, Haut-Lévêque Hospital, Pessac, France
| | - E Maury
- Nutrition-Diabetology Department, Haut-Lévêque Hospital, Pessac, France
| | | | - H Gin
- Univ. Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- Nutrition-Diabetology Department, Haut-Lévêque Hospital, Pessac, France
| | - C Helmer
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - V Rigalleau
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- Nutrition-Diabetology Department, Haut-Lévêque Hospital, Pessac, France
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18
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Laurent C, Nguyen Y, Bige N, Maury E, Dubee V. Atteinte médullaire de la tuberculose neuroméningée : à propos de 2 cas. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.188] [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: 10/20/2022]
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19
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Urbina T, Adedjouma A, Maury E, Boffa J, Coppo P, Ronco P, Mekinian A, Fain O. Microangiopathie thrombotique (MAT) hématologique dans le cadre d’une vascularite associée aux ANCA. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.066] [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: 11/26/2022]
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20
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Ichou L, Carbonell N, Rautou PE, Laurans L, Bourcier S, Pichereau C, Baudel JL, Nousbaum JB, Renou C, Anty R, Tankovic J, Maury E, Guidet B, Landraud L, Ait-Oufella H. Ascitic fluid TREM-1 for the diagnosis of spontaneous bacterial peritonitis. Gut 2016; 65:536-8. [PMID: 26141143 DOI: 10.1136/gutjnl-2015-310160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 12/11/2022]
Affiliation(s)
- L Ichou
- Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - N Carbonell
- Service d'hépatologie, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - P E Rautou
- DHU UNITY, Service d'hépatologie, Hôpital Beaujon, Clichy, France Inserm U970, Paris Research Cardiovascular Center, Paris, France
| | - L Laurans
- Inserm U970, Paris Research Cardiovascular Center, Paris, France
| | - S Bourcier
- Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France Université Pierre et Marie Curie-Paris 6, Paris, France
| | - C Pichereau
- Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France Université Pierre et Marie Curie-Paris 6, Paris, France
| | - J L Baudel
- Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - J B Nousbaum
- Service d'Hépato-Gastro-Entérologie, CHU Brest, Brest, France
| | - C Renou
- Unité d'Hospitalisation de Jour pluridisciplinaire, CHR Hyeres, Hyeres, France
| | - R Anty
- Service d'Hépato-Gastro-Entérologie, CHU Nice Sophia Antipolis, Nice, France
| | - J Tankovic
- Service de Bactériologie, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - E Maury
- Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France Université Pierre et Marie Curie-Paris 6, Paris, France
| | - B Guidet
- Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France Université Pierre et Marie Curie-Paris 6, Paris, France
| | - L Landraud
- Service de Bactériologie CHU Nice Sophia Antipolis, France
| | - H Ait-Oufella
- Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France Inserm U970, Paris Research Cardiovascular Center, Paris, France Université Pierre et Marie Curie-Paris 6, Paris, France
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Vigneron C, Baudel J, Mekinian A, Gatfosse M, Guidet B, Maury E, Fain O. Le TRALI, une complication rare et sévère des immunoglobulines intraveineuses. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.209] [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: 11/25/2022]
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Maury E, Savel J, Grouthier V, Rajaobelina K, Corvo L, Lorrain S, Gonzalez C, Gin H, Barberger-Gateau P, Rigalleau V. Is skin autofluorescence a marker of metabolic memory in pregnant women with diabetes? Diabet Med 2015; 32:1575-9. [PMID: 25981634 DOI: 10.1111/dme.12803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Accepted: 05/13/2015] [Indexed: 12/30/2022]
Abstract
AIM To determine whether skin autofluorescence can help to detect those who have previously had abnormal glucose levels among women referred for diabetes during pregnancy. METHODS Using an advanced glycation end product reader (AGE Reader(tm) (;) DiagnOptics BV, Groningen, the Netherlands), we measured forearm skin autofluorescence at 24-30 weeks of gestation in all women who were referred to our Nutrition Diabetology unit for diabetes during pregnancy. RESULTS The study included 230 women (200 with gestational diabetes and 30 with pre-gestational diabetes, of whom 21 had Type 1 and nine had Type 2 diabetes) and a reference group of 22 normoglycaemic non-pregnant women. Skin autofluorescence was significantly higher in women with pre-gestational diabetes (1.97 ± 0.44 arbitary units) compared with gestational diabetes (1.77 ± 0.32 arbitary units; P = 0.003) and lower in the reference group (1.60 ± 0.32 arbitary units; P = 0.009 vs all pregnant women). Among women with gestational diabetes, 71 had a history of hyperglycaemia (i.e. gestational diabetes or macrosomia in a previous pregnancy or discovery of diabetes before 24th gestational week in the present pregnancy). These women had higher levels of skin autofluorescence (1.83 ± 0.35 arbitary units) than women with gestational diabetes without previous history of hyperglycaemia (1.73 ± 0.30 arbitary units; P = 0.04, non-significant, adjusted for age). Skin autofluorescence increased with the number of criteria present for previous hyperglycaemia (P for trend = 0.008) and was significantly associated with having two or three criteria for hyperglycaemia after adjusting for age (P = 0.02). CONCLUSIONS Skin autofluorescence could reflect previous long-term hyperglycaemia in pregnant women, and could therefore be a marker of metabolic memory.
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MESH Headings
- Adult
- Biomarkers/metabolism
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/metabolism
- Diabetes, Gestational/blood
- Diabetes, Gestational/epidemiology
- Diabetes, Gestational/metabolism
- Female
- Fluorescence
- Forearm
- France/epidemiology
- Fructosamine/blood
- Glycated Hemoglobin/analysis
- Glycation End Products, Advanced/metabolism
- Humans
- Pregnancy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Pregnancy in Diabetics/blood
- Pregnancy in Diabetics/metabolism
- Recurrence
- Risk
- Skin/metabolism
- Spectrometry, Fluorescence
- Up-Regulation
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Affiliation(s)
- E Maury
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - J Savel
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - V Grouthier
- Department of Gynaecology, CHU Bordeau, Pellegrin Hospital, Bordeaux, France
| | - K Rajaobelina
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - L Corvo
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - S Lorrain
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - C Gonzalez
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - H Gin
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - P Barberger-Gateau
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
| | - V Rigalleau
- Nutrition Diabetology Unit, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France
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Hauguel M, Boelle P, Pichereau C, Bourcier S, Bigé N, Baudel JL, Maury E, Guidet B, Ait-Oufella H. Severe Extra-Cerebral Anticoagulant-Related Bleeding in Intensive Care Unit: A Retrospective Study From 2000 to 2013. Medicine (Baltimore) 2015; 94:e2161. [PMID: 26632750 PMCID: PMC5059019 DOI: 10.1097/md.0000000000002161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Bleeding is the most frequent complication of anticoagulant therapy, responsible for a number of hospitalizations or deaths. However, studies describing the management and prognosis factors of extra-cerebral anticoagulant-related bleedings in intensive care unit (ICU) are lacking.Retrospective observational study in an 18-bed ICU in a tertiary teaching hospital. From January 2000 to December 2013, all consecutive patients, older than 18 years, admitted for severe anticoagulant-related bleeding (SAB) except intracerebral site were included.A total of 100 patients were included, the mean age was 77 ± 11 years and 62% were women. SAB incidence in ICU doubled over 10 years (P = 0.03). In ICU, the average length of stay was 5 ± 6 days and mortality was 30%. Nonsurviving patients had a higher SAPS II (78 ± 24 vs 53 ± 24, P < 0.0001), a higher SOFA (9.0 ± 3.6 vs 4.7 ± 3.4, P < 0.0001) and received more frequently support therapy such as mechanical ventilation (87% vs 16%, P < 0.0001) and vasopressors (90% vs 27%, P < 0.0001). The volume of blood-derived products transfused was more important in nonsurvivors mainly during the first 24 hours of resuscitation. Rapid anticoagulant reversal therapy was associated with better prognosis (ICU survivors 66% vs 39%, Fisher test P = 0.04). Anterior abdominal wall was identified as a frequent site of bleeding (22%) due to epigastric artery injury during subcutaneous injection of heparin and was associated with a large mortality (55%).Extra-cerebral SAB is a life-threatening complication that requires rapid resuscitation and anticoagulant reversal therapy. Injection of heparin should be done carefully in the subcutaneous tissue thereby avoiding artery injury.
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Affiliation(s)
- M Hauguel
- From the AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale (MH, CP, SB, NB, JB, EM, BG, HA-O), Inserm U970, Paris Research Cardiovascular Center (HA-O), AP-HP, Hôpital Saint-Antoine, Service de Santé Publique (PB), Université Pierre et Marie Curie-Paris 6 (PB, CP, EM, BG, HA-O), and UMRS_1136, Paris, France (PB, EM, BG)
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Maury E, Tankovic J, Pichereau C, Varon E, Guidet B. Immunochromatographic test of pneumococcal antigen performed on cerebrospinal fluid for pneumococcal pneumoniae. Med Mal Infect 2015; 45:237-8. [PMID: 25959125 DOI: 10.1016/j.medmal.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/13/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- E Maury
- Service de réanimation médicale, medical intensive care unit, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris, France; Université Pierre-et-Marie-Curie-Paris 6, 75006 Paris, France; UMR S707, 75012 Paris, France.
| | - J Tankovic
- Department of microbiology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 75012 Paris, France
| | - C Pichereau
- Service de réanimation médicale, medical intensive care unit, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris, France; Université Pierre-et-Marie-Curie-Paris 6, 75006 Paris, France
| | - E Varon
- Centre de référence des pneumocoques, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - B Guidet
- Service de réanimation médicale, medical intensive care unit, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris, France; Université Pierre-et-Marie-Curie-Paris 6, 75006 Paris, France; UMR S707, 75012 Paris, France
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Rigalleau V, Cougnard-Gregoire A, Nov S, Gonzalez C, Maury E, Lorrain S, Gin H, Barberger-Gateau P. Association of advanced glycation end products and chronic kidney disease with macroangiopathy in type 2 diabetes. J Diabetes Complications 2015; 29:270-4. [PMID: 25468311 DOI: 10.1016/j.jdiacomp.2014.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 07/01/2014] [Revised: 10/21/2014] [Accepted: 10/23/2014] [Indexed: 11/16/2022]
Abstract
AIMS Accumulation of advanced glycation end-products (AGEs), may explain the major contribution of chronic kidney disease (CKD) to cardiovascular events in patients with type 2 diabetes (T2D) related to their impaired renal function. The aim of this study was to analyze the factors associated with AGE assessed by skin autofluorescence and their association with macroangiopathy in T2D. METHODS We measured skin autofluorescence in patients hospitalized for T2D. Glomerular filtration rates were estimated (eGFR) by the EPI-CKD formula. Associations between skin autofluorescence, renal function and macroangiopathy were explored by multivariate analyses adjusting for diabetes duration and control. RESULTS The 418 patients had T2D since 13.3 (SD 9.8) years on average, high mean HbA1C: 8.9%, (SD 1.8), (74 mmol/mol, (SD 15)) and often renal complications (49.4% with CKD). Their mean skin autofluorescence was 2.53 (SD 0.62) A.U. In multivariate linear regression, skin autofluorescence was significantly associated with age (+0.20 for ten more years, p<0.0001), renal insufficiency (-0.07 for less 10 mL/min/1.73 m² eGFR, p<0.0001) and smoking (+0.21, p=0.0004). Autofluorescence (p=0.01), but not CKD, was associated with macroangiopathy independent of diabetes duration and control. CONCLUSIONS Accumulation of AGEs is independently associated with renal insufficiency and macroangiopathy in patients with T2D.
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Affiliation(s)
- V Rigalleau
- Nutrition-Diabétologie, Bordeaux Hospital, F-33600 Pessac, France; Univ. Bordeaux, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.
| | - A Cougnard-Gregoire
- Univ. Bordeaux, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
| | - S Nov
- Univ. Bordeaux, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
| | - C Gonzalez
- Nutrition-Diabétologie, Bordeaux Hospital, F-33600 Pessac, France; Univ. Bordeaux, F-33000 Bordeaux, France
| | - E Maury
- Nutrition-Diabétologie, Bordeaux Hospital, F-33600 Pessac, France; Univ. Bordeaux, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
| | - S Lorrain
- Univ. Bordeaux, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
| | - H Gin
- Nutrition-Diabétologie, Bordeaux Hospital, F-33600 Pessac, France; Univ. Bordeaux, F-33000 Bordeaux, France
| | - P Barberger-Gateau
- Univ. Bordeaux, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
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Benhamou Y, Boelle PY, Baudin B, Ederhy S, Gras J, Galicier L, Azoulay E, Provôt F, Maury E, Pène F, Mira JP, Wynckel A, Presne C, Poullin P, Halimi JM, Delmas Y, Kanouni T, Seguin A, Mousson C, Servais A, Bordessoule D, Perez P, Hamidou M, Cohen A, Veyradier A, Coppo P. Cardiac troponin-I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center. J Thromb Haemost 2015; 13:293-302. [PMID: 25403270 DOI: 10.1111/jth.12790] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Indexed: 08/31/2023]
Abstract
BACKGROUND Cardiac involvement is a major cause of mortality in patients with thrombotic thrombocytopenic purpura (TTP). However, diagnosis remains underestimated and delayed, owing to subclinical injuries. Cardiac troponin-I measurement (cTnI) on admission could improve the early diagnosis of cardiac involvement and have prognostic value. OBJECTIVES To assess the predictive value of cTnI in patients with TTP for death or refractoriness. PATIENTS/METHODS The study involved a prospective cohort of adult TTP patients with acquired severe ADAMTS-13 deficiency (< 10%) and included in the registry of the French Reference Center for Thrombotic Microangiopathies. Centralized cTnI measurements were performed on frozen serum on admission. RESULTS Between January 2003 and December 2011, 133 patients with TTP (mean age, 48 ± 17 years) had available cTnI measurements on admission. Thirty-two patients (24%) had clinical and/or electrocardiogram features. Nineteen (14.3%) had cardiac symptoms, mainly congestive heart failure and myocardial infarction. Electrocardiogram changes, mainly repolarization disorders, were present in 13 cases. An increased cTnI level (> 0.1 μg L(-1) ) was present in 78 patients (59%), of whom 46 (59%) had no clinical cardiac involvement. The main outcomes were death (25%) and refractoriness (17%). Age (P = 0.02) and cTnI level (P = 0.002) showed the greatest impact on survival. A cTnI level of > 0.25 μg L(-1) was the only independent factor in predicting death (odds ratio [OR] 2.87; 95% confidence interval [CI] 1.13-7.22; P = 0.024) and/or refractoriness (OR 3.03; 95% CI 1.27-7.3; P = 0.01). CONCLUSIONS A CTnI level of > 0.25 μg L(-1) at presentation in patients with TTP appears to be an independent factor associated with a three-fold increase in the risk of death or refractoriness. Therefore, cTnI level should be considered as a prognostic indicator in patients diagnosed with TTP.
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Affiliation(s)
- Y Benhamou
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France; Inserm U1096, Rouen, France; Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France
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Margetis D, Maury E, Boelle PY, Alves M, Galbois A, Baudel JI, Offenstadt G, Guidet B, Ait-Oufella H. Peripheral microcirculatory exploration during mechanical ventilation weaning. Minerva Anestesiol 2014; 80:1188-1197. [PMID: 24572374] [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: 06/03/2023]
Abstract
BACKGROUND Weaning from mechanical ventilation is a daily challenge in intensive care patients. Our objective was to explore microcirculatory perfusion during mechanical ventilation weaning and to evaluate its predictive value on the weaning outcome. METHODS Prospective observational study. All consecutive patients, older than 18 years, under mechanical ventilation that met the criteria for weaning were enrolled. Patients underwent a T-piece Spontaneous Breath Trial (SBT) for 60 minutes and the usual clinical parameters were recorded every 5 minutes. Microcirculatory perfusion was evaluated using the mottling score and the Tissue Oxygen Saturation (StO2) measured by Near Infrared Spectroscopy technology on the thenar and knee area. RESULTS Seventy-three patients were studied (age: 67±15 years, men: 40, SAPS II: 47±15) after a duration of mechanical ventilation of 3 (1-6) days. Forty-five patients succeeded the first SBT. The mottling score severity recorded just before ventilator disconnection (baseline) was associated with weaning failure (P=0.03). Moreover, the mottling score increase during SBT was significantly associated with weaning failure (80% vs. 28%, P=0.001; Odds ratio 10.5 [2.0-54.8]). Baseline thenar StO2 was not different according to weaning outcome (failure 76±13% vs. success 77±7%, P=0.90) whereas baseline knee StO2 was significantly lower in patients who failed the first SBT (67±13% vs. 75±12%, P<0.01). This difference was apparent since the very beginning of the SBT and lasted throughout the trial (P=0.0001). CONCLUSION In unselected mechanically ventilated patients undergoing SBT, mottling score and knee StO2 are early predictors of weaning failure.
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Affiliation(s)
- D Margetis
- AP-HP, Hôpital Saint-Antoine, Service de réanimation médicale, Paris, France
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Cronier P, Meyer P, Chevrel G, Clergue C, Abadie Y, Lecuyer L, Choukroun G, Djouhri S, Chergui K, Maury E. Perfusion veineuse périphérique difficile : apport de l’échographie. Réanimation 2014. [DOI: 10.1007/s13546-014-0908-7] [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: 10/24/2022]
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. [Extracorporeal life support for patients with acute respiratory distress syndrome (adult and paediatric). Consensus conference organized by the French Intensive Care Society]. Rev Mal Respir 2014; 31:779-95. [PMID: 25391514 DOI: 10.1016/j.rmr.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- C Richard
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - L Argaud
- Service de réanimation médicale, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - A Blet
- Département d'anesthésie-réanimation, centre de traitement des brulés, hôpitaux universitaires Saint-Louis, Lariboisière, Fernand-Widal, hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - T Boulain
- Service de réanimation polyvalente, hôpital de La Source, centre hospitalier régional Orléans, 45067 Orléans, France
| | - L Contentin
- Service de réanimation polyvalente, hôpital Bretonneau, CHRU de Tours, 37000 Tours, France
| | - A Dechartres
- Inserm U1153, équipe « méthodes en évaluation thérapeutique des maladies chroniques », centre de recherche épidémiologie et biostatistique, centre Cochrane français, Hôtel-Dieu, 75004 Paris, France
| | - J-M Dejode
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - L Donetti
- Service de réanimation, centre hospitalier Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - M Fartoukh
- Unité de réanimation médicochirurgicale, hôpitaux universitaire Est Parisien, hôpital Tenon, AP-HP, 75020 Paris, France
| | - D Fletcher
- Département d'anesthésie, hôpitaux universitaires Paris Île-de-France Ouest, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - K Kuteifan
- Service de réanimation médicale, hôpital Émile-Muller, 68070 Mulhouse, France
| | - S Lasocki
- Pôle d'anesthésie réanimation, LUNAM université, université d'Angers, CHU d'Angers, 49000 Angers, France
| | - J-M Liet
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - A-C Lukaszewicz
- Département d'anesthésie réanimation - réanimation chirurgicale et postopératoire, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - H Mal
- Service de pneumologie, hôpitaux universitaires Paris Nord Val-de-Seine, hôpital Bichat, AP-HP, 75018 Paris, France
| | - E Maury
- Service de réanimation médicale, hôpitaux universitaire Est Parisien, hôpital Saint-Antoine, AP-HP, 75020 Paris, France
| | - D Osman
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Outin
- Service de réanimation médicochirurgicale, centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, 78300 Poissy, France
| | - J-C Richard
- Service de réanimation médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France
| | - F Schneider
- Service de réanimation médicale, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, Hautepierre, France
| | - F Tamion
- Inserm U1096, IRIB, service de réanimation médicale, université de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
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Hauguel M, Ait-Oufella H, Guidet B, Maury E, Bigé N. Hypokalemia and metabolic alkalosis: do not forget the patient's hands. Minerva Anestesiol 2014; 80:504-505. [PMID: 24257148] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- M Hauguel
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique ‑ Hôpitaux de Paris, Paris, France -
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0858-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Maury E, Hong HK, Bass J. Circadian disruption in the pathogenesis of metabolic syndrome. Diabetes Metab 2014; 40:338-46. [PMID: 24433933 DOI: 10.1016/j.diabet.2013.12.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 12/19/2022]
Abstract
Metabolic syndrome is a multifactorial process induced by a combination of genetic and environmental factors and recent evidence has highlighted that circadian disruption and sleep loss contribute to disease pathogenesis. Emerging work in experimental genetic models has provided insight into the mechanistic basis for clock disruption in disease. Indeed, disruption of the clock system perturbs both neuroendocrine pathways within the hypothalamus important in feeding and energetics, in addition to peripheral tissues involved in glucose and lipid metabolism. This review illustrates the impact of molecular clock disruptions at the level of both brain and behavior and peripheral tissues, with a focus on how such dysregulation in turn impacts lipid and glucose homeostasis, inflammation and cardiovascular function. New insight into circadian biology may ultimately lead to improved therapeutics for metabolic syndrome and cardiovascular disease in humans.
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Affiliation(s)
- E Maury
- Department of Medicine, Feinberg School of Medicine, Northwestern University, 303 E Superior Street, Lurie 7-220, Chicago, Illinois 60611, USA.
| | - H K Hong
- Department of Medicine, Feinberg School of Medicine, Northwestern University, 303 E Superior Street, Lurie 7-220, Chicago, Illinois 60611, USA
| | - J Bass
- Department of Medicine, Feinberg School of Medicine, Northwestern University, 303 E Superior Street, Lurie 7-220, Chicago, Illinois 60611, USA.
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Gonzalez C, Fagour C, Maury E, Gatta-Cherifi B, Salandini S, Pierreisnard A, Masquefa-Giraud P, Gin H, Rigalleau V. P142 L’évolution précoce de la DER et du QR sous traitement injectable prédit l’évolution pondérale des patients diabétiques de type 2 non contrôlés. NUTR CLIN METAB 2013. [DOI: 10.1016/s0985-0562(13)70474-6] [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: 10/25/2022]
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Maury E, Savel J, Grouthier V, Lorrain S, Gonzalez C, Gin H, Barberger-Gateau P, Rigalleau V. P083 Autofluorescence cutanée : un marqueur de la mémoire métabolique chez les patientes enceintes diabétiques. NUTR CLIN METAB 2013. [DOI: 10.1016/s0985-0562(13)70415-1] [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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Meyer P, Rousseau H, Maillet JM, Thierry S, Sy O, Vicaut E, Thiolliere F, Choukroun G, Chergui K, Chevrel G, Maury E. Evaluation of Blind Nasotracheal Suctioning and Non-bronchoscopic Mini-Bronchoalveolar Lavage in Critically Ill Patients with Infectious Pneumonia: A Preliminary Study. Respir Care 2013; 59:345-52. [DOI: 10.4187/respcare.02356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Avouac J, Koumakis E, Toth E, Meunier M, Maury E, Cormier C, Kahan A, Allanore Y. FRI0259 Increased risk of osteoporosis and fracture in women with systemic sclerosis: A comparative study to rheumatoid arthritis and healthy controls. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2716] [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: 11/04/2022]
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Rousseau-Bussac G, Margetis D, Lino A, Galbois A, Phin-Huynh S, Maury E, Chouaid C. Pronostic des patients atteints de cancer du poumon pris en charge en réanimation médicale. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.025] [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: 11/28/2022]
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El Mouhadi S, Ait-Oufella H, Maury E, Menu Y, Arrivé L. Ileal diverticulitis complicated by portal-mesenteric pylephlebitis and pulmonary septic foci. Diagn Interv Imaging 2012; 93:57-9. [PMID: 22277712 DOI: 10.1016/j.diii.2011.10.005] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S El Mouhadi
- Service de radiologie, hôpital Saint-Antoine, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, Assistance publique—Hôpitaux de Paris, 184 rue du Faubourg-Saint-Antoine, Paris, France
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Gonzalez C, De Ledinghen V, Vergniol J, Foucher J, Chermak F, Carlier S, Maury E, Cherifi B, Gin H, Rigalleau V. P070 La stéatose hépatique des patients biopsiés pour NASH est associée à leurs apports alimentaires glucidiques. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70137-6] [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: 10/14/2022]
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Pichereau C, Ait-Oufella H, Maury E, Guidet B. Unusual misplacement of a femoral central venous catheter. Intensive Care Med 2011; 37:1714-5. [PMID: 21688099 DOI: 10.1007/s00134-011-2283-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 11/28/2022]
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41
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Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, Joffre J, Margetis D, Guidet B, Maury E, Offenstadt G. Mottling score predicts survival in septic shock. Intensive Care Med 2011; 37:801-7. [PMID: 21373821 DOI: 10.1007/s00134-011-2163-y] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 11/30/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Experimental and clinical studies have identified a crucial role of microcirculation impairment in severe infections. We hypothesized that mottling, a sign of microcirculation alterations, was correlated to survival during septic shock. METHODS We conducted a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included during a 7-month period. After initial resuscitation, we recorded hemodynamic parameters and analyzed their predictive value on mortality. The mottling score (from 0 to 5), based on mottling area extension from the knees to the periphery, was very reproducible, with an excellent agreement between independent observers [kappa = 0.87, 95% CI (0.72-0.97)]. RESULTS Sixty patients were included. The SOFA score was 11.5 (8.5-14.5), SAPS II was 59 (45-71) and the 14-day mortality rate 45% [95% CI (33-58)]. Six hours after inclusion, oliguria [OR 10.8 95% CI (2.9, 52.8), p = 0.001], arterial lactate level [<1.5 OR 1; between 1.5 and 3 OR 3.8 (0.7-29.5); >3 OR 9.6 (2.1-70.6), p = 0.01] and mottling score [score 0-1 OR 1; score 2-3 OR 16, 95% CI (4-81); score 4-5 OR 74, 95% CI (11-1,568), p < 0.0001] were strongly associated with 14-day mortality, whereas the mean arterial pressure, central venous pressure and cardiac index were not. The higher the mottling score was, the earlier death occurred (p < 0.0001). Patients whose mottling score decreased during the resuscitation period had a better prognosis (14-day mortality 77 vs. 12%, p = 0.0005). CONCLUSION The mottling score is reproducible and easy to evaluate at the bedside. The mottling score as well as its variation during resuscitation is a strong predictor of 14-day survival in patients with septic shock.
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Affiliation(s)
- H Ait-Oufella
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris Cedex 12, France.
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Chalumeau-Lemoine L, Ioos V, Galbois A, Maury E, Hejblum G, Guidet B. Peut-on réduire le nombre de radiographies de thorax en réanimation ? Réanimation 2011. [DOI: 10.1007/s13546-010-0001-9] [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: 11/28/2022]
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Decre D, Birgand G, Geneste D, Maury E, Petit JC, Barbut F, Arlet G. Possible importation and subsequent cross-transmission of OXA-48-producing Klebsiella pneumoniae, France, 2010. Euro Surveill 2010; 15. [DOI: 10.2807/ese.15.46.19718-en] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the possible first patient-to-patient transmission of Klebsiella pneumoniae with decreased susceptibility to imipenem and producing OXA-48, CTX-M15, TEM-1 and OXA-1 in a French hospital.
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Affiliation(s)
- D Decre
- University Pierre and Marie Curie, ER8 Antibiotiques et Flore digestive, Paris VI, France
- Assistance Publique-Hôpitaux de Paris, Microbiology, Saint-Antoine Hospital, Paris, France
| | - G Birgand
- Assistance Publique-Hôpitaux de Paris, Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Saint-Antoine Hospital, Paris, France
| | - D Geneste
- University Pierre and Marie Curie, ER8 Antibiotiques et Flore digestive, Paris VI, France
| | - E Maury
- Assistance Publique-Hôpitaux de Paris, Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France
| | - J C Petit
- Assistance Publique-Hôpitaux de Paris, Microbiology, Saint-Antoine Hospital, Paris, France
| | - F Barbut
- Assistance Publique-Hôpitaux de Paris, Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Saint-Antoine Hospital, Paris, France
| | - G Arlet
- University Pierre and Marie Curie, ER8 Antibiotiques et Flore digestive, Paris VI, France
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Cormier C, Courbebaisse M, Maury E, Thervet E, Souberbielle JC. [Effect of vitamin D deficiency on cardiovascular risk]. J Mal Vasc 2010; 35:235-241. [PMID: 20570456 DOI: 10.1016/j.jmv.2010.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 04/26/2010] [Indexed: 05/29/2023]
Abstract
Vitamin D deficiency affects almost 50 % of the population worldwide. Besides its classical effects on bone and calcium metabolism, vitamin D displays a wide spectrum of non classical effects. Among these effects, those targeting the cardiovascular system are mostly documented by observational, experimental and small intervention trials that most often evaluated intermediate parameters. The time has now come for large placebo-controlled trials targeting clinical endpoints such as the incidence of major cardiovascular events and mortality.
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Affiliation(s)
- C Cormier
- Service de rhumatologie, hôpital Cochin, AP-HP, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Maury E, Brichard SM. Adipokine dysregulation, adipose tissue inflammation and metabolic syndrome. Mol Cell Endocrinol 2010; 314:1-16. [PMID: 19682539 DOI: 10.1016/j.mce.2009.07.031] [Citation(s) in RCA: 716] [Impact Index Per Article: 51.1] [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] [Received: 03/20/2009] [Revised: 07/09/2009] [Accepted: 07/23/2009] [Indexed: 02/08/2023]
Abstract
Obesity plays a causative role in the pathogenesis of the metabolic syndrome. Adipokines may link obesity to its co-morbidities. Most adipokines with pro-inflammatory properties are overproduced with increasing adiposity, while some adipokines with anti-inflammatory or insulin-sensitizing properties, like adiponectin are decreased. This dysregulation of adipokine production may promote obesity-linked metabolic disorders and cardiovascular disease. Besides considering adipokines, this review will also highlight the cellular key players and molecular mechanisms involved in adipose inflammation. Targeting the changes in the cellular composition of adipose tissue, the underlying molecular mechanisms, and the altered production of adipokines may have therapeutic potential in the management of the metabolic syndrome.
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Affiliation(s)
- E Maury
- Endocrinology and Metabolism Unit, University of Louvain, Faculty of Medicine, 1200 Brussels, Belgium
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Dulaurent S, Gaulier J, Baudel J, Fardet L, Maury E, Lachâtre G. Hair analysis to document non-fatal pesticide intoxication cases. Forensic Sci Int 2008; 176:72-5. [DOI: 10.1016/j.forsciint.2007.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
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Meyer P, Pernet P, Hejblum G, Baudel JL, Maury E, Offenstadt G, Guidet B. Haemodilution induced by hydroxyethyl starches 130/0.4 is similar in septic and non-septic patients. Acta Anaesthesiol Scand 2007; 52:229-35. [PMID: 18034867 DOI: 10.1111/j.1399-6576.2007.01521.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 12/15/2022]
Abstract
BACKGROUND Fluid therapy induces haemodilution related to plasma volume expansion. The aim of our study was to compare haemodilution after a single hydroxyethyl starches (HES) 130/0.4 infusion in two groups of patients, one with and one without sepsis. We hypothesized that a single HES challenge would induce similar sustained haemodilution in both groups. METHODS In this prospective preliminary study, patients predicted to require a single further volume-expander infusion were included immediately before receiving 500 ml of 6% HES 130/0.4 over a 15-min period. No additional fluid was administered over the next 8 h. Haematocrit, and serum albumin and protein were determined immediately before HES infusion then after 1, 2, 3, 4, and 8 h. RESULTS Twelve patients were included in each group. In both groups, all three haemodilution markers had significantly lower values after 1 h than at baseline. None of the values after 1 and 3 h differed significantly between the two groups. Neither did any of the other study variables show significant differences between the groups with and without sepsis. CONCLUSION We found that a starch-based compound was as effective in inducing haemodilution in patients with sepsis as in controls without sepsis, suggesting that HES may remain within the intravascular space even in patients with sepsis. Haemodilution parameters such as haematocrit, serum albumin and serum protein are useful for assessing the duration of plasma volume expansion induced by fluid therapy in critically ill patients.
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Affiliation(s)
- P Meyer
- AP-HP, Saint-Antoine Teaching Hospital, Medical Intensive Care Unit, Paris, F-75012 France.
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Abstract
Central-omental obesity plays a causative role in the pathogenesis of the metabolic syndrome. Adipokines are involved in the pathogenesis of this syndrome. However, adipokines secreted by omental adipose tissue (OAT) are still poorly characterized in human obesity. Therefore, we searched for novel adipokines abnormally secreted by OAT in obesity and examined their relationships with some features of metabolic syndrome and the respective contribution of adipocytes vs. stromal-vascular cells. OAT from obese and nonobese men was fractionated into adipocytes and SV cells, which were then cultured. Medium was screened by medium-scale protein arrays and ELISAs. Adipokine mRNA levels were measured by real-time RT-qPCR. We detected 16 cytokines secreted by each cellular fraction of lean and obese subjects. Of the 16 cytokines, six adipokines were newly identified as secretory products of OAT, which were dysregulated in obesity: three chemokines (growth-related oncogen factor, RANTES, macrophage inflammatory protein-1beta), one interleukin (IL-7), one tissue inhibitor of metalloproteinases (TIMP-1), and one growth factor (thrombopoietin). Their secretion and expression were enhanced in obesity, with a relatively similar contribution of the two fractions. The higher proportion of macrophages and endothelial cells in obesity may contribute to this enhanced production as well as changes in intrinsic properties of hypertrophied adipocytes. Accordingly, mRNA concentrations of most of these adipokines increased during adipocyte differentiation. Eventually, expression of the investigated adipokines did correlate with several features of the metabolic syndrome. In conclusion, six adipokines were newly identified as oversecreted by OAT in obesity. These adipokines may link obesity to its cardiovascular or metabolic comorbidities.
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Affiliation(s)
- E Maury
- Endocrinology and Metabolism Unit, University of Louvain, Faculty of Medicine, Brussels, Belgium
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Dinh A, Salomon J, Vuagnat A, De Truchis P, Maury E, Bernard L. [Antiretroviral therapy in critically ill patients: a French national study]. Med Mal Infect 2007; 37:809-15. [PMID: 17628372 DOI: 10.1016/j.medmal.2007.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 05/02/2007] [Indexed: 11/21/2022]
Abstract
SETTINGS The HIV-positive population is still increasing because the incidence of the disease remains high while the effectiveness of highly active antiretroviral therapy (HAART) has dramatically reduced mortality. HIV infected patients have an increased life expectancy and are more readily admitted to intensive care units. METHOD We conducted a nation-wide comparative study in France of how these patients are managed by ICU specialists, on one hand, and HIV specialists, on the other, to better understand the use of antiretroviral therapy in critically ill patients. RESULTS The results show heterogeneous responses of ICU specialists with an important proportion of non decisive answers. The answers of HIV specialists are more homogeneous. There appears to be little or no cooperation between the two specialties. The CISIH (French centers for the information and care of human immunodeficiency) are rarely consulted. CONCLUSIONS ICU specialists must be better informed on this rapidly evolving disease. Access to updated information or to an HIV specialists must be made easier. Studies should also be made on how HAART is employed in ICUs (pharmacology, pharmacodynamics...).
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Affiliation(s)
- A Dinh
- Service des maladies infectieuses, CHU Raymond-Poincaré, APHP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Tonnellier M, Bessereau J, Carbonnell N, Guidet B, Méritet JF, Kerr JR, Monnier-Cholley L, Offenstadt G, Maury E. A possible parvovirus B19 encephalitis in an immunocompetent adult patient. J Clin Virol 2006; 38:186-7. [PMID: 17174596 DOI: 10.1016/j.jcv.2006.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 11/08/2006] [Accepted: 11/12/2006] [Indexed: 11/28/2022]
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