« Réa’ssure moi » Des outils pour accompagner l’enfant visiteur en réanimation

Alors que se généralise progressivement l’ouverture des services de réanimation aux visites 24 heures sur 24, la présence des enfants semble encore controversée. Les unités de réanimation chirurgicale du CHU de Caen ont décidé de mettre fin à cette politique restrictive de visites. Cependant, accompagner un enfant face à la mort ou à la maladie ne s’improvise pas. La présence de ce « petit visiteur » est particulièrement stressante pour les familles et les soignants. Elle nécessite donc un encadrement spécifique, plus complexe que celui de l’adulte. En réponse à ce besoin, les équipes de réanimation du CHU de Caen ont développé divers supports (livret et pièce d’accueil, box de réanimation miniature) pour accompagner les enfants et soutenir les équipes soignantes dans cette démarche.

N-acetylcysteine targets 5 lipoxygenase-derived, toxic lipids and can synergize with prostaglandin E2 to inhibit ferroptosis and improve outcomes following hemorrhagic stroke in mice

Objectives

N‐acetylcysteine (NAC) is a clinically approved thiol‐containing redox modulatory compound currently in trials for many neurological and psychiatric disorders. Although generically labeled as an “antioxidant,” poor understanding of its site(s) of action is a barrier to its use in neurological practice. Here, we examined the efficacy and mechanism of action of NAC in rodent models of hemorrhagic stroke.

Methods

Hemin was used to model ferroptosis and hemorrhagic stroke in cultured neurons. Striatal infusion of collagenase was used to model intracerebral hemorrhage (ICH) in mice and rats. Chemical biology, targeted lipidomics, arachidonate 5‐lipoxygenase (ALOX5) knockout mice, and viral‐gene transfer were used to gain insight into the pharmacological targets and mechanism of action of NAC.

Results

NAC prevented hemin‐induced ferroptosis by neutralizing toxic lipids generated by arachidonate‐dependent ALOX5 activity. NAC efficacy required increases in glutathione and is correlated with suppression of reactive lipids by glutathione‐dependent enzymes such as glutathione S‐transferase. Accordingly, its protective effects were mimicked by chemical or molecular lipid peroxidation inhibitors. NAC delivered postinjury reduced neuronal death and improved functional recovery at least 7 days following ICH in mice and can synergize with clinically approved prostaglandin E₂ (PGE₂).

Interpretation

NAC is a promising, protective therapy for ICH, which acted to inhibit toxic arachidonic acid products of nuclear ALOX5 that synergized with exogenously delivered protective PGE₂ in vitro and in vivo. The findings provide novel insight into a target for NAC, beyond the generic characterization as an antioxidant, resulting in neuroprotection and offer a feasible combinatorial strategy to optimize efficacy and safety in dosing of NAC for treatment of neurological disorders involving ferroptosis such as ICH. Ann Neurol 2018;84:854–872

Oral recognition of forms and oral muscular coordination ability. A longitudinal study in young adults

A study has been carried out to investigate the constancy of results in oral recognition of forms (RF-test) and in tests which demand a fine coordination of the oral muscular apparatus (MA-test). Twenty examinees with a mean age of 22.5 years were tested with both test forms in 1972 and retested 4 years later in 1976. The performances in the RF- as well as in the MA-test improved considerably. As to the learning (training) effect in both test forms, the test results acquired by training during the previous period have largely been preserved until the next test period 4 years later. Individuals with a given capacity to perform either the RF- or MA-test, showed about the same grade of ability 4 years later. The RF- as well as the MA-test seem to reflect a given ability, which, at least in this age-group, remained constant during a period of 4 years. These results may be explained by reference to the notion of schema in which some motor-sensory feed-back will be stored. The specificity of the perceptual and motor patterns used, may have produced schemata with good resistance against forgetting.