Clinical outcome after a reactive hypothermic EEG following cardiac arrest.

BACKGROUND: Reactive electroencephalography (EEG) background during therapeutic hypothermia (TH) is related to favorable prognosis after cardiac arrest (CA), but its predictive value is not 100 %. The aim of this study was to investigate outcome predictors after a first reactive EEG recorded during TH after CA. METHODS: We studied a cohort of consecutive comatose adults admitted between February 2008 and November 2012, after successful resuscitation from CA, selecting patients with reactive EEG during TH. Outcome was assessed at three months, and categorized as survivors and non-survivors (no patient was in vegetative state). Demographics, clinical variables, EEG features, serum neuron-specific enolase (NSE) and procalcitonin, were compared using uni- and multivariable analyses. RESULTS: A total of 290 patients were treated with TH after cardiac arrest; 146 had an EEG during TH, which proved reactive in 90 of them; 77 (86 %) survived and 13 (14 %) died (without recovery from coma). The group of non-survivors had a higher occurrence of discontinuous EEG (p = 0.006; multivariate analysis p = 0.026), and a higher serum NSE peak (p = 0.021; multivariate analysis p = 0.014); conversely, demographics, and other clinical variables including serum procalcitonin did not differ. CONCLUSIONS: A discontinuous EEG and high serum NSE are associated with mortality after CA in patients with poor outcome despite a reactive hypothermic EEG. This suggests more severe cerebral damage, but not to higher extent of systemic disease.

Pièces relatives à l'histoire de la MAISON D'AUVERGNE (XIIe-XVIIe siècle). II Notes et copies de pièces parmi lesquelles on remarque les suivantes :

Contient : Hommage de Béraud, dauphin d'Auvergne, et de Bertrand de La Tour à l'abbé de Cluny (1376-1394), feuillets d'un registre sur papier de la fin du XIVe siècle ; Mémoire donné au roi, le 15 novembre 1694, sur l'illustration de la famille de Bouillon ; Extraits d'une ancienne généalogie des comtes de Boulogne ; Extrait de la chronique généalogique des seigneurs de Chauvigny ; « Extrait du calendrier des tesmoins vieux et valétudinaires produits par M. le duc de Berry... contre Morinot de Tourzel, seigneur d'Alegre, au mois juillet 1414 » ; Extrait des titres de Turenne ; « Extrait des comptes d'Oliergues, commençant en 1329. » ; Listes de titres communiqués à de Bar par Baluze ; Extraits des titres à l'abbaye du Bouchet (1192-1505) ; Extraits des titres et des obituaires de Brioude ; Lettre de M. d'Anfreville (6 sept. 1708) ; Armoiries diverses envoyées à Baluze et (f. 92) lettre de M. Mantaigue, de Vic-le-Comte (9 octobre 1703) ; Lettre de David, prieur de l'abbaye du Bouchet, s. d ; Copie de lettres de [Gui] Allard relatives à la maison de La Tour du Pin (1698) et de la réponse de Baluze ; Lettre de [Gui] Allard (Grenoble, 10 février 1698) ; Lettre de M. Estienne (14 octobre 1701) ; Comptes de gravures d'armoiries par l'histoire de la maison d'Auvergne

Titres faux de SOUVIGNY. — Mélanges de GENEALOGIE et d'HISTOIRE ECCLESIASTIQUE.

Contient : Pièces relatives aux titres faux de Souvigny (sur ces titres, cf. M.-A. Chazaud, Étude sur la chronologie des sires de Bourbon, Moulins, 1866, in-8°, p. 33-80) : ; Notes sur les chartes de Souvigny envoyées à M. de Barville (Chazaud, op. cit., p. 47) ; Note de Mabillon sur la charte de Childebrand II (ibid., p. 44) ; Testaments d'Aimon et d'Aimar de Bourbon, prétendus originaux en parchemin ; Note, de la main de Baluze, attribuant la fabrication de ces pièces au duc d'Epernon (ibid., p. 38) ; Rapport de Mabillon et de Baluze sur les titres de Souvigny (ibid., p. 36) ; Minute, de la main de Baluze, du procès-verbal d'examen du cartulaire de Sauxillange, par Baluze, Mabillon, Ruinart et Ch. d'Hozier (19 août 1696) ; Note, de la main de Baluze, sur P. de Bar ; Procès-verbal d'examen des titres fournis par P. de Bar au duc de Bouillon, signé de Baluze, Mabillon et Ruinart ; Lettres d'érection du marquisat de Montausier en duché et pairie (août 1664) ; Mémoires sur les droits de la terre de Chevreuse du titre de duché ; Note sur l'état de la seigneurie de Vitry-sur-Seine ; Mémoires concernant les ducs d'Atrie (Atri) et princes de Melfe (Melfi) et les maisons d'Acquaviva et « Diaceto », parmi lesquels une Remonstrance à Monseigneur le chancellier par Anne et Charlotte de Melphe d'Aquin, impr. s. d. de 4 p. in-4° (f. 44), une Descendance de Messire Scipion d'Aquavive, duc d'Atrye, placard impr. s. d. (f. 48), une Lettre envoyée et présentée au Roy de la part du comte de Chasteauvillain, impr. de 12 p. in-4°, Cambrai, 1624 (f. 49), une lettre de M. de Cadenet, lieutenant d'une compagnie de M. de Montmorency, d'Aire, 20 mai 1579 (f. 60) ; Notice généalogique sur la maison d'Albert ; Contrat de mariage d'Honoré d'Albert de Luynes et d'Anne de Rodulph (6 mars 1573) ; Lettres originales, des XVIe et XVIIe siècles, relatives à la famille de Luynes, écrites par divers personnages : ; [Richelieu], évêque de Luçon, au connétable de Luynes, s. d. ; minute ; Le même au même, s. d. ; minute originale ; La reine mère [Marie de Médicis] à M. de Luynes ; minute ; La même au même, minute ; Le cardinal G[eorges] d'Armagnac à la reine (Avignon, 13 septembre 1570) ; M. de Clermont-Lodève au roi (Toulouse, 2 septembre 1570) ; Le même au duc d'Anjou (même date) ; Instructions données par le maréchal de Montmorency d'Anville à M. de Luynes (1570) ; Lettre du même au duc d'Anjou (Nîmes, 12 septembre 1570) ; Le même à la reine (même date) ; Pièces relatives au conflit de juridiction entre François, évêque de Verdun, et Jean Gillet, lieutenant-général en la justice royale de la dite ville (31 décembre 1626-13 février 1627) ; Extraits des registres du Conseil d'État (22 juin-15 juillet 1670) relatifs à l'assemblée du clergé, avec une lettre de Du Mez à Baluze lui annonçant l'envoi desdits extraits (f. 101) ; Requête adressée au roi par le comte de Coligny ; « Relation du conclave où le pape Alexandre VII a esté esleu, composée à ce qu'on croit par M. l'abbé Charrier » [1655] ; Lettres d'Alexandre VII relatives à l'insulte faite au duc de Créquy (28 août 1662) ; « Oratio habita a... Clemente IX in concilio habito ad cardinales circa nuncium pacis inter reges Christianum, et Catholicum » ; Lettre de Clément X à l'amiral d'Estrées (22 août 1672) ; Lettres d'Innocent XI adressées à Louis XIV (27 décembre 1679), à Henri [Cauchon], évêque d'Evreux, du 21 janvier 1680 (f. 146), à Joseph [de Montpezat], archevêque de Toulouse, du 2 octobre 1680 (f. 147), aux religieuses de Charonne, du 7 août 1680 et du 15 octobre 1680 (f. 148 et 149) ; Mémoire de [C.-M. Le Tellier], coadjuteur de Reims, sur les conciles provinciaux (1670) ; Mémoire sur la régale (en italien), et documents divers, en italien, sur le même sujet, à propos de l'affaire de l'évêché de Pamiers ; Mémoire de l'ambassadeur de France au collège des cardinaux (s. d.) ; Historique des événements survenus à l'occasion de la régale de Pamiers, de 1673 à 1680 ; « Lettera d'un curiale di Roma a un suo amico in Parigi » (11 novembre 1680) ; Autre lettre d'un « curiale di Roma » (s. d.) ; « Lettera di monsieur N. scritta al sig. cardinale N., a di 16 febr. 1681. »

Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism.

BACKGROUND: Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. METHODS: In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior to warfarin with respect to the primary efficacy outcome, which occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome occurred in 349 patients (8.5%) in the edoxaban group and 423 patients (10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94; P=0.004 for superiority). The rates of other adverse events were similar in the two groups. A total of 938 patients with pulmonary embolism had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide levels; the rate of recurrent venous thromboembolism in this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group (hazard ratio, 0.52; 95% CI, 0.28 to 0.98). CONCLUSIONS: Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number, NCT00986154.).

Intracranial hypertension: what additional information can be derived from ICP waveform after head injury?

OBJECTIVE: Although intracranial hypertension is one of the important prognostic factors after head injury, increased intracranial pressure (ICP) may also be observed in patients with favourable outcome. We have studied whether the value of ICP monitoring can be augmented by indices describing cerebrovascular pressure-reactivity and pressure-volume compensatory reserve derived from ICP and arterial blood pressure (ABP) waveforms. METHOD: 96 patients with intracranial hypertension were studied retrospectively: 57 with fatal outcome and 39 with favourable outcome. ABP and ICP waveforms were recorded. Indices of cerebrovascular reactivity (PRx) and cerebrospinal compensatory reserve (RAP) were calculated as moving correlation coefficients between slow waves of ABP and ICP, and between slow waves of ICP pulse amplitude and mean ICP, respectively. The magnitude of 'slow waves' was derived using ICP low-pass spectral filtration. RESULTS: The most significant difference was found in the magnitude of slow waves that was persistently higher in patients with a favourable outcome (p<0.00004). In patients who died ICP was significantly higher (p<0.0001) and cerebrovascular pressure-reactivity (described by PRx) was compromised (p<0.024). In the same patients, pressure-volume compensatory reserve showed a gradual deterioration over time with a sudden drop of RAP when ICP started to rise, suggesting an overlapping disruption of the vasomotor response. CONCLUSION: Indices derived from ICP waveform analysis can be helpful for the interpretation of progressive intracranial hypertension in patients after brain trauma.

Spare non-occupational HIV post-exposure prophylaxis by active contacting and testing of the source person.

OBJECTIVE: HIV-1 post-exposure prophylaxis (PEP) is frequently prescribed after exposure to source persons with an undetermined HIV serostatus. To reduce unnecessary use of PEP, we implemented a policy including active contacting of source persons and the availability of free, anonymous HIV testing ('PEP policy'). METHODS: All consultations for potential non-occupational HIV exposures i.e. outside the medical environment) were prospectively recorded. The impact of the PEP policy on PEP prescription and costs was analysed and modelled. RESULTS: Among 146 putative exposures, 47 involved a source person already known to be HIV positive and 23 had no indication for PEP. The remaining 76 exposures involved a source person of unknown HIV serostatus. Of 33 (43.4%) exposures for which the source person could be contacted and tested, PEP was avoided in 24 (72.7%), initiated and discontinued in seven (21.2%), and prescribed and completed in two (6.1%). In contrast, of 43 (56.6%) exposures for which the source person could not be tested, PEP was prescribed in 35 (81.4%), P &lt; 0.001. Upon modelling, the PEP policy allowed a 31% reduction of cost for management of exposures to source persons of unknown HIV serostatus. The policy was cost-saving for HIV prevalence of up to 70% in the source population. The availability of all the source persons for testing would have reduced cost by 64%. CONCLUSION: In the management of non-occupational HIV exposures, active contacting and free, anonymous testing of source persons proved feasible. This policy resulted in a decrease in prescription of PEP, proved to be cost-saving, and presumably helped to avoid unnecessary toxicity and psychological stress.

Reduction of corneal edema in endotoxin-induced uveitis after application of L-NAME as nitric oxide synthase inhibitor in rats by iontophoresis.

PURPOSE: To investigate the involvement of the cornea during endotoxin-induced uveitis (EIU) in the rat and the effect of Ngamma-nitro-L-arginine methyl ester (L-NAME) as nitric oxide synthase (NOS) inhibitor, administered by iontophoresis. METHODS: EIU was induced in Lewis rats that were killed at 8 and 16 hours after lipopolysaccharide (LPS) injection. The severity of uveitis was evaluated clinically at 16 hours, and nitrite levels were evaluated in the aqueous humor at 8 hours. Corneal thickness was measured, 16 hours after LPS injection, on histologic sections using an image analyzer. Transmission electron microscopy (TEM) was used for fine analysis of the cornea. Transcorneoscleral iontophoresis of L-NAME (100 mM) was performed either at LPS injection or at 1 and 2 hours after LPS injection. RESULTS: At 16 hours after LPS injection, mean corneal thickness was 153.7+/-5.58 microm in the group of rats injected with LPS (n=8) compared with 126.89+/-11.11 microm in the saline-injected rats (n=8) (P < 0.01). TEM showed stromal edema and signs of damage in the endothelial and epithelial layers. In the group of rats treated by three successive iontophoreses of L-NAME (n=8), corneal thickness was 125.24+/-10.36 microm compared with 146.76+/-7.52 microm in the group of rats treated with iontophoresis of saline (n=8), (P=0.015). TEM observation showed a reduction of stromal edema and a normal endothelium. Nitrite levels in the aqueous humor were significantly reduced at 8 hours by L-NAME treatment (P=0.03). No effect on corneal edema was observed after a single iontophoresis of L-NAME at LPS injection (P=0.19). Iontophoresis of saline by itself induced no change in corneal thickness nor in TEM structure analysis compared with normal rats. CONCLUSIONS: Corneal edema is observed during EIU. This edema is significantly reduced by three successive iontophoreses of L-NAME, which partially inhibited the inflammation. A role of nitric oxide in the corneal endothelium functions may explain the antiedematous effect of L-NAME.

RF pulse concatenation for spatially selective inversion

It is shown that spatially selective inversion and saturation can be achieved by concatenation of RF pulses with lower flip angles. A concatenation rule which enables global doubling of the flip angle of any given excitation pulse applied to initial z magnetization is proposed. In this fashion, the selectivity of the single pulse is preserved, making the high selectivity achievable in the low flip-angle regime available for inversion and large flip-angle saturation purposes. The profile quality achievable with exemplary concatenated pulses is investigated in comparison with adiabatic inversion. It is verified that by using concatenated inversion in the transfer insensitive labeling technique (TILT), the MT artifact is suppressed. Copyright 2000 Academic Press.

[Lettre autographe signée de Giuseppe Verdi adressée à Escudier, Gênes, 1 (mois?) 1870]

Comprend aussi une enveloppe

Appropriateness of use of infliximab in the Swiss IBD Cohort Study

Introduction: Anti-TNFs have significantly improved the management of Crohn's disease (CD), but not all patients will benefit from this therapy. We used data from the Swiss IBD Cohort Study (SIBDCS) and preset appropriateness criteria to examine the appropriateness of use of infliximab (IFX) in CD patients. aims & methods: EPACT II (European Panel on the Appropriateness of Crohn's disease Therapy) appropriateness criteria (www.epact.ch) have been developed by a formal panel process combining evidence from the published literature and expert opinion (end 2007), yielding 3 categories of indications: appropriate, uncertain, and inappropriate. Enrolment and follow-up of all SIBDCS patients were achieved with questionnaires relating to EPACT II criteria. Patients could correspond to several clinical categories; pregnant patients or those with stenosing disease could not be assessed using EPACT II criteria. A step-by-step analysis based on frequency allowed identification of the most appropriate indication for IFX in a given patient. results: 822 CD patients were included between November 2006 and March 2009. 146 patients (18%) were on IFX at inclusion (130 maintenance of remission, 16 new treatments). At inclusion, and in comparison with non-IFX treated patients, patients on infliximab were more frequently female (56% vs 51%), younger at diagnosis (27.4 years old vs 30.4) and had a slightly shorter disease duration (10.3 years vs 11.7). Disease extension was greater in these patients, who were mainly treated in university centres (83% vs 72%). IFX therapy was considered appropriate in 47%, uncertain in 36% and inappropriate in 18 % of patients (6% of situations could not be assessed). conclusion: In this cohort, most indications (47%) for IFX therapy were appropriate. Uncertain or inappropriate indications were mostly due to complex patient characteristics (e.g. complex fistulas, history of multiple drug-failures), which reflect the broad use of IFX in clinical practice. Cohort studies are well suited to evaluating the implementation of new scientific evidence in clinical practice.

Recovery of biological motion perception and network plasticity after cerebellar tumor removal.

Visual perception of body motion is vital for everyday activities such as social interaction, motor learning or car driving. Tumors to the left lateral cerebellum impair visual perception of body motion. However, compensatory potential after cerebellar damage and underlying neural mechanisms remain unknown. In the present study, visual sensitivity to point-light body motion was psychophysically assessed in patient SL with dysplastic gangliocytoma (Lhermitte-Duclos disease) to the left cerebellum before and after neurosurgery, and in a group of healthy matched controls. Brain activity during processing of body motion was assessed by functional magnetic resonance imaging (MRI). Alterations in underlying cerebro-cerebellar circuitry were studied by psychophysiological interaction (PPI) analysis. Visual sensitivity to body motion in patient SL before neurosurgery was substantially lower than in controls, with significant improvement after neurosurgery. Functional MRI in patient SL revealed a similar pattern of cerebellar activation during biological motion processing as in healthy participants, but located more medially, in the left cerebellar lobules III and IX. As in normalcy, PPI analysis showed cerebellar communication with a region in the superior temporal sulcus, but located more anteriorly. The findings demonstrate a potential for recovery of visual body motion processing after cerebellar damage, likely mediated by topographic shifts within the corresponding cerebro-cerebellar circuitry induced by cerebellar reorganization. The outcome is of importance for further understanding of cerebellar plasticity and neural circuits underpinning visual social cognition.