28-1-20, Dixmude [voyage présidentiel de M. Raymond Poincaré accompagné de M. Alexandre Millerand et du maréchal Foch] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57795

17-1-20, Congrès de Versailles [vue de la cour d'Honneur] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57673

17-1-20, Congrès de Versailles : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57674

Clamart, 18-1-20, interclubs du comité de Paris, Denis gagnant [du cross-country] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57696

17-1-20, Congrès de Versailles : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57689

Assessment of distribution and evolution of mechanical dyssynchrony in a porcine model of myocardial infarction by cardiovascular magnetic resonance.

BACKGROUND: We sought to investigate the relationship between infarct and dyssynchrony post- myocardial infarct (MI), in a porcine model. Mechanical dyssynchrony post-MI is associated with left ventricular (LV) remodeling and increased mortality. METHODS: Cine, gadolinium-contrast, and tagged cardiovascular magnetic resonance (CMR) were performed pre-MI, 9 ± 2 days (early post-MI), and 33 ± 10 days (late post-MI) post-MI in 6 pigs to characterize cardiac morphology, location and extent of MI, and regional mechanics. LV mechanics were assessed by circumferential strain (eC). Electro-anatomic mapping (EAM) was performed within 24 hrs of CMR and prior to sacrifice. RESULTS: Mean infarct size was 21 ± 4% of LV volume with evidence of post-MI remodeling. Global eC significantly decreased post MI (-27 ± 1.6% vs. -18 ± 2.5% (early) and -17 ± 2.7% (late), p < 0.0001) with no significant change in peri-MI and MI segments between early and late time-points. Time to peak strain (TTP) was significantly longer in MI, compared to normal and peri-MI segments, both early (440 ± 40 ms vs. 329 ± 40 ms and 332 ± 36 ms, respectively; p = 0.0002) and late post-MI (442 ± 63 ms vs. 321 ± 40 ms and 355 ± 61 ms, respectively; p = 0.012). The standard deviation of TTP in 16 segments (SD16) significantly increased post-MI: 28 ± 7 ms to 50 ± 10 ms (early, p = 0.012) to 54 ± 19 ms (late, p = 0.004), with no change between early and late post-MI time-points (p = 0.56). TTP was not related to reduction of segmental contractility. EAM revealed late electrical activation and greatly diminished conduction velocity in the infarct (5.7 ± 2.4 cm/s), when compared to peri-infarct (18.7 ± 10.3 cm/s) and remote myocardium (39 ± 20.5 cm/s). CONCLUSIONS: Mechanical dyssynchrony occurs early after MI and is the result of delayed electrical and mechanical activation in the infarct.

Bordeaux, voyage présidentiel, cortège devant le palais de justice [1/3/20] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58297

Can neurally adjusted ventilatory assist (NAVA) improve patient-ventilator interaction? A preliminary study

INTRODUCTION. NAVA is a new spontaneous-assisted ventilatory mode based on thedetection of diaphragmatic electrical activity (Eadi) and its feedback to adjust ventilatorsettings. NAVA uses the Eadi, an expression of the respiratory center's activity, to initiatepressurization, set the level of pressure support and cycle the ventilator into exhalation.Therefore, NAVA should theoretically allow near-perfect synchronization between the patientand the ventilator. However there are few data documenting these effects in intensive carepatients.OBJECTIVES. To determine whether NAVA can improve patient-ventilator synchronycompared to standard pressure support (PS) in intubated intensive care patients.METHODS. Comparative study of patient-ventilator interaction during PS with cliniciandetermined ventilator settings and NAVA with NAVA gain (proportionality factor betweenEadi and the amount of delivered inspiratory pressure) set as to obtain the same peak airwaypressure as the total pressure obtained in PS. A 20 min continuous recording with eachventilatory mode was performed allowing determination of trigger delay (Td), patient neuralinspiratory time (Tin), duration of pressurization by the ventilator (Tiv), excess durationof pressurization (Ti excess = Tiv - Tin/Tin 9 100) and number of asynchrony events byminute: non-triggering breaths, auto-triggering, double triggering, premature and delayedcycling.Results are given in mean ± SD. p is considered significant if\0.05.RESULTS. Preliminary results (mean ± SD): five patients (age 75 ± 12 years, 1 M/4F,BMI 25.7 ± 4.1 kg m-2), two pts with COPD, 1 with restrictive disease, initial settings: PS14.6 ± 1.7 cm H2O, PEEP 6.4 ± 1.5 cm H2O, NAVA gain 2.8 ± 1.3PS NAVA % reduction NAVAversus PSTd (ms) 210.4 ± 63.0 51.8 ± 12.1* 74.5 ± 5.0Ti excess (%) 12.9 ± 19.6 2.2 ± 0.6 70.8 ± 37.8n asynchrony/minute 7.6 ± 6.4 4.1 ± 3.7* 47.5 ± 17.0Respiratory rate (min-1) 16.8 ± 2.6 20.4 ± 4.7 NA* p\0.05CONCLUSION. Compared to standard PS, NAVA improves patient ventilator interaction byreducing Td and the overall incidence of asynchrony events. There is also a strong trend inreducing delayed cycling. This ongoing trial should provide evidence that NAVA can indeedimprove patient-ventilator synchrony in intubated patients undergoing PS.REFERENCE(S). 1. Sinderby C, Navalesi P et al (1995) Neural control of mechanicalventilation in respiratory failure. Nat Med 5(12):1433-1436.2. Colombo D, Cammarota G et al (2008) Physiologic response to varying levels of pressuresupport and neurally adjusted ventilator assist in patients with acute respiratory failure.Intensive Care Med 34(11):2010-2018.

25/2/20, réception de M. Deschanel à la Maison des Journalistes [30 rue Louis-le-Grand à Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58196

29/2/20, Inquisitif [monté par le jockey Ed. Haës] gagnant du prix Jean Hennessy [i.e. Robert Hennessy, steeple-chase, hippodrome d'Auteuil] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58279

Cannes, 21-1-20, prince Philippe de Bourbon [jouant au tennis] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57739

1/1/20, Struxiano [Philippe], capitaine de l'équipe de France [de rugby posant avant le match France-Écosse au Parc des princes] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57441

28-1-20, voyage présidentiel à Nieuport : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57784

M. [Joseph] Paul-Boncour [16-1-20, cour du Sénat, vote préliminaire pour l'élection du président de la République] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57665

L'abbé [Eugène] Müller [16-1-20, cour du Sénat, vote préliminaire pour l'élection du président de la République] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57664