[Succès de traitement par Cabergoline d'une série de cas de cardiomyopathie du péripartum, incluant un cas critique nécessitant une assistance circulatoire mécanique]. / Successful treatment with Cabergoline in critical peripartum cardiomyopathy patient on Veno-Arterial Extra Corporeal Membrane Oxygenation.

Peripartum cardiomyopathy is a life-threatening condition that requires urgent diagnosis and management. Bromocriptine was established as disease specific therapy; less data is known about Cabergolin which is another prolactin secretion inhibitor. In this paper we report 4 peripartum cardiomyopathy cases treated successfully with Cabergoline, including a cardiogenic shock case requiring mechanical circulatory support.

Right ventricle failure in patients treated with left ventricular assist device.

This review article aim to highlight the right ventricular function peri left ventricular assist device implantation, and to assess the incidence, physiopathology, predictors, management and prognosis, of right ventricular failure post-implant.

Assessment of the risk of dermal exposure to pesticides during treatment with a back-pack sprayer in the presence and absence of vegetation.

Assessing the dermal exposure of applicators to pesticides is still an important issue, and the measurement methods used remain open to improvement. This is particularly true when it comes to characterising the exposure of applicators using back-pack sprayers. The scenarios used for the different mathematical models continue to be riddled with approximations and uncertainties. With a view to improving these scenarios, test were performed in an open environment to measure the levels of dermal exposure on various parts of an operator's body during treatment with this type of equipment. The main parameters studied are the presence of vegetation and the height of the crop. The method uses a tracer (fluorescein salt) and collectors placed all over the body in order to determine which parts are subject to most contamination during spraying. The quantitative determinations of the tracer show that exposure, in the presence of vegetation, reaches levels of 0.02%, 0.006% and 0.04% of the total quantity applied in treatment, at heights of 0.5, 1 and 2 m respectively. In the absence of vegetation, it stands at 0.21%, 0.61% and 0.62% of the total quantity applied at heights of 0.5, 1 and 2 m. In each of these situations, the lower limbs of the body (shins and thighs) collected large proportions of fluorescein. The contamination of the upper parts of the body increases in proportion to the height of treatment. These results show that the presence of vegetation and the spraying height are important parameters to be considered and to be integrated into the models, to validly assess the exposure of operators using a backpack sprayer.

[Cerebral aneurysm and subarachnoid hemorrhage revealed by a Tako Tsubo syndrome]. / Syndrome de Tako Tsubo révélant une hémorragie méningée par rupture d'anévrisme.

Cerebral hemorrhage is usually associated to many cardiac disorders, mimicking acute coronary syndrome. We relate a case of a postmenopausal woman presenting at emergency room for acute coronary syndrome and whose evaluation revealed a subarachnoidal hemorrhage, normal coronary arteries, and a typical Tako Tsubo aspect on echocardiography with apical ballooning and hyperkinesis with basal hypokinesis.

[Heart rate variability alteration in patients on chronic hemodialysis]. / Altération de la variabilité sinusale chez les malades en hémodialyse chronique.

BACKGROUND AND AIM: Decrease in heart rate variability (HRV) is a known risk factor for cardiovascular morbidity and mortality. The aim of our study is to evaluate HRV in chronic hemodialysis patients and to determine factors that might decrease or increase it. METHODS: This is a retrospective study including 51 patients, 23 males and 28 females, with a mean of age of 64.5 years (23-84 years) on chronic hemodialysis for end stage renal disease due to various causes. Twenty-four-hour heart rate monitoring was recorded in all patients to evaluate HRV. HRV of hemodialysis patients was compared to normal patients (control). We also looked for correlation between HRV and a number of clinical and biological factors. RESULTS: All HRV parameters were decreased in chronic hemodialysis patients compared to normal controls with a significant difference (p<0.0005). HRV decreases with age (p=0.012), and is lower in diabetic patients (p=0.026). Interestingly, we found that chronic hemodialysis patients on beta-blockers had higher HRV with p=0.011. CONCLUSION: HRV is reduced in chronic hemodialysis patients mainly in old and diabetic patients, but this decrease is less important in those receiving beta-blockers.

[Heart rate variability and vasovagal syncope]. / Intérêt de la variabilité sinusale dans la syncope vasovagale.

OBJECTIVE: Tilt Table testing is widely used for the diagnosis and evaluation of vasovagal syncope. By evaluating the fluctuations of the autonomic nervous system that play an important role in syncope genesis, heart rate variability (HRV) can be considered as a tool of added value. METHODS: We evaluated prospectively 123 patients admitted for recurrent syncope with a positive tilt Table testing. A time domain analysis of a 24 hours ambulatory electrocardiography was used in all patients to asses the particularities of their autonomic function. We compared their results with those obtained from a group of 82 healthy volunteers. RESULTS: Statistical analysis of the results showed a significant increase of all HRV parameters in the group of vasovagal syncope compared to the healthy volunteers. SDNNidx (58 vs 42; p < 0.001), rMSSD (40 vs 27; p < 0.001), SDNN (102 vs 83; p < 0.001), SDANN (79 vs 67; p< 0.001), pNN50 (11 vs 4.9; p <0.001). CONCLUSION: Time domain analysis of heart rate variability reveals increased values in patients with vasovagal syncope. It seems to be an interesting, easy and complementary test in the evaluation of syncope of unknown etiology.

Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry.

OBJECTIVE: To study the impact on outcomes of direct admission versus emergency room (ER) admission in patients with ST-segment elevation myocardial infarction (STEMI) DESIGN: Nationwide observational registry of STEMI patients SETTING: 369 intensive care units in France. INTERVENTIONS: Patients were categorised on the basis of the initial management pathway (direct transfer to the coronary care unit or catheterisation laboratory versus transfer via the ER). MAIN OUTCOME MEASURES: Delays between symptom onset, admission and reperfusion therapy. Mortality at five days and one year. RESULTS: Of 1204 patients enrolled, 66.9% were admitted direct and 33.1% via the ER. Bypassing the ER was associated with more frequent use of reperfusion (61.7% v 53.1%; p = 0.001) and shorter delays between symptom onset and admission (244 (interquartile range 158) v 292 (172) min; p < 0.001), thrombolysis (204 (150) v 258 (240) min; p < 0.01), hospital thrombolysis (228 (156) v 256 (227) min, p = 0.22), and primary percutaneous coronary intervention (294 (246) v 402 (312) min; p < 0.005). Five day mortality rates were lower in patients who bypassed the ER (4.9% v 8.6%; p = 0.01), regardless of the use and type of reperfusion therapy. After adjusting for the simplified Thrombolysis in Myocardial Infarction (TIMI) risk score, admission via the ER was an independent predictor of five day mortality (odds ratio 1.67, 95% confidence interval 1.01 to 2.75). CONCLUSIONS: In this observational analysis, bypassing the ER was associated with more frequent and earlier use of reperfusion therapy, and with an apparent survival benefit compared with admission via the ER.

Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study.

OBJECTIVE: To analyse the short and long term prognostic significance of admission glycaemia in a large registry of non-diabetic patients with acute myocardial infarction. METHODS: Assessment of short and long term prognostic significance of admission blood glucose in a consecutive population of 1604 non-diabetic patients admitted to intensive care units in France in November 2000 for a recent (

[Management of patients admitted for acute myocardial infarction in France from 1995 to 2000: time to admission dependent improvement in outcome]. / Prise en charge de l'infarctus du myocarde en France dans les études USIK 1995 et USIC 2000: amélioration pronoslique et rôle du délai d'admission.

The in-hospital management and short- and long-term outcomes was assessed in 2 registries of consecutive patients admitted for acute myocardial infarction, 5 years apart, in France. The 2000 cohort was younger and with a less frequent history of cardiac diseases, but was more often diabetic and with anterior infarcts. Time to admission was actually longer in 2000 than in 1995 (median 5.25 hours vs 4.00 hours). Overall, reperfusion therapy was used in 43% of the patients in both registries. However, the use of reperfusion therapy increased from 1995 to 2000 in patients admitted within 6 hours of symptom onset (64 vs 58%), with an increasing use of primary angioplasty (from 12 to 30%). Five-day mortality significantly improved from 7.7 to 6.1% (p < 0.03) and one-year survival was also less in the most recent period (85 vs 81%, p < 0.01). Multivariate analyses showed that the period of inclusion (2000 vs 1995) was an independent predictor of both short- and long-term mortality in patients admitted within 6 hours of symptom onset. Thus, in the real world setting, a continued decline in one-year mortality was observed in patients admitted to intensive care units for recent acute myocardial infarction, especially for patients admitted early. This goes along with a shift in reperfusion therapy towards a broader use of primary angioplasty, and with an increased use of the early prescription of recognised secondary prevention medications.

[Admission and fasting blood glucose are important prognostic markers in acute coronary syndromes]. / Glycémie d'admission et glycémie a jeun, marqueurs pronostiques dans les syndromes coronaires aigus.

This paper reviews current evidence on the role of admission and fasting glycaemia as prognostic markers in patients with acute coronary syndromes. Though both parameters are correlated, they give different prognostic information and are related to both in-hospital complications, including death, and long-term outcomes. As hyperglycemia at the acute stage of myocardial infarction is an independent predictor of untoward cardiovascular events, blood glucose measurements should become routine in all patients presenting with acute coronary syndromes.

Involvement of the p38 mitogen-activated protein kinase pathway in tissue inhibitor of metalloproteinases-1-induced erythroid differentiation.

We examined the role of the mitogen-activated protein (MAP) kinase pathway in tissue inhibitor of metalloproteinases-1 (TIMP-1)-mediated cellular effects in a human erythroleukemic cell line UT-7. We show that TIMP-1 induced both UT-7 cell erythroid differentiation and proliferation and tyrosine phosphorylation of many intracellular proteins. Using a panel of phosphospecific antibodies, we also demonstrate that phosphorylation of the p38 and c-Jun N-terminal kinases is increased by TIMP-1 whereas phosphorylation of extracellular signal-regulated kinase 1/2 is not induced. Moreover, inhibition of the p38 activity by SB203580 significantly reduces erythroid differentiation induced by TIMP-1, suggesting that the p38 MAP kinase pathway is involved in TIMP-1-induced erythroid differentiation.

Erythropoietin induction of tissue inhibitors of metalloproteinase-1 expression and secretion is mediated by mitogen-activated protein kinase and phosphatidylinositol 3-kinase pathways.

In the present study, we demonstrate that erythropoietin (Epo) induces the expression and the release of tissue inhibitors of metalloproteinase-1 (TIMP-1) in a time- and dose-dependent manner in Epo-dependent cell line UT-7 cells and in normal human erythroid progenitor cells from cord blood (CD36+) and required de novo protein synthesis. TIMP-1 was not expressed in the absence of Epo. Inhibition of the mitogen-activated protein kinase pathway by the specific inhibitors PD98059 and U0126 and of phosphatidylinositol 3-kinase by LY294002, strongly inhibited Epo-induced TIMP-1 expression and secretion. In the absence of Epo, both latent and active forms of matrix metalloproteinase-9 (MMP-9) were secreted into media. Upon Epo stimulation, MMP-9 and pro-MMP-9 secretion was inhibited in a dose-dependent manner parallel to TIMP-1 induction. The addition of PD98059, U0126, and LY294002 in the presence of Epo restored MMP-9 production in UT-7 and CD36+ cells. Our findings strongly suggest an inversely coordinated regulation of the TIMP-1 gene and MMP-9 production by Epo via mitogen-activated protein kinase and phosphatidylinositol 3-kinase pathways.

Erythropoietin induces glycosylphosphatidylinositol hydrolysis. Possible involvement of phospholipase c-gamma(2).

We showed that erythropoietin induced rapid glycosylphosphatidylinositol (GPI) hydrolysis and tyrosine phosphorylation of phospholipase C (PLC)-gamma(2) in FDC-P1 cells transfected with the wild-type erythropoietin-receptor. Erythropoietin-induced tyrosine phosphorylation of PLC-gamma(2) was time- and dose-dependent. By using FDC-P1 cells transfected with an erythropoietin receptor devoid of tyrosine residues, we showed that both effects required the tyrosine residues of intracellular domain on the erythropoietin receptor. Erythropoietin-activated PLC-gamma(2) hydrolyzed purified [(3)H]GPI indicating that GPI hydrolysis and PLC-gamma(2) activation under erythropoietin stimulation were correlated. Results obtained on FDC-P1 cells transfected with erythropoietin receptor mutated on tyrosine residues suggest that tyrosines 343, 401, 464, and/or 479 are involved in erythropoietin-induced GPI hydrolysis and tyrosine phosphorylation of PLC-gamma(2), whereas tyrosines 429 and/or 431 seem to be involved in an inhibition of both effects. Thus, our results suggest that erythropoietin regulates GPI hydrolysis via tyrosine phosphorylation of its receptor and PLC-gamma(2) activation.