Vascular cognitive impairment: Advances and trends.

The presence of vascular neurocognitive impairment (whatever the severity) is always associated with a functional impact and increased risk of dependency and institutionalization. However, vascular cognitive impairment remains underdiagnosed, and the mechanisms underlying post-stroke cognitive disorders are still poorly understood. However, the advent of new criteria and a standardized international neuropsychological battery is expected to lead to improved diagnosis and management, and the development of novel techniques (such as brain imaging and amyloid PET) should improve our understanding of the mechanisms underlying vascular cognitive impairment and help to identify potential targets for therapy.

Proton pump inhibitors are still overprescribed for hospitalized children.

OBJECTIVE: The use of proton pump inhibitors has increased exponentially over the past 20 years. Several side effects have been reported and concerns exist about the consequences of long-term proton pump inhibitors on health, leading to limitation of their use. The present study analyzed prescriptions of proton pump inhibitors at inpatient units and assessed their compliance with current recommendations. METHODS: This single-center, observational, retrospective study reviewed medical file of patients hospitalized at the pediatric medical departments of the Bordeaux University Hospital between April 1 and September 30, 2019. Patients younger than 18 years, hospitalized in the pediatric hospital units and treated with proton pump inhibitors were included. Prescriptions of proton pump inhibitors were compared with French and international guidelines. RESULTS: Proton pump inhibitors were prescribed for 251 of 2237 children (11%), mainly for gastroesophageal reflux disease (47%) and prevention of peptic ulcer disease (32.7%). Proton pump inhibitor prescription complied to recommendations in 34.5% of cases, less often in children aged younger than 1 year (13.5%) than in older children. Compliance to recommendations was lower when proton pump inhibitors were indicated for the prevention of peptic disease (5%) than for gastroesophageal reflux disease (48%). CONCLUSIONS: Proton pump inhibitors are frequently prescribed for hospitalized children, and indications comply with recommendations in only 35% of the cases. Efforts in spreading awareness of the recommendations on the use of proton pump inhibitors in children are mandatory among hospital pediatricians.

[Ultrasound microscopy in the upper aerodigestive tract. Initial clinical experiences]. / Ultraschallmikroskopie im oberen Aerodigestivtrakt. Erste klinische Erfahrungen.

PURPOSE: Initial clinical experiences with ultrasound microscopy in the upper aerodigestive tract are described. MATERIALS AND METHODS: In the present pilot study, 20 healthy probands and 10 patients with lesions of the oral cavity, pharynx and larynx undergoing surgery were examined using a new prototype of an ultrasound microscope. RESULTS: A total of 24 normal and six pathological findings of the upper aerodigestive tract were assessed. These included normal mucosa of the floor of the mouth, the inner cheek, the palate and the vocal fold. In addition, invasive carcinoma of the floor of the mouth, the aryepiglottic fold and the vocal fold was found. Furthermore, a papilloma of the palatal arch and two epiglottic cysts were examined. CONCLUSION: Our results demonstrate that ultrasound microscopy is also viable in hollow organs. Pathological lesions differed clearly from normal mucosa. However, to recognize the regular pattern of different lesions of the upper aerodigestive tract, further investigations need to be carried out with a larger number of patients.

Physiological effects of adding ECCO2R to invasive mechanical ventilation for COPD exacerbations.

BACKGROUND: Extracorporeal CO2 removal (ECCO2R) could be a valuable additional modality for invasive mechanical ventilation (IMV) in COPD patients suffering from severe acute exacerbation (AE). We aimed to evaluate in such patients the effects of a low-to-middle extracorporeal blood flow device on both gas exchanges and dynamic hyperinflation, as well as on work of breathing (WOB) during the IMV weaning process. STUDY DESIGN AND METHODS: Open prospective interventional study in 12 deeply sedated IMV AE-COPD patients studied before and after ECCO2R initiation. Gas exchange and dynamic hyperinflation were compared after stabilization without and with ECCO2R (Hemolung, Alung, Pittsburgh, USA) combined with a specific adjustment algorithm of the respiratory rate (RR) designed to improve arterial pH. When possible, WOB with and without ECCO2R was measured at the end of the weaning process. Due to study size, results are expressed as median (IQR) and a non-parametric approach was adopted. RESULTS: An improvement in PaCO2, from 68 (63; 76) to 49 (46; 55) mmHg, p = 0.0005, and in pH, from 7.25 (7.23; 7.29) to 7.35 (7.32; 7.40), p = 0.0005, was observed after ECCO2R initiation and adjustment of respiratory rate, while intrinsic PEEP and Functional Residual Capacity remained unchanged, from 9.0 (7.0; 10.0) to 8.0 (5.0; 9.0) cmH2O and from 3604 (2631; 4850) to 3338 (2633; 4848) mL, p = 0.1191 and p = 0.3013, respectively. WOB measurements were possible in 5 patients, indicating near-significant higher values after stopping ECCO2R: 11.7 (7.5; 15.0) versus 22.6 (13.9; 34.7) Joules/min., p = 0.0625 and 1.1 (0.8; 1.4) versus 1.5 (0.9; 2.8) Joules/L, p = 0.0625. Three patients died in-ICU. Other patients were successfully hospital-discharged. CONCLUSIONS: Using a formalized protocol of RR adjustment, ECCO2R permitted to effectively improve pH and diminish PaCO2 at the early phase of IMV in 12 AE-COPD patients, but not to diminish dynamic hyperinflation in the whole group. A trend toward a decrease in WOB was also observed during the weaning process. Trial registration ClinicalTrials.gov: Identifier: NCT02586948.

[Using an ovarian drilling by hydrolaparoscopy or recombinant follicle stimulating hormone plus metformin to treat polycystic ovary syndrome: Why a randomized controlled trial fail?]. / Drilling ovarien par fertiloscopie ou stimulation par FSH plus metformine dans le traitement du syndrome des ovaires polykystiques : pourquoi un essai thérapeutique peut être un échec.

OBJECTIVES: To evaluate pregnancy rates after randomized controlled trial (RCT) between ovarian drilling by fertiloscopy or ovarian hyperstimulation+insemination+metformine after clomifène citrate (cc) treatment fails. PATIENTS AND METHODS: Randomized controlled trial with 126 patients in each arm in 9 university centers. After 6-9 months of stimulation by cc, 2 groups were randomized: group 1, ovarian drilling with bipolar energy versus group 2: 3 months treatment by metformine followed by 3 hyperstimulation by FSH+insemination. The success rate was pregnancy rate above 12 weeks. RESULTS: RCT was stopped after the screening of 40 patients. In spite of the low number of patients, the pregnancy rate is significantly higher in medical group 8/16 versus 3/18 (p=0.04). CONCLUSION: The causes of fail of RCT were in relationship with difficulties of inclusion, with absence of final agreement by team included. Moreover, RCT between medical and surgical management is often root of difficulties for patients who decline surgical strategy. However, medical treatment appeared better than drilling in this RCT.

Expression and coupling of somatostatin receptors in rat adrenal (PC12) and pituitary (GC) cell lines.

Somatostatin (somatotropin release-inhibiting factor, SRIF) interacts with G-protein coupled receptors (sst) designated sst1 through sst5. In PC12 and GC cells, SRIF binding sites were identified and mRNA receptor expression was evaluated. SRIF binding sites were expressed at a much lower density in PC12 (Kd = 21.2 +/- 3.9 nM; Bmax = 31 +/- 8 fmol/mg protein) than in GC cells (Kd = 6.4 +/- 1.6 nM; Bmax = 643 +/- 29 fmol/mg protein). sst3 receptor mRNA (81% of the total) was mainly expressed in PC12 cells, while sst1/2 receptor mRNAs were mostly expressed in GC cells (64 and 29%, respectively). In PC12 cells, adenylyl cyclase (AC) activity was unaffected by SRIF-14 (binding all SRIF receptors), octreotide (specific for sst2/3/5 receptors), BIM 23056 (binding sst3/5 receptors) or CH275 (specific for sst1 receptors), 1 microM each. In GC cells, SRIF-14 or octreotide, but not the two other peptides, significantly inhibited AC activity.

Pulmonary edema and shock after high-dose aracytine-C for lymphoma; possible role of TNF-alpha and PAF.

Four out of 23 consecutive patients treated with high-dose Ara-C for lymphomas in our institution developed a strikingly similar syndrome during the perfusion. It was characterized by the onset of fever, diarrhea, shock, pulmonary edema, acute renal failure, metabolic acidosis, weight gain and leukocytosis. Thorough bacteriological screening failed to provide evidence of infection. Sequential biological assays of IL-1, IL-2, TNF and PAF were performed during Ara-C infusion to ten patients, including the four who developed the syndrome. TNF and PAF activity was found in the serum of respectively two and four of the cases, but not in the six controls. As TNF and PAF are thought to be involved in the development of septic shock and adult respiratory distress syndrome, we hypothesize that high-dose Ara-C may be associated with cytokine release.

High-performance liquid chromatographic analysis of a linear alkylbenzenesulfonate and its environmental biodegradation metabolites.

A simple and fast method is described for determining a linear alkylbenzenesulfonate (LAS) and its potential sulfonated and unsulfonated metabolites in natural waters. This method includes extraction of 60 ml of water with an octadecyl-bonded silica (C18) mini-column and analysis of the extract by high-performance liquid chromatography. A reversed-phase column with a 0.008 M potassium phosphate buffer (pH 2.2)-acetonitrile gradient as the mobile phase provides the separation. A UV detector, set at 215 nm, is employed.

Primary cutaneous nocardiosis in an immune-competent patient.

We present a patient who was hospitalized due to a purulent skin lesion with a surrounding erythematous area in the region of the right paranasal crease accompanied by a swelling of the right eyelid. Initially the diagnosis of a carbuncle caused by an infection with Staphylococcus aureus was supposed. A surgical debridement was performed and an antibiotic therapy was started. Only special microbial investigations requested by the clinician led to the diagnosis of a cutaneous infection with Nocardia brasiliensis. The presented case is remarkable because the nocardia infection was in an immune-competent patient and the patient showed a primary cutaneous nocardiosis without dissemination.

Broncho-alveolar lavage in sarcoidosis. Correlation between alveolar lymphocytosis and clinical data.

Bronchoalveolar lavages (BAL) were performed in patients with pulmonary sarcoidosis and in normal subjects. In both smoking and nonsmoking sarcoid patients, the proportion and number of lymphocytes were significantly increased compared to corresponding controls (p less than 0.001 in each cases). BAL lymphocytes were identified as T lymphocytes (88 +/- 9% formed E rosettes). Neither the radiological stage, nor the duration of disease are related to the lymphocyte number. However, alveolar lymphocytosis is significantly correlated with clinical pattern (p less than 0.02) and with clinical extrathoracic dissemination (p less than 0.001). Black patients have significantly more disseminated disease than Whites (p less than 0.001). The lymphocytosis of the bronchoalveolar space is associated with the presence of granulomas in bronchial biopsies (p less than 0.005). For clinical purposes, the results of BAL were helpful in determining the evolutivity of the disease, particularly progression to stage III. Together with a high lymphocyte count, a significant increase of all the polymorphonuclear leukocytes (PMNL) was found in stage III (4.0 +/- 4.6 X 10(4) PMNL/ml, p less than 0.001) compared to earlier stages (respectively 0.6 +/- 0.5 X 10(4), 0.7 +/- 0.9 X 10(4) and 0.7 +/- 0.9 X 10(4) PMNL/ml for stages I, IIA and IIB). BAL may also be used to follow up sarcoid patients. Repeated BAL were performed in 23 patients. No modification in alveolar lymphocytosis is found in patients with steady state disease, but, in healed patients the lymphocyte number returns to normal.

[Pulmonary immunology]. / Bases et approches de l'immunologie pulmonaire.

Knowledge of pulmonary immunology is essential to the understanding of certain respiratory diseases. The airways and alveolar zones may be seen separately and in contrast on the basis of the immune system of the lung. Broadly speaking, within the airways there are mast cells, polynuclear eosinophil and lymphocytes. By contrast in the alveolar zones there are macrophages and lymphocytes which are either free in the alveolar lumen or present in the pulmonary interstitial tissue, as well as lymphocytes. In most instances inhaled antigens are not at the origin of an immune response, whether deposited on the mucociliary surface or phagocytosed by the alveolar macrophage. The BALT play a probably primordial role in immune information within the tracheobronchial epithelium. The immune response occurs in the airways in the form of the secretion of secretory A immunoglobulins, whilst in the alveolus phagocytosis by the alveolar macrophage represents the principal means of defence. Such phagocytosis only rarely gives rise to inflammatory phenomena which would impair alveolar function. Finally, the collection of bronchoalveolar washings is a technique which may be used to collect immunocompetent cells of principally alveolar origin for the purpose of their study.

[Horizontal supraglottic laryngectomy. Technique, indications, oncologic results and early functional results. Apropos of 87 cases]. / La laryngectomie horizontale supraglottique. Technique, indications, résultats carcinologiques et suites fonctionnelles précoces. A propos de 87 cas.

In this article, we advocate supraglottic laryngectomy with bilateral neck dissection for the treatment of supraglottic carcinomas with preserved laryngeal mobility. Post-operative results and follow-up of 87 patients are discussed. This technique allows an excellent loco-regional control of the disease with preservation of laryngeal function. Radiation therapy is preserved for treatment of metachronous (2nd primary) in cases with satisfactory local control without neck metastases. All stage 5-year overall survival rate was 55% with a 68.5% disease survival rate. Five-year local control of the disease and regional control of neck nodes were respectively 94% and 92%. Five-year disease survival rate for N- population was 71% Vs 61% for N+ population. Five-year disease survival rate according to the tumor classification was 70% for T1, 75% for T2, 69% for T3 and 54% for T4. In the post-operative follow-up, the median of time to decanulation was 17 days, that of nasogastric tube removal was 19 days, that of hospital stay 38 days.

[Medication errors in anaesthesia: a review of reports from the French Health Products Agency]. / Erreurs médicamenteuses en anesthésie : bilan et analyse des signalements reçus à l'Afssaps.

BACKGROUND: The purpose of this study was to assess medication errors and risks of medication errors during anaesthetic practice reported at the French Health Products Agency (Afssaps) from 2005 to 2010. STUDY DESIGN: Descriptive study. METHODS: The data are issued of "Medication errors and risks of medication errors" file which group together all cases received by the Medication Errors Unit at Afssaps since 2005. RESULTS: A total of 263 cases were observed by the Medication Errors Unit at Afssaps. Among them, 159 cases were risks of medication errors, 76 cases were patent medication errors and 28 were near misses. Among the 76 cases of patent medication errors, out of which 47 cases were appreciated with adverse reaction and 35 cases were classified as serious. Adverse events were classified as haemodynamic, respiratory and neurologic events. Most of the errors occurred during administration (65%), followed by dispensing errors (14%), storage errors (15%) or preparation errors (4%). Sixty-nine percent of cases of wrong drug errors were found, followed by 26% of errors of strength, 3% of incorrect route of administration errors and 2% of patient errors. In most of cases, similarity in packaging was underlined (n=83). CONCLUSION: This study showed that the majority of medication errors and risks of medication errors during anaesthetic practice, underline similarity in packaging. Results highlighted the importance of vial labeling presentation (readability and mention understanding) in anaesthetic practice.

[Second wave of the French drug harmonisation programme to prevent medication errors: overall appreciation of healthcare professionals]. / Évaluation de l'impact auprès des professionnels de la mise en œuvre de la seconde vague du plan d'harmonisation de l'étiquetage des injectables.

BACKGROUND: Medication errors are a significant cause of severe healthcare-associated complications. In December 2006, the French Health Products Agency (Afssaps) has issued a protocol to harmonise labeling of injectable drugs vials. In 2007, a first change was launched for four drugs and was followed in 2008-2009 by a second wave concerning 42 active drugs. METHODS: The present study describes how healthcare professionals have perceived this change and their overall appreciation of the drug harmonisation programme. A survey using an electronic questionnaire was distributed to medical and non-medical professionals in anaesthesia and intensive care and pharmacists in a representative sample of 200 French hospitals. RESULTS: The harmonisation procedure was felt as being overall satisfactory by 53% of professionals who had responded but it was recognised that the new procedure is associated with improved readability and understanding of drug dosage. The use of colour coding was also well accepted by the personnel of clinical units. Respondents expressed significant criticisms regarding both the communication plan and the way the plan was implemented locally in hospitals. Old and new labeling coexisted in 66% of responding hospitals and many respondents described being aware of errors or near-misses that were considered related to the transition. For many important topics, pharmacists had views that were significantly different from clinicians. CONCLUSION: This national survey describing the perception of healthcare professionals regarding the new harmonisation procedure for injectable drugs highlighted some progress but also a number of deficiencies, notably regarding communication and implementation of the change in clinical units. This survey will be used by the French Health Products Agency to improve future steps of the long-lasting campaign against medication errors.

Split-rib reconstruction of the frontal sinus: two cases and literature review.

BACKGROUND: Large defects of the anterior wall of the frontal sinus require closure using either autologous or foreign material. In cases of osteomyelitis, the reconstruction must be resistant to bacterial infection. Split-rib osteoplasty can be used in different sites. METHODS: Two patients with malignant sinonasal tumours underwent repeated treatment, and subsequently developed osteomyelitis of the frontal bone. After adequate therapy, a large defect of the anterior wall persisted. Reconstruction was performed using the split-rib method. The literature on this topic was reviewed. RESULTS: Both patients' treatment were successful. No complications occurred. A PubMed search on the topic of rib reconstruction of the frontal sinus and skull was performed; 18 publications matched the inclusion criteria. From these sources, we noted that 182 reconstructions yielded good results with few complications. CONCLUSION: Large defects of the anterior wall of the frontal sinus can be closed successfully using autologous split-rib grafting. Aesthetic outcome is good and donor site morbidity is minimal.

Ultrasound-guided core-needle biopsy in the diagnosis of head and neck lesions.

This article describes the technique of ultrasound-guided core-needle biopsy in the head and neck, and also warns of its risks. In contrast to fine-needle aspiration, this minimally invasive procedure has the advantage of supplying a histological specimen rather than a cytological smear. Therefore, it could be used as an additional diagnostic tool in the investigation of head and neck lesions, and can be carried out within the out-patients clinic.