[Nursing care of a patient admitted to a hyperbaric chamber for a chronic wound]. / Prise en charge infirmière d'un patient admis au caisson hyperbare pour une plaie chronique.

The hyperbaric chamber is a particularly relevant therapy for the healing of chronic wounds such as radiation-induced wounds, ulcers, diabetic foot or osteomyelitis. This article describes the pathway of a patient with a chronic wound from the perspective of a hyperbaric medicine nurse.

[Immersion in the world of hyperbaric medicine with two specialist nurses]. / Immersion dans le monde de l'hyperbarie avec deux infirmiers spécialisés.

The speciality of the hyperbaric nurse, whether practised in the civil or military setting, has a wide-reaching scope. Two teams of professionals from Lyon and Toulon share their motivations and demonstrate, through the words of two nurses, a real collective passion for this original and highly technical practice.

Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial.

PURPOSE: To test whether the polymyxin B hemoperfusion (PMX HP) fiber column reduces mortality and organ failure in peritonitis-induced septic shock (SS) from abdominal infections. METHOD: Prospective, multicenter, randomized controlled trial in 18 French intensive care units from October 2010 to March 2013, enrolling 243 patients with SS within 12 h after emergency surgery for peritonitis related to organ perforation. The PMX HP group received conventional therapy plus two sessions of PMX HP. Primary outcome was mortality on day 28; secondary outcomes were mortality on day 90 and a reduction in the severity of organ failures based on Sequential Organ Failure Assessment (SOFA) scores. PRIMARY OUTCOME: day 28 mortality in the PMX HP group (n = 119) was 27.7 versus 19.5% in the conventional group (n = 113), p = 0.14 (OR 1.5872, 95% CI 0.8583-2.935). Secondary endpoints: mortality rate at day 90 was 33.6% in PMX-HP versus 24% in conventional groups, p = 0.10 (OR 1.6128, 95% CI 0.9067-2.8685); reduction in SOFA score from day 0 to day 7 was -5 (-11 to 6) in PMX-HP versus -5 (-11 to 9), p = 0.78. Comparable results were observed in the predefined subgroups (presence of comorbidity; adequacy of surgery, <2 sessions of hemoperfusion) and for SOFA reduction from day 0 to day 3. CONCLUSION: This multicenter randomized controlled study demonstrated a non-significant increase in mortality and no improvement in organ failure with PMX HP treatment compared to conventional treatment of peritonitis-induced SS.

Anatomical and electrophysiological plasticity of locomotor networks following spinal transection in the salamander.

Recovery of locomotor behavior following spinal cord injury can occur spontaneously in some vertebrates, such as fish, urodele amphibians, and certain reptiles. This review provides an overview of the current status of our knowledge on the anatomical and electrophysiological changes occurring within the spinal cord that lead to, or are associated with the re-expression of locomotion in spinally-transected salamanders. A better understanding of these processes will help to devise strategies for restoring locomotor function in mammals, including humans.

Specific neural substrate linking respiration to locomotion.

When animals move, respiration increases to adapt for increased energy demands; the underlying mechanisms are still not understood. We investigated the neural substrates underlying the respiratory changes in relation to movement in lampreys. We showed that respiration increases following stimulation of the mesencephalic locomotor region (MLR) in an in vitro isolated preparation, an effect that persists in the absence of the spinal cord and caudal brainstem. By using electrophysiological and anatomical techniques, including whole-cell patch recordings, we identified a subset of neurons located in the dorsal MLR that send direct inputs to neurons in the respiratory generator. In semi-intact preparations, blockade of this region with 6-cyano-7-nitroquinoxaline-2,3-dione and (2R)-amino-5-phosphonovaleric acid greatly reduced the respiratory increases without affecting the locomotor movements. These results show that neurons in the respiratory generator receive direct glutamatergic connections from the MLR and that a subpopulation of MLR neurons plays a key role in the respiratory changes linked to movement.

Role of ßarrestins in bradykinin B2 receptor-mediated signalling.

G protein-coupled receptors (GPCRs) can engage multiple pathways to activate ERK1/2 via both G proteins and/or ßarrestin. Receptor recruitment of ßarrestin is also important for GPCR desensitization, internalization and resensitization. Modulation of the receptor/ßarrestin interaction through modification of either component would presumably alter the output generated by receptor activation. Here we examined how ßarrestins regulate bradykinin (BK) B2 receptor (B2R) signalling and desensitization by either truncating ßarrestin1 or ßarrestin2 or by alanine substitution of a serine/threonine cluster in the C-terminal tail of B2R (B2R-4A), conditions which all affect the avidity of the B2R/ßarrestin complex. We first demonstrate that BK-mediated ERK1/2 activation is biphasic containing an early peak (between 2-5min) followed by sustained activation for at least 60min. The early but not the sustained phase was predictably affected by inhibition of either Gαq/11 or Gαi/o, whereas loss of ßarrestin2 but not ßarrestin1 resulted in diminished prolonged ERK1/2 activation. ßarrestin2's role was further examined using a truncation mutant with augmented avidity for the agonist-occupied receptor, revealing an increase in both immediate and extended ERK1/2 signalling. We also show that ERK1/2 is recruited to the B2R/ßarrestin complex on endosomes as well as the plasma membrane. Moreover, we investigated ßarrestin's role using the B2R-4A, which is deficient in ßarrestin binding and does not internalize. We show that ERK1/2 signalling downstream of the receptor is entirely G protein-dependent and receptor-mediated intracellular calcium mobilization studies revealed a lack of desensitization. Functionally, the lack of desensitization resulted in increased cell growth and migration compared to the wild-type receptor, which was sensitive to MEK inhibition. These results highlight ßarrestin's crucial role in the maintenance of proper B2R signalling.

Muscarinic control of the excitability of hindlimb motoneurons in chronic spinal-transected salamanders.

The excitability of spinal motoneurons (MNs) is regulated by acetylcholine via the activation of muscarinic receptors. The objective of the present study was to determine whether this cholinergic modulation of MN excitability is altered following a chronic spinal cord transection. Juvenile salamanders (Pleurodeles waltlii) were spinally transected at the mid-trunk level, and patch-clamp recordings from hindlimb MNs in spinal cord slices were performed 9-30 days after transection, with and without bath application of muscarine (20 mum). Our results showed that the input-output relationship was larger in MNs recorded 2 weeks after spinal transection than in MNs recorded 3-4 weeks after spinal transection. They further revealed that muscarine increased both the gain of MNs and the proportion of MNs that could exhibit plateau potentials and afterdischarges, whereas it decreased the amplitude of the medium afterhypolarizing potential. Moreover, muscarine had no effect on the hyperpolarization-activated cation current (I(h)), whereas it increased the inward rectifying K(+) current (I(Kir)) in MNs recorded > or = 2 weeks after spinal transection. We conclude that following chronic spinal cord injury, the muscarinic modulation of some intrinsic properties of MNs previously reported in acute spinal-transected animals [S. Chevallier et al. (2006)The Journal of Physiology, 570, 525-540] was preserved, whereas that of other intrinsic properties of MNs was suppressed, either transiently (I(Kir)) or definitively (I(h)). These alterations in muscarinic modulation of MN excitability may contribute to the spontaneous recovery of locomotion displayed in long-term chronic spinal-transected salamanders.

Phosphoinositides regulate P2X4 ATP-gated channels through direct interactions.

P2X receptors are ATP-gated nonselective cation channels highly permeable to calcium that contribute to nociception and inflammatory responses. The P2X(4) subtype, upregulated in activated microglia, is thought to play a critical role in the development of tactile allodynia following peripheral nerve injury. Posttranslational regulation of P2X(4) function is crucial to the cellular mechanisms of neuropathic pain, however it remains poorly understood. Here, we show that the phosphoinositides PI(4,5)P(2) (PIP(2)) and PI(3,4,5)P(3) (PIP(3)), products of phosphorylation by wortmannin-sensitive phosphatidylinositol 4-kinases and phosphatidylinositol 3-kinases, can modulate the function of native and recombinant P2X(4) receptor channels. In BV-2 microglial cells, depleting the intracellular levels of PIP(2) and PIP(3) with wortmannin significantly decreased P2X(4) current amplitude and P2X(4)-mediated calcium entry measured in patch clamp recordings and ratiometric ion imaging, respectively. Wortmannin-induced depletion of phosphoinositides in Xenopus oocytes decreased the current amplitude of P2X(4) responses by converting ATP into a partial agonist. It also decreased their recovery from desensitization and affected their kinetics. Injection of phosphoinositides in wortmannin-treated oocytes reversed these effects and application of PIP(2) on excised inside-out macropatches rescued P2X(4) currents from rundown. Moreover, we report the direct interaction of phospholipids with the proximal C-terminal domain of P2X(4) subunit (Cys(360)-Val(375)) using an in vitro binding assay. These results demonstrate novel regulatory roles of the major signaling phosphoinositides PIP(2) and PIP(3) on P2X(4) function through direct channel-lipid interactions.

Organisation of the spinal central pattern generators for locomotion in the salamander: biology and modelling.

Among living tetrapods, salamanders are regarded as most closely resembling the first terrestrial vertebrates, and are therefore an interesting group in which the evolutionary changes in the locomotor behaviour from aquatic to terrestrial habitats can be inferred. Salamanders exhibit two locomotor modes: swimming and terrestrial stepping. The swimming is anguilliform and resembles closely that of the lamprey. On the ground, the salamander switches to a stepping gait with axial undulations that is also observed in many reptiles. The salamander is therefore ideally suited for examining the neural mechanisms for the generation of these two locomotor modes, as well as the neural mechanisms of gait transition. In the present paper, we describe the kinematics and patterns of activation of axial and limb muscles during stepping and swimming in adult salamanders. We then review the current neurobiological data about the organisation of the spinal networks underlying swimming and stepping, and the mechanisms of gait transition. Finally we report modelling studies aimed at understanding the organisation and operation of the salamander locomotor circuits. Altogether, the neurobiological and the modelling data support the hypothesis of a phylogenetic conservatism from agnathians to amphibians of the spinal locomotor networks generating axial motor patterns.

Cholinergic control of excitability of spinal motoneurones in the salamander.

The cholinergic modulation of the electrical properties of spinal motoneurones was investigated in vitro, with the use of the whole-cell patch-clamp recording technique in lumbar spinal cord slices from juvenile urodeles (Pleurodeles waltlii). Bath application of acetylcholine (20 microM) with eserine (20 microM) induced an increase in the resting membrane potential, a decrease of the input resistance, a decrease of the action potential amplitude, and a reduction of the medium afterhyperpolarization (mAHP) that followed each action potential. Moreover, the firing rate of motoneurones during a depolarizing current pulse and the slope of their stimulus current-spike frequency relation were increased. All of these effects were mimicked by extracellular application of muscarine (20 microM), and blocked by application of the muscarinic receptor antagonist atropine (0.1-1 microM). They were not observed during bath application of nicotine (10 microM). These results suggest that the cholinergic modulation of spinal motoneurone excitability was mediated by activation of muscarinic receptors. Our results further show that the muscarinic action primarily resulted from a reduction of the Ca2+-activated K+ current responsible for the mAHP, an inhibition of the hyperpolarization-activated cation current, Ih, and an enhancement of the inward rectifying K+ current, I(Kir). We conclude that cholinergic modulation can contribute significantly to the production of motor behaviour by altering several ionic conductances responsible for the repetitive discharge of motoneurones.

Recovery of bimodal locomotion in the spinal-transected salamander, Pleurodeles waltlii.

Electromyographic (EMG) analysis was used to provide an assessment of the recovery of locomotion in spinal-transected adult salamanders (Pleurodeles waltlii). EMG recordings were performed during swimming and overground stepping in the same animal before and at various times (up to 500 days) after a mid-trunk spinalization. Two-three weeks after spinalization, locomotor EMG activity was limited to the forelimbs and the body rostral to the transection. Thereafter, there was a return of the locomotor EMG activity at progressively more caudal levels below the transection. The animals reached stable locomotor patterns 3-4 months post-transection. Several locomotor parameters (cycle duration, burst duration, burst proportion, intersegmental phase lag, interlimb coupling) measured at various recovery times after spinalization were compared with those in intact animals. These comparisons revealed transient and long-term alterations in the locomotor parameters both above and below the transection site. These alterations were much more pronounced for swimming than for stepping and revealed differences in adaptive plasticity between the two locomotor networks. Recovered locomotor activity was immediately abolished by retransection at the site of the original spinalization, suggesting that the spinal cord caudal to the transection was reinnervated by descending brain and/or propriospinal axons, and that this regeneration contributed to the restoration of locomotor activity. Anatomical studies conducted in parallel further demonstrated that some of the regenerated axons came from glutamatergic and serotoninergic immunoreactive cells within the reticular formation.