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Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome:A retrospective,observational cohort study

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Journal of Intensive Medicine 2024年第2期4卷 194-201页

作者： Sylvain Le pape Florent joly François Arrivé Jean-pierre Frat Maeva Rodriguez Maïa Joos Laura Marchasson Mathilde Wairy Arnaud WThille Rémi Coudroy Centre Hospitalier Universitaire de poitiers Service de Médecine Intensive RéanimationPoitiersFrance INSERM Centre d'Investigation Clinique 1402 IS-ALIVE Research GroupUniversitéde PoitiersPoitiersFrance

Background Extracorporeal membrane oxygenation(ECMO)for acute respiratory distress syndrome(ARDS)is systematically associated with decreased respiratory system compliance(CRS).It remains unclear whether transportation to the referral ECMO center,changes in ventilatory mode or settings to achieve ultra-protective ventilation,or the natural evolution of ARDS drives this change in respiratory ***,we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased *** To rule out the effect of transportation and the different modes of ventilation on CRS,we conducted a retrospective,single-center,observational cohort study from January 2013 to May 2020,on 22 patients with severe ARDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective *** was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO *** primary outcome was the relative change in CRS between 3 h before and 3 h after ECMO *** secondary outcomes included variables associated with the relative changes in CRS within the first 3 h after ECMO cannulation and the relative changes in CRS at each time *** CRS decreased within the first 3 h after ECMO cannulation(−28.3%,95%confidence interval[CI]:−38.8 to−17.9,pprotective ventilation,respiratory rate decreased in the mean by–13 breaths/min(95%CI:−15 to−11)and driving pressure by−8.3 cmH2O(95%CI:−11.2 to−5.3),resulting in decreased tidal volume by−3.3 mL/kg of predicted body weight(95%CI:−3.9 to−2.6)as compared to before ECMO cannulation(pplateau pressure reduction,driving pressure reduction,and tidal volume reduction were significantly associated with decreased CRS after ECMO cannulation,whereas neither respiratory rate,positive end-expiratory pr

关键词： Acute respiratory distress syndrome Extracorporeal membrane oxygenation Driving pressure Respiratory compliance

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根据可消化氨基酸配制鸡日粮的好处

国外畜牧学（饲料） 1995年第6期 35-36页

作者：李凯年 p.joly

多年来,营养学家根据化学饲料分析确定动物的营养需要,而没有考虑原料的真消化值。但是,根据消化值配个鸡日粮可以提高生产性能。

关键词：鸡饲料可消化氨基酸配方

一项关于大疱性类天疱疮患者生存预测的前瞻性研究

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世界核心医学期刊文摘（皮肤病学分册） 2005年第10期1卷 21-22页

作者： joly p Benichou J Lok C 李晓莉 Clinique Dermatologique Hpital Charles Nicolle 1 rue de Germont 76031 Rouen Cedex France.Dr

Objective: To identify the prognostic factors of bullous pemphigoid (Bp). Design: prospective study of patients with Bp included in a randomized, controlled trial. Setting: Twenty dermatology departments in France. patients: One hundred seventy patients with Bp initially treated with a 40-g/d dosage of clobetasol propionate cream (testing sample) and 171 patients initially treated with oral corticosteroids at a dosage of 0.5 or of 1.0 mg/kg per day, depending on the extent of Bp (validation samples). Main Outcome Measures: The end point was overall survival during the first year after Bp diagnosis. From the testing sample, associations of clinical and biological variables with overall survival were assessed using univariate and multivariate analyses. Selected predictors were included in a prognostic model. To verify that these predictors were not dependent on the treatment used, the model was then validated independently on the 2 series of Bp patients treated with oral corticosteroids. Results: Median age of the Bp patients included in the testing sample was 83 years. The 1-year Kaplan-Mei er survival rate was 74%. From univariate analysis, the main deleterious predictorswere demographic factors (ie, older age and female sex), associated medical conditions (ie, cardiac insufficiency, history of stroke, and dementia), and low Karnofsky score, which is a measure of the patient’s general condition. No factors directly related to Bp, in particular extent of cutaneous lesions, were shown to be related to the patients’ prognosis. From multivariate analysis, only older age (p=.02) and low Karnofsky score (pppeared independently predictive of death. From the Cox model including these 2 predictors, the predicted 1-year survival rates were 90%(95%confidence interval [CI], 85%-96%) for patients 83 years or younger with Karnofsky score greater than 40, 79%(95%CI, 69%-90%) for patients older than 83 years with Karnofsky score greater than 40, 65%(95%CI, 50%-86%) for pati

关键词：大疱性类天疱疮试验样本皮质激素治疗预后因子皮损范围随机对照试验卒中史心功能不全单变量分析影响因子

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性交困难和Sjgren综合征(法语)

世界核心医学期刊文摘（皮肤病学分册） 2006年第4期2卷 30-31页

作者： Sellier S. Courville p. joly p. 李晓莉 Clinique Dermatologique CHU de Rouen 1 rue de Germont 76031 Rouen

Background. Dyspareunia is frequently associated with a psychiatric origin, particularly in patients with no obvious Sjogrens Sjogrens Sjogrens Sjogrens¨ Sjogrensvulvovaginal or pelvic disease. The aim of t... 详细信息

Background. Dyspareunia is frequently associated with a psychiatric origin, particularly in patients with no obvious Sjogrensp> p>Sjogrensp> p>Sjogrensp> p>Sjogrensp>¨ p>Sjogrensp>vulvovaginal or pelvic disease. The aim of this study was to assess the frequency of dry syndrome in patients with dyspareunia and to evaluate the main clinical and biological features and follow-up data for women with dyspareunia and dry syndrome. patients and methods. Twenty-two patients presenting chronici diopathic dyspareunia (without clear vulvovaginal dermatosis or infection) were included in this retrospective study. All patients underwent history-taking, gynecological examination, a Schirmer tear test, a sugar test, labial salivary gland biopsy assessment and immunological examination. A diagnosis of syndrome was considered where histological examination of the salivary glands showed a lymphocyte infiltration corresponding to stage 3 or 4 in the Chisholm classification. Diagnosis of dry syndrome without syndrome was made in patients with xerostomia and/or xerophthalmia without a specific histological picture of syndrome or immunological abnormalities at salivary gland biopsy. Results. Based on our criteria, 10 patients (45% ) had dry syndrome, including 4 with syndrome and 6 with dry syndrome without syndrome. 9 of these 10 patients presented either xerostomia (7 cases) and/or xerophthalmia (7 cases). Vaginal dryness was reported by 3 of the 10 women with dry syndrome but also by 4 of 12 women without dry syndrome. Examination of the vulva showed no particular clinical features and treatment with an emollient was not effective in all cases. Discussion. This study showed a high frequency of dry syndrome in patients with chronic “ idiopathic” dyspareunia. The incidence of the condition was even greater in women with functional conditions evocative of dry syndrome. Women presenting dyspareunia with no clearly related clinical causes should th

关键词：性交困难 Sj gren 唇腺眼干燥精神因素外阴皮肤组织学检查口干燥病史采集

利妥昔单抗治疗系统性红斑狼疮相关的免疫性血小板减少(法语)

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世界核心医学期刊文摘（皮肤病学分册） 2006年第4期2卷 34-35页

作者： Lehembre S. Macario-Barrel A. Musette p. p. joly 焦婷 Clinique Dermatologique Charles Nicolle 1 rue de Germont 76031 Rouen Cedex France

Background. Immune thrombocytopenic purpura is an autoimmune disorder occasionally associated with systemic lupus erythematosus for which oral corticosteroids constitute the firstline treatment. Therapy may be complex, particularly in the event of a contraindication to the standard treatment, namely corticosteroids, splenectomy or immunosuppressants. We report the case of a patient with systemic lupus associated with immune thrombocytopenic purpura and multisystem tuberculosis. Because of a contraindication to corticosteroids, the patient was successfully treated with rituximab (anti- CD20 antibody)- . This medication (Mabthera ) is indicated in the treatment of relapsing or refractory follicular lymphoma. Case report. A 31- year- old North African woman had been treated for 10 years with prednisone, hydroxychloroquine, methotrexate and non- steroidal anti- inflammatory drugs for systemic lupus erythematosus. She presented severe immune thrombocytopenic purpura (platelet count: 4Gl) 3 months after initiation of antitubercular treatment for multisystem tuberculosis. The patient was unsuccessfully treated at the outset with 3 infusions of intravenous immunoglobulin. Since thrombocytopenia remained under 5 Gl, she was given rituximab 375 mgm2week for 4 weeks. Thrombocytopenia and native anti- DNA antibody levels decreased after the third infusion (D16). No side effects of treatment were observed. The patient did not experience any relapse during the 29 months following the final infusion. Discussion. In the present case, rituximab was used because of multisystem tuberculosis. Rituximab appears to constitute a safe and effective treatment for refractory immune thrombocytopenic purpura associated with SLE in patients having a contraindication to or refractory to conventional therapy.

关键词：系统性红斑狼疮利妥昔单抗硫酸羟氯喹自身免疫性疾病美罗华滤泡淋巴瘤皮质激素单克隆抗体甲

Waldmann病的松解坏死型游走性红斑(法语)

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世界核心医学期刊文摘（皮肤病学分册） 2006年第12期2卷 55-56页

作者： Baricault S. Soubrane J.C. Courville p. p. joly 王琼 Clinique Dermatologique Charles Nicolle CHU de Rouen 1 rue de Germont 76031 Rouen Cedex

Background. We report a case of necrolytic migratory erythema in a patient with Waldmann’s disease. patients and methods. A 55-year-old male patient with a history of Waldmann’s disease was hospitalized for a rash on the trunk and limbs comprising annular polycyclic lesions with peripheral scaling evocative of necrolytic migratory erythema. High-protein and fatty-acid-supplemented parenteral feeding led to rapid improvement of the patient’s cutaneous lesions. Discussion. Waldmann’s disease is characterized by intestinal lymphatic abnormalities leading to exudative intestinal disease causing protein loss in the bowel lumen and deficient fatty acid absorption. The pathogenesis of necrolytic migratory erythema is not fully understood. Increased serum glucagon does not appear to be the only mechanism involved. The occurrence of necrolytic migratory erythema in a patient with Waldmann’s disease supports the current physiopathological hypothesis of the role of decreased plasma protein and amino acid levels in necrolytic migratory erythema.

关键词：红斑坏死型游走性

甲氨蝶呤治疗慢性皮肤结节病:4例病例报道(法国)

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世界核心医学期刊文摘（皮肤病学分册） 2005年第12期1卷 31-32页

作者： Gary A. Modeste A.- B. Richard C. p. joly 惠海英 Clinique Dermatologique Hpital Charles Nicolle 1 rue de Germont 76031 Rouen Cedex France

Introduction. pathogenesis of sarcoidosis remains partially unknown. Cutaneous lesions are frequent (20 to 35% of cases). Their clinical features and follow- up data are highly variable. Numerous treatments have been proposed. The clinical features and followup data of four patients with chronic cutaneous sarcoidosis treated with methotrexate are reported. Case report. Mean age of patients (3 female, 1 male) was 40 years old (34- 49 years). One patient presented with a lupus pernio, two patients with papules and nodules, and the last with an annular lesion of the face. All patients had been previously treated with topical corticosteroids and/or hydroxychloroquine without any success. patients were treated with methotrexate at doses ranging from 12.5 mg to 30 mg per week for at least 6 months. Complete remission of cutaneous lesions was observed in 3 of 4 patients after a mean treatment duration of 29 months (16 to 36). Methotrexate side effects were observed in one patient (elevated liver enzymes) leading to methotrexate discontinuation. Discussion. Methotrexate seems to be an effective treatment of cutaneous sarcoidosis. It should be used namely in patients who failed to respond to previous treatments with topical corticosteroids or antimalarial drugs.

关键词：皮肤结节甲氨蝶呤环状损害冻疮样狼疮结节病皮质激素抗疟药羟化发病机制酶水平

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木材干燥

木材干燥

每周2次服用盐酸氮芥和局部外用皮质激素治疗早期蕈样肉芽肿:一项前瞻性研究

作者： p.·若利(p. joly) F.·莫尔-谢瓦利埃(F. More-chevalive)

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世界核心医学期刊文摘（皮肤病学分册） 2006年第4期2卷 36-37页

作者： De Quatrebarbes J. Esté ve E. Bagot M. p. joly 焦婷 Clinique Dermatologique Charles Nicolle 1 rue de Germont 76031 Rouen Cedex FranceDr.

Objective: To determine if a therapeutic regimen of twice weekly applications of mechlorethamine hydrochloride and betamethasone dipropionate cream is effective in the treatment of early- stage mycosis fungoides while increasing cutaneous tolerance. Design: prospective nonrandomized study conducted from November 1999 to November 2002. Setting: Eleven university or hospital dermatology departments in France. patients: Sixty- four consecutive patients with newly diagnosed early- stage mycosis fungoides (stage IA, n=33; stage IB, n=26; stage IIA, n=5). Interventions: patients were treated with twice- weekly applications of a 0.02% aqueous solution of mechlorethamine followed by an application of betamethasone cream during a 6- month period. Main OutcomeMeasures: The primary end point was the rate of complete response during the treatment. Secondary end points were mean delay to achieve complete response, rate of severe cutaneous reactions of intolerance, and rate of relapse after achieving complete response. Results: Thirty- seven patients (58% ) had a complete response after a mean± SD treatment duration of 3.6± 2.5 months: 20 (61% ) of 33 patients with stage IA disease, 15 (58% ) of 26 patients with stage IB disease, and 2 (40% ) of 5 patients with stage IIA disease. Eighteen patients (28% ) developed severe cutaneous reactions of intolerance that necessitated treatment discontinuation. Relapse was observed in 17 patients (46% )- after a mean± SD time of 7.7± 6.5 months. Conclusions: A regimen of twice- weekly applications of mechlorethamine and betamethasone cream is an effective treatment for early- stage mycosis fungoides. The decreased frequency of applications provides an advantage to the patient by being easy to use with limited adverse effects.

关键词：蕈样肉芽肿盐酸氮芥皮质激素治疗皮肤反应二丙酸倍他米松药物耐受性复发率次要终点随机研究