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Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders

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World Journal of Gastroenterology 2017年第11期23卷 2029-2036页

作者： Clémence Bildstein ChloéMelchior Guillaume Gourcerol Estelle Boueyre Valérie Bridoux Eric Vérin Anne-Marie Leroi inserm U1073 Service de Physiologie DigestiveCHU Rouen inserm U1073 Service de Chirurgie DigestiveCHU Rouen EA 3830 Pole 3RCHU RouenGroupe de Recherche sur le Handicap Ventilatoire inserm cic 0204

AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for *** The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of *** Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.

关键词： Neurogenic bowel dysfunction Fecal incontinence Constipation Obstructed defecation Transanal irrigation

Early identification of acute respiratory distress syndrome in times of the COVID-19 pandemic

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Journal of Intensive Medicine 2023年第1期3卷 1-3页

作者： Arnaud W.Thille CHU de Poitiers Médecine Intensive RéanimationPoitiers 86021France inserm cic 1402 IS-ALIVE Universitéde PoitiersPoitiers 86021France

Acute respiratory distress syndrome(ARDS)was reported for the first time in 1967 in 12 patients with sudden respiratory failure due to a non-cardiogenic pulmonary edema.[1]Even though these patients had no underlying pulmonary disease,they rapidly developed severe hypoxemia,stiff lungs,and pulmonary bilateral infiltrates within a few days after a precipitating *** revealed a characteristic histological pattern of diffuse alveolar damage involving hyaline membranes,edema,necrosis,and cell proliferation.[2,3]The definition of ARDS evolved markedly over time and the Berlin definition,which was proposed in 2012,is currently the most recent one.[4]First,acute onset of respiratory symptoms appearing or worsening within 7 days of a clinical insult,thereby excluding patients who develop respiratory failure over more prolonged periods due to idiopathic pulmonary fibrosis,non-specific interstitial pneumonitis,organizing pneumonia,or pulmonary vasculitis.

关键词： respiratory distress markedly

Evolution of respiratory system compliance and potential for lung recruitment in COVID-19–induced acute respiratory distress syndrome

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Journal of Intensive Medicine 2022年第4期2卷 260-267页

作者： Maeva Rodriguez Sylvain Le Pape François Arrivé Jean-Pierre Frat Arnaud WThille Rémi Coudroy CHU de Poitiers Service de Médecine Intensive RéanimationPoitiers F86000France inserm CIC-1402 IS-ALIVE Research GroupUniversity of PoitiersPoitiers F86000France

Background:Coronavirus disease 2019(COVID-19)has been frequently complicated by severe acute respiratory distress syndrome(ARDS)with prolonged invasive *** respiratory system compliance and lung recruitability have been described within the first days after ICU admission,data about their longitudinal changes are still ***,we conducted this study to assess the evolution of respiratory system compliance and lung recruitability in patients with COVID-19–related ***:We conducted a prospective single-center study in patients admitted for COVID-19–related ARDS during the first wave of the pandemic,from March 16,2020 to April 10,*** system compliance was calculated daily at clinical positive end-expiratory pressure(PEEP)during passive *** potential for lung recruitment was assessed by measuring the volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O,and using the calculation of the recruitment-to-inflation ratio(R/I ratio).Recruitable lung was considered when the R/I ratio was at least *** primary outcome was the evolution of respiratory mechanics over *** secondary outcome was the evolution of lung recruitability over ***:Thirty-two patients were included in this *** respiratory mechanics were assessed 222 times(7±5 times per patient).Respiratory system compliance at clinical PEEP was 29.1 mL/cmH2 O(interquartile range[IQR]:24.1–33.9 mL/cmH2 O)and decreased significantly over time(P<0.0001).Lung recruitability was assessed in 22 out of the 32 patients(60 assessments).The median volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O was 246.8 mL(IQR:180.8–352.2 mL)and the median R/I ratio was 0.56(IQR:0.39–0.73).Neither changed significantly over *** proportion of patients with recruitable lung was 50.0%(6/12)within the first 3 days after intubation,69.2%(9/13)between day 4 and day 7,and 66.7%(8/12)after day 7(P=0.7934).Conclusions:In our cohort,respiratory system compliance was low

关键词： Lung compliance Alveolar recruitability Respiratory distress syndrome COVID-19

Septic cardiomyopathy: Diagnosis and management

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Journal of Intensive Medicine 2022年第1期2卷 8-16页

作者： Florence Boissier Nadia Aissaoui Service de Médecine Intensive Réanimation CHU de PoitiersPoitiers 86021France Universitéde Poitiers Poitiers INSERM CIC 1402(ALIVE group)France Service de Médecine Intensive Réanimation Hôpital CochinAPHPParis 75014France Universitéde Paris Paris Cardiovascular Research CenterINSERM U970Paris 75015France

There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been *** may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular(LV)dysfunction and/or right ventricular *** should consider this diagnosis in patients with sepsis-associated organ dysfunction,and particularly in cases of septic shock that require *** is currently the gold standard for diagnosis of *** ventricular ejection fraction is the most common parameter used to describe LV function in the literature,but its dependence on loading condi-tions,particularly afterload,limits its use as a measure of intrinsic myocardial ***,repeated echocardiography evaluation is *** of global longitudinal strain(GLS)may be more sensi-tive and specific for SCM than LV ejection fraction(LVEF).Standard management includes etiological treatment,adapted fluid resuscitation,use of vasopressors,and *** of inotropes remains uncertain,and heart rate control could be an option in some patients.

关键词： Septic shock Myocardial dysfunction Echocardiography Septic cardiomyopathy

Clustering of prostate cancer healthcare pathways in the French National Healthcare database

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Cancer Innovation 2023年第1期2卷 52-64页

作者： Roméo Baulain Jérémy Jové Dunia Sakr Marine Gross‐Goupil Magali Rouyer Marius Puel Patrick Blin Cécile Droz‐Perroteau Régis Lassalle Nicolas H.Thurin École nationale de la statistique et de l'administrationéconomique Paris(ENSAE) Institut Polytechnique ParisPalaiseauFrance Univ.Bordeaux INSERM CIC‐P 1401Bordeaux PharmacoEpiBordeauxFrance Medical Oncology Hôpital Saint AndréCHU de BordeauxBordeauxFrance

Background:Healthcare pathways of patients with prostate cancer are heterogeneous and complex to apprehend using traditional descriptive *** and visualization methods can enhance their ***:Patients with prostate cancer in 2014 were identified in the French National Healthcare database(Système National des Données de Santé—SNDS)and their data were extracted with up to 5 years of history and 4 years of follow‐***‐one‐specific encounters constitutive of prostate cancer management were synthesized into four macro‐variables using a clustering *** values over patient follow‐ups constituted healthcare *** matching was applied to calculate distances between *** around medoids was then used to define consistent groups across four exclusive cohorts of incident prostate cancer patients:Hormone‐sensitive(HSPC),metastatic hormone‐sensitive(mHSPC),castration‐resistant(CRPC),and metastatic castration‐resistant(mCRPC).Index plots were used to represent pathways ***:The repartition of macro‐variables values—surveillance,local treatment,androgenic deprivation,and advanced treatment—appeared to be consistent with prostate cancer *** to five clusters of healthcare pathways were observed in each of the different cohorts,corresponding for most of them to relevant clinical patterns,although some heterogeneity *** instance,clustering allowed to distinguish patients undergoing active surveillance,or treated according to cancer progression risk in HSPC,and patients receiving treatment for potentially curative or palliative purposes in mHSPC and ***:Visualization methods combined with a clustering approach enabled the identification of clinically relevant patterns of prostate cancer *** of these care pathways is an essential element for the comprehension and the robust assessment of healthcare technology effectiveness.

关键词： prostate cancer healthcare pathway clustering machine learning SNDS

Comparison of alternative arterial anastomosis site during liver transplantation when the recipient’s hepatic artery is unusable

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 1-12页

作者： Jean Marie Beaurepaire Francesco Orlando Giovanni Battista Levi Sandri Caroline Jezequel Edouard Bardou-Jacquet Christophe Camus Mohamed Lakehal Veronique Desfourneaux Aude Merdrignac Elodie Gaignard Alexandre Thobie Damien Bergeat Bernard Meunier Michel Rayar CHU Rennes Service de Chirurgie Hépatobiliaire et DigestiveRennesFrance UniversitéRennes 1 Facultéde MédecineRennesFrance CHU Rennes Service des Maladies du FoieRennesFrance inserm CIC 1414RennesFrance CHU Rennes Service de Maladies Infectieuses et Réanimation MédicaleRennesFrance

Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not ***:We retrospectively evaluated the outcomes of LT performed using the different alternative sites to ***:Between 2002 and 2017,1,677 LT were performed in our institution among which 141(8.4%)with unusable recipient HA were *** groups were defined according to the site of anastomosis:the splenic artery(SA group,n=26),coeliac trunk(CT group,n=12),aorta using or not the donor’s vessel(Ao group,n=91)and aorta using a vascular prosthesis(Ao-P group,n=12)as *** median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups(5,5,8.5 and 16 for SA,CT,Ao and Ao-P group respectively,P=0.002),as well as fresh frozen plasma(4.5,2.5,10,17 for the SA,CT,Ao and Ao-P groups respectively,P=0.001).Hospitalization duration was also significantly increased in the Ao and Ao-P groups(15,16,24,26.5 days for the SA,CT,Ao and Ao-P groups respectively,P<0.001).The occurrence of early allograft dysfunction(EAD)(P=0.07)or arterial complications(P=0.26)was not statistically *** of factor V,INR,bilirubin and creatinine during the 7th postoperative days(POD)was significantly improved in the SA *** difference was observed regarding graft(P=0.18)and patient(P=0.16)***:In case of unusable HA,intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.

关键词： Liver transplantation(LT) hepatic artery(HA) arterial anastomosis splenic artery(SA)

Hemodynamic monitoring in cardiogenic shock

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Journal of Intensive Medicine 2023年第2期3卷 104-113页

作者： Olfa Hamzaoui Florence Boissier Service de Médecine Intensive Réanimation Hopital Robert DebréUniversitéde ReimsReims 51092France UnitéHERVI Hémostase et Remodelage Vasculaire Post-IschémieEA 3801Reims 51092France Médecine Intensive Réanimation H?pital Universitaire de PoitiersPoitiers 90577France inserm cic 1402(ALIVE Group) Universitéde PoitiersPoitiers 90577France

Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to *** diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume ***,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic *** monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical *** is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient *** more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce *** this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.

关键词： Echocardiography Cardiogenic shock Hemodynamic monitoring Pulmonary artery catheter Transpulmonary thermodilution device

皮肤微生态与寻常痤疮:关于葡萄球菌在痤疮发病中的新认识

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中华皮肤科杂志 2022年第1期55卷 88-89页

作者： Dreno B Martin R Moyal D Department of Dermatology Nantes University Hospital Nantes France cic Inserm U892-CNRS 6299 Nantes France L'Oréal Research and Innovation Tours France La Roche-Posay Dermatological Laboratories Asnières France Cooperative Institute for Research in Environmental Sciences University of Colorado Boulder CO USA

人体皮肤上定植的微生物借助天然和获得性免疫系统的复杂信息交换与宿主保持共生关系,即微生态平衡,是健康皮肤所必需的。在皮肤上已鉴定出有四个主要的细菌门:放线菌门、厚壁菌门、变形菌门和拟杆菌门。最常见的三个菌属是棒状杆菌属... 详细信息

人体皮肤上定植的微生物借助天然和获得性免疫系统的复杂信息交换与宿主保持共生关系,即微生态平衡,是健康皮肤所必需的。在皮肤上已鉴定出有四个主要的细菌门:放线菌门、厚壁菌门、变形菌门和拟杆菌门。最常见的三个菌属是棒状杆菌属、丙酸杆菌属和葡萄球菌属。

关键词：寻常痤疮棒状杆菌属微生态平衡葡萄球菌属信息交换共生关系人体皮肤细菌门

Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

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Journal of Intensive Medicine 2023年第2期3卷 147-154页

作者： Florian Jolly Marine Jacquier Delphine Pecqueur Marie Labruyère Christophe Vinsonneau Isabelle Fournel Jean-Pierre Quenot The READIAL Study group Service de Médecine Intensive-Réanimation CHU Dijon-BourgogneDijon 21000France Equipe Lipness Centre de recherche INSERM UMR1231 et LabEx LipSTICUniversitéde Bourgogne-Franche ComtéDijon 21000France inserm CIC 1432Module Epidémiologie CliniqueDijon 21000France CHU Dijon-Bourgogne Centre d’Investigation CliniqueModule Epidémiologie Clinique/Essais CliniquesDijon 21000France Service de Médecine Intensive Réanimation-Unitéde Sevrage Ventilatoire et Réhabilitation CH de BethuneBethune 62408France 不详

Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the ***:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, ***:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

关键词： Renal replacement therapy Acute kidney injury Intensive care unit Practice evaluation Bedside