HAL Portal Chu Clermont-Ferrand
Not a member yet
7589 research outputs found
Sort by
Optimisation d’un montage de perfusion sur cathéter veineux central courte durée et gestion des incompatibilités médicamenteuses en réanimation adulte
No full textInternational audienceIntroductionDe nombreux médicaments intraveineux peuvent être administrés sur cathéter veineux central (CVC) courte durée en réanimation. Les mélanges dans les volumes communs des montages exposent à des risques d’incompatibilité physicochimique (IPC) ou perturbations dans la dynamique des flux et débits (PDFD). Dans notre établissement, cinq services de réanimations adultes disposent d’une base commune de montage. Suite à deux évènements indésirables (EI) (PDFD avec bolus de chlorure de potassium), un travail pluridisciplinaire a été réalisé pour optimiser le montage des lignes et sites de branchement des thérapeutiques.Matériel & méthodeAprès identification d’objectifs prioritaires, une enquête sur les pratiques de branchement des médicaments sur le montage a été conduite afin d’évaluer les divergences de pratique et proposer une voie préférentielle par médicament. En parallèle, le groupe a travaillé sur l’optimisation du montage de perfusion et améliorer la procédure institutionnelle sur ces problématiques.Résultats & discussionSix objectifs ont été identifiés : actions correctives en regard des EI, harmonisation des pratiques avec messages clés sur le branchement des thérapeutiques, gestion des IPC et PDFD, et mise à jour du protocole institutionnel. 69 % de divergences de pratique sur les 219 médicaments analysés ont été constatées. Une harmonisation sur une voie préférentielle a pu être faite. Plusieurs phases de communication et d’informations ont été déployées. Une majorité des objectifs a été atteinte avec succès, bien qu’il ait été impossible de produire une solution clés en main pour les IDE. In fine, cette procédure constitue un socle plus robuste pour améliorer la sécurité des soins en perfusion sur CVC courte durée
Mitochondrial respiration in white adipose tissue is dependent on body mass index and tissue location in patients undergoing oncological or parietal digestive surgery
No full textInternational audienceAdipose tissue (AT), is a major endocrine organ that plays a key role in health and disease. However, adipose dysfunctions, especially altered energy metabolism, have been under‐investigated as white adipocytes have relatively low mitochondrial density. Nevertheless, recent studies suggest that mitochondria could play a major role in AT disorders and that AT mitochondrial activity could depend on adiposity level and location. This clinical study aimed to evaluate mitochondrial respiration and metabolism in human visceral (vAT) and subcutaneous (scAT) AT and their relationship with body mass index (BMI). This clinical study enrolled 67 patients (30 females/37 males) scheduled for digestive surgery without chemotherapy and parietal infection. BMI ranged from 15.4 to 51.9 kg·m −2 and body composition was estimated by computed tomographic images. Mitochondrial respiration was measured in situ in digitonin‐permeabilized AT using high‐resolution respirometry and a substrate/inhibitor titration approach. Protein levels of mitochondrial and lipid metabolism key elements were evaluated by Western blot. Maximal mitochondrial respiration correlated negatively with BMI ( p < .01) and AT area ( p < .001) regardless of the anatomical location. However, oxidative phosphorylation respiration was significantly higher in vAT (2.22 ± 0.15 pmol·sec −1 ·mg −1 ) than scAT (1.79 ± 0.17 pmol·sec −1 ·mg −1 ) ( p < 0.001). In line with oxygraphy results, there were higher levels of mitochondrial respiratory chain complexes in low‐BMI patients and vAT. Mitochondrial respiration decreased with increasing BMI in both scAT and vAT, without sex‐associated difference. Mitochondrial respiration appeared to be higher in vAT than scAT. These differences were both qualitative and quantitative. Clinical Trials Registration ID NCT05417581
Impact of melanoma histological regression on first-line immunotherapy response in stage-IV disease.
No full textInternational audienc
Morbidity Associated with Early Neonatal Anemia in Preterm and Term Infants: An Observational Study with Propensity Score Matching
No full textInternational audienceIntroduction:Anemia in preterm infants is associated with neonatal morbidity outcomes, such as intraventricular hemorrhage (IVH), necrotizing enterocolitis, and bronchopulmonary dysplasia. This study aimed to describe the prevalence of early neonatal anemia (ENA) and evaluate the morbidity and mortality in preterm and term infant. Methods: We conducted a single-center case-control study among a cohort of 1,603 inborn infants admitted in our neonatal medicine department between June 2017 and April 2021. We included 115 infants with ENA defined as first hemoglobin level <14 g/dL. A control group of 115 infants were matched using a propensity score. Results:The median hemoglobin at admission value was of 12.3 g/dL for cases and 17.3 g/dL for controls. Cases with ENA needed more cardiopulmonary resuscitation in the delivery room (OR 4.7; 95% CI: 2.1-12.3) and mechanical ventilation (OR 2.4; 95% CI: 1.4-4.2). ENA was significantly associated with circulatory failure requiring aminergic support (OR 3.2; 95% CI: 1.5-7), transfusion (OR 11; 95% CI: 4.4-32.6), and volume expansion (OR 4.7; 95% CI: 2.2-11). Hemodynamically significant patent ductus arteriosus and IVH (OR 3; 95% CI: 1.5-6.3) are significantly increased in the anemia group. Conclusion: ENA is significantly associated with severe hemodynamics, respiratory and neurological morbidities. These complications seem to occur during the adaptation to the extrauterine life. Early peripartum detection of anemia should be investigated in further studies.</div
Biomarqueurs sanguins de l’atrophie musculaire : une opportunité de diagnostic
No full textInternational audienceSkeletal muscle loss occurs in different physiological (e.g., age-related sarcopenia) or pathological (chronic diseases-linked cachexia) situations. This skeletal muscle loss is characterized by a more or less rapid and progressive decrease in muscle mass and strength, with a deterioration in functional performance. This mechanism is adaptive and beneficial in the short term but becomes deleterious when it persists, ultimately leading to increased morbidity and mortality. Early diagnosis using reliable biomarkers is desirable because it is very difficult to reverse sarcopenia once it is established. The development of muscle atrophy is of multifactorial origin and several metabolic pathways can be differentially activated depending on the catabolic stimulus, which may involve inflammatory conditions, endocrine dysfunction, metabolic alterations or simply a loss of stimulation (e.g., bed rest). This represents a significant obstacle to diagnosis because many studies have focused on a particular pathophysiological situation only, and the proposed biomarkers may then be representative of the pathology studied more than of muscle atrophy. Currently, no reliable means exist to diagnose the onset of muscle atrophy. Indeed, imaging techniques to assess muscle mass have limitations and are hardly applicable in routine and there is no known efficient biomarker in biological fluids. This review describes the limitations of the techniques/approaches currently available, specifying the essential criteria for the development of a reliable diagnosis at an affordable cost for its use in hospital routine
Reduction of the risk of complete sternotomy scar dehiscence in cardiac surgery: a protocol for a randomised, open-label multicentre clinical investigation comparing negative pressure wound therapy (NPWT) versus standard dressing (PRISTER study)
No full textInternational audienceIntroduction Cardiac surgical procedures are associated with a high incidence of postoperative infection, a risk attributed to their inherently invasive nature and extended duration. The goal of this study is to evaluate the efficacy of negative pressure wound therapy (NPWT) compared with standard dressings in preventing sternal scar dehiscence in patients undergoing cardiac surgery via complete vertical midline sternotomy, comparing a 3 day change system (NPWT 3/7 d) versus a 7 day wear system (NPWT 7d) versus standard dressings. Methods and analysis The PRISTER study is a prospective open-label multicentre, randomised, controlled, three-arm trial. Patients aged ≥18 years and meeting all the following inclusion criteria: patients undergoing scheduled or semiurgent cardiac surgery, with or without extracorporeal circulation, and patients managed by complete vertical median sternotomy will be recruited. Total sample size will consist of 660 patients. The primary outcome, surgical wound dehiscence after complete median sternotomy, expressed as occurrence or non-occurrence during the first 30 postoperative days, will be assessed by tablet calibrated photos analysed by an independent blinded staff. The secondary outcomes will be the number of dressing repairs between D7 (excluding initial protocol) and D90, length of initial hospital stay, occurrence of surgical site infection and its classification collected on day 90 (D90), use of an anti-infectious treatment and its duration, incidence of postoperative mediastinitis defined by dehiscence of the sternum with positive sternal samples, incidence of surgical revision for dehiscence of the surgical wound at D90 and collection of all operations involving surgical revision of the sternotomy wound, number of rehospitalisations (including hospital consultations) and their duration (evaluated at D90). Medicoeconomic assessment will be assessed by evaluation of hospital and extrahospital costs (number of days in hospital, consultations, rehospitalisations, imaging, biology and drugs), dressing costs and patient quality of life by EQ-5D-5L. Ethics and dissemination The study was approved by the French Agency for the Safety of Health Products (ANSM, Agence National de Sécurité du Médicament) as well as by the Ethics Committee (CPP Ile de France VIII) N°ID-RCB: 2023-A01782-43. Recruitment began in April 2024 and ended on 26 May 2025. Trial registration number clinicaltrials.gov NCT06207630
MYH6 in Congenital Heart Defects: A Genotype–Phenotype Characterization in a French Cohort
No full textInternational audienceCongenital heart defects (CHD) are among the most frequent congenital anomalies and represent a significant source of morbidity and mortality in infants. Both genetic and environmental factors are involved, and variants in the MYH6 are potential major genetic factors. The objective of the present study was to describe cardiac phenotypes in individuals with CHD and MYH6 variants. We included individuals with CHD and a MYH6 variant identified in four French genetics laboratories. Clinical and family data were collected. Of the 29 individuals included, 20 (68.9%) had a principal phenotype of left heart defect: hypoplastic left heart syndrome (n = 11, 37.9%), left heart obstruction at multiple sites (n = 6, 20.7%), and coarctation of aorta (n = 3, 10.3%). Nine individuals (31%) had other CHD, such as tetralogy of Fallot, pulmonary stenosis, and septal defects. Prevalence of persistent left superior vena cava (LSVC) was much higher here (n = 11, 37.9%) than in literature (0.31-5.9%). Most of the 19 MYH6 variants were heterozygous, missenses, and inherited. Family screening demonstrated incomplete penetrance and variable phenotypic expressivity. MYH6 variants are associated with various CHD with a predominance of left heart defects and persistent LSVC. Our findings support broad indication for the molecular screening of MYH6 in CHD-particularly when familial recurrence is uncertain
Modalities and safety of cardiac rehabilitation in a population managed for spontaneous haematoma or coronary disruption: insights from the READAPT-DISCO study
No full textInternational audienceNo abstract availabl
Rôle des endocannabinoïdes comme marqueurs biologiques de l'obésité sarcopénique chez les patients en situation d'obésité sévère
No full textInternational audienc
Appetite-Control and Eating-Behavior Traits Might Not Be Impacted by a Single Weight-Cycling Episode in Weight-Cycling Athletes: Results of the Wave Study
No full textInternational audiencePurpose : The impact of weight cycling (WC)—successive weight loss (WL) and weight regain (WG)—on athlete performance is well documented, but effects on appetite are not. This study assessed the impact of a WC episode on dietary and appetitive profiles in athletes, considering sex and sport type. Methods : Athletes (28 male, 20 female) from combat (n = 23), strength (n = 12), and endurance (n = 13) sports participated in 3 conditions during a WC episode (baseline, WL, WG). Measurements included body composition (dual-energy X-ray absorptiometry), energy intake (48-h food record), appetite (visual analog scale), dietary profile (questionnaires), and food reward (computer task). Results : Overall, athletes lost 4.4% (2.3%) of their body weight and regained 4.5% (2.9%) ( P < .001). Energy intake decreased during WL ( P < .001) with a higher protein intake (% of energy intake) before returning to baseline in WG ( P > .05). WL increased hunger, prospective food consumption, and desire to eat compared with the baseline condition, but these changes were not seen in WG. Liking and wanting for fat and sweet foods were higher during WL and remained elevated in WG ( P < .05). No eating disorders were found during the WC episode, but combat-sport athletes and females had a higher binge-eating risk than others, independent of the condition. Conclusions : Moderate WC episodes do not seem to impair appetite responses in athletes experienced with WC, likely due to their maintaining high physical activity levels. However, their long-term eating-behavior traits, especially in combat and female athletes, seem negatively affected. Practitioners should consider the long-term impacts of these WC practices on nutritional health