494 research outputs found
Shorter antibiotic courses for bloodstream infections can reduce healthcare spending : author's reply
No full textReply to : Biebelberg B. Shorter antibiotic courses for bloodstream infections can reduce healthcare spending. Intensive Care Med. 2025 Jun 4. doi: 10.1007/s00134-025-07952-8. Epub ahead of print. PMID: 40464903. Which is a comment on : Gajdos L, Buetti N, Tabah A, Ruckly S, Akova M, Sjöval F, Arvanti K, de Waele J, Bracht H, Barbier F, Timsit JF; EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology, the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP) and the OUTCOMEREA Network. Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database. Intensive Care Med. 2025 Mar;51(3):518-528. doi: 10.1007/s00134-025-07857-6. Epub 2025 Apr 7. PMID: 40192823. https://archive-ouverte.unige.ch/unige:185050</a
Year in review in Intensive Care Medicine 2012. II: Pneumonia and infection, sepsis, coagulation, hemodynamics, cardiovascular and microcirculation, critical care organization, imaging, ethics and legal issues
No full textNon
Groove-backbone interaction in B-DNA. Implication for DNA condensation and recombination.
No full textInternational audienceDNA self-fitting is revealed by the study of intermolecular contacts found in the crystal packing of a dodecamer where the helices are locked together by a reciprocal groove-backbone interaction and form a crossed structure. It is proposed that it could be a model for DNA-DNA interaction in several biological processes such as the node of supercoiled DNA and synapsis in recombination. The main topological and symmetrical features of this crossed structure are described and the symmetry-homology relationships are analyzed in the more general case of B-DNA interacting helices. Model-building of Holliday junctions with minimal change from the starting crystal coordinates of the crossed structure leads to at least three different solutions. These various models are compared from the point of view of their symmetry and topology, in the light of their branch migration and resolution properties. In addition, a model for a self-favored reciprocal unwinding mechanism based on the experimentally observed structural alterations, such as the packing-induced opening of G.C base-pairs is proposed. In this model, the phosphate groups of the invading backbone trigger the opening of the base-pairs of the other helix, by pulling cytosine or adenine bases out of the major groove after binding to their amino group
Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey
No full textIntroduction: Although fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exist on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs.
Methods: Site leaders of the multi-national EUROBACT study were surveyed regarding diagnosis and management of temperature abnormalities among patients admitted to their ICUs.
Results: Of the 162 ICUs originally included in EUROBACT, responses were received from 139 (86%) centers in 23 countries in Europe (117), South America (8), Asia (5), North America (4), Australia (3) and Africa (2). A total of 117 (84%) respondents reported use of a specific temperature threshold in their ICU to define fever. A total of 14 different discrete levels were reported with a median of 38.2 degrees C (inter-quartile range, IQR, 38.0 degrees C to 38.5 degrees C). The use of thermometers was protocolized in 91 (65%) ICUs and a wide range of methods were reportedly used, with axillary, tympanic and urinary bladder sites as the most common as primary modalities. Only 31 (22%) of respondents indicated that there was a formal written protocol for temperature control among febrile patients in their ICUs. In most or all cases practice was to control temperature, to use acetaminophen, and to perform a full septic workup in febrile patients and that this was usually directed by physician order. While reported practice was to treat nearly all patients with neurological impairment and most patients with acute coronary syndromes and infections, severe sepsis and septic shock, this was not the case for most patients with liver failure and fever.
Conclusions: A wide range of definitions and management practices were reported regarding temperature abnormalities in the critically ill. Documenting temperature abnormality management practices, including variability in clinical care, is important to inform planning of future studies designed to optimize infection and temperature management strategies in the critically ill
Inferior Thyroid Artery Injury After Attempts of Internal Jugular Venous Catheterization
No full text[No abstract available]Abbott G, 2001, BRIT J ANAESTH, V86, P143, DOI 10.1093-bja-86.1.143; Cuhaci B, 2000, AM J NEPHROL, V20, P476, DOI 10.1159-000046203; Jeganath V, 2001, BRIT J ANAESTH, V87, P302, DOI 10.1093-bja-87.2.302; MACGEE DC, 2003, NEW ENGL J MED, V348, P1123; Merrer J, 2001, JAMA-J AM MED ASSOC, V286, P700, DOI 10.1001-jama.286.6.700; Peces R, 1998, NEPHROL DIAL TRANSPL, V13, P1009, DOI 10.1093-ndt-13.4.1009; Randolph AG, 1996, CRIT CARE MED, V24, P2053, DOI 10.1097-00003246-199612000-00020; Ruesch S, 2002, CRIT CARE MED, V30, P454, DOI 10.1097-00003246-200202000-00031; Timsit JF, 1998, CHEST, V114, P207, DOI 10.1378-chest.114.1.20733
Approche comprehensive du meurtre et des meurtriers dans une perspective psychobiologique
No full textA fraca incidência de perturbações mentais como determinantes do comportamento homicida reduziu o interesse das classificaões psiquiátricas geralmente utilizadas. O objectivo deste artigo é o de apresentar
uma nova categorização, elaborada a partir de observações realizadas no quadro de exames médico-legais de 90 homicidas - 75 homens e 15 mulheres. Os autores sublinham O interesse de uma categorização que tenha em conta, numa dupla perspectiva psicobiológica
e psicodinâmica, as dimensões motivacionais e
relacionais. Em relação ao eixo motivacional, distinguem a conduta aversiva - (a) - que visa «pôr fim a uma emoção dolorosa episódica ou a uma dor moral mais durável, ao agir sobre a situação que lhe esteve na origem» (Karli, 1987), da conduta apetitiva -
(b) - cujo objectivo é o de se (apropriar de um objecto cobiçado e que se pretende possuir com antecipação da emoção agradável que dai é suposto resultar.
» No que respeita ao eixo relacional, distinguem homicídios cometidos na Pessoa de indivíduos próximos e familiares - (c) - e na Pessoa de desconhecidos e não-familiares - (d).Aplicado ao estudo dos Potenciais Lentos Cerebrak, cujo interesse esta demonstrado no conhecimento em processos cognitivos e emocionais e nos fenómenos neurobiológicos subjacentes, este sistema classificatório
revelou-se particularmente pertinente. Permitiu esclarecer, ao níve1 dos parâmetros de Amplitude e de duração da Variação Contingente Negativa, diferenças significativas entre os perfis apurados em duas categorias tipicas: por um lado, os homicidas passionais - (a) e (c) - e , por outro lado, os psicopatas que cometeram crimes com fins lucrativos - @) e
(d) -. Nos primeiros, aumento da amplitude e duração prolongada; nos segundos, amplitude fraca e duração breve.En Psychologie Criminelle, il est bien établi que la faible incidence des maladies avérées dans la détermination des conduites meurtriéres réduit la portée des classifications d’inspiration psychiatrique généralement utilisées. Aussi, à partir d’observations réalisées dans le cadre s’expertises pénales chez 90 meurtriers
- 75 hommes et 15 femmes -, les auteurs soulignentils l’intérêt d’une catégorisation qui prendrait en compte, dans une double perspective psychobiologique et psychodynamique, les dimensions motivationnelles et relationelles, opposant, la premiére les conduites «aversives» - (a) - visant à (mettre un terme à une émotion douloureuse épisodique ou à une douleur morale plus durable, en agissant sur la situation qui l’avait sucitéen (Karli, 1987), aux conduites «appétitives» - (b) -, dont le but est de ((s’approprier un objet convoité et qu’on entend posséder avec
anticipation de l’émotion plaisante qui est censée en résulter», la seconde, par référence au statut de la
victime par rapport à l’auteur, meurtres commis sur des personnes proches et familières - (c)-, et à
l’inverse, meurtres commis sur des personnes étrangéres et non-familières - (d).
Appliqué à l’étude des Potentiels Lents Cérébraux, potentiels dont on sait l’intérêt qu’ils présentent dans l’approche des processus cognitifs et émotionnels et
des phénoménes neurophysiologiques qui les sous--tendent, ce systéme classificatoire s’est révélé particulliérement pertinnent et a permis de dégager au niveau des paramètres d’Amplitude et de Durée de la Variation Contingente Négative, des différences
significatives entre les profils relevés dans deux catégories typiques, les meurtriers passionnels, d’une part - (a) (c) - et les psychopathes auteurs de crimes visée lucrative d’autre part - (b) (d) - amplitude
augmentée et durée prolongée chez les premiers, faible amplitude et durée bréve chez les seconds.The Weak incidence of mental diseases in inducing murderous behaviour has reduced the interest of psychiatric classifications as they have been used in criminal Psychology. The aim of this paper was to present a new categorization which has been elaborated
from a study carried out on 90 murderers - 75
males and 15 females - examinated in the framework of expert’s reports requested by Cnminal Courts. This categorization emphasises individual differences and
takes into account both motivation and interpersonal relationships of the murderers Thus, according to the motivation axis, the authors distinguished aversive behaviour (a) which aims «to put a term to either a
painful emotional episode or a long lasting worrying by acting-out upon the situation which has given rise to it» (Karli, 1987), from appetitive behaviour (b)
which consists (do wish to appropriate and to possess a coveted object with anticipation of the pleasant emotion which is supposed to result)). Moreover, according to the interpersonal relationship axis, they
distinguished murders committed against familiar and closely related people (c), from those committed against non-familiar and unknown people (d).
This categorization appeared as relevant when
applied to a murder’s psychophysiological approach using Cognitive Event Related Potentials (ERPs). It is well knowwn that ERPs and in particular Contingent Negative Variation (CNV) are modulated by cognitive, emotional and neurochemical facttors.
Thus, the murderers Who committed crimes of passion - (a) (c) - displayed high amplitude and long duration CNV while antisocial psychopaths Who killed with an utilitarian incentive - @) (d) - displayed low amplitude short duration CNV
Incidence des infections urinaires fébriles à germes producteurs de bétalactamase à spectre étendu, aux urgences pédiatriques
No full textLE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF
Base-pairing shift in the major groove of (CA)n tracts by B-DNA crystal structures
No full textInternational audiencethe crystal packing of the B-DNA dodecamer d(ACCG-GCGCCACA).d(TGTGGCGCCGGT) is characterized by the reciprocal fit of double helices with specific base-backbone interactions in the major groove. Cooling the crystals below -10 degrees C stabilizes a new conformational state with a long-range sequence-dependent one-step shift in the major-groove base pairing. The tilt of the bases leads to the disruption of the Watson-Crick pairing in the major groove and to the formation of interactions with the 5' neighbour of their complement. This alteration propagates along the helical axis over more than half a turn. As a result, the molecular structure is normal when seen from the minor groove side and mismatched in the major groove. Comparison with a parent isomorphous dodecamer structure corresponding to the codon 10-13 of the c-Ha-ras proto-oncogene show that this new structural feature is sequence dependent and clearly favoured by (CA)n tracts. As(CA)n tracts of DNA are involved both in recombination and in transcription, this new recognition pattern should be considered in the analysis of the various processes involving the reading of the genetic information
DNA structure and polymerase fidelity 1 1Edited by T. Richmond
No full textInternational audienceThe accuracy of DNA replication results from both the intrinsic DNA polymerase fidelity and the DNA sequence. Although the recent structural studies on polymerases have brought new insights on polymerase fidelity, the role of DNA sequence and structure is less well understood. Here, the analysis of the crystal structures of hotspots for polymerase slippage including (CA)n and (A)n tracts in different intermolecular contexts reveals that, in the B-form, these sequences share common structural alterations which may explain the high rate of replication errors. In particular, a two-faced "Janus-like" structure with shifted base-pairs in the major groove but an apparent normal geometry in the minor groove constitutes a molecular decoy specifically suitable to mislead the polymerases. A model of the rat polymerase beta bound to this structure suggests that an altered conformation of the nascent template-primer duplex can interfere with correct nucleotide incorporation by affecting the geometry of the active site and breaking the rules of base-pairing, while at the same time escaping enzymatic mechanisms of error discrimination which scan for the correct geometry of the minor groove.In contrast, by showing that the A-form greatly attenuates the sequence-dependent structural alterations in hotspots, this study suggests that the A-conformation of the nascent template-primer duplex at the vicinity of the polymerase active site will contribute to fidelity. The A-form may play the role of a structural buffer which preserves the correct geometry of the active site for all sequences. The detailed comparison of the conformation of the nascent template-primer duplex in the available crystal structures of DNA polymerase-DNA complexes shows that polymerase beta, the least accurate enzyme, is unique in binding to a B-DNA duplex even close to its active site. This model leads to several predictions which are discussed in the light of published experimental data
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