1,721,021 research outputs found
New Challenges in Diagnosis, Prognosis and Management of Rare Immunological Disorders in Intensive Care Unit
No full textLes maladies immunologiques systémiques rares sont un ensemble de pathologies pouvant être responsables de l’atteinte concomitante ou asynchrone de plusieurs organes. Leur origine procède d’une altération de la réponse/régulation immunitaire ou inflammatoire. Elles partagent des caractéristiques qui justifient de les regrouper pour les étudier. Ces affections peuvent être responsables de défaillances d’organes et conduire à une admission en soins critiques. Le diagnostic et le traitement en réanimation en sont particulièrement complexes et spécifiques, justifiant d’être un champ d’étude à part entière. L’objectif de ce travail est de faire progresser les connaissances sur ces affections dans leur globalité puis en étudiant spécifiquement certaines maladies. L’un des temps majeurs de ce travail est la description d’une nouvelle entité : la myocardite associée aux anticorps anti-ARN-polymérase-III. Il s’agit de la survenue chez de jeunes femmes, porteuses d’anticorps ciblant l’anticorps anti-ARN-polymérase-III, de myocardites et/ou de péricardites liées à des virus à ARN comme la grippe ou la COVID-19. Leur présentation clinique est très grave et justifie dans la majorité des cas un séjour en réanimation, avec un recours fréquent à l’assistance circulatoire extracorporelle. Ces myocardites sont récidivantes selon un intervalle variable. L’étude du profil cytokinique révèle une réponse antivirale médiée par l’interféron-2 à la différence d’autres formes de myocardites. Entre deux épisodes de myocardites les patientes sont asymptomatiques et la grande majorité des malades ne présente pas de sclérodermie systémique. Les maladies systémiques sont un cadre nosologique en constante évolution. De nouvelles maladies continuent d’apparaitre, fruits des avancées des méthodes diagnostiques générant leur cortège de manifestations graves. La physiopathologie de nombreuses maladies systémiques résiste encore aux avancées de la recherche translationnelle faisant de l’étude de ces affections, particulièrement dans leurs formes les plus sévères, un sujet d’actualité et d’avenir.Rare immunological systemic diseases is a group of disorders defined by their ability to affect several organs concomitantly or asynchronously. They proceed from an altered or dysregulated immune or inflammatory response. They share common characteristics that makes appropriate to study them altogether. These conditions can be responsible for organ failures requiring intensive care unit admission. Their diagnosis and treatment in intensive care is difficult and misleading needing to be specifically investigated. Our work aims to expand the knowledge on the severe manifestations of these conditions studying them firstly altogether, then specifically investigating some on them. One of our major findings is the description of a new condition: the myocarditis associated with anti-RNA-polymerase-III antibodies. It is defined by the occurrence in mainly young female, with detectable serum anti-RNA-polymerase-III antibodies, of severe myocarditis and/or pericarditis related to RNA virus infections (i.e. the flu or COVID-19). Myocarditis are usually severe, responsible for intensive care unit admission, and frequent need for temporary circulatory support. These myocarditis often relapse with a variable time interval. The cytokine profiling revealed an interferon-a2-mediated response, conversely to other forms of myocarditis. In between episodes, patients are asymptomatic, the vast majority having no sign of systemic sclerosis. Rare immunological systemic diseases is an ever evolving group of diseases. New conditions are regularly being discovered, owing advances in diagnostic methods, with their share of severe clinical manifestations. The pathophysiology of a significant number of these diseases still remains elusive. Further investigating critically-ill patients with rare immunological systemic diseases is a urgently needed
Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence
No full textInternational audiencePURPOSE OF REVIEW: Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications, and discusses the results of recent case series and trials.RECENT FINDINGS: VA-ECMO is utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support, and withdrawal in case of futility. VA-ECMO is considered the first-line TCS as it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella (Abiomed, Danvers, MA, USA) or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, and refractory cardiac arrest are among emerging indications for TCS.SUMMARY: TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies
Idiopathic lung fibrosis and anti myeloperoxidase glomerulonephritis: the tree that hides the forest
Full text linkInternational audienceBackground: Although anti-neutrophil cytoplasmic antibodies [ANCA] are frequently found in patients diagnosed with idiopathic pulmonary fibrosis [IPF], current guidance does not recommend serologic testing for vasculitis. Case presentation: A 71-year old Caucasian male, diagnosed with IPF three years earlier, presented with rapidly progressive glomerulonephritis. ANCA were found both in current and historical sera. A kidney biopsy sample was taken, which revealed a pauci-immune glomerulonephritis, but also areas of glomerular fibrosis, hence strongly suggesting unrecognized flares of an indolent vasculitis in his past. This made the diagnosis of " idiopathic " pulmonary fibrosis very unlikely. Conclusion: As nephrologists, we argue that testing for ANCA should be performed on a systematic basis, at least in elderly patients, even in the absence of extra-pulmonary signs of vasculitis at presentation
Response to: ‘Presence of anti-phospholipid antibodies in COVID-19: a case series study’ by Amezcua-Guerra et al
No full textInternational audienc
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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