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Ruiz-Matus S, Goldstein P. On the universality of viscosity in supersaturated binary aqueous sugar solutions: Cryopreservation by vitrification. Cryobiology 2024; 115:104886. [PMID: 38555011 DOI: 10.1016/j.cryobiol.2024.104886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
Nowadays, the physical nature of supersaturated binary aqueous sugar solutions in the vicinity of the glass transition represents a very important issue due to their biological applications in cryopreservation of cells and tissues, food science and stabilization and storage of nano genetic drugs. We present the construction of the Supplemented Phase Diagram and the non-equilibrium nature of the undersaturated-supersaturated kinetic transition. The description of its thermodynamic nature is achieved through the study of behavior of their viscosity as temperature is lowered and concentration increased. In this work, we find a universal character for the viscosities of several sugar water solutions.
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Affiliation(s)
- Soledad Ruiz-Matus
- Department of Physics, Faculty of Science, National Autonomous University of México, 04510, Coyoacán, Ciudad de México, Mexico.
| | - Patricia Goldstein
- Department of Physics, Faculty of Science, National Autonomous University of México, 04510, Coyoacán, Ciudad de México, Mexico.
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Matus SR, Goldstein P. The universal behavior of viscosity in supersaturated aqueous sugar solutions and the cryopreservation implications. Cryobiology 2022. [DOI: 10.1016/j.cryobiol.2022.11.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Leys D, Dequatre-Ponchelle N, Ferrigno M, Henon H, Mounier-Vehier F, Moulin S, Casolla B, Tortuyaux R, Chochoi M, Moreau C, Girard-Buttaz I, Pruvo JP, Goldstein P, Cordonnier C. Access to mechanical thrombectomy for cerebral ischaemia: A population-based study in the North-of-France. Rev Neurol (Paris) 2019; 175:519-527. [PMID: 31208814 DOI: 10.1016/j.neurol.2018.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/18/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Hospitals admitting acute strokes should offer access to mechanical thrombectomy (MT), but local organisations are still based on facilities available before MT was proven effective. MT rates and outcomes at population levels are needed to adapt organisations. We evaluated rates of MT and outcomes in inhabitants from the North-of-France (NoF) area. METHOD We prospectively evaluated rates of MT and outcomes of patients at 3 months, good outcomes being defined as a modified Rankin scale (mRS) 0 to 2 or like the pre-stroke mRS. RESULTS During the study period (2016-2017), 666 patients underwent MT (454, 68.1% associated with intravenous thrombolysis [IVT]). Besides, 1595 other patients received IVT alone. The rate of MT was 81 (95% confidence interval [CI] 72-90) per million inhabitants-year, ranging from 36 to 108 between districts. The rate of IVT was 249 (95% CI 234-264) per million inhabitants-year, ranging from 155 to 268. After 3 months, 279 (41.9%) patients who underwent MT had good outcomes, and 167 (25.1%) had died. Patients living outside the district of Lille where the only MT centre is, were less likely to have good outcomes at 3 months, after adjustment on age, sex, baseline severity, and delay. CONCLUSION The rate of MT is one of the highest reported up to now, even in low-rate districts, but outcomes were significantly worse in patients living outside the district of Lille, and this is not only explained by the delay.
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Affiliation(s)
- D Leys
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance.
| | | | - M Ferrigno
- University of Lille, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - H Henon
- Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - F Mounier-Vehier
- Stroke unit, Lens hospital, neurology clinic, 59800 Lille, France
| | - S Moulin
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - B Casolla
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - R Tortuyaux
- Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - M Chochoi
- Neurology clinic, CHU Lille, 59800 Lille, France
| | - C Moreau
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Neurology clinic, CHU Lille, 59800 Lille, France
| | - I Girard-Buttaz
- Stroke unit, Valenciennes hospital, neurology clinic, 59800 Lille, France
| | - J-P Pruvo
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Neuroradiology department, CHU Lille, 59800 Lille, France
| | - P Goldstein
- Emergency department, SAMU 59, CHU Lille, 59800 Lille, France
| | - C Cordonnier
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
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Garrigue D, Godier A, Glacet A, Labreuche J, Kipnis E, Paris C, Duhamel A, Resch E, Bauters A, Machuron F, Renom P, Goldstein P, Tavernier B, Sailliol A, Susen S. French lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial. J Thromb Haemost 2018; 16:481-489. [PMID: 29274254 DOI: 10.1111/jth.13929] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Indexed: 01/08/2023]
Abstract
Essentials An immediate supply of plasma in case of trauma-induced coagulopathy is required. The Traucc trial compared French Lyophilised Plasma (FLyP) and Fresh Frozen Plasma (FFP). FLyP achieved higher fibrinogen concentrations compared with FFP. FLyP led to a more rapid coagulopathy improvement than FFP. SUMMARY Background Guidelines recommend beginning hemostatic resuscitation immediately in trauma patients. We aimed to investigate if French lyophilized plasma (FLyP) was more effective than fresh frozen plasma (FFP) for the initial management of trauma-induced coagulopathy. Methods In an open-label, phase 3, randomized trial (NCT02750150), we enrolled adult trauma patients requiring an emergency pack of 4 plasma units within 6 h of injury. We randomly assigned patients to receive 4-FLyP units or 4-FFP units. The primary endpoint was fibrinogen concentration at 45 min after randomization. Secondary outcomes included time to transfusion, changes in hemostatic parameters at different time-points, blood product requirements and 30-day in-hospital mortality. Results Forty-eight patients were randomized (FLyP, n = 24; FFP, n = 24). FLyP reduced the time from randomization to transfusion of first plasma unit compared with FFP (median[IQR],14[5-30] vs. 77[64-90] min). FLyP achieved a higher fibrinogen concentration 45 min after randomization compared with FFP (baseline-adjusted mean difference, 0.29 g L-1 ; 95% confidence interval [CI], 0.08-0.49) and a greater improvement in prothrombin time ratio, factor V and factor II. The between-group differences in coagulation parameters remained significant at 6 h. FLyP reduced fibrinogen concentrate requirements. Thirty-day in-hospital mortality rate was 22% with FLyP and 29% with FFP. Conclusion FLyP led to a more rapid, pronounced and extended increase in fibrinogen concentrations and coagulopathy improvement compared with FFP in the initial management of trauma patients. FLyP represents an attractive option for trauma management, especially when facing logistical issues such as combat casualties or mass casualties related to terror attacks or disasters.
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Affiliation(s)
- D Garrigue
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- CHU Lille, Pôle de l'Urgence, Lille, France
| | - A Godier
- Service d'Anesthésie-Réanimation, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- NSERM, UMR-S1140, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - A Glacet
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- CHU Lille, Pôle de l'Urgence, Lille, France
| | - J Labreuche
- Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - E Kipnis
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- Université Lille, EA 7366, Lille, France
| | - C Paris
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
| | - A Duhamel
- Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - E Resch
- EFS Hauts de France, Lille, France
| | - A Bauters
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
| | - F Machuron
- Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - P Renom
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
| | - P Goldstein
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- CHU Lille, Pôle de l'Urgence, Lille, France
| | - B Tavernier
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
| | - A Sailliol
- Centre de Transfusion Sanguine des Armées, Clamart, France
| | - S Susen
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
- Université Lille, Inserm, CHU Lille, U1011 - EGID, Lille, France
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Dahan B, Lemaitre A, Blanchart K, Bignon M, Roule V, Sabatier R, Roupie E, Goldstein P, Beygui F. P6423Physician- versus paramedic-based pre-hospital management of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Decourcelle A, Moulin S, Dequatre-Ponchelle N, Bodenant M, Rossi C, Girot M, Hénon H, Wiel E, Bordet R, Goldstein P, Pruvo JP, Cordonnier C, Leys D. Are the results of intravenous thrombolysis trials reproduced in clinical practice? Comparison of observed and expected outcomes with the stroke-thrombolytic predictive instrument (STPI). Rev Neurol (Paris) 2017; 173:381-387. [PMID: 28454980 DOI: 10.1016/j.neurol.2017.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/03/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
AIM In patients with cerebral ischemia, intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) increases survival without handicap or dependency despite an increased risk of bleeding. This study evaluated whether the results of randomized controlled trials are reproduced in clinical practice. METHOD Data from a registry of consecutive patients treated by rt-PA at Lille University Hospital were retrospectively analyzed for outcomes, using modified Rankin Scale (mRS) scores, at 3 months. The observed outcomes were then compared with the probability of good (mRS 0-1) and of catastrophic (mRS 5-6) outcomes, as predicted by the stroke-thrombolytic predictive instrument (STPI). RESULTS Of the 1000 consecutive patients (469 male, median age 74 years, median baseline National Institutes of Health Stroke Scale 11, median onset-to-needle time 143min), 438 (43.8%) had a good outcome, 565 (56.5%) had an mRS score 0-2 or similar to their pre-stroke mRS, 155 (15.5%) died within 3 months and 74 (7.4%) developed symptomatic intracerebral hemorrhage according to ECASS-II (Second European-Australasian Acute Stroke Study) criteria. Of the 613 patients (61.3%) eligible for evaluation by the s-TPI, the observed rate of good outcomes was 41.3% (95% CI: 37.5-45.3%), while expected rates with and without rt-PA were 48.8% (95% CI: 44.8-52.7%) and 32.5% (95% CI: 28.8-36.2%), respectively; the observed rate of catastrophic outcomes was 17.0% (95% CI: 14.0-19.9%), while the expected rate was 19.2% (95% CI: 16.1-22.4%) with or without rt-PA. CONCLUSION In clinical practice, the rate of good outcomes is slightly lower than expected, according to the s-TPI, except for the most severe cases, whereas the rate of catastrophic outcomes is roughly similar. However, the rate of good outcomes is higher than predicted without treatment. This finding suggests that rt-PA is effective for improving outcomes in clinical practice.
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Affiliation(s)
- A Decourcelle
- Univ. Lille, Roger Salengro Hospital, 59037 Lille, France; CHU Lille, Roger Salengro Hospital, 59037 Lille, France
| | - S Moulin
- Univ. Lille, Roger Salengro Hospital, 59037 Lille, France; CHU Lille, Roger Salengro Hospital, 59037 Lille, France; INSERM, U1171, Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France
| | | | - M Bodenant
- CHU Lille, Roger Salengro Hospital, 59037 Lille, France
| | - C Rossi
- CHU Lille, Roger Salengro Hospital, 59037 Lille, France
| | - M Girot
- Emergency Department and SAMU 59, France
| | - H Hénon
- CHU Lille, Roger Salengro Hospital, 59037 Lille, France; INSERM, U1171, Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France
| | - E Wiel
- Univ. Lille, Roger Salengro Hospital, 59037 Lille, France; Emergency Department and SAMU 59, France
| | - R Bordet
- Univ. Lille, Roger Salengro Hospital, 59037 Lille, France; CHU Lille, Roger Salengro Hospital, 59037 Lille, France; INSERM, U1171, Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France
| | | | - J P Pruvo
- Univ. Lille, Roger Salengro Hospital, 59037 Lille, France; CHU Lille, Roger Salengro Hospital, 59037 Lille, France; INSERM, U1171, Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France
| | - C Cordonnier
- Univ. Lille, Roger Salengro Hospital, 59037 Lille, France; CHU Lille, Roger Salengro Hospital, 59037 Lille, France; INSERM, U1171, Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France
| | - D Leys
- Univ. Lille, Roger Salengro Hospital, 59037 Lille, France; CHU Lille, Roger Salengro Hospital, 59037 Lille, France; INSERM, U1171, Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France.
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Peled-Avron L, Goldstein P, Yellinek S, Weissman-Fogel I, Shamay-Tsoory SG. Empathy during consoling touch is modulated by mu-rhythm: An EEG study. Neuropsychologia 2017; 116:68-74. [PMID: 28442340 DOI: 10.1016/j.neuropsychologia.2017.04.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 12/25/2022]
Abstract
The aim of the present study was to examine the mechanisms of empathy for pain that contribute to consoling touch, a distress-alleviating contact behavior carried out by an observer in response to the suffering of a target. We tested romantic couples in a paradigm that involves consoling touch and examined the attenuation of the mu/alpha rhythm (8-13Hz) in the consoling partner. During the task, the toucher either held the consoled partner's right hand (human touch) or held onto the armrest of the chair (non-human touch), while the consoled partner experienced inflicted pain (pain condition) or did not experience any pain (no-pain condition). In accordance with our hypotheses, the results revealed an interaction between touch and pain at in mu/alpha rhythms in all central sites (C3, C4, Cz). Specifically, we found that the toucher's mu suppression was higher in the consoling touch condition, i.e., while touching the partner who is in pain, compared to the three control conditions. Additionally, we found that in the consoling touch condition, mu suppression at electrode C4 of the toucher correlated with a measure of situational empathy. Our findings suggest that electrophysiological and behavioral measures that have been associated with empathy for pain are modulated during consoling touch.
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Affiliation(s)
- L Peled-Avron
- Department of Psychology, University of Haifa, Haifa, Israel
| | - P Goldstein
- Department of Psychology, University of Haifa, Haifa, Israel
| | - S Yellinek
- Department of Psychology, University of Haifa, Haifa, Israel
| | - I Weissman-Fogel
- Department of Physical Therapy, University of Haifa, Haifa, Israel
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Mair FS, Goldstein P, May C, Angus R, Shiels C, Hibbert D, O'Connor J, Boland A, Roberts C, Haycox A, Capewell S. Patient and provider perspectives on home telecare: Preliminary results from a randomized controlled trial. J Telemed Telecare 2016; 11 Suppl 1:95-7. [PMID: 16036011 DOI: 10.1258/1357633054461976] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A randomized controlled trial of home telecare for the management of acute exacerbations of chronic obstructive pulmonary disease has been undertaken in the north-west of England. A videophone was used that communicates via the ordinary telephone network. The intervention period for each participant was two weeks. Participants in the telecare arm of the trial were asked to complete logbooks to record their experiences of each telecare encounter. A simple, self-completed, 10–item questionnaire was used that consisted of a Likert scale, ranging from 1 (totally disagree) to 5 (totally agree). Fourteen nurses completed 150 logbooks and 22 patients completed 145 logbooks. These results demonstrate significant differences in perception between patients and their health-care providers with regard to telecare encounters across all the domains addressed. Participating patients consistently demonstrated more positive views of the telecare encounters than their health-care providers.
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Affiliation(s)
- F S Mair
- University of Liverpool, Liverpool, UK.
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Abstract
We analysed the difficulties encountered in recruiting predominantly older patients, suffering from an acute exacerbation of a chronic illness, to a randomized controlled trial of home telecare. Of 653 patients approached for study participation, after full assessment, 80% (519) met the trial eligibility criteria. Of these, 104 (20%) consented to study participation and 415 (80%) refused. A logistic regression model was constructed to examine independent effects of patient factors on probability of trial participation. Only two independent variables were associated with decreased likelihood of consent: increasing age (1 year older: odds ratio [OR] = 0.96); and being on inhaled steroid medication (OR = 0.60). The most common reason for refusal to participate, accounting for almost one-third of respondents, was a stated preference for a face-to-face nurse visiting service rather than a telecare service. Perhaps home telecare services should continue to be targeted at the more stable chronically ill population and not at those suffering from acute illness.
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Affiliation(s)
- F S Mair
- University of Glasgow, Glasgow, UK.
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10
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Braun F, Ammirati C, Auchères G, Duché-Taillez M, Goldstein P, Jenvrin J, Julié V, Lévy-Chazal P, Nace L, Roy H, Valette P, Miklin J. Retour d’expérience des attentats du 13 novembre 2015. Organisation des renforts par les Samu de province. Ann Fr Med Urgence 2016. [DOI: 10.1007/s13341-016-0612-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Plancke L, Ducrocq F, Clément G, Chaud P, Haeghebaert S, Amariei A, Chan-Chee C, Goldstein P, Vaiva G. Les sources d’information sur les tentatives de suicide dans le Nord - Pas-de-Calais. Apports et limites. Rev Epidemiol Sante Publique 2014; 62:351-60. [DOI: 10.1016/j.respe.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 09/12/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022] Open
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Shavadia J, Zheng Y, Maleki ND, Van F, Werf D, Goldstein P, Armstrong P. MYOCARDIAL INFARCT SIZE AND SHOCK/HEART FAILURE: DOES REPERFUSION STRATEGY MATTER IN EARLY PRESENTING STEMIS? Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Huber K, Gersh BJ, Goldstein P, Granger CB, Armstrong PW. The organization, function, and outcomes of ST-elevation myocardial infarction networks worldwide: current state, unmet needs and future directions. Eur Heart J 2014; 35:1526-32. [DOI: 10.1093/eurheartj/ehu125] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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14
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Affiliation(s)
- Gabriel O. Ibáñez-García
- Facultad de Ciencias, Departamento de Física; Universidad Nacional Autónoma de México; México D.F México 14390
| | - Patricia Goldstein
- Facultad de Ciencias, Departamento de Física; Universidad Nacional Autónoma de México; México D.F México 14390
| | - Alicia Zarzosa-Pérez
- Facultad de Ciencias, Departamento de Física; Universidad Nacional Autónoma de México; México D.F México 14390
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15
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Assez N, Mauriaucourt P, Cuny J, Goldstein P, Wiel E. [Fever and jaundice... and if it was a leptospirosis. About a case of L. interrogans icterohaemorrhagiae in Northern France]. Ann Fr Anesth Reanim 2013; 32:439-443. [PMID: 23702161 DOI: 10.1016/j.annfar.2013.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/18/2013] [Indexed: 06/02/2023]
Abstract
Leptospirosis is an anthropozoonose, an animal disease transmissible to humans, caused by a spirochete of the genus Leptospira that lives mainly among rodents but also in wetlands. It occurs worldwide, particularly in Asia, Latin America and Africa. In Europe, the incidence is small (except in France and Great Britain, where its frequency has increased in recent years) but the frequency may be underestimated. Some areas overseas are particularly affected. In France, the potential epidemic of leptospirosis is subject to climatic variations, justifying a constant monitoring of the disease provided by the National Reference Centre (CNR) of leptospires. Transmission to humans primarily occurs through contact with environments contaminated by the urine of infected animals. The disease can affect the liver and kidneys (hepatonephritis) as cytolysis, cholestasis and renal failure associated with fever. A coagulopathy usually accompanies the clinical table. Its diagnosis is difficult because of the clinical polymorphism. Early diagnosis of leptospirosis allows effective medical care, improving patient outcomes. This is currently based on gene amplification (PCR) or serology positive by the microscopic agglutination test (MAT), which is the reference method. Its evolution is usually favorable with appropriate antibiotic treatment (aminopenicillin). However 5-10% of symptomatic patients have a severe multisystem defaillance. Nearly a century after the discovery of the causative agent, this zoonosis remains a public health problem, zoonosis priority in terms of virulence, its reporting is mandatory in our country. We report the case of a severe form of hepatonephritis due to water contaminated with Leptospira observed in Northern France.
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Affiliation(s)
- N Assez
- Pôle de l'urgence, Samu régional de Lille, 5, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Ibáñez-García GO, Goldstein P, Hanna S. Brownian dynamics simulations of confined tethered polymers in shear flow: the effect of attractive surfaces. Eur Phys J E Soft Matter 2013; 36:56. [PMID: 23715882 DOI: 10.1140/epje/i2013-13056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 12/04/2012] [Accepted: 05/07/2013] [Indexed: 06/02/2023]
Abstract
Coarse grain Brownian dynamics simulations of the bead-spring model are used to investigate the effect of attractive surfaces on the stretching of confined tethered polymers under shear flow. The weak and strong adsorbed regimes have been addressed by means of a coarse grain van der Waals potential to simulate polymer substrate interactions. Different stationary cyclic dynamics are observed upon varying shear flow intensity and surface potential strength. Polymer stretching decreases as increasing the attractive potential strength, breaking down the scaling predictions for non-adsorbed polymers. We found that adsorption is enhanced by the shear flow strength in agreement to simulations of adsorbed non-tethered polymers.
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Affiliation(s)
- Gabriel O Ibáñez-García
- Facultad de Ciencias, Departamento de Física, Universidad Nacional Autónoma de México, 04510, México D.F, México.
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Campagne G, Cuny J, Gosselin P, Goldstein P, Assez N, Wiel E. Prehospital management of COPD patients in respiratory failure and short-term outcome. Crit Care 2013. [PMCID: PMC3642437 DOI: 10.1186/cc12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cuny J, Campagne G, Gosselin P, Goldstein P, Assez N, Wiel E. Analysis of management of non-invasive ventilation support in prehospital care for COPD patients and short-term outcome. Crit Care 2013. [PMCID: PMC3642460 DOI: 10.1186/cc12082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tilak O, Cuny J, Assez N, Goldstein P, Wiel E. Analysis of emergency calls achieved in a French emergency dispatching centre: what resources for which patients. Crit Care 2013. [PMCID: PMC3642563 DOI: 10.1186/cc12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Assez N, Lemanski-Brulin C, Aboukais W, Sebilleau Q, Adriansen C, Rouyer F, Wiel E, Goldstein P. Défis de la prise en charge du syndrome coronaire aigu en pré-hospitalier. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70835-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Assez N, Wiel E, Lemanski-Brulin C, Adriansen C, Goldstein P. Syndromes coronariens aigus : prise en charge thérapeutique en urgence. Ann Fr Med Urgence 2011. [DOI: 10.1007/s13341-011-0116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Tubaro M, Danchin N, Goldstein P, Filippatos G, Hasin Y, Heras M, Jansky P, Norekval TM, Swahn E, Thygesen K, Vrints C, Zahger D, Arntz HR, Bellou A, de La Coussaye JE, de Luca L, Huber K, Lambert Y, Lettino M, Lindahl B, McLean S, Nibbe L, Peacock WF, Price S, Quinn T, Spaulding C, Tatu-Chitoiu G, van de Werf F. Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology. ACTA ACUST UNITED AC 2011; 13:56-67. [DOI: 10.3109/17482941.2011.581292] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rouyer F, Facon A, Adriansen C, Assez N, Auffray JL, Bauchart JJ, Ennezat PV, Asseman P, Wiel E, Goldstein P. 245 Improvement of ST Elevation Myocardial Infarction (STEMI) management. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041624.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Girot M, Wiel E, Hardy A, Smith G, Pruvo JP, Leclerc X, Goldstein P. 249 Stroke network, stroke, intravenous thrombolysis, intra-hospital delay, imaging. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041632.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hinglais E, Goldstein P, Ducasse JL, Banaei-Bouchareb L, Erbault M, Riolacci-Dhoyen N, Desplanques-Leperre A. 275 Trends in the quality of myocardial infarction management in France: from evidence-based medicine to optimal clinical pathways. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041608.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hubert H, Guinhouya C, Wiel E, Vilhelm C, Goldstein P. Construction of an adaptable and specific severity score for prehospital emergencies. Emerg Med J 2009; 26:529-31. [DOI: 10.1136/emj.2007.047407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wiel E, Lebuffe G, Erb C, Assez N, Menu H, Facon A, Goldstein P. Intérêt de la simulation réaliste dans l’évaluation de l’enseignement de l’intubation difficile aux médecins urgentistes. ACTA ACUST UNITED AC 2009; 28:542-8. [DOI: 10.1016/j.annfar.2009.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 04/15/2009] [Indexed: 11/17/2022]
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Charbonnel C, Ennezat PV, Darchis J, Auffray JL, Bauchart JJ, Aubert JM, Godart F, Goldstein P, Asseman P. [Pulmonary embolism and right diaphragmatic paralysis: "one train can hide another"]. Arch Mal Coeur Vaiss 2007; 100:61-3. [PMID: 17405556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The authors report the case of an 84 year old woman admitted for a mild pulmonary embolism associated with severe hypoxaemia. The association of a right diaphragmatic paralysis with renewed patency of a foramenovale and creation of a right-to-left shunt is probably an underestimated cause of refractory hypoxaemia.
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Affiliation(s)
- C Charbonnel
- Service des urgences et soins inten- sifs cardiologiques
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Vannesson C, Ennezat PV, Aubert JM, Darchis J, Auffray JL, Bauchart JJ, Lesenne M, Sudre A, Goldstein P, Asseman P. [Myocardial infarction with normal coronary arteries: role of transesophageal echocardiography]. Arch Mal Coeur Vaiss 2007; 100:68-71. [PMID: 17405558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report the case of 74 years-old female patient hospitalized for a ST+ acute coronary syndrome with normal coronary angiography. The association of a patent foramen ovale, a deep venous thrombosis and a pulmonary embolism led us to conclude the diagnosis of paradoxical coronary embolism. This case allows us to remind different etiologies to be considered in case of myocardial infarction with normal coronary arteries, and the interest of transesophageal echocardiography for the diagnosis of its etiology.
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Affiliation(s)
- C Vannesson
- Service d'urgences et soins intensifs cardiologiques
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Mathé G, Amiel JL, Schwarzenberg L, Doré JF, Goldstein P, Sekiguchi M, Bechet JM. CONDITIONING OF IMMUNOLOGICALLY COMPETENT CELLS BY INCUBATION AT 37°C*. Ann N Y Acad Sci 2006. [DOI: 10.1111/j.1749-6632.1966.tb12864.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Steg PG, Cambou JP, Goldstein P, Durand E, Sauval P, Kadri Z, Blanchard D, Lablanche JM, Guéret P, Cottin Y, Juliard JM, Hanania G, Vaur L, Danchin N. Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry. Heart 2006; 92:1378-83. [PMID: 16914481 PMCID: PMC1861049 DOI: 10.1136/hrt.2006.101972] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To study the impact on outcomes of direct admission versus emergency room (ER) admission in patients with ST-segment elevation myocardial infarction (STEMI) DESIGN: Nationwide observational registry of STEMI patients SETTING 369 intensive care units in France. INTERVENTIONS Patients were categorised on the basis of the initial management pathway (direct transfer to the coronary care unit or catheterisation laboratory versus transfer via the ER). MAIN OUTCOME MEASURES Delays between symptom onset, admission and reperfusion therapy. Mortality at five days and one year. RESULTS Of 1204 patients enrolled, 66.9% were admitted direct and 33.1% via the ER. Bypassing the ER was associated with more frequent use of reperfusion (61.7% v 53.1%; p = 0.001) and shorter delays between symptom onset and admission (244 (interquartile range 158) v 292 (172) min; p < 0.001), thrombolysis (204 (150) v 258 (240) min; p < 0.01), hospital thrombolysis (228 (156) v 256 (227) min, p = 0.22), and primary percutaneous coronary intervention (294 (246) v 402 (312) min; p < 0.005). Five day mortality rates were lower in patients who bypassed the ER (4.9% v 8.6%; p = 0.01), regardless of the use and type of reperfusion therapy. After adjusting for the simplified Thrombolysis in Myocardial Infarction (TIMI) risk score, admission via the ER was an independent predictor of five day mortality (odds ratio 1.67, 95% confidence interval 1.01 to 2.75). CONCLUSIONS In this observational analysis, bypassing the ER was associated with more frequent and earlier use of reperfusion therapy, and with an apparent survival benefit compared with admission via the ER.
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Affiliation(s)
- P G Steg
- Department of Cardiology, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Assez N, Adriansen C, Charpentier S, Baixas C, Ducasse JL, Goldstein P. [Management of acute coronary syndromes without ST elevation: the TOSCANE registry]. Arch Mal Coeur Vaiss 2005; 98:1123-9. [PMID: 16379109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The problem of pre-hospital management of acute coronary syndromes without ST elevation has not been extensively studied. The practitioner is faced with three simultaneous problems: suspecting the diagnosis, how to confirm the diagnosis to introduce appropriate, rapid and effective treatment, and which prognostic criteria to use to install aggressive therapy in high risk groups (anti GP lIb/IIIa, clopidogrel, angioplasty). TOSCANE is the first multicentre French registry which analyses the impact of the emergency ambulance serve in the management of these patients. There are two objectives: to gather epidemiological data about pre-hospital and hospital management by the emergency physician and the cardiologist, and to identify at an early stage criteria of "high risk" (HR) which, according to the recommendations of the European Society of Cardiology, justify using the most aggressive therapies. From April to September 2003, 797 patients with suspected acute coronary syndromes were enrolled by 36 French centre. Of these patients, 780 were managed successfully by the emergency ambulance service and hospital cardiological department with or without a "Cath Lab", and included for analysis. The diagnosis of acute coronary syndrome without ST elevation was rarely certain in the pre-hospital period. The lack of formal paraclinical features confirming the diagnosis was often a handicap for the emergency physician. Although the European recommendations are well observed in the cardiology departments, their application and adaptability should be improved in the pre-hospital period. TOSCANE showed that all invasive strategies preceded by platelet anti-aggregant therapy in the prehospital period administered to high risk patients, significantly reduced the mortality and morbidity at one month.
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Affiliation(s)
- N Assez
- SAMU régional de lille, CHRU de Lille.
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Goldstein P, Wiel E. Management of prehospital thrombolytic therapy in ST-segment elevation acute coronary syndrome (<12 hours). Minerva Anestesiol 2005; 71:297-302. [PMID: 15886591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED Acute myocardial infarction (AMI) is the prototype of a real emergency, and both efficacy and speed are necessary for effective management. The advent of thrombolysis therapy has transformed the care of these patients. In fact, the most frequent complication of AMI is sudden death which still occurs within the first hour after symptom onset. Thrombolytic therapy has been shown to reduce early and long term mortality about 20%. The mortality gain is dependent on the delay time of early reperfusion. A large number of studies have shown that this relationship is best described as exponential: in the first 1 to 2 hours after the onset of chest pain, the benefit of thrombolysis is greater. Reducing the time to thrombolysis must therefore be the main objective of prehospital treatment of AMI. In the last 10 years, a large number of strategies to reduce the time to reperfusion have been evaluated, including initiation of thrombolytic therapy prior to arrival to hospital. In France, prehospital emergency medicine is an integral part of the medical care system. The SAMU is a hospital department whose function is to centralize emergency medical calls and organise an appropriate response with the intention of ensuring the shortest delay between the initial call and the appropriate treatment. In the event of an emergency medical call concerning chest pain, the medical dispatcher of SAMU may decide to send a MICU (mobile intensive care unit). If a diagnosis of AMI is confirmed, clinical ECG criteria, prehospital thrombolysis is currently seen as the best treatment strategy. The SAMU experience has proven that prehospital thrombolysis is both safe and effective. During the last ten years to fifteen years the field of reperfusion during acute myocardial infarction was a real battlefield between the proponents of thrombolysis and those of primary percutaneous interventions. Nowadays there is a growing number of physicians who will consider that the best way forward is not to oppose these two effective methods but to find the most appropriate niche for each or even better to combine them to achieve reperfusion. In this respect, the concept of facilitated percutaneous intervention is a very attractive one which shows promising results. A large number of studies are now ongoing to demonstrate its efficacy and to help us to choosing the ideal combination of anti-thrombotic agents to be used. That is one of the main interests of the CAPTIM study. French trial comparing prehospital thrombolysis to primary angioplasty. There is no difference between the two strategies in term of primary end points. That could be the real life for acute myocardial infarction. We have to consider in this study the fact than 33% of the patients had a pre hospital thrombolysis followed by a fast angioplasty. The results are impressing: the 30 day mortality in the pre hospital thrombolysis arm is only 3.8%. But if the delay between pain to pre hospital thrombolysis is under 2 hours this 30 day mortality fall down to 2.2%. This is better RESULTS Than il all the recent trials published comparing on site thrombolysis to primary angioplasty (DANAM II, C Port, PRAGUE II). These good results in the CAPTIM study when the delay pain to treatment is less than 2 hours include also the occurrence of cardiogenic shock in favour of pre hospital thrombolysis (1.3%). The good strategy in a next future could be the association of pre hospital thrombolysis and angioplasty. In a recent French register (USIC 2000) including all the patients arriving in CICU during a month and regarding the one month mortality this strategy seems to be the best (3.6%). The arrival of TNK-tPA is now changing the general management of prehospital AMI by reducing the time to treatment. This is clearly now the new standard of prehospital treatment. The reduction of UHF dose is recommended and the LWMH is considered as the next step as recently demonstrated in the ASSENT 3 and 3+ trials. Several recent registries have shown than we offer reperfusion to only half of the patients and even more important, when we do not offer it, this is unjustified in nearly half of the cases and these patients , forgotten for reperfusion have all a very poor prognosis. The other major problem is that patients are treated too late mainly because the call the emergency system too late. The are several ways to improve the time to treatment : information of the patients , shortening of the intra-hospital delays by better organisation and finally and perhaps more importantly , pre hospital triage and treatment. The efficacy and safety of the pre hospital strategy is now recognised worldwide. The best strategy for acute myocardial infarction should involve emergency physicians and cardiologist in a real local task-force to join and coordinate their efforts. That is the way to open more arteries earlier, that is to say save myocardium and more lives.
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Affiliation(s)
- P Goldstein
- Emergency Department, Lille Univesity Hospital, CHRU Lille Cedex, France.
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Welsh RC, Chang W, Goldstein P, Adgey J, Granger CB, Verheugt FWA, Wallentin L, Van de Werf F, Armstrong PW. Time to treatment and the impact of a physician on prehospital management of acute ST elevation myocardial infarction: insights from the ASSENT-3 PLUS trial. Heart 2005; 91:1400-6. [PMID: 15774607 PMCID: PMC1769177 DOI: 10.1136/hrt.2004.054510] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the impact of variation in prehospital care across distinct health care environments in ASSENT (assessment of the safety and efficacy of a new thrombolytic) -3 PLUS, a large (n = 1639) contemporary multicentred international trial of prehospital fibrinolysis. Specifically, the objectives were to assess predictors of time to treatment, whether components of time to treatment vary across countries, and the impact of physician presence before hospitalisation on time to treatment, adherence to protocol, and clinical events. METHODS Patient characteristics associated with early treatment (< or = 2 hours), comparison of international variation in time to treatment, and components of delay were assessed. Trial specific patient data were linked with site specific survey responses. RESULTS Younger age, slower heart rate, lower systolic blood pressure, and prior percutaneous coronary intervention were associated with early treatment. Country of origin accounted for the largest proportion of variation in time. Intercountry heterogeneity was shown in components of elapsed time to treatment. Physicians in the prehospital setting enrolled 63.8% of patients. The presence of a physician was associated with greater adherence to protocol mandated treatments and procedures but with delay in time to treatment (120 v 108 minutes, p < 0.001). CONCLUSION Country of enrollment accounted for the largest proportion of variation in time to treatment and intercountry heterogeneity modulated components of delay. The effectiveness and safety of prehospital fibrinolysis was not influenced by the presence of a physician. These data, acquired in diverse health care environments, provide new understanding into the components of prehospital treatment delay and the opportunities to further reduce time to fibrinolysis for patients with ST elevation myocardial infarction.
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Affiliation(s)
- R C Welsh
- University of Alberta, Edmonton, Alberta, Canada.
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Vahanian A, Goldstein P. [Form a chain of survival for the management of cardiac arrest outside hospital!]. Arch Mal Coeur Vaiss 2005; 98:85-6. [PMID: 15787297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Dujardin JJ, Steg PG, Puel J, Montalescot G, Ravaud P, Goldstein P, Jullien G, Chevalier B, Monassier JP, Huynh-Ba O, Kempf C. [FACT: French national registry of acute coronary syndromes. Specific study of French general hospital centers]. Ann Cardiol Angeiol (Paris) 2003; 52:337-43. [PMID: 14714350 DOI: 10.1016/s0003-3928(03)00107-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
UNLABELLED The FACT registry is currently the French registry including the greatest number of patients with acute coronary syndromes. PURPOSE The study presents epidemiologic data, modalities and delays for medical admission. METHOD Three thousand nine hundred and two patients were included in FACT by 362 French centers of cardiology between 06/01/2003 and 03/02/2003. One thousand eight hundred and ten patients, who had been placed in the cardiology departments of French general hospitals, were isolated from this registry. The French general hospitals represented 50.8% of the 362 centers. In order to clarify the study, these patients were divided into three groups: group A: patients without ST segment elevation but with suggestive ECG modifications; group B: patients with ST segment elevation; group C: all other patients. The results were mainly studied for groups A and B and compared. These results were also compared to those of the FACT registry and of other registries. RESULTS The results show that the average delay for admission is 2.9 h after a first delay between the pain and the help of 6.7 h. The first intervening party is a general practitioner (36.4%) then the SAMU (31.6%) and finally the emergency departments (18.7%). 16.6% of the patients from group B undergo pre-hospital thrombolysis. The recommendations of the European Society of Cardiology are widely applied except for the most recent of them since only 27.6% of the patients from group A having a TIMI score > or = 5 receive an anti-GIIB IIIA treatment. The reasons of the non-prescription of the recommended classes are mostly linked to contra-indication and intolerance. The strategy of coronary reopening mainly depends on the presence or the absence in the department of an available medical equipment for angioplasty. If there is one, the percentage of primary angioplasty reaches 54.2% and the percentage of thrombolysis 7.9%. On the opposite, there is 8.3% of angioplasty and 54.2% of thrombolysis for the unequipped centers. The global mortality reaches 5.8% but is inversely proportional to the level of equipment of the departments: 5.9% for the departments with angioplasty, 11% for the departments with coronarography but without angioplasty and 13.8% for the departments without any interventional equipment. Nevertheless, the age of the patients is different and this influences the results: we notice that the less equipped the department is, the older the patients are. CONCLUSION The FACT registry and the data from the general hospitals give the opportunity to think about the possibilities to improve the delays of call to the first intervening party (more particularly to the SAMU) but it also allows us to think about how to better organize the geographical distribution giving access to a medical equipment for angioplasty. All these information will also help the cardiologists to gather around the recommendations by convincing them that the benefit/risk ratio is positive.
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Affiliation(s)
- J J Dujardin
- Service de cardiologie, centre hospitalier de Douai, BP 740, Douai cedex 59507, France.
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Wallentin L, Goldstein P, Armstrong PW, Granger CB, Adgey AAJ, Arntz HR, Bogaerts K, Danays T, Lindahl B, Mäkijärvi M, Verheugt F, Van de Werf F. Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 PLUS randomized trial in acute myocardial infarction. Circulation 2003; 108:135-42. [PMID: 12847070 DOI: 10.1161/01.cir.0000081659.72985.a8] [Citation(s) in RCA: 279] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The combination of a single-bolus fibrinolytic and a low-molecular-weight heparin may facilitate prehospital reperfusion and further improve clinical outcome in patients with ST-elevation myocardial infarction. METHODS AND RESULTS In the prehospital setting, 1639 patients with ST-elevation myocardial infarction were randomly assigned to treatment with tenecteplase and either (1) intravenous bolus of 30 mg enoxaparin (ENOX) followed by 1 mg/kg subcutaneously BID for a maximum of 7 days or (2) weight-adjusted unfractionated heparin (UFH) for 48 hours. The median treatment delay was 115 minutes after symptom onset (53% within 2 hours). ENOX tended to reduce the composite of 30-day mortality or in-hospital reinfarction, or in-hospital refractory ischemia to 14.2% versus 17.4% for UFH (P=0.080), although there was no difference for this composite end point plus in-hospital intracranial hemorrhage or major bleeding (18.3% versus 20.3%, P=0.30). Correspondingly, there were reductions in in-hospital reinfarction (3.5% versus 5.8%, P=0.028) and refractory ischemia (4.4% versus 6.5%, P=0.067) but increases in total stroke (2.9% versus 1.3%, P=0.026) and intracranial hemorrhage (2.20% versus 0.97%, P=0.047). The increase in intracranial hemorrhage was seen in patients >75 years of age. CONCLUSIONS Prehospital fibrinolysis allows 53% of patients to receive reperfusion treatment within 2 hours after symptom onset. The combination of tenecteplase with ENOX reduces early ischemic events, but lower doses of ENOX need to be tested in elderly patients. At present, therefore, tenecteplase and UFH are recommended as the routine pharmacological reperfusion treatment in the prehospital setting.
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Affiliation(s)
- L Wallentin
- Department of Cardiology and Uppsala Clinical Research Centre, Uppsala, Sweden.
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Merlin J, Goldstein A, Goldstein P. Three-Dimensional Ultrastructural Karyotype Analysis from the Meiotic Parthenogenetic Nematode Heterodera betulae. J Nematol 2003; 35:228-231. [PMID: 19266000 PMCID: PMC2620618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Meiotic chromosome structure and function are described in the plant-parasitic nematode Heterodera betulae. Twelve synaptonemal complexes (SCs) were reconstructed from pachytene nuclei; therefore, n=12 is predicted for this species. Morphologically distinct sex chromosomes were not observed. Only one end of the SC is attached to the nuclear envelope, and there is no bouquet arrangement at pachytene. The structure of the SC in this meiotic parthenogenetic nematode was different than in other nematodes that reproduce via amphimixis; a striated central element with transverse filaments was not observed. Multiple SCs, or polycomplexes, were present in the nucleus. Recombination nodules were not observed. The centrioles were comprised of nine doublet microtubules connected by a ring, which is a distinct modification from the typical nine triplet microtubules without any interconnecting structure.
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Merlin J, Goldstein A, Goldstein P. Meiotic Structures in the Animal-Parasitic Nematode Ascaris megalocephala: Synaptonemal Complexes, Recombination Nodules, and Centrioles. J Nematol 2003; 35:223-227. [PMID: 19265999 PMCID: PMC2620616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Two synaptonemal complexes (SCs) were present in the pachytene nuclei of Ascaris megalocephala. The SC was tripartite and comprised of two lateral elements (25 nm) with a striated central element (25 nm) and a central region of 65 nm. Spherical recombination nodules were observed to be associated only with the central element, although they are non-existent in the related A. lumbricoides var. suum (Goldstein, 1977). The SCs were attached to the nuclear envelope at only one end, while the other end was free in the nucleoplasm. This lack of bouquet formation of the chromosomes is consistent with all other nematodes studied. Morphologically distinct sex chromosomes were not observed, which differs from the presence of five Y-chromosomes present in A. lumbricoides var. suum (Goldstein and Moens, 1976). Centrioles (0.2 microm wide) reproduced by budding off the parental centriole. The centrioles consisted of nine singlet microtubules connected by an electron-dense proteinaceous ring. This structure is consistent with centrioles described in other nematodes, yet distinctly different from the centriole structure observed in most organisms in which it consists of nine triplet microtubules without any connecting ring. Multiple synaptonemal complexes, or polycomplexes, are found in A. megalocephala and A. lumbriocoides var. suum. They appear as stacked SC and are present inside the nucleus during zygotene and in the cytoplasm at pachytene.
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Chevalier V, Alauze C, Soland V, Cuny J, Goldstein P. [Impact of a public-directed media campaign on emergency call to a mobile intensive care units center for acute chest pain]. Ann Cardiol Angeiol (Paris) 2003; 52:150-8. [PMID: 12938566 DOI: 10.1016/s0003-3928(03)00061-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiovascular diseases represent the second highest cause of mortality among the 25-65 age group in the Nord-Pas-de-Calais region. The Monica study clearly showed that in 1996 the average length of time between a casualty showing the first signs of a coronary and the commencement of treatment was 3 h 30 in northern region of France compared with an average of 2 hours for the rest of the country. Many factors play a part: lack of knowledge of the symptoms, ignorance of the benefits of making an early call to the ambulance, lack of awareness of the french emergency services- centre 15 and its role, absence of any structured network for coronary emergencies. Given these observations, an extensive regional informative campaign is being launched for the first time in France, which will involve all relevant health professionals. The 2 aims of this campaign are to encourage people to call centre 15 directly and as quickly as possible after noticing the first coronary symptoms, and to encourage general practitioners (GPs) to "prescribe calling centre 15". The impact of this campaign has been estimated using the descriptive analysis of the relationship between the number of calls made to centre 15 by the general public and doctors and the number of successful prehospital interventions by the mobile emergency unit of Lille in cases of coronaries and thrombosis. The results of 3 telephone surveys of 1200 people carried out by the emergency services and 2 surveys carried out by a private company were also used for this evaluation. The analysis of this data provides a wealth of arguments in favour of the effectiveness of the campaign. On one hand this is due to the quality of its contents, which we compared to a similar campaign and on the other hand it is due to its lengthy duration.
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Affiliation(s)
- V Chevalier
- SAMU régional de Lille, CHRU, 5, avenue Oscar-Lambret, 59037 Lille, France.
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Goldstein P. Pre-Hospital Reperfusion Strategies to Optimize Outcomes in Acute Myocardial Infarction. Intensive Care Med 2003. [DOI: 10.1007/978-1-4757-5548-0_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kacet S, Zghal N, Kouakam C, Benameur N, Goldstein P. [Use of semi-automatic defibrillators outside the hospital]. Arch Mal Coeur Vaiss 2002; 95:945-9. [PMID: 12462906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
With an annual incidence of 1 to 2@1000 and a rate of survival without complication of 2%, sudden death outside hospital constitutes a serious public health problem in France. Ventricular fibrillation (VF) is responsible for more than three quarters of these deaths. The rate of survival is inversely proportional to the duration of VF making early defibrillation a strong link in the chain of survival. The chances of survival are much greater if the cardio-respiratory arrest occurs with a witness, basic first aid is started rapidly, diagnosis of VF is made quickly and the first shock is delivered as soon as possible. These last two criteria are being met more often since the advent of the semi-automatic defibrillator (SAD) and its availability to first line rescuers. The SAD is a light and compact defibrillator capable of automatic analysis of the electrocardiographic trace, charging if it detects ventricular tachycardia (VT) or VF. By analysing the QRS amplitude, its slope, its morphology, its spectral density and the duration of the isoelectric line, the SAD is capable of recognising VF with a sensibility of 98% and a specificity of 93%. The shock, however, is only delivered with a manoeuvre from the operator. The SAD memorizes both the rhythmic event treated and certain parameters relating to its use. During the last decade, the SAD has benefited from the technological evolutions of the implantable automatic defibrillator, with the introduction of a biphasic shock. The use of a biphasic shock allows reduction in the minimal defibrillation charge and thus lightens the apparatus and increases the number of shocks which the SAD can deliver on a charged battery. In authorizing paramedics by statute to use the SAD, it has been possible to reduce the interval from alert to first delivered shock to 8 minutes although it would be 10 minutes if the medical team was awaited, and to obtain a survival rate without complication of 6.3%. The progress achieved by the use of the SAD in the chain of survival cannot be denied. However, to surpass automatic defibrillation and widen the use of defibrillators to an informed and motivated public would certainly bring our results closer to those obtained in America where the survival rate reaches 30% in the best cases; subject to widespread first aid training for the population.
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Affiliation(s)
- S Kacet
- Service de cardiologie A, CHRU de Lille, boulevard du Pr-Leclercq, 59037 Lille
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Woimant F, Hommel M, Adnet Bonte C, Baldauf E, Chedru F, Cohen A, de Broucker T, Devailly JP, Duclos H, Gaston A, Grobuis S, Kassiotis P, Levasseur M, Merland JJ, Mounier Vehier F, Nibbio A, Orgogozo JM, Outin H, Pinel F, Pruvo JP, Rancurel G, Saudeau D, Scart-Gres C, Sévène M, Touboul PJ, Vassel P, Zuber M, Arquizan C, Baron JC, Becker F, Bes A, Boulliat J, Bousser MG, Bracard S, Branchereau A, Castel JP, Caussanel JP, Civit J, Collard M, Davoine P, Deroudille L, Dumas R, Frerebeau P, Giroud M, Goldstein P, Lagarrigue J, Lejeune JP, Lestavel P, Leys D, Mahagne MH, Manelfe C, Mas JL, Masson M, Michel D, Moulin T, Perret J, Petit H, Proust B, Rouanet F, Rougemont D, Roux FX, Samson Y, Trouillas P. [Recommendations for the creation of neuro-vascular units]. Rev Neurol (Paris) 2001; 157:1447-56; discussion 1457-8. [PMID: 11924017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- F Woimant
- Service de Neurologie, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris
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Goldstein P, Raphael D, Ruiloba MC. Sex bodies and synaptonemal complexes of Balb/C mice: antioxidant intervention of oxyradical insult. Cytobios 2001; 104:7-23. [PMID: 11219732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Spermatogenesis is inhibited in Balb/C mice as a result of oxyradical insult. However, mammalian spermatocytes and synaptonemal complexes retain their structure and function after oxyradical insult due to protection afforded by the antioxidant vitamin E. Control groups were compared with experimental groups which were fed various vitamin E-deficient diets and subjected to varying times in an humidified 100% oxygen (hyperoxia) chamber. Measurements were made of sex body volume (SBV), nuclear envelope aberrations (NEA), and synaptonemal complex structure in spermatocytes during pachytene of meiosis prophase I. Changes in the volume of the sex body were positively correlated with increased oxyradical insult. The structure of the synaptonemal complex was not altered in any of the experimental groups which is a significant observation. It is suggested that vitamin E affords antioxidant protection and inhibits the alteration of membranes and sex chromosomes in mice during meiosis.
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Affiliation(s)
- P Goldstein
- Department of Biological Sciences, University of Texas at El Paso, 79968, USA
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Goldstein P. Effect of a superovulation drug on the synthesis and release of CA 125 by ovarian cells in culture. Obstet Gynecol 2001. [DOI: 10.1016/s0029-7844(01)01178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Diependaele JF, Rakza T, Truffert P, Abazine A, Riou Y, Goldstein P, Lequien P, Storme L. [Experimental study of changes in FiO2 during manual ventilation]. Arch Pediatr 2001; 8:368-73. [PMID: 11339127 DOI: 10.1016/s0929-693x(00)00212-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Discrepancies exist in the recommendations about the oxygen flow to deliver during manual ventilation. The aim of the present study was to determine the effects of ventilatory frequency (FR), inspiratory pressure (P) and oxygen flow on the concentration of the delivered oxygen (FiO2) to obtain FiO2 near 1. MATERIAL AND METHODS Experimental study with self-inflating resuscitation bag (Ambu with oxygen reservoir) tested on a mono-compartmental test lung (resistant tube and elastic bag [Draeger]; characteristics: compliance = 0.6 mL/cmH2O; resistance = 85 cmH2O.L-1.s-1). Protocol 1: six neonatologists ventilated this model as if they were ventilating premature newborn infants with RDS at various ventilatory rates from 30 to 120 bpm and at various oxygen flows (from 2 to 12 L/min). Tidal volumes (Vt), inspiratory times (Ti), P and FiO2 were recorded continuously during the study. Protocol 2: a graduated manometer was added to visualize pressure. The same protocol was then applied. RESULTS Protocol 1 (without visual control of the pressure): increase in oxygen flow delivered with the Ambu increases the FiO2 values (P < 0.0001); the higher the ventilatory frequency, the lower the FiO2 (P < 0.0001). The mean value of delivered FiO2 was related to the operator (extreme: 47-86%) (P < 0.001). Multivariate statistical analysis showed that O2 flow, ventilator rate and operator modulated independently the FiO2. Ti and Vt did not change the FiO2. Protocol 2 (with visual control of the pressure: the mean inflating pressures were less than those obtained without visual control of the pressure (26 vs 40 cmH2O respectively; P < 0.05). FiO2 was independent of O2 flow and ventilatory rate. CONCLUSIONS A special device for continuous visual control of airway pressure is recommended during neonatal manual ventilation. It prevents ventilatory rate-induced FiO2 fluctuations and overdistention.
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Abstract
Endotracheal intubation is widely used for airway management in a prehospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome in adult patients. The benefits, in term of outcomes of invasive airway management before reaching hospital, remain controversial. However, inadequate airway management in this patient population is the primary cause of preventable mortality. An increase in intubation failures and in the rate of complications in trauma patients should induce us to improve airway management skills at the scene of trauma. If the addition of emergency physicians to a prehospital setting is to have any influence on outcome, further studies are merited. However, it has been established that sedation with rapid sequence intubation is superior in terms of success, complications and rates of intubation difficulty. Orotracheal intubation with planned neuromuscular blockade and in-line cervical alignment remains the safest and most effective method for airway control in patients who are severely injured.
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Affiliation(s)
- F Adnet
- Hôpital Avicenne, Bobigny, France.
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