Triaging in pulmonary embolism

Risk stratification of patients with pulmonary embolism represents an important step and may help to guide initial therapeutic management. Pulmonary embolism can be stratified into several groups, with different risk of early death or complications based on the presence of several risk factors. High-risk pulmonary embolism is defined by shock or peripheral signs of hypoperfusion. It is a life-threatening emergency with high short-term mortality (>25%) requiring specific therapeutic strategy with inotropic agents and fibrinolysis. In normotensive patients with pulmonary embolism, the presence of right ventricular dysfunction assessed by echocardiography or myocardial injury based on elevated levels of biomarkers, is associated with an intermediate risk of early death. These patients require close monitoring, and the role of thrombolytic treatment is currently assessed in a large trial. Lastly, patients with normotensive pulmonary embolism and without right ventricular dysfunction or myocardial injury have a low risk of death and complications. These patients may be candidates for home treatment. Several scores combining these risk factors have been described.     

Incomplete thymic involution in systemic sclerosis and rheumatoid arthritis

ObjectiveThe thymus plays a crucial role in immune system homeostasis. Thymic abnormalities have been reported in many autoimmune diseases, but data for systemic sclerosis (SSc) and rheumatoid arthritis (RA) are sparse. The aim of this study was to evaluate the prevalence and correlates of radiological incomplete involution of the thymus in SSc and RA patients, and in a non-autoimmune group of controls.MethodsAll patients were at least 40 years old: 96 SSc patients (median age 59 years, 80% women) and 65 RA patients (median age 57 years, 88% women) were compared with 32 control individuals (median age 63 years, 62% women). Pulmonary CT-scans performed for lung assessment were available for all individuals. For the purpose of our study, complete involution of the thymus was defined as the absence of a residual thymus or a gland thickness, corresponding to the short axis on the axial slice, of less than 7 mm. We defined incomplete involution of the thymus as a residual thymic tissue more than 7 mm thick.ResultsThe frequency of incomplete thymus involution was significantly higher in SSc and RA patients (respectively 15 and 14%) than in the control group (0%; P < 0.05). Incomplete thymus involution was associated with pulmonary restrictive syndrome in SSc patients, and with biotherapy and an absence of antinuclear antibodies in RA patients.ConclusionOur findings show that two autoimmune diseases, SSc and RA, are associated with incomplete thymus involution.     

The disconnection syndrome in the Alzheimer’s disease: The cross-modal priming example

Implicit memory is generally supposed to be preserved in Alzheimer’s disease (AD). Yet, some implicit priming effects are impaired and others are not. The preserved/impaired priming effects are often interpreted according to the perceptual/conceptual or identification/production distinctions. Perceptual–identification priming paradigms shall be preserved and conceptual–production priming paradigms impaired. A third interpretation is yet possible based on the disconnection syndrome hypothesis which states that patients with AD should fail tasks requiring relatively complex brain communications. In this case, patients with AD should not demonstrated a significant perceptual priming effect in an identification task if this one involved complex brain communications. The present study tests this latter hypothesis with two cross-modal priming experiments using a categorization task. A visual meaningless mask presented with half of the auditory primes tested the nature of the cross-modal priming effect. The control group exhibited significant priming effects for unmasked primes. The interference effect of the mask demonstrated that the priming effect was perceptually driven. Patients with AD did not present any priming effect nor mask interference. The present findings therefore showed that perceptual priming using an identification task could be impaired in AD supporting the disconnection syndrome hypothesis.