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51.
Damien Contou Romain Sonneville Florence Canoui-Poitrine Gwenhaël Colin Rémi Coudroy Frédéric Pène Jean-Marc Tadié Martin Cour Gaëtan Béduneau Antoine Marchalot Laurent Guérin Sébastien Jochmans Stephan Ehrmann Nicolas Terzi Sébastien Préau François Barbier Guillaume Schnell Damien Roux Olivier Leroy Claire Pichereau Elodie Gélisse Lara Zafrani Richard Layese Christian Brun-Buisson Armand Mekontso Dessap Nicolas de Prost For the Hopeful Study Group 《Intensive care medicine》2018,44(9):1502-1511
Purpose
Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality.Methods
A 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up).Results
Among the 306 included patients, 126 (41.2%; 95% CI 35.6–46.9) died and 180 (58.8%; 95% CI 53.3–64.3) survived during the follow-up period [13 (3–24) days], including 51/180 patients (28.3%, 95% CI 21.9–35.5) who eventually required limb amputations, with a median number of 3 (1–4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR)?=?1.03 (1.02–1.04); p?<?0.001], lower leucocytes [HR 0.83 (0.69–0.99); p?=?0.034] and platelet counts [HR 0.77 (0.60–0.91); p?=?0.007], and arterial blood lactate levels [HR 2.71 (1.68–4.38); p?<?0.001] were independently associated with hospital death, while a neck stiffness [HR?0.51 (0.28–0.92); p?=?0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06–3.38); p?=?0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis.Conclusion
Purpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation.Trials registration
NCT03216577.52.
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54.
Tissue-type plasminogen activator (t-PA) is stored in Weibel-Palade bodies in human endothelial cells both in vitro and in vivo 总被引:9,自引:6,他引:9
Vascular endothelial cells are thought to be the main source of plasma tissue-type plasminogen activator (t-PA) and von Willebrand factor (VWF). Previous studies have suggested that both t-PA and VWF are acutely released in response to the same stimuli, both in cultured endothelial cells and in vivo. However, the subcellular storage compartment in endothelial cells has not been definitively established. We tested the hypothesis that t-PA is localized in Weibel-Palade (WP) bodies, the specialized endothelial storage granules for VWF. In cultured human umbilical vein endothelial cells (HUVECs), t-PA was expressed in a minority of cells and found in WP bodies by immunofluorescence. After up-regulation of t-PA synthesis either by vascular endothelial growth factor (VEGF) and retinoic acid or by sodium butyrate, there was a large increase in t-PA-positive cells. t-PA was exclusively located to WP bodies, an observation confirmed by immunoelectron microscopy. Incubation with histamine, forskolin, and epinephrine induced the rapid, coordinate release of both t-PA and VWF, consistent with a single storage compartment. In native human skeletal muscle, t-PA was expressed in endothelial cells from arterioles and venules, along with VWF. The 2 proteins were found to be colocalized in WP bodies by immunoelectron microscopy. These data indicate that t-PA and VWF are colocalized in WP bodies, both in HUVECs and in vivo. Release of both t-PA and VWF from the same storage pool likely accounts for the coordinate increase in the plasma level of the 2 proteins in response to numerous stimuli, such as physical activity, beta-adrenergic agents, and 1-deamino-8d-arginine vasopressin (DDAVP) among others. 相似文献
55.
56.
Pablo Aschner Juan Jos Gagliardino Hasan Ilkova Fernando Lavalle Ambady Ramachandran Jean Claude Mbanya Marina Shestakova Yann Bourhis Jean-Marc Chantelot Juliana C.N. Chan 《Diabetes care》2021,44(5):1100
OBJECTIVEDepression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS).RESEARCH DESIGN AND METHODSIDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms.RESULTSOf 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n = 4,729; OGLDs plus insulin, n = 1,892; insulin only, n = 964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10–19) were observed in 8–16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control.CONCLUSIONSDepressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction. 相似文献
57.
David Hassanein Berro Solène Collet Jean-Sébastien Guillamo Ararat Chakhoyan Jean-Marc Constans Emmanuèle Lechapt-Zalcman Jean-Michel Derlon Mathieu Hatt Dimitris Visvikis Stéphane Guillouet Cécile Perrio Myriam Bernaudin Samuel Valable 《Journal of neuroradiology. Journal de neuroradiologie》2021,48(4):230-231
58.
59.
Baron Sophie Alexandra Pascale Léa-Marie Million Matthieu Briantais Antoine Durand Jean-Marc Hadjadj Linda Rolain Jean-Marc 《European journal of clinical microbiology & infectious diseases》2021,40(5):1073-1077
European Journal of Clinical Microbiology & Infectious Diseases - We described three clinical cases of pyogenic liver abscess caused by hypervirulent Klebsiella pneumoniae (hvKp) successfully... 相似文献
60.
Patrick Niccola? Lemlih Ouchchane Maurice Libier Fay?ale Beouche Monique Belon Jean-Marc Vedrinne Bilal El Drayi Laurent Vallet Franck Ruiz Céline Biermann Pascal Duchêne Claudine Chirat Sylvie Soule-Sonneville Christian Dualé Claude Dubray Pierre Schoeffler 《Canadian journal of surgery》2015,58(2):114-120