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The benefits of a rehabilitation program before surgical lung cancer resection remain to be defined. The purpose of this prospective observational study was to assess the effects of rehabilitation together with the use of noninvasive ventilation (NIV) in patients who were at a high operative risk. Between January 2010 and June 2011, 20 consecutive patients (16 males, four females, mean age: 66 years [44-79]) with a clinical N0 non-small cell lung cancer were included. Eligibility criteria were predicted post-operative respiratory function (FEV1, VO2 max) below the guideline thresholds for eligibility for surgical resection and/or associated with severe co-morbidities. The protocol included a cardiorespiratory rehabilitation program and 3 hours of NIV each day. Functional tests were repeated after 3 weeks of therapy. Participants displayed a significant increase in their FEV1 and VO2 max, which allowed surgical resection to go ahead in all patients (lobectomy, n=15; pneumonectomy, n=3; bilobectomy, n=2). The morbidity rate was 20% (acute renal failure, n=2; pneumonia, n=1; haemothorax, n=1). The mortality rate was 5% (myocardial infarction, n=1). Further postoperative rehabilitation allowed a return at home in 19 patients after a mean hospital stay of 11 days. Pulmonary rehabilitation associated with a period of preoperative NIV allows surgery to be performed in patients who are not initially eligible for resection. An evaluation of long-term outcomes survival in comparison to non-surgical therapies is necessary. Copyright © 2013. Published by Elsevier Masson SAS.

Jegou F.,University of Versailles | Jegou F.,French National Center for Scientific Research | Godin-Beekman S.,University of Versailles | Correa M.P.,Federal University of Itajuba | And 9 more authors.
Atmospheric Chemistry and Physics | Year: 2011

In order to test the validity of ultraviolet index (UVI) satellite products and UVI model simulations for general public information, intercomparison involving three satellite instruments (SCIAMACHY, OMI and GOME-2), the Chemistry and Transport Model, Modélisation de la Chimie Atmosphérique Grande Echelle (MOCAGE), and ground-based instruments was performed in 2008 and 2009. The intercomparison highlighted a systematic high bias of ∼1 UVI in the OMI clear-sky products compared to the SCIAMACHY and TUV model clear-sky products. The OMI and GOME-2 all-sky products are close to the ground-based observations with a low 6 % positive bias, comparable to the results found during the satellite validation campaigns. This result shows that OMI and GOME-2 all-sky products are well appropriate to evaluate the UV-risk on health. The study has pointed out the difficulty to take into account either in the retrieval algorithms or in the models, the large spatial and temporal cloud modification effect on UV radiation. This factor is crucial to provide good quality UV information. OMI and GOME-2 show a realistic UV variability as a function of the cloud cover. Nevertheless these satellite products do not sufficiently take into account the radiation reflected by clouds. MOCAGE numerical forecasts show good results during periods with low cloud covers, but are actually not adequate for overcast conditions; this is why Météo-France currently uses human-expertised cloudiness (rather than direct outputs from Numerical Prediction Models) together with MOCAGE clear-sky UV indices for its operational forecasts. From now on, the UV monitoring could be done using free satellite products (OMI, GOME-2) and operational forecast for general public by using modelling, as long as cloud forecasts and the parametrisation of the impact of cloudiness on UV radiation are adequate. © 2011 Author(s).

Raynaud C.,Center Hospitalier Victor Dupouy | Roche N.,University of Paris Descartes | Chouaid C.,University Pierre and Marie Curie
Respiratory Research | Year: 2011

An association between HIV infection and chronic obstructive pulmonary disease (COPD) has been observed in several studies.Objective and methods: we conducted a review of the literature linking HIV infection to COPD, focusing on clinical and epidemiological data published before and during widespread highly active antiretroviral therapy (HAART).Results: Interactions between HIV infection and COPD appear to be influenced by multiple factors. In particular, the bronchopulmonary tract can be damaged by HIV infection, the immunodeficiency it induces, and the resulting increase in the risk of pulmonary infections. In addition, the prevalence of smoking and intravenous drug use is higher in HIV-infected populations, also increasing the risk of COPD. Before the advent of HAART, respiratory tract infections probably played a major role. Since the late 1990s and the widespread use of HAART, the frequency of opportunistic infections has fallen but new complications have emerged as life expectancy has increased.Conclusion: given the high prevalence of smoking among HIV-infected patients, COPD may contribute significantly to morbidity and mortality in this setting. © 2011 Raynaud et al; licensee BioMed Central Ltd.

Ehrmann S.,Service de reanimation medicale polyvalente | Badin J.,Service de reanimation medicale polyvalente | Savath L.,Montpellier University | Pajot O.,Center Hospitalier Victor Dupouy | And 5 more authors.
Critical Care Medicine | Year: 2013

Objectives: To assess whether the use of iodinated contrast medium increases the incidence of acute kidney injury in ICU patients, compared with patients not receiving iodinated contrast medium. Design: Prospective observational matched cohort study. Setting: Two ICUs in two tertiary teaching hospitals. Patients: A total of 380 adults were included (20% more than once), before an iodinated contrast medium infusion (contrast inclusions, n = 307) or before an intrahospital transfer without iodinated contrast medium infusion (control inclusions, n = 170). Interventions: None. Measurements and Main Results: Among contrast inclusions, iodinated contrast medium-associated acute kidney injury occurred after 23 administrations (7.5%) according to the Acute Kidney Injury Network definition (stage ≥ 1, over 48 hr). As expected, a broader definition (≥ 25% increase in serum creatinine over 72 hr) yielded a greater incidence (16%). In 146 pairs of contrast and control inclusions, matched on propensity for iodinated contrast medium infusion, the incidence of acute kidney injury was similar (absolute difference in incidence, 0%; 95% confidence interval,-5.2; 5.2%), Acute Kidney Injury Network definition). Hospital mortality was also similar in 71 contrast and 71 control patients included only once and matched the same way. Contrary to iodinated contrast medium infusion (odds ratio, 1.57; 95% confidence interval, 0.69-3.53), the Sequential Organ Failure Assessment score at inclusion (odds ratio, 1.18; 95% confidence interval, 1.07-1.31) and the number of other nephrotoxic agents (odds ratio, 1.38; 95% confidence interval, 1.03-1.85) were independent risk factors for acute kidney injury. Conclusions: The specific toxic effect of monomeric nonionic low-osmolar iodinated contrast medium in ICU patients with multiple renal aggressions seemed minimal. Severity of disease and the global nephrotoxic burden were risk factors for acute kidney injury, regardless of iodinated contrast medium infusion. © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Liu N.,Outcomes Research Consortium | Boichut N.,University of Besancon | Genty A.,Clinique Saint Augustin | Herail T.,Center Hospitalier Of Dreux | And 9 more authors.
British Journal of Anaesthesia | Year: 2014

Background Nitrous oxide (N2O) offers both hypnotic and analgesic characteristics. We therefore tested the hypothesis that N 2O administration decreases the amount of propofol and remifentanil given by a closed-loop automated controller to maintain a similar bispectral index (BIS). Methods In a randomized multicentre double-blind study, patients undergoing elective surgery were randomly assigned to breathe 60% inspired N2O (N2O group) or 40% oxygen (AIR group). Anaesthesia depth was evaluated by the proportion of time where BIS was within the range of 40-60 (BIS40-60). The primary outcomes were propofol and remifentanil consumption, with reductions of 20% in either being considered clinically important. Results A total of 302 patients were randomized to the N2O group and 299 to the AIR group. At similar BIS40-60 [79 (67-86)% vs 76 (65-85)%], N2O slightly decreased propofol consumption [4.5 (3.7-5.5) vs 4.8 (4.0-5.9) mg kga1 ha1, P=0.032], but not remifentanil consumption [0.17 (0.12-0.23) vs 0.18 (0.14-0.24) μg kg a1 mina1]. For the subgroups of men, at similar BIS 40-60 [80 (72-88)% vs 80 (70-87)%], propofol [4.2 (3.4-5.3) vs 4.4 (3.6-5.4) mg kga1 ha1] and remifentanil [0.19 (0.13-0.25) vs 0.18 (0.15-0.23) μg kga1 mina1] consumptions were similar in the N2O vs AIR group, respectively. For the subgroups of women, at similar BIS40-60 [76 (64-84)% vs 72 (62-82)%], propofol [4.7 (4.0-5.8) vs 5.3 (4.5-6.6) mg kga1 ha1, P=0.004] and remifentanil [0.18 (0.13-0.25) vs 0.20 (0.15-0.27) μg kga1 mina1, P=0.029] consumptions decreased with the co-administration of N2O. Conclusions With automated drug administration titrated to comparable BIS, N2O only slightly reduced propofol consumption and did not reduce remifentanil consumption. There was a minor gender dependence, but not by a clinically important amount. Clinical trial registration This study was registered at ClinicalTrials.gov, number NCT00547209. © 2014 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

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