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Le Touquet – Paris-Plage, France

Louis B.,French Institute of Health and Medical Research | Louis B.,University Paris Est Creteil | Leroux K.,ADEP Assistance | Isabey D.,French Institute of Health and Medical Research | And 5 more authors.
European Respiratory Journal | Year: 2010

Most pressure-support devices use a single circuit with an exhalation port integrated in the mask. The aim of the current study was to compare the effects of masks having different manufacturer-inserted leaks on ventilator performance. We simulated chronic obstructive pulmonary disease and restrictive disease. Four ventilators (VENTImotion (Weinmann, Hamburg, Germany), VPAP III STA (ResMed, Saint Priest, France), Synchrony 2 (Respironics, Nantes, France) and Vivo 40 (Breas, Saint Priest)) were tested with the recommended masks and with the masks having the largest and smallest leaks. Tests were performed with pressure support levels of 10, 15 and 20 cmH2O. The in vivo evaluation compared two ventilators using recommended masks opposed in terms of exhaled port resistance. The ventilators were tested with their recommended mask, and after mask exchange. The mask with the largest leak induced auto-triggering and/or increased inspiratory-trigger sensitivity was the VENTImotion under both simulated conditions and VPAP III STA under the simulated obstructive-disease condition. The mask with the smallest leak-increased inspiratorytrigger delay was Synchrony 2 in the simulated obstructive-disease condition and increased rebreathing. The in vivo study confirmed the bench results. When switching to a mask that has a different leak, evaluation is needed to adjust trigger sensitivity and pressurisation level and to check the absence of rebreathing. Copyright © ERS Journals Ltd 2010.

Essoh C.,University Paris - Sud | Essoh C.,French National Center for Scientific Research | Blouin Y.,University Paris - Sud | Blouin Y.,French National Center for Scientific Research | And 10 more authors.
PLoS ONE | Year: 2013

Phage therapy may become a complement to antibiotics in the treatment of chronic Pseudomonas aeruginosa infection. To design efficient therapeutic cocktails, the genetic diversity of the species and the spectrum of susceptibility to bacteriophages must be investigated. Bacterial strains showing high levels of phage resistance need to be identified in order to decipher the underlying mechanisms. Here we have selected genetically diverse P. aeruginosa strains from cystic fibrosis patients and tested their susceptibility to a large collection of phages. Based on plaque morphology and restriction profiles, six different phages were purified from "pyophage", a commercial cocktail directed against five different bacterial species, including P. aeruginosa. Characterization of these phages by electron microscopy and sequencing of genome fragments showed that they belong to 4 different genera. Among 47 P. aeruginosa strains, 13 were not lysed by any of the isolated phages individually or by pyophage. We isolated two new phages that could lyse some of these strains, and their genomes were sequenced. The presence/absence of a CRISPR-Cas system (Clustered Regularly Interspaced Short Palindromic Repeats and Crisper associated genes) was investigated to evaluate the role of the system in phage resistance. Altogether, the results show that some P. aeruginosa strains cannot support the growth of any of the tested phages belonging to 5 different genera, and suggest that the CRISPR-Cas system is not a major defence mechanism against these lytic phages. © 2013 Essoh et al.

Tallot M.,HOpital Armand Trousseau
Medecine Therapeutique Pediatrie | Year: 2011

Cataplexy is defined by a sudden loss of muscular tone triggered by emotional situations. Cataplexy is described in 50 to 70% of narcoleptic children in association with excessive daytime sleepiness, hypnagogic hallucinations, sleep paralysis and obesity. Narcolepsy can be a primitive neurologic disorder or secondary to a hypothalamic lesion, which has to be searched in children. Attacks of cataplexy are present in 20% of late-infantile forms of Niemann-Pick disease, in favour of this diagnosis if combined with prolonged neonatal cholestasis, splenomegaly and vertical supranuclear gaze palsy. Cataplexy may be associated with Prader-Willi syndrome in 16 to 23% of cases in which the diagnosis of the sudden loss of tone can be difficult because of frequent income of epileptic events in these patients, such as in Coffin-Lowry syndrome patients. Cataplexy has to be distinguished from cardiac stroke, epileptic events and sleep paralysis regarding to the natural history, the clinical examination and the investigations. Sodium oxybate treatment, used in adult patients, may be efficient in children as antidepressants or some stimulants, but not validated in pediatric population.

Egevad L.,Karolinska Institutet | Ahmad A.S.,Queen Mary, University of London | Algaba F.,Autonomous University of Barcelona | Berney D.M.,St. Bartholomews Hospital | And 13 more authors.
Histopathology | Year: 2013

Aims: The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7. Methods and results: Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases (P=0.009). Conclusions: While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization. © 2012 Blackwell Publishing Limited.

Fauroux B.,HOpital Armand Trousseau | Leboulanger N.,University Pierre and Marie Curie | Roger G.,University Pierre and Marie Curie | Denoyelle F.,University Pierre and Marie Curie | And 4 more authors.
Pediatric Critical Care Medicine | Year: 2010

Objective: To show that noninvasive positive-pressure ventilation by means of a nasal mask may avoid recannulation after decannulation and facilitate early decannulation. Design: Retrospective cohort study. Setting: Ear-nose-and-throat and pulmonary department of a pediatric university hospital. Patients: The data from 15 patients (age = 2-12 yrs) who needed a tracheotomy for upper airway obstruction (n = 13), congenital diaphragmatic hypoplasia (n = 1), or lung disease (n = 1) were analyzed. Four patients received also nocturnal invasive ventilatory support for associated lung disease (n = 3) or congenital diaphragmatic hypoplasia (n = 1). Decannulation was proposed in all patients because endoscopic evaluation showed sufficient upper airway patency and normal nocturnal gas exchange with a small size closed tracheal tube, but obstructive airway symptoms occurred either immediately or with delay after decannulation without noninvasive positive-pressure ventilation. Interventions: In nine patients, noninvasive positive-pressure ventilation was started after recurrence of obstructive symptoms after a delay of 1 to 48 mos after a successful immediate decannulation. Noninvasive positive-pressure ventilation was anticipated in six patients who failed repeated decannulation trials because of poor clinical tolerance of tracheal tube removal or tube closure during sleep. Measurements and Main Results: After noninvasive positive-pressure ventilation acclimatization, decannulation was performed with success in all patients. Noninvasive positive-pressure ventilation was associated with an improvement in nocturnal gas exchange and marked clinical improvement in their obstructive sleep apnea symptoms. None of the 15 patients needed tracheal recannulation. Noninvasive positive-pressure ventilation could be withdrawn in six patients after 2 yrs to 8.5 yrs. The other nine patients still receive noninvasive positive-pressure ventilation after 1 yr to 6 yrs. Conclusions: In selected patients with upper airway obstruction or lung disease, noninvasive positive-pressure ventilation may represent a valuable tool to treat the recurrence of obstructive symptoms after decannulation and may facilitate early weaning from tracheotomy in children who failed repeated decannulation trials. © 2010 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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