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Azabou E.,Raymond Poincare Hospital AP HP | Azabou E.,University of Versailles | Roche N.,Raymond Poincare Hospital AP HP | Roche N.,University of Versailles | And 6 more authors.
Respiratory Physiology and Neurobiology | Year: 2013

We investigated effects of transcranial direct-current stimulation (tDCS) on the diaphragmatic corticospinal pathways in healthy human. Anodal, cathodal, and sham tDCS were randomly applied upon the left diaphragmatic motor cortex in twelve healthy right-handed men. Corticospinal pathways excitability was assessed by means of transcranial magnetic stimulation (TMS) elicited motor-evoked-potential (MEP). For each tDCS condition, MEPs were recorded before (Pre) tDCS then after 10. min (Post1, at tDCS discontinuation in the anodal and cathodal sessions) and 20. min (Post2). As result, both anodal and cathodal tDCS significantly decreased MEP amplitude of the right hemidiaphragm at both Post1 and Post2, versus Pre. MEP amplitude was unchanged versus Pre during the sham condition. The effects of cathodal and anodal tDCS applied to the diaphragm motor cortex differ from those observed during tDCS of the limb motor cortex. These differences may be related to specific characteristics of the diaphragmatic corticospinal pathways as well as to the diaphragm's functional peculiarities compared with the limb muscles. © 2013 Elsevier B.V.


PubMed | Bambino Gesu Childrens Hospital, French Institute of Health and Medical Research, Raymond Poincare Hospital AP HP and University of Versailles
Type: Journal Article | Journal: British journal of clinical pharmacology | Year: 2016

The combination of hydrocortisone and fludrocortisone improved outcomes in septic shock. However, the specific role of fludrocortisone remains controversial and its pharmacokinetics (PK) has never been investigated in septic shock. This study aimed at characterizing the PK of fludrocortisone in septic shock.This was a single-centre ancillary PK study of a large multinational trial of crystalloids versus colloids for acute hypovolemia in intensive care unit (ICU) patients. In 21 adults with septic shock, fludrocortisone plasma concentrations were measured by liquid chromatography-mass spectrometry tandem analysis, before and repeatedly until 18h after an oral dose of 50g. PK parameters were estimated using a nonlinear mixed-effects modelling.Undetectable plasma concentrations were observed in 7 out of 21 patients. In the remaining 14 patients, plasma fludrocortisone concentrations were best described by a one-compartmental model with first-order absorption, a lag time (TA single oral dose of fludrocortisone yielded undetectable plasma concentrations in one-third of adults with septic shock. Fludrocortisone PK showed a short plasma elimination half-life and a large inter-individual variability.


Colin G.,Raymond Poincare Hospital AP HP | Nardi O.,Raymond Poincare Hospital AP HP | Nardi O.,University of Versailles | Polito A.,Raymond Poincare Hospital AP HP | And 13 more authors.
Critical Care Medicine | Year: 2012

Objective: This study aimed to investigate, in patients with severe sepsis, the correlation between central venous oxygen saturation and tissue oxygen saturation at different levels. Design: Prospective observational study. Setting: General intensive care unit at an academic medical center in France. Patients: Thirty-eight patients with underresuscitated severe sepsis and septic shock on intensive care unit admission. Interventions: None. Measurements and Main Results; During early resuscitation according to the 6-hr bundles of the Surviving Sepsis Campaign guidelines, tissue oxygen saturation was recorded every other hour at the level of the thenar, masseter, and deltoid muscles along with central hemodynamics, arterial lactate concentrations, and central venous oxygen saturation. Over the 6-hr resuscitation period, thenar tissue oxygen saturation was consistently higher than masseter tissue oxygen saturation (p = .04) and deltoid tissue oxygen saturation (p = .002), and masseter tissue oxygen saturation was consistently higher than deltoid tissue oxygen saturation (p = .04). Receiver operating characteristic curves analyses showed that masseter tissue oxygen saturation was better predictor of central venous oxygen saturation >70% than thenar tissue oxygen saturation (area under the curve, 0.80; 95% confidence interval 0.71-0.89 vs. 0.67; 95% confidence interval 0.56-0.77; p = .02). The crude 28-day mortality was 36.8%. Receiver operating characteristic curve analysis showed that masseter tissue oxygen saturation (area under the curve 0.87; 0.75-0.98) and deltoid tissue oxygen saturation (area under the curve 0.88; 0.77-0.98) but not thenar tissue oxygen saturation (area under the curve 0.66; 0.46-0.86) or central venous oxygen saturation (area under the curve 0.56; 0.38-0.80) were strong predictors of 28-day mortality. Conclusions: This study suggested that in the early 6-hr resuscitation period, masseter tissue oxygen saturation accurately identified patients with severe sepsis and central venous oxygen saturation >70%. Both masseter tissue oxygen saturation and deltoid tissue oxygen saturation but not central venous oxygen saturation or thenar tissue oxygen saturation are strong predictors of 28-day mortality. Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.


Nardi O.,Raymond Poincare Hospital AP HP | Nardi O.,University of Versailles | Polito A.,Raymond Poincare Hospital AP HP | Polito A.,University of Versailles | And 14 more authors.
Journal of Clinical Monitoring and Computing | Year: 2013

The scientific community has agreed upon developing accurate monitoring of tissue perfusion and oxygenation to improve the management of subjects with sepsis. This pilot study aimed to investigate the feasibility of targeting tissue oxygen saturation (StO2) in addition to the currently recommended resuscitation goals, central venous pressure, mean arterial pressure and central venous oxygen saturation, in patients with severe sepsis or septic shock. A pilot, single-centre, randomised, non-blinded trial recruited 30 subjects with severe sepsis upon intensive care unit admission at an academic medical centre in France. Subjects were randomly assigned to a 6 h resuscitation strategy following the Surviving Sepsis Campaign guidelines with (experimental) or without (control) StO2. StO2 was measured over several muscles (masseter, deltoid and pectoral or thenar muscles), and a StO 2 above 80 % over at least 2 muscles was the therapeutic goal. The primary outcome was evaluated as follows: 7-day mortality or worsening of SOFA score between day 7 and study onset, i.e., DSOFA > 0). Thirty subjects were included in the study over a period of 40 weeks. Fifteen subjects were included in each group. Monitoring of StO2 over three areas was performed in the experimental group. However, measures over the pectoral muscle provided poor results. At study day 7, there were 5/15 (33.3 %) subjects who died or had a DSOFA > 0 in the experimental arm and 4/15 (26.6 %) who died or had a DSOFA > 0 in the control arm (p = 1.00). This pilot study was the first randomised controlled trial using an algorithm derived from the SSC recommendations, which included StO2 as a treatment goal. However, the protocol showed no clear trend for or against targeting StO2. © 2013 Springer Science+Business Media New York.


Scemama C.,Raymond Poincare Hospital AP HP | Lestrat V.,Raymond Poincare Hospital AP HP | Combourieu B.,Raymond Poincare Hospital AP HP | Judet T.,Raymond Poincare Hospital AP HP
International Orthopaedics | Year: 2015

Purpose: Hip fusion conversion has shown mixed results, in particular a higher rate of failure than primary total hip replacement. Conversion is usually carried out by a lateral approach. Methods: We reported a series of 37 hip fusion conversions performed by an anterior approach. Clinical and radiographic outcomes of this unusual approach were reported at eight years of follow up. Results: At eight years of follow up, survivorship was 86. 6 % (IC 95 %: 62.4–95.7 %). Sixteen patients reported good relief of the pre-operative back spine or knee pain. PMA score was significantly improved. Two implant aseptic loosenings needing revision surgery were reported. Conclusion: The anterior approach seemed to be as good as the other hip approaches for hip fusion conversion to total hip replacement. © 2015 SICOT aisbl


PubMed | Raymond Poincare Hospital AP HP
Type: Comparative Study | Journal: Critical care medicine | Year: 2012

This study aimed to investigate, in patients with severe sepsis, the correlation between central venous oxygen saturation and tissue oxygen saturation at different levels.Prospective observational study.General intensive care unit at an academic medical center in France.Thirty-eight patients with underresuscitated severe sepsis and septic shock on intensive care unit admission.None.During early resuscitation according to the 6-hr bundles of the Surviving Sepsis Campaign guidelines, tissue oxygen saturation was recorded every other hour at the level of the thenar, masseter, and deltoid muscles along with central hemodynamics, arterial lactate concentrations, and central venous oxygen saturation. Over the 6-hr resuscitation period, thenar tissue oxygen saturation was consistently higher than masseter tissue oxygen saturation (p = .04) and deltoid tissue oxygen saturation (p = .002), and masseter tissue oxygen saturation was consistently higher than deltoid tissue oxygen saturation (p = .04). Receiver operating characteristic curves analyses showed that masseter tissue oxygen saturation was better predictor of central venous oxygen saturation >70% than thenar tissue oxygen saturation (area under the curve, 0.80; 95% confidence interval 0.71-0.89 vs. 0.67; 95% confidence interval 0.56-0.77; p = .02). The crude 28-day mortality was 36.8%. Receiver operating characteristic curve analysis showed that masseter tissue oxygen saturation (area under the curve 0.87; 0.75-0.98) and deltoid tissue oxygen saturation (area under the curve 0.88; 0.77-0.98) but not thenar tissue oxygen saturation (area under the curve 0.66; 0.46-0.86) or central venous oxygen saturation (area under the curve 0.56; 0.38-0.80) were strong predictors of 28-day mortality.This study suggested that in the early 6-hr resuscitation period, masseter tissue oxygen saturation accurately identified patients with severe sepsis and central venous oxygen saturation >70%. Both masseter tissue oxygen saturation and deltoid tissue oxygen saturation but not central venous oxygen saturation or thenar tissue oxygen saturation are strong predictors of 28-day mortality.


PubMed | Raymond Poincare Hospital AP HP
Type: Journal Article | Journal: International orthopaedics | Year: 2016

Hip fusion conversion has shown mixed results, in particular a higher rate of failure than primary total hip replacement. Conversion is usually carried out by a lateral approach.We reported a series of 37 hip fusion conversions performed by an anterior approach. Clinical and radiographic outcomes of this unusual approach were reported at eightyears of follow up.At eightyears of follow up, survivorship was 86. 6% (IC 95%: 62.4-95.7%). Sixteen patients reported good relief of the pre-operative back spine or knee pain. PMA score was significantly improved. Two implant aseptic loosenings needing revision surgery were reported.The anterior approach seemed to be as good as the other hip approaches for hip fusion conversion to total hip replacement.

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