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Search Results: 1 - 10 of 153414 matches for " Christophe Clec'h "
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Model for predicting short-term mortality of severe sepsis
Christophe Adrie, Adrien Francais, Antonio Alvarez-Gonzalez, Roman Mounier, Elie Azoulay, Jean-Ralph Zahar, Christophe Clec'h, Dany Goldgran-Toledano, Laure Hammer, Adrien Descorps-Declere, Samir Jamali, Jean-Francois Timsit, the Outcomerea Study Group
Critical Care , 2009, DOI: 10.1186/cc7881
Abstract: In this prospective multicentre observational study on a multicentre database (OUTCOMEREA) including data from 12 ICUs, 2268 patients with 2737 episodes of severe sepsis were randomly divided into a training cohort (n = 1458) and a validation cohort (n = 810). Up to four consecutive severe sepsis episodes per patient occurring within the first 28 ICU days were included. We developed a prognostic model for predicting death within 14 days after each episode, based on patient data available at sepsis onset.Independent predictors of death were logistic organ dysfunction (odds ratio (OR), 1.22 per point, P < 10-4), septic shock (OR, 1.40; P = 0.01), rank of severe sepsis episode (1 reference, 2: OR, 1.26; P = 0.10 ≥ 3: OR, 2.64; P < 10-3), multiple sources of infection (OR; 1.45, P = 0.03), simplified acute physiology score II (OR, 1.02 per point; P < 10-4), McCabe score ([greater than or equal to]2) (OR, 1.96; P < 10-4), and number of chronic co-morbidities (1: OR, 1.75; P < 10-3, ≥ 2: OR, 2.24, P < 10-3). Validity of the model was good in whole cohorts (AUC-ROC, 0.76; 95%CI, 0.74 to 0.79; and HL Chi-square: 15.3 (P = 0.06) for all episodes pooled).In ICU patients, a prognostic model based on a few easily obtained variables is effective in predicting death within 14 days after the first to fourth episode of severe sepsis complicating community-, hospital-, or ICU-acquired infection.Severe sepsis remains a leading cause of death in industrialised countries, and the number of deaths caused by sepsis is increasing despite improved survival rates [1,2]. Apart from measures directed to the infectious cause (antibiotics and surgery), the treatment remains chiefly supportive despite many randomised controlled trials [3,4]. Sepsis is a syndrome, not a disease; and many factors explain the variability of outcomes, such as differences in infection sites, causative pathogens, and time and location of infection onset (community, hospital or intensive care unit (ICU)) [1]. This hete
Efficacy of renal replacement therapy in critically ill patients: a propensity analysis
Christophe Clec'h, Micha?l Darmon, Alexandre Lautrette, Frank Chemouni, Elie Azoulay, Carole Schwebel, Anne-Sylvie Dumenil, Ma?té Garrouste-Orgeas, Dany Goldgran-Toledano, Yves Cohen, Jean-Fran?ois Timsit
Critical Care , 2012, DOI: 10.1186/cc11905
Abstract: We performed a propensity analysis using data of the French longitudinal prospective multicenter Outcomerea database. Two propensity scores for RRT were built to match patients who received RRT to controls who did not despite having a close probability of receiving the procedure. AKI was defined according to RIFLE criteria. The association between RRT and hospital mortality was examined through multivariate conditional logistic regression analyses to control for residual confounding. Sensitivity analyses were conducted to examine the impact of RRT timing.Among the 2846 study patients, 545 (19%) received RRT. Crude mortality rates were higher in patients with than in those without RRT (38% vs 17.5%, P < 0.001). After matching and adjustment, RRT was not associated with a reduced hospital mortality. The two propensity models yielded concordant results.In our study population, RRT failed to reduce hospital mortality. This result emphasizes the need for randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing.Acute kidney injury (AKI) significantly contributes to the morbidity and the mortality of critically ill patients through metabolic derangements, fluid overload and harmful effects of these disturbances on other failing organs. Renal replacement therapy (RRT), although not achieving the same level of homeostasis as a normally functioning kidney, helps limit the consequences of AKI and allows adequate administration of fluids and nutritional support. However, its benefits (aside from life-threatening complications, such as severe hyperkalemia, pulmonary edema, and intractable acidosis) in critically ill patients with AKI remain unclear.Available data are derived from uncontrolled studies, which all showed higher mortality rates among populations treated with RRT [1-5]. Due to their design, however, confounders and biases may have limited their accuracy. Particularly, treatment selection bias [6] may have
Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic
Mehdi Merouani, Bruno Guignard, Fran?ois Vincent, Stephen W Borron, Philippe Karoubi, Jean-Philippe Fosse, Yves Cohen, Christophe Clec'h, Eric Vicaut, Carole Marbeuf-Gueye, Frederic Lapostolle, Frederic Adnet
Critical Care , 2008, DOI: 10.1186/cc7149
Abstract: Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation.Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] μg/kg versus 1.4 [0.6 to 2.7] μg/kg; P < 0.01).Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion.Trial registration: Clinicaltrials.gov NCT00763906.Despite advances in critical care, the death rate from severe sepsis remains approximately 30% to 50%. In 1995, severe sepsis accounted for 9.3% of all deaths in the USA [1]. It is generally agreed that fluid resuscitation and vasopressors should be initiated promptly to treat shock and organ failure, and rapidly restore the mean arterial pressure (MAP) to 60 to 90 mmHg [2,3].The vasopressor in most common use is norepinephrine (noradrenaline) but, because of its weak inotropic effect and concerns about regional blood flow, dobutamine is often administered concomit
Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study
Kevin B Laupland, Benoit Misset, Bertrand Souweine, Alexis Tabah, Elie Azoulay, Dany Goldgran-Toledano, Anne-Sylvie Dumenil, Aurélien Vésin, Samir Jamali, Hatem Kallel, Christophe Clec'h, Michael Darmon, Carole Schwebel, Jean-Francois Timsit
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-321
Abstract: Adults (≥18 years) admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.Among the 7,380 patients included, 61% (4,481) were male, the median age was 62 (IQR, 49-75) years, and the median SAPS II score was 40 (IQR, 28-56). Admissions to ICU occurred during weekends (Saturday and Sunday) in 1,708 (23%) cases, during the night (18:00-07:59) in 3,855 (52%), and on nights and/or weekends in 4,659 (63%) cases. Among 5,992 survivors to ICU discharge, 903 (15%) were discharged on weekends, 659 (11%) at night, and 1,434 (24%) on nights and/or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk (odds ratio, 1.54; 95% confidence interval, 1.12-2.11) for death.In this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.Patients who suffer acute illness and are admitted during the "after hours" (weekends or nights) may be at higher risk for adverse outcome as compared to patients admitted during weekdays [1]. Cavallazzi et al recently conducted a meta-analysis of ten studies conducted in adult ICUs and found that while night time admission was not associated with an increased risk, a small but significant increased risk for death was associated with weekend admission [2]. Since, Kuijsten et al reported a relative risk for death associated with admission in the afterhours of 1.059 (95% confidence interval 1.031-1.088) among 149,894 admissions to Dutch ICUs [3]. More recently Kevat et al reported on 245,057 admissions to Australian ICUs and found an increased risk for hospital mortality associated with admission during evenings/nights (17% vs. 14%; p < 0.001) and during
Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change
Michael Darmon, Eric Diconne, Bertrand Souweine, Stéphane Ruckly, Christophe Adrie, Elie Azoulay, Christophe Clec'h, Ma?té Garrouste-Orgeas, Carole Schwebel, Dany Goldgran-Toledano, Hatem Khallel, Anne-Sylvie Dumenil, Samir Jamali, Christine Cheval, Bernard Allaouchiche, Fabrice Zeni, Jean-Fran?ois Timsit
Critical Care , 2013, DOI: 10.1186/cc11937
Abstract: Observational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively.A total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality.One-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected.Dysnatremia is a common finding at ICU admission [1-3]. Abnormal serum sodium concentrations are known to adversely affect physiologic function and an increasing body of evidence suggests that dysnatremia may be associated with adverse outcome [1-4]. Critically ill patients are particularly exposed to dysnatremia due to the nature of the disease leading to ICU admission and to lack of free access to water [2,4,5]. Up to one-third of critically ill patients have a dys
Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis
Christophe Clec'h, Frédéric Gonzalez, Alexandre Lautrette, Molière Nguile-Makao, Ma?té Garrouste-Orgeas, Samir Jamali, Dany Golgran-Toledano, Adrien Descorps-Declere, Frank Chemouni, Rebecca Hamidfar-Roy, Elie Azoulay, Jean-Fran?ois Timsit
Critical Care , 2011, DOI: 10.1186/cc10241
Abstract: Unselected patients admitted between 1997 and 2009 to 13 French medical or surgical intensive care units were included in this observational cohort study. AKI was defined according to the RIFLE criteria. The following data were recorded: baseline characteristics, daily serum creatinine level, daily Sequential Organ Failure Assessment (SOFA) score, vital status at hospital discharge and length of hospital stay. Patients were classified according to the maximum RIFLE class reached during their ICU stay. The association of AKI with hospital mortality with "discharge alive" considered as a competing event was assessed according to the Fine and Gray model.Of the 8,639 study patients, 32.9% had AKI, of whom 19.1% received renal replacement therapy. Patients with AKI had higher crude mortality rates and longer lengths of hospital stay than patients without AKI. In the Fine and Gray model, independent risk factors for hospital mortality were the RIFLE classes Risk (sub-hazard ratio (SHR) 1.58 and 95% confidence interval (95% CI) 1.32 to 1.88; P < 0.0001), Injury (SHR 3.99 and 95% CI 3.43 to 4.65; P < 0.0001) and Failure (SHR 4.12 and 95% CI 3.55 to 4.79; P < 0.0001); nonrenal SOFA score (SHR 1.19 per point and 95% CI 1.18 to 1.21; P < 0.0001); McCabe class 3 (SHR 2.71 and 95% CI 2.34 to 3.15; P < 0.0001); and respiratory failure (SHR 3.08 and 95% CI 1.36 to 7.01; P < 0.01).By using a competing risks approach, we confirm in this study that AKI affecting critically ill patients is associated with increased in-hospital mortality.Acute renal failure (ARF) is as an abrupt decline in kidney function. Although simple to define conceptually, there has long been no consensus on an operational definition of ARF. As reported in a recent survey, more than 35 definitions have been used so far [1]. Depending on the definition used, ARF has been shown to affect from 1% to 25% of intensive care unit (ICU) patients and has led to mortality rates from 15% to 60% [2].Because the lack of a uni
I-Theory: A Unifying Quantum Theory?  [PDF]
H. H. Swami Isa, Christophe Dumas
Journal of High Energy Physics, Gravitation and Cosmology (JHEPGC) , 2019, DOI: 10.4236/jhepgc.2019.52019
Abstract: This paper gives an overview of a new theory called the “I-Theory”, in the context of several accepted theories in physics and cosmology. This paper reviews the salient features of the “I-Theory”, which introduces new particles like I, S and A1 particles and provides a fuller understanding about Dark Matter, Dark Energy, Matter/Anti Matter and the four fundamental forces. “I-Theory” introduces a new concept of the “quality” of energy with White, Black and Red matter formed with regard to the frequency level of the energy vibration. The authors discuss the main features and controversies of the Standard Model, General Relativity, Big Bang, and Supersymmetry and attempt to answer some of the unsolved questions. It is proposed that the “I-Theory” can successfully encompass all major theories and thereby becomes the theory of the whole, the Unifying Theory.
A Psychometric Study of Cognitive Self-Regulation: Are Self-Report Questionnaires and Behavioural Tasks Measuring a Similar Construct?  [PDF]
Anja Waegeman, Carolyn H. Declerck, Christophe Boone
Psychology (PSYCH) , 2014, DOI: 10.4236/psych.2014.519218
Abstract: Assessing individual differences in cognitive self-regulation, an effortful process that relies heavily on executive functions, has proven difficult in non-psychiatric populations. We report the results of a psychometric and a behavioural study that investigate convergent, discriminant, and predictive validity of three self-report measures of self-regulation (Adult Temperament Questionnaire, Temperament and Character Inventory, and locus of control (LOC) scale) and two behavioural tasks assessing impulse control and cognitive flexibility respectively. Factor analysis in study 1 (n = 492 college students) indicates that effortful control, persistence and self-directedness measure a similar cognitive self-regulatory construct. Harm avoidance and novelty seeking correlate negatively with cognitive self-regulation while intelligence is independent of cognitive self-regulatory capacity. In study 2 (n = 78 college students), we replicate this factor and test for correlations with behavioural tasks. Only internal LOC correlates positively with impulse control behaviour. We conclude that construct validity of self-reported cognitive self-regulation is robust but that predictive validity is lacking.
High Virulence of Wolbachia after Host Switching: When Autophagy Hurts
Winka Le Clec'h,Christine Braquart-Varnier,Maryline Raimond,Jean-Baptiste Ferdy,Didier Bouchon,Mathieu Sicard
PLOS Pathogens , 2012, DOI: 10.1371/journal.ppat.1002844
Abstract: Wolbachia are widespread endosymbionts found in a large variety of arthropods. While these bacteria are generally transmitted vertically and exhibit weak virulence in their native hosts, a growing number of studies suggests that horizontal transfers of Wolbachia to new host species also occur frequently in nature. In transfer situations, virulence variations can be predicted since hosts and symbionts are not adapted to each other. Here, we describe a situation where a Wolbachia strain (wVulC) becomes a pathogen when transfected from its native terrestrial isopod host species (Armadillidium vulgare) to another species (Porcellio d. dilatatus). Such transfer of wVulC kills all recipient animals within 75 days. Before death, animals suffer symptoms such as growth slowdown and nervous system disorders. Neither those symptoms nor mortalities were observed after injection of wVulC into its native host A. vulgare. Analyses of wVulC's densities in main organs including Central Nervous System (CNS) of both naturally infected A. vulgare and transfected P. d. dilatatus and A. vulgare individuals revealed a similar pattern of host colonization suggesting an overall similar resistance of both host species towards this bacterium. However, for only P. d. dilatatus, we observed drastic accumulations of autophagic vesicles and vacuoles in the nerve cells and adipocytes of the CNS from individuals infected by wVulC. The symptoms and mortalities could therefore be explained by this huge autophagic response against wVulC in P. d. dilatatus cells that is not triggered in A. vulgare. Our results show that Wolbachia (wVulC) can lead to a pathogenic interaction when transferred horizontally into species that are phylogenetically close to their native hosts. This change in virulence likely results from the autophagic response of the host, strongly altering its tolerance to the symbiont and turning it into a deadly pathogen.
Multi-Infections of Feminizing Wolbachia Strains in Natural Populations of the Terrestrial Isopod Armadillidium Vulgare
Victorien Valette, Paul-Yannick Bitome Essono, Winka Le Clech, Monique Johnson, Nicolas Bech, Frédéric Grandjean
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082633
Abstract: Maternally inherited Wolbachia (α-Proteobacteria) are widespread parasitic reproductive manipulators. A growing number of studies have described the presence of different Wolbachia strains within a same host. To date, no naturally occurring multiple infections have been recorded in terrestrial isopods. This is true for Armadillidium vulgare which is known to harbor non simultaneously three Wolbachia strains. Traditionally, such Wolbachia are detected by PCR amplification of the wsp gene and strains are characterized by sequencing. The presence of nucleotide deletions or insertions within the wsp gene, among these three different strains, provides the opportunity to test a novel genotyping method. Herein, we designed a new primer pair able to amplify products whose lengths are specific to each Wolbachia strain so as to detect the presence of multi-infections in A. vulgare. Experimental injections of Wolbachia strains in Wolbachia-free females were used to validate the methodology. We re-investigated, using this novel method, the infection status of 40 females sampled in 2003 and previously described as mono-infected based on the classical sequencing method. Among these females, 29 were identified as bi-infected. It is the first time that naturally occuring multiple infections of Wolbachia are detected within an individual A. vulgare host. Additionally, we resampled 6 of these populations in 2010 to check the infection status of females.
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