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Search Results: 1 - 10 of 1280 matches for " Damien Galanaud "
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Cardiac arrest - has the time of MRI come?
Damien Galanaud, Louis Puybasset
Critical Care , 2010, DOI: 10.1186/cc8905
Abstract: In the past year, three studies have been published evaluating the use of magnetic resonance imaging (MRI) to determine the prognosis of patients suffering out-of-hospital cardiac arrest, a leading cause of death in developed countries [1-3]. The initial survival of these patients has improved recently thanks to the increased availability of automated defibrillators and induced hypothermia [4,5], leading to an increasing number of patients hospitalized with post-anoxic coma. However, survival rates without major neurological sequelae remain low, and intensive care must be withdrawn in a significant number of patients who will otherwise evolve to a vegetative or minimally conscious state. This decision is currently based on clinical data. Lack of motor response at 24 and 72 hours, absent corneal reflex and pupillary response at 24 hours have been shown to be indicative of poor clinical outcome [6]. This approach, however, has many limitations. While it can reliably predict a poor clinical outcome, prediction of good clinical evolution is still difficult. Among patients with a good clinical outcome, it is impossible to separate those who will have a complete recovery (restitutio ad integrum) from those whose quality of life will be hampered by significant neurological sequelae. Clinical examination can provide variable results and is not compatible with the deep sedation required by some therapeutic protocols, especially hypothermia.MRI is now widely available, and, with some precautions, can be performed in patients under mechanical ventilation. Despite the fact that MRI with diffusion-weighted imaging (DWI) has been shown to efficiently detect anoxo-ischemic brain injury (especially in stroke), its application for the evaluation of cardiac arrest patients had not been developed until very recently. Three recent papers attempt to address this issue.In Critical Care, Choi and colleagues [1] have shown in a series of 39 survivors of cardiac arrest that the presence of
Clinical review: Prognostic value of magnetic resonance imaging in acute brain injury and coma
Nicolas Weiss, Damien Galanaud, Alexandre Carpentier, Lionel Naccache, Louis Puybasset
Critical Care , 2007, DOI: 10.1186/cc6107
Abstract: Severe brain impairment, most notably persistent coma, may follow traumatic brain injury (TBI), anoxic/hypoxic encephalopathy, or stroke. Although progress in the management of critically ill neurological patients has led to improved survival rates [1], some survivors remain in a persistent vegetative or minimally conscious state. Up to 14% of patients with TBI remain in a persistent vegetative state after 1 year [2-4], and their medical cost has been estimated at US$1 to 7 billion per year in the USA [5]. The possibility that aggressive medical management may lead to survival with severe brain impairment raises ethical issues. Adapting the level of medical care to long-term neurological prognosis is a major challenge for neurological intensive care. The first step in meeting this challenge is validation of tools that accurately predict long-term neurological outcome after severe cerebral insult.Magnetic resonance imaging (MRI) is more sensitive than computed tomography at detecting stroke in the early phase, subtle abnormalities related to anoxic/hypoxic encephalopathy, and diffuse axonal injury (DAI) in patients with TBI. MRI provides valuable diagnostic information, although it is cumbersome to perform in the acute phase in comatose patients who are undergoing mechanical ventilation. Several MRI sequences and techniques have been used to explore the structures, metabolism and functions of the brain. The data supplied by these methods could be used to predict long-term neurological outcome.In this review we briefly describe the MRI sequences and techniques used in critically ill neurological patients, and then we discuss their prognostic value in comatose patients with TBI, anoxic/hypoxic encephalopathy, or stroke. Finally, we discuss the prognostic influences of the main anatomical structures that are involved in arousal and awareness, and we suggest avenues for future research.Conventional MRI relies chiefly on four sequences [6]. Fluid-attenuated inversion reco
A French multicenter randomised trial comparing two dose-regimens of prothrombin complex concentrates in urgent anticoagulation reversal
Delphine Kerebel, Luc-Marie Joly, Didier Honnart, Jeannot Schmidt, Damien Galanaud, Claude Negrier, Friedrich Kursten, Pierre Coriat, Lex206 Investigator Group
Critical Care , 2013, DOI: 10.1186/cc11923
Abstract: We performed a phase III, prospective, randomised, open-label study including patients with objectively diagnosed VKA-associated intracranial haemorrhage between November 2008 and April 2011 in 22 centres in France. Patients were randomised to receive 25 or 40 IU/kg of 4-factor PCC. The primary endpoint was the International Normalised Ratio (INR) 10 minutes after the end of 4-factor PCC infusion. Secondary endpoints were changes in coagulation factors, global clinical outcomes and incidence of adverse events (AEs).A total of 59 patients were randomised: 29 in the 25 IU/kg and 30 in the 40 IU/kg group. Baseline demographics and clinical characteristics were comparable between the groups. The mean INR was significantly reduced to 1.2 - and [lessthan or equal to] 1.5 in all patients of both groups - 10 min after 4-factor PCC infusion. The INR in the 40 IU/kg group was significantly lower than in the 25 IU/kg group 10 min (p=0.001), 1 hour (p=0.001) and 3 hours (p=0.02) after infusion. The 40 IU/kg dose was also effective in replacing coagulation factors such as PT (p=0.038), FII (p=0.001), FX (p<0.001), protein C (p=0.002) and protein S (0.043), 10 min after infusion. However, no differences were found in hematoma volume or global clinical outcomes between the groups. Incidence of death and thrombotic events was similar between the groups.Rapid infusion of both doses of 4-factor PCC achieved an INR of 1.5 or less in all patients with a lower INR observed in the 40 IU/kg group. No safety concerns were raised by the 40 IU/kg dose. Further trials are needed to evaluate the impact of the high dose of 4-factor PCC on functional outcomes and mortality. Trial registration: Eudra CT number 2007-000602-73.
Free Anterolateral Thigh Perforator Flap for Head and Neck Cancer Resection in a Nonagenarian  [PDF]
Frank Lin, Damien Grinsell
Modern Plastic Surgery (MPS) , 2012, DOI: 10.4236/mps.2012.21001
Abstract: With an aging population, free flap reconstruction for head and neck cancer ablation in the elderly is becoming more commonplace. In nonagenarians, however, such major operations are still rarely offered due to its physiological demands. We report the first case of successful resection and reconstruction of head and neck cancer with a free perforator flap in a 96 year old patient. We feel that with careful patient and flap selection, careful preoperative workup and close collaboration between treating teams, age alone should not preclude patients from receiving the best possible curative treatment and reconstruction in head and neck cancers. Even in nonagenarians, perforator free flaps, such as the anterolateral thigh flap, can be used safely to achieve good functional and aesthetic outcomes.
An Inquiry into the Effectiveness of Student Generated MCQs as a Method of Assessment to Improve Teaching and Learning  [PDF]
Damien Hutchinson, Jason Wells
Creative Education (CE) , 2013, DOI: 10.4236/ce.2013.47A2014

In anticipation of helping students mature from passive to more active learners while engaging with the issues and concepts surrounding computer security, a student generated Multiple Choice Question (MCQ) learning strategy was designed and deployed as a replacement for an assessment task that was previously based on students providing solutions to a series of short-answer questions. To determine whether there was any educational value in students generating their own MCQs students were required to design MCQs. Prior to undertaking this assessment activity each participant completed a pre-test which consisted of 45 MCQs based on the topics of the assessment. Following the assessment activity the participants completed a post-test which consisted of the same MCQs as the pre-test. The pre and post test results as well as the post test and assessment activity results were tested for statistical significance. The results indicated that having students generate their own MCQs as a method of assessment did not have a negative effect on the learning experience. By providing a framework to the students based on the literature to support their engagement with the learning material, we believe the creation of well-structured MCQs resulted in a more advanced understanding of the relationships between the concepts of the learning material as compared with plainly answering a series of short-answer questions from a textbook. Further study is required to determine to what degree this learning strategy encouraged a deeper approach to learning.

What Is the Natural Weight of the Current Old?  [PDF]
Damien Gaumont, Daniel Leonard
Theoretical Economics Letters (TEL) , 2013, DOI: 10.4236/tel.2013.35043
Abstract: We consider a simple overlapping generations model with an externality à la Arrow-Romer [1,2] and a government with fiscal powers. If it wishes to maximize a criterion depending on the lifelong utility of agents, is there a natural weight for the utility of the current old? We show in a simple example that this weight depends on the specific features of the model, in particular the length of the horizon, and cannot be chosen arbitrarily. Our result has a neat economic interpretation [2].
Evaluation of Tobacco Use and Her-2 Receptor Expression in Breast Cancer in an Ethnically Diverse Inner-City Population  [PDF]
Damien M. Hansra, Judith Hurley
Open Journal of Epidemiology (OJEpi) , 2014, DOI: 10.4236/ojepi.2014.42014
Abstract: Background: Tobacco is linked to most cancers however despite overwhelming biological plausibility and decades of epidemiological studies, no association has been established between tobacco and breast cancer. Although estrogen receptor status has been looked at as a variable there has been no evaluation of the role of Her-2 and smoking in breast cancer. Methods: Review of records from patients treated at the University of Miami/Jackson Memorial Hospital from 1998-2012. The incidence of smoking and Her-2 expression in1255 women was evaluated. Data was analyzed by age, race, ethnic group, menopausal status, tumor stage, and ER/PR/Her-2 receptor status. Results: 1255 charts were analyzed with 1094 having full information. Overall rate of Her-2 expression 18.1%. The rate of Her-2 expression was 21.4% in smokers and 17.0% in non-smokers (p = 0.10). The rate of Her-2 expression was 10.8% in Caucasian smokers and 9.8% in Caucasian non-smokers (p = 0.88); 24.5% in smokers of African descent and 17.3% in non-smokers of African descent (p = 0.24); 22.9% in Latino smokers and 17.4% in Latino non-smokers (p = 0.10). The rate of Her-2/ER expression was 9.4% in smokers and 7.9% in non-smokers (p = 0.42); 5.4% in Caucasian smokers and 4.9% in Caucasian non-smokers (p = 0.916); 12.2% in smokers of African descent and 5.9% in non-smokers of African descent (p = 0.11); 9.5% in Latin smokers and 8.8% in Latin non-smokers (p = 0.77). Conclusions: We found non-statistically significant positive associations in all analyses between Her-2 expression with or without ER expression and tobacco exposure when analyzed by ethnicity.
F-box proteins: more than baits for the SCF?
Damien Hermand
Cell Division , 2006, DOI: 10.1186/1747-1028-1-30
Abstract: Recent evidences in various species suggest that some F-box proteins have functions not directly related to the SCF complex raising questions about the actual connection between the large F-box protein family and protein degradation, but also about their origins and evolution.The small polypeptide ubiquitin (76 amino acids) is used in many processes including signal transduction, DNA repair, transcription and chromatin remodelling [1-5]. However, ubiquitin is best characterized has a post-translational modification required to label proteins for recognition and degradation by the proteasome [6]. Ubiquitin contains seven lysine residues used to form poly-ubiquitin chains and chains linked to lysine 48 are the most commonly used to target a substrate for proteolysis. Ubiquitin conjugation is catalysed by enzymes designated E1, E2 and E3. The E3 ubiquitin ligase determines substrate specificity. E3 complexes of the SCF subfamily typically contain at least four subunits: Skp1, a cullin, a RING finger protein (Rbx1, also called Hrt1 or Roc1), and a member of the large family of F-box adaptor protein directly involved in the substrates recruitment (for a review, see [7]). The F-box is a degenerated sequence of about 70 amino acids required but not sufficient for the interaction between a given F-box protein and Skp1 [8]. Structure-function studies in yeast and mammals have demonstrated that the cullin functions as a scaffold in assembling the different subunits of the SCF complex. The cullin interacts at its carboxyl terminus with the RING domain protein Rbx1 to form the catalytic domain, and at its amino terminus end with Skp1 (Figure 1A). Protein degradation mediated by the SCF complexes has been shown to influence a variety of cellular processes such as the cell cycle, signal transduction and gene expression [9-14]. Beside the canonical SCF, it appears that in some cases, Skp1 and F-box proteins may function in non-SCF complexes and that some F-box proteins have functi
Los Modos de Acción Eterior de la Unión Europea:(1) El Caso del Caucaso del sur
Análisis Político , 2006,
Abstract: this article proposes a framework for the analysis of the european union?s foreign action system, to contribute to an understanding of its functioning. based on the concept of modes of foreign action, this article studies the case of the south caucasus. it attempts to describe, understand, and explain european foreign actions in a region about which there is practically no literature available concerning the policies of the eu and its member states, and in which their policies and actions only partially reflect their power logic and determining factors.
Pouvoir et sexualité. Le discours féministe sur la prostitution en France (1968-1986).
Damien Simonin
Genre & Histoire , 2010,
Abstract: Cette recherche porte sur les discours sur la prostitution dans la presse féministe, entre 1968 et 1986 en France. Durant cette période, le mouvement féministe est composé de courants conflictuels (courants réformistes et révolutionnaires, différentialistes et universalistes) et il porte des discours hétérogènes (informations sur la prostitution, analyses théoriques et politiques, témoignages de prostituées). Pourtant, ces discours s'accordent sur la revendication d'une libération des rapport...
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