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Search Results: 1 - 10 of 28683 matches for " Jean-Michel Constantin "
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Measurement of alveolar derecruitment in patients with acute lung injury: computerized tomography versus pressure–volume curve
Qin Lu, Jean-Michel Constantin, Ania Nieszkowska, Marilia Elman, Silvia Vieira, Jean-Jacques Rouby
Critical Care , 2006, DOI: 10.1186/cc4956
Abstract: P–V curves (constant-flow method) and spiral CT scans of the whole lung were performed at PEEPs of 15 and 0 cmH2O in 19 patients with acute lung injury or acute respiratory distress syndrome. Alveolar derecruitment was defined as the difference in lung volume measured at an airway pressure of 15 cmH2O on P–V curves performed at PEEPs of 15 and 0 cmH2O, and as the difference in the CT volume of gas present in poorly aerated and nonaerated lung regions at PEEPs of 15 and 0 cmH2O.Alveolar derecruitments measured by the CT and P–V curve methods were 373 ± 250 and 345 ± 208 ml (p = 0.14), respectively. Measurements by both methods were tightly correlated (R = 0.82, p < 0.0001). The derecruited volume measured by the P–V curve method had a bias of -14 ml and limits of agreement of between -158 and +130 ml in comparison with the average derecruited volume of the CT and P–V curve methods.Alveolar derecruitment measured by the CT and P–V curve methods are tightly correlated. However, the large limits of agreement indicate that the P–V curve and the CT method are not interchangeable.Reducing tidal volume during mechanical ventilation decreases mortality in patients with acute respiratory distress syndrome (ARDS) [1]. However, selecting the right level of positive end-expiratory pressure (PEEP) remains a difficult issue [2,3]. A recent multicenter randomized trial failed to demonstrate a decrease in mortality when a high PEEP was applied to patients with ARDS [3]. Several studies using computed tomography (CT) have suggested that the right level of PEEP should be selected according to the specific lung morphology of each individual patient, taking into consideration not only the potential for recruitment but also the risk of lung overinflation [2,4-7].In the early 1990s, Ranieri and colleagues suggested that PEEP-induced alveolar recruitment could be measured from pressure–volume (P–V) curves [8]. Based on the physiological concept that any increase in lung volume at a given s
Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery
Emmanuel Futier, Emmanuel Robin, Matthieu Jabaudon, Renaud Guerin, Antoine Petit, Jean-Etienne Bazin, Jean-Michel Constantin, Benoit Vallet
Critical Care , 2010, DOI: 10.1186/cc9310
Abstract: This is a secondary analysis of results obtained in a study involving 70 adult patients (ASA I to III), undergoing major abdominal surgery, and treated with an individualized goal-directed fluid replacement therapy. All patients were managed to maintain a respiratory variation in peak aortic flow velocity below 13%. Cardiac index (CI), oxygen delivery index (DO2i), ScvO2, P(cv-a)CO2 and postoperative complications were recorded blindly for all patients.A total of 34% of patients developed postoperative complications. At baseline, there was no difference in demographic or haemodynamic variables between patients who developed complications and those who did not. In patients with complications, during surgery, both mean ScvO2 (78 ± 4 versus 81 ± 4%, P = 0.017) and minimal ScvO2 (minScvO2) (67 ± 6 versus 72 ± 6%, P = 0.0017) were lower than in patients without complications, despite perfusion of similar volumes of fluids and comparable CI and DO2i values. The optimal ScvO2 cut-off value was 70.6% and minScvO2 < 70% was independently associated with the development of postoperative complications (OR = 4.2 (95% CI: 1.1 to 14.4), P = 0.025). P(cv-a)CO2 was larger in patients with complications (7.8 ± 2 versus 5.6 ± 2 mmHg, P < 10-6). In patients with complications and ScvO2 ≥71%, P(cv-a)CO2 was also significantly larger (7.7 ± 2 versus 5.5 ± 2 mmHg, P < 10-6) than in patients without complications. The area under the receiver operating characteristic (ROC) curve was 0.785 (95% CI: 0.74 to 0.83) for discrimination of patients with ScvO2 ≥71% who did and did not develop complications, with 5 mmHg as the most predictive threshold value.ScvO2 reflects important changes in O2 delivery in relation to O2 needs during the perioperative period. A P(cv-a)CO2 < 5 mmHg might serve as a complementary target to ScvO2 during GDT to identify persistent inadequacy of the circulatory response in face of metabolic requirements when an ScvO2 ≥71% is achieved.Clinicaltrials.gov Identifier: NCT
Viruses take center stage in cellular evolution
Jean-Michel Claverie
Genome Biology , 2006, DOI: 10.1186/gb-2006-7-6-110
Abstract: The reputedly intractable problem of the origin of viruses has long been neglected. In the modern literature, 'virus evolution' has come to refer to studies more akin to population genetics, such as the worldwide scrutiny of new polymorphisms appearing daily in the H5N1 avian flu virus [1], than to the fundamental question of where viruses come from. This is now rapidly changing, as a result of the coincidence of bold new ideas (and the revival of old ones), the unexpected spectacular features of some recently isolated giant viruses [2,3], as well as the steady increase in the numbers of genomic sequences for 'regular' viruses and cellular organisms, which enhances the power of comparative genomics [4]. After being considered non-living and relegated to the wings by most biologists, viruses are now center stage: they might have been there at the origin of DNA, might have played a central role in the emergence of the eukaryotic cell, and might even have been the cause of partitioning of biological organisms into the three domains of life: Bacteria, Archaea and Eukarya. In this article, I shall briefly survey some of the recent discoveries and the new evolutionary thoughts they have prompted, before adding to the discussion with a question of my own: what if we have totally missed the true nature of (at least some) viruses?As of April 2006, more than 1,600 viral genomes have been sequenced, approximately equally divided between RNA and DNA viruses. In view of this fundamental difference in their genetic material (and thus in their replication mechanisms, size, genetic complexity, host range and other features) it is tempting to immediately rule out the idea that viruses are monophyletic, that is, that they derive from a common ancestor. That might not be so easy to do, however. Although there are many arguments in favor of the idea that RNA and DNA viruses were generated independently - RNA viruses first, in the context of the 'RNA world' theory - their genesis might
The role of secretory leukocyte proteinase inhibitor and elafin (elastase-specific inhibitor/skin-derived antileukoprotease) as alarm antiproteinases in inflammatory lung disease
Jean-Michel Sallenave
Respiratory Research , 2000, DOI: 10.1186/rr18
Abstract: Cytokines form one of the major classes of chemical mediator responsible for initiating, regulating and terminating the inflammatory response. Their synthesis, switch-on and switch-off mechanisms and their mode of action are tightly regulated in what is now classically called a cytokine network. Indeed, early cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor (TNF), are synthesized very quickly, within 1 h of the onset of inflammation, or in response to stimuli such as bacterial lipopolysaccharides (LPS).These cytokines set in motion the migration of inflammatory cells such as neutrophils and monocytes, whose function is to eliminate the injurious agent and restore homeostasis. To migrate from the vascular space and gain access to the inflammatory site through the interstitium, it has been hypothesized that these inflammatory cells use a variety of proteases (such as neutrophil and monocyte/macrophage metalloproteases and elastases).To contain the potential injurious effects of excess release of these proteases, the host secretes large amounts of antiproteinases, which also seem to have developed in a parallel network, consisting of `alarm' and `systemic' inhibitors, the latter being synthesized principally in the liver [such as α1-proteinase inhibitor (A1-Pi) and antichymotrypsin].We are particularly interested in the former group, which include the two low-molecular-mass proteinase inhibitors of the ALP family, antileukoprotease (ALP), also known as secretory leukocyte proteinase inhibitor [1], mucus proteinase inhibitor or bronchial inhibitor (it will henceforth be referred to as SLPI), and elastase-specific inhibitor (ESI), also known as elafin or skin-derived antileukoprotease (SKALP) [2]. They are synthesized and secreted locally at the site of injury and are produced in response to primary cytokines such as IL-1 and TNF; they might therefore be part of a first wave of local, inducible defense in the antiproteinases network [3]. Although potenti
Giant viruses in the oceans: the 4th Algal Virus Workshop
Jean-Michel Claverie
Virology Journal , 2005, DOI: 10.1186/1743-422x-2-52
Abstract: The 4th Algal Virus Workshop http://www.avw4.org webcite organized by Corina Brussaard and Herman Gons, and hosted by the Royal Netherlands Institute for Sea Research, was held in Amsterdam 17–21 april 2005. Though marine ecology rather than basic virology was the main focus of this meeting, exciting new results on the genomics of large/giant viruses kept turning up in many talks. In the context of a comparative study, Corina Brussaard (in collaboration with the US DoE) is herself sequencing a variety of Micromonas pusilla and Phaeocystis globosa dsDNA viruses some of them estimated to have a genome sizes up to 460 kb.In his overview, Curtis Suttle (University of British Columbia, Vancouver, Canada) pointed out that viruses (including RNA-, DNA-, prokaryotic and eukaryotic viruses) constitute a significant part of the biomass in ocean coastal waters (with up to 50 millions particles/ml, for a total estimate of 25 to 270 Megatons in the oceans) where they play a dominant role in the control of phyto- and bacterio-plankton populations, and hence on the production of oxygen and atmospheric dimethylsulphide, an important factor in climate regulation. Most of these viruses are uncharacterized [1].Ironically, this is in a freshwater unicellular green alga that the best characterized large DNA virus Paramecium bursaria chlorella virus (PBCV-1), the prototype of the Phycodnaviridae, was isolated more than 20 years ago in Jim van Etten's laboratory (University of Nebraska, Lincoln)[2]. Liza Fitzgerald (Van Etten's laboratory) reported on the ongoing annotation of the genomic sequences of two new species of Paramecium bursaria chlorella viruses: NY-2A (infecting PBCV-1 host Chlorella species NC64A) and Chlorella Pbi virus MT325. NY-2A genome contains 368,683 bp, making it the largest chlorella virus sequenced to date. Despite a 10% difference in size, the NY-2A genome and PBCV-1 genome (330 kb) exhibits a near perfect colinearity. With 314,335 bp the MT325 genome is slightly
Elitismo cultural e "democratiza??o da cultura" no Império Romano Tardio
Carrié, Jean-Michel;
História (S?o Paulo) , 2010, DOI: 10.1590/S0101-90742010000100027
Abstract: a produ??o literária e artística dos últimos séculos da antiguidade apresenta todos os sinais de elitismo cultural. por trás desta aparência, e contrastando com a impossibilidade radical de democratiza??o política do regime imperial, podemos, no entanto, reconhecer os sinais de um processo que o historiador italiano santo mazzarino denominou de "democratiza??o da cultura". outros historiadores denomiranarm-no de "vulgariza??o". a historiografia catastrofista do "declínio" do mundo antigo e da queda do império romano atribuiu uma grande responsabilidade ao que apresentava como um nivelamento por baixo da sociedade antiga e de sua cultura sob a a??o conjugada de dois fatores: a cristianiza??o, promotora de um populismo cultural, e a barbariza??o, destruidora das mais altas realiza??es da tradi??o clássica. todavia, a "democratiza??o" pode também ser analisada em termos de "democratiza??o positiva", ascendente (de baixo para cima). o debate continua vivo entre os historiadores atuais para definir se essas tendências à democratiza??o da cultura representaram um fen?meno negativo ou positivo. é necessário, no entanto, afastar todo julgamento de valor a priori, necessariamente subjetivo, se quisermos estudar o fen?meno em seus diversos aspectos. os resultados desse tipo de pesquisa s?o diversos, segundo os domínios em que se manifesta uma democratiza??o: a produ??o literária e artística, a produ??o material, o pensamento jurídico, as cren?as religiosas, as evolu??es linguísticas, a afirma??o das culturas nacionais.
Para introduzir a quest?o da puls?o invocante
Vives, Jean-Michel;
Revista Latinoamericana de Psicopatologia Fundamental , 2009, DOI: 10.1590/S1415-47142009000200007
Abstract: in this article the author endeavors to show how the mental apparatus develops a structure around a "deaf spot," understood as the expression of primal repression. the establishment of this "deaf spot" allows the subject to be inscribed in the dynamics of invocation and therefore be inscribed in the world of desire.
Dialogue des droits et dialogues des traditions juridiques
Jean-Michel Blanquer
Synergies Pologne , 2005,
Traite, esclavage et fortifications dans l’Ouest africain
Jean-Michel Deveau
EchoGéo , 2008,
Abstract: La première colonisation d’Afrique occidentale a été circonscrite aux littoraux et à cause de la résistance des pouvoirs locaux, elle n’a pas pu s’étendre à l’intérieur des terres. Les européens (Portugais, Hollandais, Fran ais, Anglais, Danois) qui à partir du XVe siècle se disputaient la terre africaine ont connu les mêmes barrages, diplomatiques ou constitués par la force. Ils ne purent installer que des bastions sur les c tes avec l’autorisation des souverains africains à qui ils donnaient une contrepartie sous forme de cadeaux et de redevances. Ainsi, avec la bénédiction des pouvoirs africains en place, les européens ont pu commencer la traite des esclaves pour effectuer le travail agricole organisé par les colons aux Amériques. A partir de l’exemple de l’histoire du Ghana défriché récemment par les chercheurs et celui de la Sénégambie en cours d’étude, on s’aper oit des nouvelles perspectives de décryptage de l’histoire du continent africain qui vont à l’encontre des idées re ues de l’idéologie de fatalité et de victimologie des africains. The first colonization of Western Africa was circumscribed with the littorals and because of the resistance of the local authorities, it could not extend inside the grounds. The Europeans (Portuguese, Dutch, French, English, Danish) which starting from XVe century disputed the African land knew the same stoppings, diplomatic or constituted by the force. They could install only bastions on the coasts with the authorization of the African sovereigns to whom they gave a counterpart in the form of gifts and of royalties. Thus, with the blessing of the African powers in place, Europeans could begin the draft of the slaves to carry out the agricultural work organized by the colonists in Americas. From the example of the history of Ghana cleared recently by the researchers and that of Senegambia under study, one realizes new prospects for decoding of the history of the African continent which go against the generally accepted ideas of the ideology of fate and victimology of the Africans.
Au-delà de la précarité et de son ambivalence : la contribution de l’approche par les capacités
Jean-Michel Bonvin
SociologieS , 2011,
Abstract: Pour l’auteur, les articles du débat sur la précarité assument des points de vue plus complémentaires qu’antagoniques. Afin de mettre en lumière cette complémentarité, il mobilise deux notions forgées par Amartya Sen : l’objectivité positionnelle, suivant laquelle chaque observateur ou analyste d’une situation donnée se caractérise par un point de vue particulier et néanmoins objectif sur cette réalité (en fonction du contexte national ou institutionnel dans lequel il est situé, de sa trajectoire de vie, etc.). Ensuite, le concept de base informationnelle de jugement en justice qui désigne les informations prises en compte lorsque l’on cherche à évaluer une situation sociale donnée. Dans un premier temps, l’article identifie les différences d’objectivités positionnelles et de bases informationnelles entre les deux auteurs du débat, avant de proposer en conclusion une autre conception, enracinée dans l’approche par les capacités d’Amartya Sen, qui vise à suggérer une base informationnelle alternative en vue de compléter la connaissance disponible sur le phénomène étudié. Beyond the “vulnerability” and its ambivalences: contribution of the capacities approachFor this author, the articles on the vulnerability debate adopt points of view that are more complementary than antagonistic. In order to bring out the complementarity, he mobilizes two notions elaborated by Amartya Sen: positional objectivity, according to which each observer or analyst of a particular situation is characterised by a particular point of view, nevertheless objective, with regards to this reality (in function of the national or institutional context in which he is situated, of his own life history, etc.). Next, the concept of informational base of judgement in justice which points to the information to be considered when one attempts to evaluate a particular social situation. The article first identifies the differences between the two authors of the debate with regards to positional objectivities and informational bases. He then proposes another conception, grounded in Amartya Sen’s capacities approach, which suggests an alternative informational base in order to complete accessible knowledge of studied phenomena. Mas allá que la precariedad y su consiguiente ambivalencia: el aporte del encaminamiento de las capacidades.Los artículos suscitados por el tema de la precariedad engloban más aspectos complementarios que antagónicos. Con objeto de resaltar esta complementariedad el autor utiliza dos nociones forjadas por Amartya Sen: la primera es la objetividad posicional, según la cual ca
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