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In order to assess the impact of tobacco smoking on nasal quality of life, a cross-sectional pilot study was carried out on 185 sales representatives from all regions of France during their yearly seminar. Tobacco smoking is thought to induce nasal symptoms which may impair quality-of-life but there is no study which has analyzed the impact of tobacco smoking in normal subjects or patients with allergic rhinitis. Thirty-eight subjects had a previous diagnosis of allergy made by a physician with skin tests and/or serum-specific Immunoglobulin E.

STUDY DESIGN: Prospective study of self-assessed symptom severity. OBJECTIVES: To carry out a comparative semiological analysis of pain in scoliotic and nonscoliotic adults with low back pain, and to study the factors that correlate with the severity of pain in scoliotic patients. SUMMARY OF BACKGROUND DATA: Low back pain is a frequent complaint in subjects with adult lumbar scoliosis. Few studies have taken an interest in the semiological specificities of lumbar pain in such patients. METHODS: Fifty adults with lumbar scoliosis and suffering from chronic low back pain and 50 nonscoliotic adults with chronic low back pain, matched for age and gender underwent a standard examination. The characteristics of the pain described in the 2 groups were compared. Relationships between the features of the scoliosis and the intensity of the pain were sought. RESULTS: There was no difference between the 2 groups with regard to pain severity (duration and intensity). The pain evolved more steadily in scoliotic patients. Inguinal pain (P < 0.001) and cruralgia (P < 0.05) were particularly associated with scoliosis. In scoliotics, the severity of the low back pain correlated well with the radiologic aspects: Cobb angle (P < 0.05), vertebral rotation (P < 0.05) and rotatory olisthesis (P < 0.05). Cruralgia was significantly associated with the presence of rotatory dislocation (P < 0.01). CONCLUSION: The pain felt by scoliotic adults has several semiological features, in particular the frequency of inguinal pain and cruralgia. Lumbar scoliosis with a great curvature and/or rotatory olisthesis increases the intensity of low back pain in adults. These findings suggest that the magnitude of the curvature and the existence of rotatory olisthesis must be targeted for prevention and treatment of the chronic low back pain in subjects with a lumbar scoliosis. [ABSTRACT FROM AUTHOR]

Escherichia coliurinary tract isolates were collected in 1997–2003 from Nîmes University Hospital in order to investigate long-term trends in antibiotic resistance and to explore the relationship between antibiotic use and the emergence of resistance. Time-series analysis (ARIMA models) and dynamic regression models were used to investigate relationships between antibiotic use and resistance to ofloxacin and ciprofloxacin. Significant increases were seen in the frequency of ofloxacin (8.9 to 16.7%) and ciprofloxacin resistance (6.2 to 10.1%) (p < 0.001). Using multivariate dynamic regression analysis, it was found that an increased use of one defined daily dose (DDD)/1000 patient-days for ofloxacin, ciprofloxacin and norfloxacin induced average increases of 0.81%, 0.65% and 0.53% inE. coliofloxacin resistance (p < 0.01), with average delays of 4, 4 and 6 months, respectively. An increase of 1 DDD/1000 patient-days of ciprofloxacin, ofloxacin and norfloxacin use induced increases of 0.73%, 0.82% and 0.63% inE. coliciprofloxacin resistance (p < 0.01), with average delays of 4, 4 and 5 months, respectively. The use of nalidixic acid was not associated significantly with an increase in resistance to fluoroquinolones by multivariate analysis. [ABSTRACT FROM AUTHOR]

Le catastrophisme est une réponse cognitive et affective négative à un stimulus anxiogène comme la douleur. Le catastrophisme joue un rôle dans l'amplification et le maintien des douleurs chroniques. L'objectif de cette étude était d'évaluer la prévalence du catastrophisme dans la spondyloarthrite axiale (SA) et le rhumatisme psoriasique (RPso), son évolution dans le temps ainsi que les facteurs associés au catastrophisme dans ces deux pathologies. Étude observationnelle bicentrique prospective sur 1 an de patients suivis pour une SA (critères ASAS 2009) ou un RPso (critères CASPAR 2006), d'octobre 2019 à janvier 2021. Ont été analysées à l'inclusion, 3 mois, 6 mois et 1 an, les données sociodémographiques, cliniques, biologiques, traitements, des patients SA et RPso. Le patient remplissait une série d'autoquestionnaires sur l'activité de la maladie (BASDAI), le catastrophisme (PCS), le coping (CSQ), la qualité de vie (Sf12, EQ5D), le handicap fonctionnel (BASFI, HAQ), le dépistage de la fibromyalgie (FiRST), l'anxiété et la dépression (HADS, GAD7) et l'insomnie (ISI). Les analyses statistiques comprenaient des modèles linéaires mixtes (PCS en continu) et des modèles linéaires généralisés mixtes (PCS ≥ 20). Les méthodes de classification Kmeans et classification hiérarchique ont été utilisées sur les trois visites de suivi des patients (différence des scores du catastrophisme entre 2 visites) afin d'identifier des profils d'évolution du catastrophisme. Nous avons réalisé des analyses de sensibilité avec imputation des données manquantes. En tout, 302 patients ont été inclus (194 SA, 108 RPso). À l'inclusion, le score moyen du PCS était de 18,64/52 (DS 13,12) dans la SA et 18,9/52 (13,51) dans le Rpso et la prévalence d'un fort taux de catastrophisme (PCS ≥ 20) était de 45,08 % [37,92 ; 52,39] dans la SA et de 44,86 % [35,23 ; 54,78] dans le RPso. En tout, 91 % des patients SA et 89 % des patients RPso ont fait leur visite à 1 an. Le score moyen du PCS à 12 mois était de 12,95/52 dans la SA et 16,02/52 dans le Rpso ; la prévalence d'un fort taux de catastrophisme a diminué à 25,44 % [19,07 ; 32,70] dans la SA et 31,91 % [22,67 ; 42,33] dans le Rpso. Le catastrophisme était significativement associé à l'anxiété, la dépression, l'impact fonctionnel et le BASDAI dans la SA ; à l'anxiété, la dépression, l'impact fonctionnel, la douleur, le BASDAI et DAS28 CRP dans le Rpso. Aucune association n'était retrouvée entre catastrophisme et fibromyalgie. Le catastrophisme a significativement diminué à chaque visite (3, 6, 12 mois). Des profils évolutifs de catastrophismes se dégagent, confirmant qu'il ne s'agit pas d'un trait de personnalité, mais bien d'un facteur fluctuant dans le temps. Près de la moitié des patients avec une SA ou un RPso ont des scores élevés de catastrophisme, avec une association nette à différents paramètres (anxiété, dépression, fonction), mais également un score subjectif d'activité (BASDAI), rendant pertinent sa détection et sa prise en charge. Le catastrophisme n'est pas associé à la fibromyalgie. Cette meilleure compréhension des facteurs associés au catastrophisme ouvre un nouvel axe de traitements pour les patients atteints de rhumatisme inflammatoire chronique. [ABSTRACT FROM AUTHOR]

Le catastrophisme est une réponse cognitive et affective négative à un stimulus anxiogène comme la douleur. Le catastrophisme joue un rôle dans l'amplification et le maintien des douleurs chroniques. L'objectif de cette étude était d'évaluer la prévalence du catastrophisme dans polyarthrite rhumatoïde (PR), son évolution dans le temps ainsi que les facteurs associés au catastrophisme dans cette pathologie. Étude observationnelle bicentrique prospective sur 1 an de patients suivis pour une PR (critères ACR-EULAR), d'octobre 2019 à janvier 2021. Ont été analysées à l'inclusion, 3 mois, 6 mois et 1 an, les données sociodémographiques, cliniques, biologiques, traitements, des patients PR. Le patient remplissait une série d'autoquestionnaires sur l'activité de la maladie (DAS28), le catastrophisme (PCS), le coping (CSQ), la qualité de vie (Sf12, EQ5D), le handicap fonctionnel (HAQ), le dépistage de la fibromyalgie (FiRST), l'anxiété et la dépression (HADS, GAD7) et l'insomnie (ISI). Les analyses statistiques comprenaient des modèles linéaires mixtes (PCS en continu) et des modèles linéaires généralisés mixtes (PCS ≥ 20). Les méthodes de classification Kmeans et classification hiérarchique ont été utilisées sur les trois visites de suivi des patients (différence des scores du catastrophisme entre 2 visites) afin d'identifier des profils d'évolution du catastrophisme. Nous avons réalisé des analyses de sensibilité avec imputation des données manquantes. En tout, 231 patients PR ont été inclus. À l'inclusion, le score moyen du PCS était de 18,11/52 (DS 12,87) et la prévalence d'un fort taux de catastrophisme (PCS ≥ 20) était de 54,6 %. En tout, 201 patients PR ont fait leur visite à 1 an. Le score moyen du PCS à 12 mois était de 13,37/52 (12,63) et la prévalence d'un fort taux de catastrophisme a diminué à 30,5 %. Le catastrophisme était significativement associé à l'anxiété, la dépression, l'impact fonctionnel et l'insomnie. Aucune association n'était retrouvée entre catastrophisme et fibromyalgie. Le catastrophisme a significativement diminué à chaque visite (3,6,12 mois). Des profils évolutifs de catastrophismes se dégagent, confirmant qu'il ne s'agit pas d'un trait de personnalité, mais bien d'un facteur fluctuant dans le temps. La moitié des patients avec une PR ont des scores élevés de catastrophisme, avec une association nette à différents paramètres (anxiété, dépression, fonction, insomnie, douleur) rendant pertinent sa détection et sa prise en charge. Le catastrophisme n'est pas associé à la fibromyalgie. Cette meilleure compréhension des facteurs associés au catastrophisme ouvre un nouvel axe de traitements pour les patients atteints de rhumatisme inflammatoire chronique. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Fluid therapy is one of the major elements of severe sepsis and septic shock management. A systematic initial fluid bolus is recommended before evaluation of left ventricular filling pressure by the use of indicators of fluid responsiveness, preferentially dynamic ones. A massive fluid therapy could be damaging for the patient. Dynamic indicators of fluid responsiveness are not often relevant in the emergency department. This study was aimed to evaluate the use of indicators of fluid responsiveness by emergency practitioners during septic shock management. Study design: Cross sectional survey using anonymous self-questionnaire. Methods: We included all practitioners working in public emergency department of Languedoc-Roussillon (France). Primary-end point was the use of one indicator of fluid responsiveness at least. Uni- and multivariate analysis was conducted to find associated factors. Results: Of 232 practitioners included, we collected 149 questionnaires (response rate=64%). Hundred and eight practitioners (72% [64–79%]) used at least one indicator of fluid responsiveness. Fifty-six practitioners (38% [30–46%]) used echocardiography, 54 practitioners (36% [29–44%]) used blood lactate concentration, 45 practitioners (30% [23–38%]) used passive leg raising. The use of indicators of fluid responsiveness is associated with easy access to echography device (odd ratio=2.94 [1.16–7.62], P =0.03). Conclusion: Emergency practitioners use preferentially less invasive and less time-consuming indicators of fluid responsiveness. [Copyright &y& Elsevier]

BACKGROUND: The biological response to antiplatelet drugs has repeatedly been shown to predict the recurrence of major adverse cardiovascular events (MACEs). However, most studies involved coronary artery disease patients with recent vessel injury shortly after the initiation of antiplatelet therapy. Data on stable cardiovascular patients are scarce, and the added predictive value of specific assays (the vasodilator phosphoprotein assay for the clopidogrel response and serum thromboxane B2 for the aspirin response) and aggregation-based assays relative to common predictors has rarely been addressed. METHODS AND RESULTS: Stable cardiovascular outpatients participating in the Antiplatelet Drug Resistances and Ischemic Events (ADRIE) study (n=771) were tested twice, at 2 separate visits, with specific and aggregation-based assays. Follow-up lasted 3 years, and <1% of patients were lost to follow-up. MACEs were adjudicated by an independent committee. Multivariate survival analyses included relevant variables identified in univariate analysis and platelet function test results. The C-index was used to express the prognostic value of various multivariate models. MACEs, the primary end point, occurred in 16% of patients. Hypertension, smoking, older age, and elevated low-density lipoprotein cholesterol were predictive of MACE recurrence, with a C-index of 0.63 (P<0.001). Neither the specific nor the aggregation-based assays added significant predictive value for the primary end point. CONCLUSIONS: Biological antiplatelet drug responsiveness, measured with specific or aggregation-based assays, has no incremental predictive value over common cardiovascular risk factors for MACE recurrence in stable cardiovascular outpatients. These results do not support platelet function testing for MACE risk evaluation in stable cardiovascular patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00501423. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: We determined whether the implementation of a bundle of 10 recommendations leads to the reduction of mortality in ICU patients with severe sepsis or septic shock. Methods: All patients with severe sepsis or septic shock during two consecutive phases: a 6-month quality control period (observational) and secondly a 6-month intervention period based on the implementation of a bundle of 10 recommendations adapted from the Surviving Sepsis Campaign guidelines (initial bacteriological samples and initiating antibiotics, measurement of arterial lactate, volume expansion ≥20ml/kg, targeted mean arterial pressure ≥65mmHg and the assessments of central venous pressure and ScvO2; glucose control, low doses of corticosteroids, a tidal volume ≤8ml/kg in mechanically ventilated patients with ALI; adequate use of recombinant human activated protein C) were evaluated in 15 ICUs. The primary endpoint was the 28-day mortality rate and the secondary endpoint was the compliance with the recommendations of the care bundle. Measurement and results: Four hundred and forty-five patients (230 and 215 in the observational and intervention periods, respectively) were included. In the two periods, the patients had similar characteristics. The 28-day mortality rate significantly decreased from 40% in the observational period to 27% in the intervention period (P =0.02). According to each recommendation, compliance with the care bundle was achieved in 9 to 100% of patients. Conclusion: The implementation of a care bundle adapted from the Surviving Sepsis Campaign guidelines decreases the 28-day mortality rate in patients with severe sepsis and/or septic shock. [Copyright &y& Elsevier]

Abstract: Introduction: The French Express study compared two alveolar recruitment managements (maximal versus standard) in Acute Respiratory Distress Syndrome (ARDS) patients ventilated with 6ml/kg of ideal body weight (IBW). The objective of the present study was to assess in a single intensive care unit, the impact of Express study on the mechanical ventilation settings in non-included ARDS patients. Patients and methods: From 16 October 2002 to 14 January 2005 all consecutive eligible but non-included patients in Express study were studied. The maximal and minimal tidal volumes, and the minimal and maximal respiratory rates were retrospectively recorded. These parameters were compared according to the date of patient''s admission and then the patients were separated in four quartiles (14, 15, 15, 15 patients). Results: From the first to the last study period separated by 26 months, the mean maximal tidal volume decreased from 9.0±1.3 to 7.4±1.0ml/kg of IBW (p =0.03), the proportion of patients ventilated with a maximal tidal volume greater than 8ml/kg decreased from 93% to 20% (p <0.01), the median minimal respiratory rate increased from 14 to 18 b/min (p =0.03) and the proportion of patients with a respiratory rate less than 20 b/min decreased from 100% to 73% (p <0.01). There were correlations between the time of patient''s admission and the maximal tidal volume (r =−0.43, p <0.01), the minimal tidal volume (r =−0.28, p <0.04) and the minimal respiratory rate (r =0.33, p <0.02). Conclusion: The participation in Express study led physicians to modify their mechanical ventilation settings. The maximal tidal volume decreased and the minimal respiratory rate increased in the ARDS eligible but non-included patients. [Copyright &y& Elsevier]

Lymph node involvement is one of the most significant prognostic factors of patients with rectal cancer. However, the distribution of mesorectal lymph nodes is not well known. This study was designed to assess lymph nodes in the mesorectum and to evaluate the correlation between the volume and weight of the mesorectum and the number of lymph nodes. The mesorectums of 20 human cadavers were studied. The volume and weight of the superior rectal mesentery, superior mesorectum and inferior mesorectum were measured. Lymph nodes were sought by manual dissection and were submitted for histological examination. The correlation between the number of lymph nodes and the volume and weight of the mesorectum was evaluated by non-parametric Spearman test. A total of 178 lymph nodes were identified. The mean number of lymph nodes per specimen was 9.2 ± 4.5. The lymph nodes were mostly smaller than 3 mm and located in the superior and posterior parts of the mesorectum. A positive correlation was found between the number of mesorectal lymph nodes and the volume and weight of the mesorectum. The number of lymph nodes in the superior rectal mesentery was independent of its volume and its weight. Mesorectal lymph nodes are mainly located above the peritoneal reflection within the posterior mesorectum. The positive correlation between the volume or the weight of the mesorectum and the number of mesorectal lymph nodes should be considered as a possible means to determine the minimum number of mesorectal lymph nodes required for histological examination. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To study the correlation between expired air carbon (EACO) and urinary cotinine, and to determine the impact of tobacco smoking on in vitro fertilization (IVF) results. Patients and methods: We studied prospectively 221 patients in our ART center from October 2002 to October 2004: 51 active smokers, 85 passive smokers, and 85 non-smokers. Patients were classified into active, passive smokers, or non-smokers, based on a questionnaire. We measured urinary cotinine and EACO on the embryo transfer day and we recorded the IVF parameters. Results: Two hundred and twenty-one patients were included. We observed a 17.2% reduction of estradiolemy (P =0.05), a 1.5% reduction of pregnancies (NS), a 7.8% reduction of infants born alive (NS), a 28.5% reduction of twin pregnancies (P =0.06), as well as a 10% increase of miscarriages (NS) in the active smokers in comparison with non-smokers (the same trends were observed between active and passive smokers). EACO and urinary cotinine were well correlated. There was a negative correlation between estradiolemy and urinary cotinine (R =–0.15, P =0.02). Discussion and conclusion: Tobacco smoking intensity may be dilatory on IVF results. There is a high correlation between EACO and urinary cotinine. Other larger studies would probably obtain results more statistically significant. [Copyright &y& Elsevier]

To evaluate plasma levels of dehydroepiandrosterone sulphate (DHEAS) in a cohort of HIV-infected patients and to analyse factors associated with DHEAS levels. This is the first report of the determination of DHEAS plasma levels in HIV/HCV coinfected patients. When age and sex were taken into account, the DHEAS plasma level was found to be significantly lower in HCV coinfected patients. To date, the pathophysiology of such findings is unknown. [ABSTRACT FROM AUTHOR]

Numerous studies have demonstrated efficacy of imipenem-cilastatin, 50mg/kg/day, as first line therapy in febrile patients with neutropenia of short duration consecutive to cytostatic chemotherapy. However, only two studies used low dosage of this antibiotic as 1.5 g/day, in prospective, double blind, randomized clinical trials, in this indication. Efficacy and tolerability of imipenem-cilastatin 0.5 g three times daily IV in 30-min infusions, as first-line empiric therapy, were retrospectively evaluated in our hematological unit. From January 1996 to September 2000, 30 neutropenic patients (12 females) with 45 febrile episodes were included. Median age was 57.5 years (31-75). Twenty-four of them had lymphomas, 4 solid tumors and 2 myelomas. There were 13 clinically documented infections, (CD, 28.8%), 16 microbiologically documented infections, (MD, 35.6%) and 16 febrile episodes corresponding to fever of unknown origin, (FUO, 35.6%). The median neutrophils count on nadir (n = 44), was 67/mm³ (8-369). The median duration of neutropenia was 5 days (3-15). Bacteremia was observed in 10 patients, urinary tract infection in 3 patients. The most frequently isolated microorganism was Escherichia coli. The overall success rate of the first line therapy was 66.7%. Adverse events were observed in 11.1% of the patients without necessity to stop treatment. The MD infections showed a lower rate of success compared with CD infections and FUO. These data were in accordance with the previous studies. The importance of number of microorganisms (p = 0.007) and of infected sites (p = 0.01) appeared as prognostic factors (univariate analysis). Although imipenem-cilastatin has been used in numerous studies as empiric broad-spectrum antibiotic therapy in the treatment of febrile neutropenic cancer patients, the exact dosage of this antibiotic is still not standardized. However, utilization of this antibiotic in monotherapy at low dosage seems to us to be safe and effective as... [ABSTRACT FROM AUTHOR]

Background: Cardiac troponins I (cTnI) and T (cTnT) have been shown to be highly sensitive and specific markers of myocardial cell injury. We investigated the diagnostic value of cTnI and cTnT for the diagnosis of myocardial damage in a rat model of doxorubicin (DOX)-induced cardiomyopathy, and we examined the relationship between serial cTnI and cTnT with the development of cardiac disorders monitored by echocardiography and histological examinations in this model. Methods: Thirty-five Wistar rats were given 1.5 mg/kg DOX, i.v., weekly for up to 8 weeks for a total cumulative dose of 12 mg/kg BW. Ten rats received saline as a control group. cTnI was measured with Access® (ng/ml) and a research immunoassay (pg/ml), and compared with cTnT, CK-MB mass and CK. By using transthoracic echocardiography, anterior and posterior wall thickness, LV diameters and LV fractional shortening (FS) were measured in all rats before DOX or saline, and at weeks 6 and 9 after treatment in all surviving rats. Histology was performed in DOX-rats at 6 and 9 weeks after the last DOX dose and in all controls. Results: Eighteen of the DOX rats died prematurely of general toxicity during the 9-week period. End-diastolic (ED) and end-systolic (ES) LV diameters/BW significantly increased, whereas LV FS was decreased after 9 weeks in the DOX group (p<0.001). These parameters remained unchanged in controls. Histological evaluation of hearts from all rats given DOX revealed significant slight degrees of perivascular and interstitial fibrosis. In 7 of the 18 rats, degeneration and myocyte vacuolisation were found. Only five of the controls exhibited evidence of very slight perivascular fibrosis. A significant rise in cTnT was found in DOX rats after cumulative doses of 7.5 and 12 mg/kg in comparison with baseline (p<0.05). cTnT found in rats after 12 mg/kg were significantly greater than that found after 7.5 mg/kg DOX. Maximal cTnI (pg/ml) and cTnT levels were significantly increased in DOX rats compared with controls (p=0.006, 0.007). cTnI (ng/ml), CK-MB mass and CK remained unchanged in DOX rats compared with controls. All markers remained stable in controls. Analysis of data revealed a significant correlation between maximal cTnT and ED and ES LV diameters/BW (r=0.81 and 0.65; p<0.0001). A significant relationship was observed between maximal cTnT and the extent of myocardial morphological changes, and between LV diameters/BW and histological findings. Conclusions: Among markers of ischemic injury after DOX in rats, cTnT showed the greatest ability to detect myocardial damage assessed by echocardiographic detection and histological changes. Although there was a discrepancy between the amount of cTnI and cTnT after DOX, probably due to heterogeneity in cross-reactivities of mAbs to various cTnI and cTnT forms, it is likely that cTnT in rats after DOX indicates cell damage determined by the magnitude of injury induced and that cTnT should be a useful marker for the prediction of experimentally induced cardiotoxicity and possibly for cardioprotective experiments. [Copyright &y& Elsevier]

Antiphospholipid antibodies (aPL) have been detected in various liver diseases, particularly cirrhosis. The role of alcoholic consumption per se has been suggested. The aim of our study was to assess the prevalence of aPL in patients with alcoholic liver disease at various states and to correlate the presence of aPL with both liver injury and alcoholic consumption. Three groups were prospectively included. Group A: 74 controls (age- and sex-matched); group B: 46 patients with alcoholic steatosis; group C: 28 patients with alcoholic cirrhosis. For each patient, lupus anticoagulant, anticardiolipin antibodies and anti-β2-glycoprotein I antibodies were tested. The prevalence of aPL (presence of at least one positive test) was 5% in group A, 20% in group B and 50% in group C (P<0.04). No correlation appeared between aPL and Child Pugh score in group C. No correlation was found between the presence of aPL and alcohol intake in patients with either steatosis or cirrhosis. Our study confirms that aPL positivity is more frequently encountered in patients with alcoholic liver disease than in controls. Their prevalence increases with the degree of histological damage but not with the level of alcoholic intake. Lupus (2000) 9, 451–455. [ABSTRACT FROM AUTHOR]

There is little information about the relation between mild cardiac troponin I (cTn-I) increase after coronary interventions and late outcome. We therefore focused on the long-term outcome and the clinical, morphologic, and procedural correlates of elevation of cTn-I compared with cardiac troponin T, creatine kinase (CK), CK-MB activity and mass, and myoglobin in 105 patients with successful elective percutaneous transluminal coronary angioplasty (PTCA) for stable or unstable angina. Patients with myocardial infarction and those with unstable angina who had a detectable increase in serum markers before PTCA were excluded. Markers were measured before and after the procedure and for 2 days. Patients were followed up to record recurrent angina, myocardial infarction, cardiac death, repeat PTCA, or elective coronary artery bypass graft surgery. Procedure success was achieved in all cases. Elevation in cTn-I (> or =0.1 microg/L) was observed in 23 of 105 patients (22%) (median peak: 0.25 microg/L); 18% had cardiac troponin T (cTn-T) release (> or = 0.1 microg/L, median peak 0.21); 11.4% CK-MB mass (> or =5 microg/L), and 7.6% myoglobin (> or =90 microg/L) release. Five and 2 patients had elevated CK and CK-MB activity, respectively. Fourteen of 18 patients with cTn-T elevation had a corresponding elevation in cTn-I (kappa 0.68; p = 0.001). Patients positive for cTn-I had more unstable angina (p = 0.042) and heparin before PTCA (p = 0.046), and had longest total time (p = 0.004) and single inflation (p = 0.01). By multivariate logistic regression, predictors of postprocedure cTnI elevation were maximum time of each inflation (odds ratio 9.2; p = 0.0012), type B lesions (odds ratio 6.6; p = 0.013), unstable angina (p = 0.041), and age > or =60 years (p = 0.032). Clinical follow-up was available in 103 patients (98%) (mean 19+/-10 months). Kaplan-Meier survival analysis showed that cTn-I elevation was not an important correlate of cardiac events (p = 0.34, by log-rank analysis). The incidence of recurrent angina, myocardial infarction, cardiac death, and repeat revascularization after 12 months was not different in patients positive or negative for cTn-I. We conclude that cTn-I elevation after successful PTCA is not associated with significantly worse late clinical outcome. Levels of cTn-I allow a much higher diagnostic accuracy in detecting minor myocardial injury after PTCA compared with other markers, but there is no association with periprocedural myocardial cell injury and late outcome when cTn-I and other markers are considered. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Inappropriate sedation could prolong the duration of mechanical ventilation. The present “before–after” study assessed the impact of a goal-directed sedation using an algorithm with a combination of propofol and remifentanil on the time to extubation. Methods: During 16 months, ICU-patients requiring sedation greater than 24h were prospectively studied. In the first eight months, sedation was achieved using continuous infusions of a benzodiazepine (flunitrazepam or midazolam) and an opioid (fentanyl or sufentanil). In the following eight months, sedation using a propofol-remifentanil combination was given and adapted by the nurses according to the Ramsay score and a pain scale. The main endpoint was the time to extubation (from the cessation of sedation to extubation). The secondary endpoints were the duration of mechanical ventilation, the length of ICU stay, the ICU mortality rate, the need of vasopressive support, the occurrence of self-extubations and Ventilator-Associated Pneumonia (VAP). Results: Forty-six and 39 patients were included in the first and second periods, respectively. The durations of sedation were similar. The time to extubation was shorter in the second period (10 versus 92h, p <0.0001). The duration of mechanical ventilation, the length of stay in ICU, the mortality rate, the need for vasopressor support and the occurrence of VAP were similar. Five self-extubations occurred in the second period versus one in the first one (p =0.02). Conclusion: Sedation with adapted infusions of propofol and remifentanil according to the Ramsay score and a pain scale decreases the time to extubation in ICU patients requiring sedation longer than 24h but increases the rate of self-extubations. [Copyright &y& Elsevier]