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This study aimed at evaluating the performance of Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color-Doppler (SQP) to predict de novo AKI in the subgroup of critically ill patients without AKI at admission.This study is an ancillary analysis of a prospective multicenter cohort study. Consecutive ICU patients requiring mechanical ventilation were included. Renal Doppler was performed at ICU admission. The diagnostic performance of RI and SQP to predict de novo AKI at day 3 was evaluated.Among the 371 patients of the prospective cohort, 118 without AKI at study inclusion were included. Thirty-four patients (29%) developed an AKI. Neither RI (0.64 UI [0.57-0.70] vs 0.67 [0.62-0.70] in no AKI and de novo AKI group respectively, p = 0.177) nor SQP (2 [2, 3] vs 2 [1-3] in no AKI and de novo AKI group respectively, p = 0.061) were associated with AKI occurrence. Overall performance in predicting de novo AKI was null to poor with area under ROC curve of respectively 0.60 (95% CI 0.49-0.65) and 0.58 (95% CI 0.47-0.60) for RI and SQP. Similar results were obtained after adjustment for confounders.These results confirm the poor performance of Doppler-based indices in predicting renal prognosis of ICU patients.

The Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color Doppler (SQP) have shown promising results for predicting persistent acute kidney injury (AKI) in preliminary studies. This study aimed at evaluating the performance of RI and SQP to predict short-term renal prognosis in critically ill patients.Prospective multicenter cohort study including unselected critically ill patients. Renal Doppler was performed at admission to the intensive care unit. The diagnostic performance of RI and SQP to predict persistent AKI at day 3 was evaluated.Overall, 371 patients were included, of whom 351 could be assessed for short-term renal recovery. Two thirds of the included patients had AKI (n = 233; 66.3%), of whom 136 had persistent AKI (58.4%). Doppler-based RI was higher and SQP lower in AKI patients and according to AKI recovery. Overall performance in predicting persistent AKI was however poor with area under ROC curve of respectively 0.58 (95% CI 0.52-0.64) and 0.59 (95% CI 0.54-0.65) for RI and SQP. Optimal cutoff was respectively 0.71 and 2 for RI and SQP. At optimal cutoff, sensitivity and specificity were 50% (95% CI 41-58%) and 68% (62-74%) for RI and 39% (32-45%) and 75% (66-82%) for SQP.Although statistically associated with AKI occurrence, RI and SQP perform poorly in predicting persistent AKI at day 3. Further studies are needed to adequately describe factors influencing Doppler-based assessment of renal perfusion and to delineate whether these indicators may be useful at the bedside. CLINICALTRIAL.GOV: NCT02355314.

This chapter explores the ways reflexive practice guided two anthropologists through methodological and ethical concerns. In their research, Sakti and Reynaud both examined the ways societies deal with legacies of violence, albeit on different sides of the globe—Sakti in Timor-Leste and Indonesia, where she explored social repair among a conflict-divided community, and Reynaud in Quebec, where she explored experiences of the Indian Residential Schools Settlement alongside Algonquin survivors. As this chapter illustrates, their understanding of reconciliation as ongoing trust building or rebuilding (Govier and Verwoerd 2002) transpires not only in the way they conducted their studies, but also in how they considered issues of positionality and ethics. They argue that putting into practice their understanding of reconciliation was key to making their fieldwork ‘successful’.

As the largest class action suit in Canadian history, the Indian Residential Schools Settlement Agreement (2007-2015) had a great impact on the lives of Aboriginal survivors across Canada. In a rare account exploring survivor perspectives, Anne-Marie Reynaud considers the settlement's reconciliatory aspiration in conjunction with the local reality for the Mitchikanibikok Inik First Nations in Quebec. Drawing from anthropological fieldwork, this carefully crafted book weaves survivor experiences of the financial compensations and the Truth and Reconciliation Commission together with current theorizing on emotions, memory, trauma and transitional justice.

Few data are available on the efficacy of noninvasive ventilation (NIV) in postoperative patients with acute respiratory failure (ARF).Seventy-two patients coming from the surgical wards with postoperative ARF were retrospectively evaluated. The major characteristics of patients who were intubated were compared with the characteristics of those who were not after a trial of NIV. Predictive factors for failure of NIV were analysed.Out of 72 patients with ARF after surgery who were treated with NIV, 42 avoided intubation (58%). On a univariate analysis, a decrease in the paO2/FiO2 ratio after 1 h of NIV (223 +/- 84 to 160 +/- 68 mmHg, P0.05) was associated with NIV failure and need for tracheal intubation because of nosocomial pneumonia and an increased simplified acute physiology score (SAPS) 2. In a multivariate analysis, nosocomial pneumonia [odds ratio (OR) 4.189; 95% confidence interval (CI) 1.383-12.687] and SAPS 2 higher than 35 (OR 4.969; 95% CI 1.627-15.172) were independent predictive factors of NIV failure. NIV success was associated with a reduced ICU stay (16.8 vs. 26.1 days, P0.001).NIV could be considered in postoperative patients who presented with ARF. Nosocomial pneumonia is predictive of NIV failure.

Since the declaration of the novel influenza A (H1N1) pandemic by the World Health Organization in June 2009, several neurologic complications have been reported including encephalitis, encephalopathy, seizures, and neuropsychiatric perturbations [1, 2]. Most of the cases concerned children [1] and had a benign course with early and appropriate management. When performed, brain magnetic resonance imaging (MRI) was normal. We report the first case of H1N1 virus related to acute hemorrhagic leukoencephalopathy. A 56-year-old Caucasian woman without past medical history consulted her general practitioner 24 h after the onset of an influenza syndrome. She received imipenem per os 2 g per day for 10 days. On the fifth day, the patient was referred for permanent dyspnea, headache, and 38.5 C fever. No cognitive changes were observed. Pulmonary auscultation found crackles. A chest X-ray showed features of acute respiratory distress syndrome with bilateral infiltrative opacities. At admission, H1N1 was isolated from nasopharyngeal specimens by reverse-transcription polymerase chain reaction (RT-PCR) [3]. The virus could not be isolated by cell culture for sequencing. One hundred fifty milligrams oseltamivir and 40 mg methylprednisolone intravenous per day were administered over 5 days while imipenem was continued. On the sixth day, massive oxygen desaturation occurred despite noninvasive oxygenotherapy. The patient became comatose. She was transferred to the intensive care unit. Mechanical ventilation was then performed after intubation. Brain MRI with T2-, T2*-, and T1-weighted sequences with and without gadolinium infusion showed extensive bilateral hemispheric leukoencephalopathy predominating in the subcortical regions and extending in the right striatum. Several microbleeds were present in the same territories (Fig. 1a–g). MRI angiography was normal. Electroencephalography recorded bilateral slow waves. Cerebrospinal fluid (CSF) was xanthochromic and contained 0.51 g/L protein in a polyclonal pattern with 90 red blood cells and 8 lymphocytes/ mm. PCR was negative for cytomegalovirus, herpes simplex, Epstein–Barr, and H1N1 viruses. Specific antiH1N1 antibody titer determined by hemagglutination inhibition against the A/California/7/2009 strain was 10 in CSF and more than 1,280 in serum. Culture for bacteria and mycosis remained sterile. Neither antinuclear nor onconeural antibodies were noted. On the tenth day, the patient awoke but was deeply confused. The Mini-Mental State Examination (MMSE) score was 19/30 with deficit in time and space orientation and calculation errors. Neurological examination found a left pyramidal syndrome with 4/5 Medical Research Council score on limb muscle testing. Diagnosis of acute partially hemorrhagic leukoencephalopathy linked to the H1N1 virus was reached, and steroid therapy started with methylprednisolone 500 mg daily for 3 days. On the 40th day, muscle strength was normal. The MMSE was 29/30. An extensive neuropsychological expertise showed minor abnormalities with normal memory, verbal comprehension, and executive F. A. Cisse J.-C. Antoine G. Jousserand J.-P. Camdessanche (&) Department of Neurology, University Hospital, 42055 Saint-Etienne Cedex 02, France e-mail: j.philippe.camdessanche@chu-st-etienne.fr