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We chose, for this update on novelties in treatments for pulmonary disorders in 2016, to focus on advances in 3 pulmonary disorders : chronic obstructive pulmonary disease (COPD), asthma and IPF. For COPD, the contribution of inhaled glucocorticosteroids and roflumilast are revisited and the benefits obtained through endoscopic volume reduction procedures are clarified. In asthma and IPF, new molecules offer new hopes : a bettre control of exacerbations in asthma and a stabilisation or slowing of disease progression in IPF.Nous avons choisi, pour cette mise au point sur les nouveautés en pneumologie en 2016, de commenter les acquisitions thérapeutiques les plus récentes dans 3 pathologies pulmonaires : la bronchopneumopathie chronique obstructive (BPCO), l’asthme, et la fibrose pulmonaire idiopathique (FPI). Dans la BPCO, la place des corticostéroïdes inhalés et celle du roflumilast sont revisitées et les bénéfices de la réduction de volume par voie endoscopique interventionnelle se précisent. Dans l’asthme et dans la FPI, de nouvelles molécules offrent de nouveaux espoirs : meilleur contrôle des exacerbations dans l’asthme et stabilisation ou ralentissement du déclin fonctionnel dans la FPI.

Summary Objective The purpose of this study was to determine the future, in terms of scientific publication, of medical thesis (MT) defended in the Medical School of Lille 2 University (MSL2U) between January 1st, 2001 and December 31st, 2007. Methods The collection of MT published as a corresponding scientific article was realized from PubMed ® . For every corresponding article, we determined the journal Impact Factor (IF), the language of publication and the rank of the student and his MT director in the author list. Analyses were also realized according to the group of speciality of the TM. Results In all, 11.3% of the 2150 MT defended in the MSL2U were followed up by a scientific publication. The average IF was 2.32 with a median at 1.75 and extreme values from 0 to 14.78. Seventy percent of the articles were published in English. The rank of the student was placed before his MT director (2.06 vs. 3.15). The MT defended by students in the field of medical specialities presented the highest rate of publication (25.1%). The general medicine was the second speciality the most productive in term of number of published articles ( n = 49) after medical specialities ( n = 103). Conclusion The MT director and the PhD students must be more motivated to publish their results. The value of 11.3% could be considered as weak but, because of a huge lack of references, it is impossible to compare our results to those of other French medical schools. It remains important to reform the objectives and the modalities of the writing of a MT: should we not have to turn to thesis called “on article”?

Background Acute kidney injury (AKI) is a common and important complication of critical illness associated with increased morbidity, mortality and costs. Alterations in renal perfusion are thought to play a central role in its pathogenesis. This causal relationship remains, however, largely speculative as data on renal perfusion in AKI and critical illness are scarce. Indeed, methods enabling renal perfusion quantification are either invasive, expensive or inapplicable to critically ill patients. Contrast-enhanced ultrasonography (CEUS) is a recent imaging modality which provides a unique means of visualizing tissue perfusion. Studies have suggested that CEUS could enable blood flow quantification. CEUS would be an ideal tool in the intensive care unit (ICU) where knowledge of renal perfusion could help prevent or manage AKI. However, CEUS was never used nor validated in the ICU and its clinical use remains to be established. Hypothesis and specific aims We hypothesized that evaluation of renal microcirculation with CEUS was feasible and could change medical management in the ICU. To test this hypothesis, we have designed four studies with the following specific aims: 1. Validate preliminary results and improve technical measurements in a sheep model. 2. Demonstrate CEUS’s feasibility and safety in the ICU. Obtain preliminary results of renal microcirculation modifications associated with elective cardiac surgery. 3. Evaluate the impact of CEUS measurements in two clinical situations: a. Circulatory failure requiring noradrenaline infusion b. Type-1 hepato-renal syndrome requiring terlipressin treatment Overall methods and main results 1. In a sheep model in which renal blood flow could be modified pharmacologically and mechanically, we have compared CEUS-derived parameters to measurements of a an implanted flow probe. We found that CEUS derived parameters were highly heterogeneous and that they did not parallel changes in renal blood flow. Technical measurements were improved and simpler protocols designed for further studies. 2. We have performed CEUS studies before and after an elective cardiac surgery in twelve patients. This study was the first attempt to quantify renal microcirculation in critically ill patients and has demonstrated CEUS’s safety and feasibility in ICU. 3. We have compared changes in CEUS-derived parameters under two levels of blood pressure (BP) in twelve patients with circulatory shock. We have established that microcirculatory response to an increase in BP as assessed by CEUS was highly heterogeneous and unpredictable. This finding is consistent with data from large trials and suggest that a CEUS-guided strategy to determine ideal target BP could be tested. 4. We have compared changes in CEUS-derived parameters before and after the administration of terlipressin in four patients with type-1 hepato-renal syndrome. We found dramatic changes in CEUS-derived parameters after terlipressin therapy and perfusion responses appeared variable. Larger studies are necessary to establish the sensitivity and specificity of CEUS to predict terlipressin responsiveness. Conclusions CEUS is safe and feasible in the intensive care unit. CEUS-derived perfusion indices might not fully correlate with renal blood flow as they are indicative of renal microcirculation changes. Further studies are required to establish the significance of CEUS-derived indices changes in clinical practice.

Epoetin-delta (Dynepo Shire Pharmaceuticals, Basing stoke, UK) is a synthetic form of erythropoietin (EPO) whose resemblance with endogenous EPO makes it hard to identify using the classical identification criteria. Urine samples collected from six healthy volunteers treated with epoetin-delta injections and from a control population were immuno-purified and analyzed with the usual IEF method. On the basis of the EPO profiles integration, a linear multivariate model was computed for discriminant analysis. For each sample, a pattern classification algorithm returned a bands distribution and intensity score (bands intensity score) saying how representative this sample is of one of the two classes, positive or negative. Effort profiles were also integrated in the model. The method yielded a good sensitivity versus specificity relation and was used to determine the detection window of the molecule following multiple injections. The bands intensity score, which can be generalized to epoetin-alpha and epoetin-beta, is proposed as an alternative criterion and a supplementary evidence for the identification of EPO abuse.

BACKGROUND Nutritional factors play an important role in the regulation of blood pressure and in the development of hypertension. In this analysis, we explored the associations of 24-hour urinary Na+, K+ and urea excretion with blood pressure levels and the risk of hypertension in the Swiss population, taking regional linguistic differences into account. METHODS The Swiss Survey on Salt is a population based cross-sectional study that included 1336 subjects from the three main linguistic regions (French, German and Italian) of Switzerland. Blood pressure was measured with a validated oscillometric Omron HEM 907 device. Hypertension was defined as current antihypertensive treatment or a mean systolic blood pressure >140 mm Hg and/or diastolic >90 mm Hg, based on eight blood pressure measurements performed at two visits. Na+, K+ and urea excretion were assessed in 24-hour urine collections. We use multiple logistic/linear regressions to explore the associations of urine Na+, K+ and urea with blood pressure / hypertension, taking into account potential confounders and effect modifiers. RESULTS The prevalence of hypertension was 30%, 26% and 17% in the German-, French- and Italian- speaking regions respectively, (p-value across regions

QUESTIONS UNDER STUDY: To update the prevalence of vitamin D insufficiency and to identify factors associated with vitamin D status in the Swiss adult population. METHODS: Data from the 2010-2011 Swiss Study on Salt intake, a population-based study in the Swiss population, was used. Vitamin D concentration in serum was measured by liquid chromatography- tandem mass spectrometry. Major factors that influence vitamin D levels were taken into account. Survey statistical procedures were used to estimate means and prevalences of vitamin D levels and status. Monthly-specific tertiles of vitamin D and ordinal logistic regression were used to determine the associations of covariates of interest with vitamin D status. RESULTS: The prevalences of vitamin D insufficiency (serum 25-hydroxyvitamin D: 20-29.9 ng/ml) and deficiency (

The purpose of this study was to determine the future, in terms of scientific publication, of medical thesis (MT) defended in the Medical School of Lille 2 University (MSL2U) between January 1st, 2001 and December 31st, 2007.The collection of MT published as a corresponding scientific article was realized from PubMed(®). For every corresponding article, we determined the journal Impact Factor (IF), the language of publication and the rank of the student and his MT director in the author list. Analyses were also realized according to the group of speciality of the TM.In all, 11.3% of the 2150 MT defended in the MSL2U were followed up by a scientific publication. The average IF was 2.32 with a median at 1.75 and extreme values from 0 to 14.78. Seventy percent of the articles were published in English. The rank of the student was placed before his MT director (2.06 vs. 3.15). The MT defended by students in the field of medical specialities presented the highest rate of publication (25.1%). The general medicine was the second speciality the most productive in term of number of published articles (n=49) after medical specialities (n=103).The MT director and the PhD students must be more motivated to publish their results. The value of 11.3% could be considered as weak but, because of a huge lack of references, it is impossible to compare our results to those of other French medical schools. It remains important to reform the objectives and the modalities of the writing of a MT: should we not have to turn to thesis called "on article"?

The goal of this study was to investigate the effect of sodium intake on renal tissue oxygenation in humans. To this purpose, we measured renal hemodynamics, renal sodium handling, and renal oxygenation in normotensive (NT) and hypertensive (HT) subjects after 1 week of a high-sodium and 1 week of a low-sodium diet. Renal oxygenation was measured using blood oxygen level–dependent magnetic resonance. Tissue oxygenation was determined by the measurement of R2* maps on 4 coronal slices covering both kidneys. The mean R2* values in the medulla and cortex were calculated, with a low R2* indicating a high tissue oxygenation. Ten male NT (mean age: 26.5±7.4 years) and 8 matched HT subjects (mean age: 28.8±5.7 years) were studied. Cortical R2* was not different under the 2 conditions of salt intake. Medullary R2* was significantly lower under low sodium than high sodium in both NT and HT subjects (28.1±0.8 versus 31.3±0.6 s −1 ; P −1 ; P

INTRODUCTION: Auscultatory nonmercury manual devices seem good alternatives for the mercury sphygmomanometers in the clinic and for research settings, but individual internal validation of each device is time-consuming. The aim of this study was to validate a new technique capable of testing two devices simultaneously, based on the International protocol of the European Society of Hypertension. METHODS: The concept of the new technique is to measure blood pressure alternatively by two observers using a mercury sphygmomanometer and by two observers using the A&D UM-101 and Accoson Greenlight 300 devices, connected by Y-tube to obtain simultaneous readings with both nonmercury devices. Thirty-three participants were enrolled (mean age 47.2+/-14.0 years). Nine sequential blood pressure measurements were performed for each participant. RESULTS: Both devices passed phase 1 using 15 participants. In phase 2.1 (n=33), on a maximum of 99 measurements, the Accoson device produced 81/95/99 measurements within 5/10/15 mmHg for systolic blood pressure (SBP) and 87/98/99 for diastolic blood pressure (DBP). The A&D device produced 86/96/99 for SBP and 94/99/99 for DBP. In phase 2.2 (n=33), 30 participants had at least 2 out of 3 SBP obtained with Accoson device within 5 mmHg of the mercury device, as compared with 29 of 33 participants with the A&D device. For DBP, this was 33 of 33 participants for both devices. CONCLUSION: Both the nonmercury devices passed the International protocol. The new technique of simultaneous device testing using a Y-tube represents a time saving application of the International protocol.