Summary We have analysed the contribution of the Msn2/4 transcription factors and the Ras‐cAMP‐proteine kinase A (PKA) pathway to the control of the yeast H 2 O 2 response. Strains deleted for MSN2 and MSN4 are hypersensitive to H 2 O 2 , although they can still adapt to this oxidant. They are also unable to induce 27 proteins of the H 2 O 2 stimulon as shown by quantitative two‐dimensional gel analysis. This peculiar H 2 O 2 tolerance defect, the nature of the proteins of the Msn2/4 regulon, and the partial overlap of this regulon with the Yap1 H 2 O 2 ‐response regulon, suggest an independent and distinctive role of these two H 2 O 2 stress response pathways. A strain lacking PDE2 , and therefore carrying high intracellular cAMP levels, is also hypersensitive to H 2 O 2 . In the presence of exogenous cAMP, this strain does not induce the entire H 2 O 2 Msn2/4 regulon and some other proteins. This, and the normal H 2 O 2 induction of a gene reporter under control of the Yap1 regulator when intracellular cAMP level are high, demonstrate that the Ras‐cAMP pathway negatively affects the H 2 O 2 stress response through Msn2/4. However, the high H 2 O 2 sensitivity of a strain lacking the PKA‐negative regulatory subunit Bcy1, is not only the consequence of the inhibition of Msn2/4 but also of Yap1 through a yet undefined mechanism.
Heated and humidified high flow nasal cannula oxygen therapy (HFNC) represents a new alternative to conventional oxygen therapy that has not been evaluated in the emergency department (ED). We aimed to study its feasibility and efficacy in patients exhibiting acute respiratory failure presenting to the ED.Prospective, observational study in a university hospital's ED. Patients with acute respiratory failure requiring > 9 L/min oxygen or with ongoing clinical signs of respiratory distress despite oxygen therapy were included. The device of oxygen administration was then switched from non-rebreathing mask to HFNC. Dyspnea, rated by the Borg scale and a visual analog scale, respiratory rate, and S(pO(2)) were collected before and 15, 30, and 60 min after beginning HFNC. Feasibility was assessed through caregivers' acceptance of the device in terms of practicality and perceived effect on the subjects, evaluated by questionnaire.Seventeen subjects, median age 64 y (46-84.7 y), were studied. Pneumonia was the most common reason for oxygen therapy (n = 9). HFNC was associated with a significant decrease in both dyspnea scores: Borg scale from 6 (5-7) to 3 (2-4) (P < .001), and visual analog scale from 7 (5-8) to 3 (1-5) (P < .01). Respiratory rate decreased from 28 breaths/min (25-32 breaths/min) to 25 breaths/min (21-28 breaths/min) (P < .001), and S(pO(2)) increased from 90% (88.5-94%) to 97% (92.5-100%) (P < .001). Fewer subjects exhibited clinical signs of respiratory distress (10/17 vs 3/17, P = .03). HFNC was well tolerated and no adverse event was noted. Altogether, 76% of healthcare givers declared preferring HFNC, as compared to conventional oxygen therapy.HFNC is possible in the ED, and it alleviated dyspnea and improved respiratory parameters in subjects with acute hypoxemic respiratory failure.
Hospital length of stay (days) and revenues per day (euros) could be different depending on admission mode. To determine the impact of admission mode as a function of clinical pathway, we conducted the present study. Data sources: We included 159,206 admissions to three academic hospitals during a four-year period. Data were obtained from the electronic system of the hospital trust.A case (through-emergency department)-control (elective (EA)) study was conducted (77,052), matched by age, stay severity and type, disease-related group, and discharge mode. Principal findings: Through-emergency department were significantly elderly, more severe, had more intensive care stays, a higher mortality rate, longer length of stay (days) (9.5 ± 12 vs. 6.8 ± 9.5; p < 0.0001), and lower revenues per day (647 ± 451 vs. 721 ± 422; p = 0.01). In case-control study, mean differences between cases and controls were: longer length of stay -0.64 and revenues per day -75.6; for ≥75 years -1.2 and -102.1; medical -0.9 and -90.4; and discharge to facilities care centers -1.5 and -81.8. Among cases, 40% had a stay in observation unit before being admitted in hospital ward. Differences were strongly reduced for patients who did not go to observation unit before being admitted. Differences were reduced from 0.64 to 0.2 days for length of stay and from 79 to 41 euros for revenues per day when patients did not stay in observation unit before being admitted.We conclude that admission mode is associated with length of stay and revenues. However, as differences are weak, elective admissions should not be prioritized on economic arguments. Otherwise, our study indicates that among through-emergency department admissions, observation unit stay is associated with longer length of stay and lower revenues.
Les besoins d’adaptation de la main-d’œuvre aux evolutions du marche du travail different selon les metiers. En Bretagne, une dizaine de professions presente des enjeux de renouvellement tandis que sept autres comportent des enjeux de reconversion. Ces besoins d’adaptation varient egalement selon les territoires, au gre de la dynamique locale des metiers et de leur poids relatif dans l’emploi total. Ils mettent en exergue huit groupes de zones d’emploi en Bretagne et mobilisent des leviers qui varient entre formation et mobilite professionnelle.
Etude experimentale et numerique de la dispersion de taylor dans un tube capillaire. Mise en oeuvre d'une methode d'etude d'un milieu poreux (dit d'injection et retour) dans un systeme de tubes capillaires. Les milieux stratifies constituent un cas modele de milieu heterogene. On etudie la dispersion en fonction du debit, de la distance parcourue et de l'epaisseur des couches
Abstract Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease ( P = 0.008), worse SAPS II ( P < 0.0001), flail chest ( P = 0.02), worse Injury Severity Score ( P = 0.0003), higher respiratory rate at admission ( P = 0.02), alcohol withdrawal syndrome ( P < 0.001), and noninvasive ventilation ( P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. Conclusions EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.
