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Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P = 0.036), and on day 3, creatinine (P = 0.025), drain fluid amylase concentration (P = 0.023), lipase concentration (P0.001), and C-reactive protein (CRP) concentration (P0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring.

Pierre des Noyers, secretary of Queen of Poland Louise-Marie Gonzaga, is known for his role as a messenger, envoy, court journalist and sometimes propagandist. His work as an unofficial diplomat for the Queen and ambassador for France is less famous though no less interesting. Even though he was already quite involved in these time-consuming tasks, Pierre des Noyers also acted as a scientific intermediary for the quite curious Queen Louise-Marie of Poland. He maintained contacts with many scholars from France and Italy. He could nurture this network thanks to his position as an informal diplomat at the court of the Queen and his dedication to science in general. Even by discarding his most official and political letters, his known correspondence amounts to several hundred letters written in a period of around 50 years to various friends and scholars. Roberval, Gassendi, Boulliau, Hevelius or Pascal are among these contacts and he plays for most of them the role of a scientific intermediary sharing with them observations, books and anecdotes. His letters are filled with astronomical observations, prodigies and prophecies. Des Noyers was alsoa practitioner of science. Having possessed a rather large collection of scientific instruments he always sought the improved ones and his daily life was marked by scientific studies. He wrote meteorological bulletins for Academia del Cimento in Florence, studied the measurement of time, observed the sun and showed interest in the inner workings of the human body. This article will delve further into more scientific aspects of Pierre des Noyers’s life, both at the court of Louise-Marie and outside. The first part presents a rough overview of the secretary’s contacts in the scientific environment of 17th Century France and how they were used to connect scholars from Poland with this environment. The second part of this work presents Pierre des Noyers’s practice of science as a tool to understand the world and for which utmost diligence in measurement and practice is required. The last part focuses on des Noyers’s application of this scientific method in two, now pseudo-scientific fields: astrology and divination., Pierre des Noyers, sekretarz Ludwiki Marii Gonzagi – królowej Polski, znany jest jako poseł, ambasador, nadworny dziennikarz oraz propagandysta. Jego praca jako nieoficjalnego dyplomaty królowej i ambasadora Francji jest natomiast mniej znana, chociaż nie mniej interesująca. Pomimo tego czasochłonnego zaangażowania, Pierre des Noyers działał również jako pośrednik naukowy dla zaciekawionej królowej. Utrzymywał on kontakty z wieloma uczonymi z Francji i Włoch, a do rozwoju tej sieci powiązań przyczyniała się zarówno pozycja nieformalnego dyplomaty na dworze królowej jak i oddanie nauce. Nie wliczając listów oficjalnych i politycznych, jego korespondencja prywatna, prowadzona z przyjaciółmi i uczonymi na przestrzeni 50 lat, liczy kilkaset listów. Wśród tych kontaktów są Roberval, Gassendi, Boulliau, Heweliusz oraz Pascal, a dla większości z nich odgrywa on rolę naukowego pośrednika dzieląc się z nimi obserwacjami, książkami i anegdotami. Jego korespondencja obfituje w obserwacje astronomiczne, przepowiednie i opisy zjawisk nadzwyczajnych. Pierre des Noyers prowadził również własne badania. Posiadając stosunkowo liczną kolekcję instrumentów naukowych zawsze poszukiwał ulepszonych narzędzi, a jego codzienne życie znaczone było pracą badawczą. Pisał biuletyny meteorologiczne dla florenckiej Academia del Cimento, prowadził badania nad pomiarem czasu, obserwał słońce oraz interesował się wewnętrznym funkcjonowaniem ludzkiego ciała. W niniejszym artykule zagłębimy się w bardziej naukowe aspekty życia Pierre’a des Noyers, zarówno na dworze Ludwiki Marii, jak i poza nim. W pierwszej części przedstawiony został zarys jego kontaktów w środowisku naukowym XVII-wiecznej Francji oraz w jaki sposób były one wykorzystywane do łączenia z tym środowiskiemuczonych z Polski. Druga część pracy przedstawia jego badania naukowe, które traktował jako narzędzie do zrozumienia świata, do czego potrzebna jest najwyższa staranność w pomiarze i praktyce. Ostatnia część skupia się na zastosowaniu przez des Noyersa tej naukowej metody w dwóch, obecnie pseudonaukowych dziedzinach: astrologii i wróżbiarstwie.

BackgroundAcute respiratory failure (ARF) is a life-threatening complication in onco-hematology patients. Optimal ventilation strategy in immunocompromised patients has been highly controversial over the last decade. Data are lacking on patients presenting with ARF associating isolated cardiac dysfunction or in combination with another etiology. The aim of this study was to assess prognostic impact of initial ventilation strategy in onco-hematology patients presenting ARF with associated cardiac dysfunction.MethodsWe conducted an observational retrospective study in Institut Paoli-Calmettes, a cancer-referral center, assessing all critically ill cancer patients admitted to the ICU for a ARF with cardiac dysfunction.ResultsBetween 2010-2017, 127 patients were admitted. ICU and hospital mortality were 29% and 57%. Initial ventilation strategy was invasive mechanical ventilation (MV) in 21%. Others ventilation strategies were noninvasive ventilation (NIV) in 50%, associated with oxygen in 21% and high flow nasal oxygen (HFNO) in 29%, HFNO alone in 6% and standard oxygen in 23%. During ICU stay, 48% of patients required intubation. Multivariate analysis identified 3 independent factors associated with ICU mortality: SAPSII at admission (OR = 1.07/point, 95%CI = 1.03-1.11, pConclusionIn onco-hematology patients admitted for ARF with associated cardiac dysfunction, severity at ICU admission, invasive fungal infections and initial ventilation strategy were independently associated with ICU mortality. NIV was a protective factor on ICU mortality.