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Resume Les personnes diabetiques, surtout celles atteintes de diabete de type 2, sont assez âgees et leur etat buccodentaire amene regulierement les specialistes implantologistes a questionner le medecin traitant quant a l’existence d’eventuelles contre-indications du fait du statut du patient. On sait, en effet, qu’il existe un sur-risque de parodontopathies (environ x 2 a 3) et de perte dentaire chez les sujets porteurs d’un diabete, de type 1 comme de type 2. L’analyse de la litterature, pourtant particulierement abondante, ne permet de retenir que tres peu d’etudes rigoureuses quant aux conditions et taux de reussite implantaire chez les sujets diabetiques. La plupart manquent de precision quant au statut des diabetiques et portent sur de faibles effectifs. On retiendra des donnees des quelques etudes rigoureuses, des taux de reussite equivalents, ou presque, a ceux enregistres chez des sujets non-diabetiques. Ceci presuppose expertise de l’operateur specialiste d’odontologie, rigueur de son bilan, bonne hygiene buccodentaire, et bon controle glycemique au moment et dans les semaines et mois qui suivent le geste. Ceci implique une collaboration etroite entre les differents acteurs de sante impliques. Il en serait de meme pour que de meilleures etudes soient menees dans le futur en y impliquant les diabetologues.

Neutropenic enterocolitis (NE) is a diagnostic and therapeutic challenge associated with high mortality rates, with controversial opinions on its optimal management. Physicians are usually reluctant to select surgery as the first-choice treatment, concerns being raised regarding the potential risks associated with abdominal surgery during neutropenia. Nevertheless, no published studies comforted this idea, literature is scarce and surgery has never been compared to medical treatment. This review and meta-analysis aimed to determine the prognostic impact of abdominal surgery on outcome of neutropenic cancer patients presenting with NE, versus medical conservative treatment. This meta-analysis included studies analyzing cancer patients presenting with NE, treated with surgical or medical treatment, searched by PubMed and Cochrane databases (1983–2016), according to PRISMA recommendations. The endpoint was hospital mortality. Fixed-effects models were used. The meta-analysis included 20 studies (385 patients). Overall estimated mortality was 42.2% (95% CI = 40.2–44.2). Abdominal surgery was associated with a favorable outcome with an OR of 0.41 (95% CI = 0.23–0.74; p = 0.003). Pre-defined subgroups analysis showed that neither period of admission, underlying malignancy nor neutropenia during the surgical procedure, influenced this result. Surgery was not associated with an excess risk of mortality compared to medical treatment. Defining the optimal indications of surgical treatment is needed.Trial registration PROSPERO CRD42016048952

Febrile neutropenia in cancer patients is associated with a high mortality. Patients are frequently admitted to Intensive Care Unit (ICU) for severe sepsis or septic shock. Empirical antibiotic treatment, including monotherapy β-lactam covering Pseudomonas aeruginosa, must be prompt. The ICU management is slightly different, due to a particular microbial ecology. A standardized approach to obtain a microbiological documentation is the cornerstone in these patients, leading to an adapted antimicrobial treatment. Systematic reassessment of initial antibiotic regimen should be realised. Neutropenic patients with severe sepsis or septic shock should receive promptly a β-lactam-aminoglycoside combination, as well as glycopeptides in case of severity or absence of documented infection. Early catheter removal should be considered widely. In the actual context of growing resistance, antibiotics saving became a major concern. According to context and microbial documentation, an escalade or de-escalade approach is recommended, to take into account multi-resistant pathogens. The addition of antifugal treatment is also a major issue in these patients and has well-defined indications. In neutropenic patients admitted in the ICU for severe sepsis or septic shock, controlling local microbial epidemiology and the emergence of multi-resistant bacteria are the key issues.

Fatal ARDS with diffuse alveolar damage: donor lymphocyte infusion imputability? http://ow.ly/WhxP3034P6s

International audience; BackgroundOrgan failures are the main prognostic factors in septic shock. The aim was to assess classical clinico-biological parameters evaluating organ dysfunctions at intensive care unit admission, combined with proteomics, on day-30 mortality in critically ill onco-hematology patients admitted to the intensive care unit for septic shock. MethodsThis was a prospective monocenter cohort study. Clinico-biological parameters were collected at admission. Plasma proteomics analyses were performed, including protein profiling using isobaric Tag for Relative and Absolute Quantification (iTRAQ) and subsequent validation by ELISA. ResultsSixty consecutive patients were included. Day-30 mortality was 47%. All required vasopressors, 32% mechanical ventilation, 33% non-invasive ventilation and 13% renal-replacement therapy. iTRAQ-based proteomics identified von Willebrand factor as a protein of interest. Multivariate analysis identified four factors independently associated with day-30 mortality: positive fluid balance in the first 24 h (odds ratio = 1.06, 95% CI = 1.01-1.12, P = 0.02), severe acute respiratory failure (odds ratio = 6.14(,) 95% CI = 1.04-36.15, P = 0.04), von Willebrand factor plasma level > 439 ng/ml (odds ratio = 9.7, 95% CI = 1.52-61.98, P = 0.02), and bacteremia (odds ratio = 6.98, 95% CI = 1.17-41.6, P = 0.03). ConclusionEndothelial dysfunction, revealed by proteomics, appears as an independent prognostic factor on day-30 mortality, as well as hydric balance, acute respiratory failure and bacteremia, in critically ill cancer patients admitted to the intensive care unit. Endothelial failure is underestimated in clinical practice and represents an innovative therapeutic target.

Background Ventilator-associated pneumonia (VAP) is a care-related event that could be promoted by immune suppression caused by critical diseases, malignancies and cancer treatments. Low dose of hydrocortisone was proposed for modulation of immune response in the critically ill population. Methods In this monocentric observational study, all cancer patients mechanically ventilated for more than 48 h were included. Effect of low-dose hydrocortisone administered during the first 48 h of mechanical ventilation was evaluated applying inverse probability weighting analysis after propensity score assessment. VAP impact on 1-year mortality, ICU length of stay and mechanical ventilation duration was secondarily determined. Results Within this cohort, 190 cancer patients were followed. VAP was confirmed in 22.1% of cases in the early hydrocortisone group and confirmed in 42.6% of cases in the no or late hydrocortisone group. Early hydrocortisone exhibited a protective effect on the risk of VAP (OR 0.23; 95% CI 0.12–0.44; P

In severe sepsis, guidelines recommend de-escalating the empirical antimicrobial treatment as soon as the microbiological results are available. We aimed to determine the rate of de-escalation of the empirical antimicrobial treatment in neutropenic patients with severe sepsis. The characteristics of antimicrobial treatment associated with de-escalation and its impact on short- and long-term survival were also determined.In the intensive care unit (ICU) of a cancer referral center, we prospectively collected observational data related to the antimicrobial management in neutropenic patients who developed severe sepsis and were admitted to ICU for at least 48 h. De-escalation of antimicrobial therapy consisted either of deleting one of the empirical antibiotics of a combined treatment, or, whenever possible, to use a betalactam antibiotic with a narrower spectrum of activity. Multivariate logistic regression was conducted to determine the factors associated with de-escalation, while a Cox proportional hazards model with a time-dependent covariate was fitted to assess the effect of de-escalation on 30-day survival. Finally 1-year survival after ICU discharge was compared across de-escalation groups.Cumulative incidence of de-escalation of the empirical antimicrobial treatment among the 101 patients of the cohort was 44%, [95% confidence interval (CI) 38-53%], including 30 (68%) patients with ongoing neutropenia. A microbiological documentation was available in 63 (63%) patients. Factors associated with de-escalation were the adequation of the empirical antimicrobial treatment in ICU [OR = 10.8 (95% CI 1.20-96)] for adequate documented treatment versus appropriate empirical treatment, the compliance with guidelines regarding the empirical choice of the anti-pseudomonal betalactam [OR = 10.8 (95% CI 1.3-89.5)]. De-escalation did not significantly modify the hazard of death within the first 30 days [HR = 0.51 (95% CI 0.20-1.33)], nor within 1 year after ICU discharge [HR = 1.06 (95% CI 0.54-2.08)].Our data suggest that, in ICU, de-escalation of the empirical antimicrobial treatment is frequently applied in neutropenic cancer patients with severe sepsis. No evidence of any prognostic impact of this de-escalation was found.

International audience; Background: Major postoperative events (acute respiratory failure, sepsis, and surgical complications) are frequent early after elective gastroesophageal and pancreatic surgery. It is unclearwhether these complications impact equally on long-term outcome. Methods: Prospective observational study including the patients admitted to the surgical intensive care unit between January 2009 and October 2011 after elective gastroesophageal and pancreatic surgery. Risk factors for 30-day major postoperative events and long-term outcome were evaluated. Results: During the study period, 259 patients were consecutively included. Among them, 166 (64%), 54 (21%), and 39 (15%) patients underwent pancreatic surgery, gastric surgery, and esophageal surgery, respectively. Using the Clavien-Dindo classification, 117 patients (45%) developed at least 1 postoperative complication, including 60 (23%) patients with acute respiratory failure, 77 (30%) with sepsis, and 89 (34%) with surgical complications. Themedian followup from the time of intensive care unit admission was 34months (95% confidence interval, 30-37 months). The 1-year survival was 95% (95% confidence interval, 92-98). Among the perioperative variables, postoperative sepsis and an American Society of Anesthesiologists score higher than 2 were independently associated with long-term mortality. In septic patients, death (n=16) was significantly associated with cancer recurrence (n=10; P < .0001). Independent factors associated with postoperative sepsis were a Sequential Organ Failure Assessment score on day 1, a systemic inflammatory response syndrome on day 3, positive intraoperativemicrobiological samples, Simplified Acute Physiology Score II and an American Society of Anesthesiologists score higher than 2 (P < .005). Conclusions: Postoperative sepsis was the only major postoperative event associated with long-termmortality. Postoperative sepsis may reflect a deep impairment of immune response, which is potentially associated with cancer recurrence and mortality. (C) 2015 Elsevier Inc. All rights reserved.

Background The short-term survival of critically ill patients with cancer has improved over time. Studies providing long-term outcome for these patients are scarce. Methods We prospectively analyzed outcomes and rates of successful discharge of 111 consecutive critically ill cancer patients admitted to intensive care unit (ICU) in 2008 and identified factors influencing these results. Results ICU mortality was 32% and hospital mortality was 41%. None of the characteristics of the malignancy nor age or neutropenia were significantly different between survivors and others. Two variables were independently associated with ICU mortality: high Logistic Organ Dysfunction score on day 7 and a diagnosis of viral infection and/or reactivation. The 1-year mortality rate for ICU survivors was 58% and was significantly lower in patients with a diagnosis of acute leukemia or multiple myeloma. Conclusion Organ failure scores on day 7 can predict outcome for cancer patients in the ICU. Viral infection and reactivation appear to worsen the prognosis. One-year mortality rate is high and depends on the malignancy.

Background: Major cancer surgery is a high-risk situation for sepsis in the post-operative period. The aim of this study was to assess the relation between the monocyte production of IL-12 and the development of post-operative sepsis in patients undergoing major cancer surgery. Methods: In 19 patients undergoing major cancer surgery, the production of cytokines by basal and lipolysaccharide (LPS)-stimulated monocytes was measured before and after (from day 1 to day 3 and day 7) surgery. Seven of them developed a post-operative sepsis. Ten healthy volunteers were used as controls for the assessment of pre-operative values. Results: Before surgery, the production of interleukin (IL)-12 p40 by LPS-stimulated monocytes was similar in the patients and the healthy volunteers. The production of IL-12 p40 by unstimulated monocytes was higher in the patients than in the healthy volunteers. IL-12 production did not differ between the septic and the non-septic patients. After surgery, the production of IL-12 p40 was dramatically reduced in the LPS-stimulated monocytes of the septic patients from day 1 to day 3, as compared with that of the non-septic patients. Before surgery, the production of IL-6, IL-10, and IL-1 receptor antagonist (IL-1ra) in the patients was significantly higher than that of the healthy volunteers for both stimulated and unstimulated monocytes. After surgery, the production of these cytokines by both stimulated and unstimulated monocytes of the septic patients was similar to that of the non-septic patients. Intragroup analysis showed significant changes for IL-6, IL-10, and IL-1ra under all conditions, with the exception of changes in unstimulated monocytes of septic patients that were not significant for IL-10 release. Conclusion: After surgery, the septic patients showed drastic failure to up-regulate monocyte LPS-stimulated production of IL-12 p40.

Resume La neutropenie febrile chez le patient d’oncohematologie est une situation a haut risque de mortalite. L’antibiotherapie empirique prescrite dans ce contexte est une veritable urgence medicale qui doit couvrir la majorite des microorganismes habituellement rencontres. Bien que les infections a cocci a Gram positif soient actuellement plus frequentes que celles a bacilles a Gram negatif (BGN), ces dernieres sont associees a une mortalite plus importante. Jusqu’a recemment, l’association d’une betalactamine (BL) active sur Pseudomonas aeruginosa et d’un aminoside representait l’option therapeutique systematique de premiere intention. Il est maintenant recommande de prescrire une BL active sur Pseudomonas aeruginosa en monotherapie. L’adjonction d’un aminoside est proposee en cas de choc septique ou de sepsis severe ou de resistance du BGN. De meme, la prescription de glycopeptides n’est plus systematique, mais elle reste recommandee en cas de choc et/ou hypotension, de colonisation a Staphylococcus aureus resistant a la meticilline, de sepsis cutane ou des parties molles et d’infections sur catheter. La prescription empirique d’antifongiques se discute devant la persistance du syndrome febrile au-dela du cinquieme jour malgre une antibiotherapie suivant les recommandations et lorsque la sortie d’aplasie n’est pas prevue a breve echeance. La reevaluation de l’antibiotherapie initiale doit etre systematique afin de maitriser l’epidemiologie bacterienne locale et limiter l’emergence de germes multiresistants.

Background Patients who undergo major surgery for cancer are at high risk of postoperative sepsis. Early markers of septic complications would be useful for diagnosis and therapeutic management in patients with postoperative sepsis. The aim of this study was to investigate the association between early (first postoperative day) changes in interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) serum concentrations and the occurrence of subsequent septic complications after major surgery. Methods Serial blood samples were collected from 50 consecutive patients for determination of IL-6, PCT and CRP serum levels. Blood samples were obtained on the morning of surgery and on the morning of the first postoperative day. Results Sixteen patients developed septic complications during the first five postoperative days (group 1), and 34 patients developed no septic complications (group 2). On day 1, PCT and IL-6 levels were significantly higher in group 1 (P-values of 0.003 and 0.006, respectively) but CRP levels were similar. An IL-6 cut-off point set at 310 pg ml−1 yielded a sensitivity of 90% and a specificity of 58% to differentiate group 1 patients from group 2 patients. When associated with the occurrence of SIRS on day 1 these values reached 100% and 79%, respectively. A PCT cut-off point set at 1.1 ng ml−1 yielded a sensitivity of 81% and a specificity of 72%. When associated with the occurrence of SIRS on day 1, these values reached 100% and 86%, respectively. Conclusions PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

Cancer patients present a high risk of sepsis and are exposed to cardiotoxic drugs during chemotherapy. Myocardial dysfunction is common during septic shock and can be evaluated at bedside using echocardiography. The aim of this study was to identify early cardiac dysfunctions associated with intensive care unit (ICU) mortality in cancer patients presenting with septic shock.Seventy-two cancer patients admitted to the ICU underwent echocardiography within 48 h of developing septic shock. History of malignancies, anticancer treatments, and clinical characteristics were prospectively collected.ICU mortality was 48%. Diastolic dysfunction (e' ≤8 cm s(-1)) was an independent echocardiographic parameter associated with ICU mortality {odds ratio (OR) 7.7 [95% confidence interval (CI), 2.58-23.38]; P0.001}. Overall, three factors were independently associated with ICU mortality: sepsis-related organ failure assessment score at admission [OR 1.35 ( 95% CI, 1.05-1.74); P=0.017], occurrence of diastolic dysfunction [OR 16.6 (95% CI, 3.28-84.6); P=0.001], and need for conventional mechanical ventilation [OR 16.6 (95% CI, 3.6-77.15); P0.001]. Diastolic dysfunction was not associated with exposure to cardiotoxic drugs.Early diastolic dysfunction is a strong and independent predictor of mortality in cancer patients presenting with septic shock. It is not associated with exposure to cardiotoxic drugs. Further studies incorporating monitoring of diastolic function and therapeutic interventions improving cardiac relaxation need to be evaluated in cancer patients presenting with septic shock.

Resume Pour diminuer les risques de l'auto-analgesie controlee dus a une mauvaise utilisation, un enseignement du personnel infirmier a ete mis en place et evalue. Une formation theorique et pratique a ete completee par une mise en situation fictive. L'evaluation a ete faite a distance de l'enseignement. Des erreurs ont ete notees dans la preparation de la morphine et dans la manipulation de la ligne veineuse. Toutes les erreurs de programmation ont pu etre spontanement corrigees par les infirmieres. Le constat de ces echecs a permis d'elaborer des precautions d'utilisation pour renforcer la securite. Cette formation a rendu possible la creation, dans chaque unite de soins, d'un reseau d'infirmiers referents, qui a contribue a la diffusion de cette technique. L'auto-analgesie est utilisee en routine dans tout le departement de chirurgie pour traiter la douleur postoperatoire avec une securite accrue.

Trichosporon asahii has been reported as an increasingly common cause of disseminated fungal sepsis, especially in patients who have neutropenia and cancer. In this situation, the mortality rate is very high despite amphotericin B therapy. We report a case of disseminated T. asahii infection in a 17-year-old neutropenic patient with acute leukemia, septic shock, and acute respiratory distress syndrome (ARDS) who was treated successfully with amphotericin, voriconazole, and splenectomy. She experienced acute respiratory failure during chemotherapy for acute myeloid leukemia. Treatment with broad-spectrum antibiotics, amphotericin B, and voriconazole was followed by improvements in the septic shock and ARDS. Despite neutropenia recovery, she had a persistent fever and numerous splenic abscesses. Splenectomy was performed. She became afebrile 10 days later and was discharged from the hospital 4 months after ICU admission. Surgical treatment of deep fungal abscesses may be necessary when systemic antifungal treatment alone fails.

Electrical resistance of M1/M3 stack for Aluminium based technology showed anomalous values when no Ti is inserted between AlCu and cap TiN. Process investigations lead to suspect formation of AlN layer at this interface. Blanket wafers were processed at different temperatures to reproduce the layer formation and characterize the film by numerous techniques including XPS and EELS-TEM profiling. Full use of the different results shows the formation of a very thin (a few nms) and highly resistive AlN layer at the cap TiN / AlCu interface as well as a thicker but less resistive AlN layer at the bottom TiN / AlCu interface. PVD process changes were attempted to reduce the M1/M3 button stack resistance. Modification of the N2/Ar flow ratio for TiN sputtering shows slightly more stoechiometric TiN with reduced stack resistance by 35%.

During the qualification phase of a 0.25 mum technology node for power and RF applications, the reliability test was degraded on the voltage breakdown (Vbd) of the gate oxide, with a potential root cause due to oxide itself. A partitioning has been done on common root causes without any result: gate oxide thinning on shallow trench isolation (STI) corner, charging during a process operation, poly-silicon deposition, gate oxide pre-clean. Failure analysis on the bad parts was not successful to solve the problem. Therefore a specific test method has been developed in order to identify the leaky parts without destroying them whereas the reliability test does. Failure analysis has confirmed that the breakdown was coming at the edge of the poly-silicon gate, and that the gate oxide has a good integrity. Data analysis with the implementation of the new test has pointed out the silicide module. Then salicide and spacer module experiments have been done and the fixes were spacer oxide deposition pressure and bridging removal.

The overall prognosis of critically ill patients with cancer has improved during the past decade. The aim of this study was to identify early prognostic factors of intensive care unit (ICU) mortality in patients with cancer. We designed a prospective, consecutive, observational study over a one-year period. Fifty-one cancer patients with septic shock were enrolled. The ICU mortality rate was 51% (26 deaths). Among the 45 patients who benefited from transthoracic echocardiography evaluation, 17 showed right ventricular dysfunction, 18 showed left ventricular diastolic dysfunction, 18 showed left ventricular systolic dysfunction, and 11 did not show any cardiac dysfunction. During the first three days of ICU course, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in patients presenting cardiac dysfunctions compared to patients without any cardiac dysfunction. Multivariate analysis discriminated early prognostic factors (within the first 24 hours after the septic shock diagnosis). ICU mortality was independently associated with NT-proBNP levels at day 2 (odds ratio, 1.2; 95% confidence interval, 1.004 to 1.32; p = 0.022). An NT-proBNP level of more than 6,624 pg/ml predicted ICU mortality with a sensitivity of 86%, a specificity of 77%, a positive predictive value of 79%, a negative predictive value of 85%, and an accuracy of 81%. We observed that critically ill cancer patients with septic shock have an approximately 50% chance of survival to ICU discharge. NT-proBNP was independently associated with ICU mortality within the first 24 hours. NT-proBNP could be a useful tool for detecting high-risk cancer patients within the first 24 hours after septic shock diagnosis.

Early identification of high-risk patients undergoing major surgery can result in an aggressive management affecting the outcome.We designed a prospective cohort study of 93 adult patients undergoing major oncological surgery to identify the predictive risk factors for developing postoperative severe sepsis.Nineteen of 93 patients developed a severe sepsis after surgery; seven of the septic patients died in intensive care unit. Multivariate analysis discriminated preoperative and postoperative (first and second day after surgery) predictive risk factors. The postoperative severe sepsis was independently associated with preoperative factors like male gender (OR 4.7, 95% CI between 1.5 and 15.5, P0.01) and Charlson co-morbidity index (OR 1.3, 95% CI between 1.07 and 1.6, P0.01). After the surgery, the presence of systemic inflammatory response syndrome (OR 4.0, 95% CI between 1.02 and 15.7, P0.05) and a logistic organ dysfunction score on day 2 (OR 3.3, 95% CI between 1.9 and 5.7, P0.001) were found as independent predictive factors.We have shown that some of the markers that can be easily collected in the preoperative or postoperative visits can be used to screen the patients at high risk for developing severe sepsis after major surgery.

Background and Aim Acute myeloid leukemia (AML) at diagnosis can be an emergency. Induction mortality reaches 5 to 15% for patients under 60 years of age, and 15 to 30% for subjects over 60. 10 to 34% of patients will require a shift to intensive care unit (ICU) during induction and most of organ failures occur in the first few days. To optimize and improve the initial management of AML, we selected patients with high risk of induction mortality based on white blood cell count (WBC) ≥ 50 G/l and thrombocytopenia ≤ 50G/l at diagnosis. These patients were systematically admitted into ICU even without organ failure. Patients and Methods Our study was conducted in two hospitals, between 1st January 2000 and 31thDecember 2010. We included patients with newly diagnosed AML, aged 18 to 75 years, with both WBC ≥ 50G/l and platelets ≤ 50G/l, and no organ failure (group 1). 41 patients transferred to ICU based on conventional criteria (organ failure) during this period were not included in the study. Patients were directly admitted in ICU for diagnosis and treatment of AML(induction chemotherapy), and were jointly managed by both the intensivist and the hematologist. Patients were discharged from ICU without any non-hematological organ failure. Results were compared to a control group of similar patients admitted in another university hospital were high-risk patients are managed conventionnaly (ie no systematic ICU transfer in the absence of organ failure) (group 2). We defined organ failure by the requirement of mechanical ventilation for respiratory deficiency, renal remplacement therapy for renal failure, vaso-active drugs for hemodynamic and heart failure and when glasgow score was Results 130 patients were included, 50 patients in group 1 and 79 patients in group 2. Neither age at diagnosis and AML characteristics differed significantly between the two groups, nor complete remission rate(80% versus 70,5%) and relapse rate(55% versus 49%). 18 patients (36%) presented organ failure in group 1, 9 (11%) in group 2. The median time between induction and organ failure was 1 day(1-6) in group 1 and 3 days (1-24) in group 2. The main organ failure was acute respiratory failure, with 10 patients (56%) who needed invasive mechanical ventilation in group 1 and 8 (89%) in group 2. In group 1, renal replacement therapy and vaso-active drugs was used in 4 (22%) and 6 (33%) patients, respectively, versus 3 (33%) and 7 patients (78%), respectively, in group 2. The median length of stay in ICU was 5 days in patients without organ failure in group 1 (2-18), 11,5 days in patients with organ failure in group 1 (4-45), and 6 days in group 2 (1-37). Overall survival was not significantly different between the two groups (p 0.28). Six patients (12%) died in the group 1 at day 30 of induction chemotherapy, 14 patients (18%) in the group 2. Concerning patients who developed organ failure, the 30 days survival was significantly better in patients already monitored in ICU (group 1), 67 %, versus 22% in group 2 (p=0.02). The overall survival of patients of group 1 who had presented organ failure but alive after their ICU stay, was not statistically different compared to patients of group 1 without organ failure during induction (median 8 months versus 16 months, p 0,09). Conclusion There were more critical patients in the study group, but their 30 days survival was significantly better than in patients with organ failure in the control group. However, overall survival of the two groups was comparable. This study highlights a new strategy to improve initial management of AML. The rapid onset of complications ( Disclosures: No relevant conflicts of interest to declare.

Introduction In severely neutropenic septic acute respiratory distress syndrome (ARDS) patients, macrophages and monocytes are the last potentially remaining innate immune cells. We have previously shown, however, a deactivation of the alveolar macrophage in neutropenic septic ARDS patients. In the present study, we tried to characterize in vitro monocyte baseline cytokine production and responsiveness to lipopolysaccharide exposure. Methods Twenty-two consecutive patients with cancer were prospectively enrolled into a prospective observational study in an intensive care unit. All patients developed septic ARDS and were divided into two groups: neutropenic patients (n = 12) and non-neutropenic patients (n = 10). All of the neutropenic patients received granulocyte colony-stimulating factor whereas no patient in the non-neutropenic group received granulocyte colony-stimulating factor. We compared monocytes from neutropenic patients with septic ARDS with monocytes from non-neutropenic patients and healthy control individuals (n = 10). Peripheral blood monocytes were cultured, and cytokine levels (TNFα, IL-1β, IL-6, IL-10, and IL-1 receptor antagonist) were assayed with and without lipopolysaccharide stimulation. Results TNFα, IL-6, IL-10 and IL-1 receptor antagonist levels in unstimulated monocytes were lower in neutropenic patients compared with non-neutropenic patients. Values obtained in the healthy individuals were low as expected, comparable with neutropenic patients. In lipopolysaccharide-stimulated monocytes, both inflammatory and anti-inflammatory cytokine production were significantly lower in neutropenic patients compared with non-neutropenic patients and control individuals. Conclusion Consistent with previous results concerning alveolar macrophage deactivation, we observed a systemic deactivation of monocytes in septic neutropenic ARDS. This deactivation participates in the overall immunodeficiency and could be linked to sepsis, chemotherapy and/or the use of granulocyte colony-stimulating factor.

Resume La presence de fer ferrique accroit fortement les vitesses de gonflement du copolymere Hycar 4021 en milieu chlorhydrique aqueux ou ethanolique. La fixation de l'element metallique sur le copolymere correspond a un phenomene de partage et s'accompagne de la distribution d'especes chimiques non strictement necessaires au maintien de l'electroneutralite de la phase solide. Leurs proportions relatives sont etablies. Elles definissent des composes quasi-stoechiometriques internes.

Resume La mesure des coefficients de distribution d'importantes quantites de fer ferrique en milieu ethanol chlorhydrique sur le copolymere Hycar 4021 et la determination de la diffusivite de l'ion metallique en phase solide permettent la connaissance du role de l'ethanol sur la fixation du fer par le copolymere. Par ailleurs on met en evidence que des traces de fer(III) ne sont pas fixees par le copolymere selon le meme processus que des quantites plus importantes.

The different parameters affecting the separation characteristics by pervaporation of a benzene—n-heptane mixture on poly(butadiene—acrylonitrile) (NBR) and poly(butadiene —styrene) (SBR) membranes were investigated. A selectivity for benzene of between 2 and 8 may be obtained with pervaporation rates from 600 to 20 μm-l/hr-m 2 . In the ranges investigated, level of curing agent, agitation and downstream pressure factors have a negligible effect compared with membrane composition, temperature and feed composition.

A simple mathematical model based on a well-known flow equation permits determination of progressive strains at all points within a viscous slab flowing in an inclined rectangular channel. Differences in strain patterns between central and lateral domains of the slab may aid in determining boundary effects within natural structures formed by gravity-sliding.

The pervaporation of binary mixtures through moderately swelling membranes is analyzed as a solution—diffusion process, on the assumption that the diffusion coefficient of each permeant is an exponential function of both concentrations. A model is derived in which changes in selectivity and fluxes are related to major external conditions: the upstream mole fraction in the feed and the downstream total pressure of the pervaporate. This model leads to the computation of the pervaporation selectivity and the fluxes as a function of the parameters of the model. Numerical examples are given, relative to different shapes of curves for selectivity and fluxes. A flowsheet is given and allows, through the comparison with experimental results, the determination of the parameters of the model. Internal concentration profiles in the membrane may also be computed. In order to test the validity of this model, it has been applied to a set of experimental data for the pervaporation of hydrocarbon binary mixtures through nitrile—butadiene and styrene—butadiene copolymers.

The permeation characteristics and the selectivity of four nitrile rubber films with respect to 1,3-butadiene and isobutene were studied as a function of experimental conditions and the nature of membrane material. A specific research apparatus was developed, allowing the determination of both permeation rate and selectivity, at a temperature varying between 0° and 30°C and under a pressure of from 1 to 3 bars. The inverse proportion of permeation rate to membrane thickness was verified for a thickness of from 12 to 500 microns. An increase in temperature promotes liquid permeation and is detrimental to gas permeation, the latter being facilitated by an increase in pressure. The introduction of an inert gas pressure on the liquid did not bring about an increase in the liquid permeation rate. The permeation rate decreases as a result of an increase in the proportion of acrylonitrile in the rubber, which also affects selectivity; the latter reaches a maximum value when said proportion is about 23%. The effect of the composition of the feed mixture was also studied and curves were determined relating, simultaneously, selectivity and permeation rate to the 1,3-butadiene content. Selectivity is maximal with mixtures having a very high 1,3-butadiene content. The solubilities of 1,3-butadiene and of isobutene in the four types of nitrile rubber were measured at 0°C and at 20°C (68°F). Selectivity can be interpreted in terms of the solubilities of the two hydrocarbons.

Iris epithelial cells of adult newts, which are fully differentiated melanocytes and non-dividing, become dedifferentiated and converted into lens cells when put in culture. A recent study shows that this dedifferentiation is based on an autophagic process which is associated with proliferation and mainly affects melanosomes. The present report shows that in primary culture of iris epithelial cells after the majority of melanosomes have disappeared, myelinoid bodies, which are interpreted to be telolysosomes of autophagic nature, appear in high frequencies. This suggests that in these cells autophagy persists after the loss of melanosomes. A possible connection of this type of autophagy with the differentation of lens fiber which occurs in this culture is discussed. In the TVI cell line which is believed to be derived from the same cell type, but devoid of melanosomes, similar myelinoid bodies are a characteristic cell component, suggesting that the tendency for autophagy is inherited in this cell line.

This investigation compares the effects of single and double doses of nitrazepam (5 and 10 mg) and zopiclone (7.5 and 15 mg) and placebo for 1 night in 40 psychiatric patients. The results indicate that zopiclone is an active hypnotic compound, comparable in its effects to those of nitrazepam, the higher dosage being best adapted to the type of patients included in the study.

Zopiclone is a non-benzodiazepine hypnotic with a pharmacological spectrum of activity which resembles that of the benzodiazepines (BZD), but it binds to the GABA complex at a site different from the BZD receptor. Pharmacokinetic properties class ZPC in the category of hypnotics with intermediate-short half-life (5-7 hours) and explain the low incidence of unwanted effects reported. The influence of zopiclone 7.5 mg on sleep architecture is minimal. In healthy volunteers, the amount of deep sleep is increased. No depressant effect on respiratory function and no rebound effect has been demonstrated.

The ultrastructure of dedifferentiating iris epithelial cells of adult newts was studied in vitro, under the conditions which allow subsequent conversion into lens cells. The dense population of melanosomes which characterize the normal differentiated cells are progressively lost before the cells convert into lens cells. The loss of melanosomes is accompanied by the appearance of a layer of material of intermediate density surrounding the melanosomes. Subsequently vacuoles of various sizes appear in which melanosomes, ribosomes, and multivesicular bodies are sequestered. Further observations suggest that these affected organelles are destined for exocytosis. The cytochemical test for acid phosphatase is positive in the immediate vicinity of melanosomes, in the melanosome clusters, and in the multivesicular bodies. On the other hand, normal iris epithelial cells in situ are negative to the acid phosphatase test. The results are interpreted to indicate that autophagy and exocytosis of melanosomes and other organelles occur during the dedifferentiation of iris epithelial cells.

The pervaporation of binary mixtures through moderately swollen membranes is analyzed as a’ solution-Diffusion’ process and on the assumption that the diffusivity of each permeant is an exponential function of both concentrations. A model is derived, in which changes in selectivity and fluxes are related to major external conditions: the upstream mole fraction in the feed and the downstream total pressure of the pervaporate. In order to test the validity of this model, it has been applied to a set of experimental data for the pervaporation of hydrocarbon binary mixtures through rubber membranes.