BackgroundMindfulness-Based Stress Reduction (MBSR) has demonstrated benefits in chronic conditions such as cancer, chronic pain, cardiovascular disease, and type 2 diabetes. However, evidence in chronic obstructive pulmonary disease (COPD) remains limited, particularly regarding the feasibility of implementing a full standardized program within pulmonary rehabilitation.MethodsThis prospective pilot study evaluated the feasibility of delivering a standardized 8-weeks MBSR program to people with COPD enrolled in pulmonary rehabilitation. Feasibility outcomes included recruitment, program completion, attendance at group sessions, home practice, and reasons for withdrawal. Adherence was conceptualized as behavioral engagement, assessed through predefined measures (session attendance and weekly self-reported home practice), and interpreted post hoc using thresholds commonly applied in previous MBSR feasibility studies (attendance ≥6/8 sessions; home practice ≥3 days/week). Reasons for discontinuation were collected by phone or email follow-up. Descriptive statistics were used.ResultsEighteen people with COPD (56% women, mean age 68 (±7.4) years; mean FEV1 48 (±16%) predicted) were enrolled. 14 participants (78%) completed the program, and 86% attended at least eight of nine sessions. Participants reported an average of 4.4 (±2.3) days of home practice per week, indicating regular engagement despite inter-individual variability. Reasons for withdrawal included musculoskeletal pain (n = 2) and limited availability (n = 2).ConclusionsThe standardized, in-person 8-weeks MBSR program was feasible in people with COPD undergoing pulmonary rehabilitation, as reflected by their regular attendance at hospital sessions and reported engagement in home practice. This structured context likely supported adherence and program fidelity, but its generalizability to individuals with reduced mobility or clinical instability remains uncertain. Future research should evaluate the feasibility of extending this approach to broader COPD populations and its potential psychological and clinical benefits.

OBJECTIVE:The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. DATA SOURCES:MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. METHODS:Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. PRIMARY ENDPOINT:In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. DISCUSSION:This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?'Protocol version 0.4 - 06/26/2023PROSPERO registration:CRD42021278869.

BackgroundOnly one third of European countries use intermediate care units (IMCs). An IMC makes it possible to manage patients who do not require intensive care but who need a higher level of nursing care that cannot be provided on the general ward. In Belgium, there are no national criteria for ICU admission or discharge, and no policies regarding IMC care or for differentiating ICU intensity levels.Aim/sThe aim of our study was to analyse the profile of ICU patients in Belgium on the basis of registered nursing activity in order to quantify the number of ICU days potentially transferable to an IMC.Study DesignThe study was conducted on 310 ICU beds. Patients admitted to the study were recruited during two different one-month periods in 2018 and were included into a prospective database that evaluated nursing workload carried out in 15 hospitals in the French-speaking part of Belgium. The number of ICU days that could be supported on an IMC was defined according to the Nursing Activities Score (NAS) items.ResultsA total of 3279 ICU patients for a total of 13 942 ICU days were included. 4987 days (35.8%) were considered as "transferable" to an IMC. The proportion of ICU days transferable to an IMC was highly variable among hospitals, ranging from 20.4% to 59.5% of all ICU days. On the day of ICU admission, 665/2142 (31.0%) of the patients were already identified as transferable to an IMC; this percentage significantly increased on day 2 (972/2066, 47.1%) and day 3 (650/1390, 46.7%).ConclusionsIn Belgian ICUs, 35.8% of ICU hospital days, as per recorded NAS, do not necessitate intensive monitoring. These 35.8% of days of ICU hospitalization could be supported on an IMC.Relevance for Clinical PracticeIn this study, a significant number of days spent in the ICU could be supported on an IMC, this could alleviate the workload of nurses and reduce the occupancy rate of intensive care units.

Background: Right ventricular (RV) dysfunction remains a major problem after heart transplantation and may be associated with brain death (BD) in a donor. A calcineurin inhibitor tacrolimus was recently found to have beneficial effects on heart function. Here, we examined whether tacrolimus might prevent BD-induced RV dysfunction and the associated pathobiological changes. Methods: After randomized tacrolimus (n = 8; 0.05 mg·kg−1·day−1) or placebo (n = 9) pretreatment, pigs were assigned to a BD procedure and hemodynamically investigated 1, 3, 5, and 7 h after the Cushing reflex. After euthanasia, myocardial tissue was sampled for pathobiological evaluation. Seven pigs were used as controls. Results: Calcineurin inhibition prevented increases in pulmonary vascular resistance and RV-arterial decoupling induced by BD. BD was associated with an increased RV pro-apoptotic Bax-to-Bcl2 ratio and RV and LV apoptotic rates, which were prevented by tacrolimus. BD induced increased expression of the pro-inflammatory IL-6-to-IL-10 ratio, their related receptors, and vascular cell adhesion molecule-1 in both the RV and LV. These changes were prevented by tacrolimus. RV and LV neutrophil infiltration induced by BD was partly prevented by tacrolimus. BD was associated with decreased RV expression of the β-1 adrenergic receptor and sarcomere (myosin heavy chain [MYH]7-to-MYH6 ratio) components, while β-3 adrenergic receptor, nitric oxide-synthase 3, and glucose transporter 1 expression increased. These changes were prevented by tacrolimus. Conclusions: Brain death was associated with isolated RV dysfunction. Tacrolimus prevented RV dysfunction induced by BD through the inhibition of apoptosis and inflammation activation.

OBJECTIVE: The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. DATA SOURCES: MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. METHODS: Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. PRIMARY ENDPOINT: In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. DISCUSSION: This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?' Protocol version 0.4 - 06/26/2023 PROSPERO registration: CRD42021278869

To explore the impact of omecamtiv mecarbil (OM) on the gene expression profile in adult male rats. Fourteen male Wistar rats were randomly assigned to a single OM (1.2 mg/kg/h; n = 6) or placebo (n = 8) 30-min infusion. Echocardiography was performed before and after OM infusion. Seven days after infusion, rats were euthanized, and left ventricular (LV) tissues were removed for real-time quantitative polymerase chain reaction (RTq-PCR) experiments. After OM infusion, pro-apoptotic Bax-to-Bcl2 ratio was decreased, with increased Bcl2 and similar Bax gene expression. The gene expression of molecules regulating oxidative stress, including glutathione disulfide reductase (Gsr) and superoxide dismutases (Sod1/Sod2), remained unchanged, whereas the expression of antioxidant glutathione peroxidase (Gpx) increased. While LV gene expression of key energy sensors, peroxisome proliferator activator (Ppar) α and γ, AMP-activated protein kinase (Ampk), and carnitine palmitoyltransferase 1 (Cpt1) remained unchanged after OM infusion, and the expression of pyruvate dehydrogenase kinase 4 (Pdk4) increased. The LV expression of the major myocardial glucose transporter Glut1 decreased, with no changes in Glut4 expression, whereas the LV expression of oxidized low-density lipoprotein receptor 1 (Olr1) and arachidonate 15-lipoxygenase (Alox15) increased, with no changes in fatty acid transporter Cd36. An increased LV expression of angiotensin II receptors AT1 and AT2 was observed, with no changes in angiotensin I-converting enzyme expression. The Kalikrein-bradykinin system was upregulated with increased LV expression of kallikrein-related peptidases Klk8, Klk1c2, and Klk1c12 and bradykinin receptors B1 and B2 (Bdkrb1 and Bdkrb2), whereas the LV expression of inducible nitric oxide synthase 2 (Nos2) increased. LV expression in major molecular determinants involved in calcium-dependent myocardial contraction remained unchanged, except for an increased LV expression of calcium/calmodulin-dependent protein kinase II delta (Cacna1c) in response to OM. A single intravenous infusion of OM, in adult healthy rats, resulted in significant changes in the LV expression of genes regulating apoptosis, oxidative stress, metabolism, and cardiac contractility.

New Findings What is the central question of this study? The beneficial effects of supplemental oxygen in patients with acute myocardial infarction are still uncertain: what are the effects of ischaemia–reperfusion injury during hyperoxia and normoxia in mature rats with and without cardiovascular risk factors? What is the main finding and its importance? Despite elevated baseline oxidative stress in rodents with cardiovascular risk factors, hyperoxic reperfusion limited myocardial necrosis and anti/pro‐oxidant imbalance in spontaneously hypertensive and Zucker rats. In contrast, this effect was exacerbated in healthy Wistar rats. These results suggest that oxygen supplementation may not be harmful in patients with acute myocardial injury. AbstractRecent studies on O2 supplementation in acute coronary syndrome patients are equivocal. We tested the hypothesis that oxidative stress is increased in rodents with cardiovascular risk factors and enhances ischaemia–reperfusion injury in the presence of hyperoxia. A total of 43 Wistar rats (WR), 30 spontaneously hypertensive rats (SHR) and 33 obese Zucker rats (ZR) were randomized in a sham procedure (one‐third) or underwent a left anterior descending ligation of the coronary artery for 60 min (two‐thirds). This was followed by 3 h of reperfusion while animals were randomized either in a hyperoxic (HR) or a normoxic reperfusion (NR) group. Myocardial infarction size and oxidative stress biomarkers (myeloperoxidase (MPO), malondialdehyde and total free thiols) were assessed in blood samples. Baseline troponin T was higher in SHR and ZR than in WR (both P < 0.001). Baseline total MPO was elevated in ZR in comparison to SHR and WR (both P < 0.001). SHR had lower thiol concentration compared to WR and ZR (P < 0.000001). HR was associated with a lower troponin T rise in SHR and ZR than in NR (both P < 0.001), while the reverse occurred in WR (P < 0.001). In SHR, HR limited total MPO increase as compared to NR (P = 0.0056) and the opposite effect was observed with total MPO in WR (P = 0.013). NR was associated with a drastic reduction of total thiols as compared to HR both in SHR and in ZR (both P < 0.001). Despite a heightened baseline oxidative stress level, HR limited myocardial necrosis and anti/pro‐oxidant imbalance in SHR and ZR whereas this effect was exacerbated in healthy WR.

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Fonds Erasme Recent studies on O2 supplementation in acute coronary syndrome patients are equivocal. We tested the hypothesis that oxidative stress (OS) is increased in rodents with cardiovascular risk factors and enhances ischemia reperfusion injury in the presence of hyperoxia. Forty-three Wistar rats (WR), 30 spontaneous hypertensive rats (SHR) and 33 obese Zucker rats (ZR) were randomized in a sham procedure (1/3rd) or a left anterior descending ligation for 60 minutes (2/3rd). This was followed by 3 hours of reperfusion while animals were randomised either in a hyperoxic (HR) or a normoxic reperfusion group (NR). Baseline troponin (cTnT) was larger in SHR and ZR than WR (both p < 0.001). HR was associated with a lesser troponin rise in SHR and ZR than in NR (both p < 0.001); while the reverse occurred in WR (p < 0.001). In SHR, HR limited total MPO (myeloperoxydase) increase as compared to NR (p = 0.0056) to the contrary of total MPO in WR (p = 0.013). NR was associated with a drastic reduction of total thiols as compared to HR both in SHR and in ZR (both p < 0.001). Despite a heightened baseline OS, HR rather restrained myocardial necrosis and anti/pro-oxidant imbalance in SHR and ZR, to the reverse of healthy WR. Baseline characteristics of the 3 strainWR¹ (n = 41)SHR² (n = 29)ZR³ (n = 33)Age (months)9.0 (7.0 - 10.0)6.0 (6.0 - 8.3) ¹ vs 27.0 (6.0 - 8.0) 1 vs 3, 2 vs 3Weight (mg)590 (553 - 646)436 (419 - 485) ¹ vs 2670 (622 - 716) 2 vs 3Systolic arterial pressure (mmHg)146 (120 - 174)165 (120 - 197)188 (169 - 215) 1 vs 3Heart rate (beat/minute)284 (268 - 310) ¹ vs 2244 (216 - 270)254 (230 - 288) 1 vs 3Troponin T (ng/l)13 (9 - 20)42 (33 - 60) 1vs233 (23 - 53) 2vs3Triglyceride (mg/dl)/87 (64 - 110)1062 (683 - 2459) 2vs3MDA (nmoles)0.10 (0.04)0.09 (0.06)0.14 (0.10) 2vs3Total MPO (ng/ml)2889.7 (932.1)2684.0 (681.7)4479.7 (728.0) 1vs3,2vs3Free total thiols (µM)222.6 (213.9 - 240.5)40.2 (5.3 - 60.2) 1vs282.3 (17.5 - 235.7) 2vs3Abbreviations WR: Wistar rats. SHR: Spontaneous Hypertensive rats. ZR Zucker rats.Both paired t-test and Wilcoxon signed rank test were used. Variables are shown in means with standard deviation (mean (SD)) or in median (interquartile range. IQR). Pairwise test – p < 0.05; 1vs2: WR vs SHR. 1vs3: WR vs ZR. 2vs3: SHR vs ZR.WR were older than the SHR and ZR. ZR were older than SHR. The ZRs were more obese than SHR and more hypertensive than WR. Baseline Troponin T was larger in SHR than ZR and WR. ZR had higher level of triglyceride than SHR. Total MPO was more elevated in ZR than SHR and WR. Oxidative stress was enhanced in ZR than SHR (higher MDA. more elevated total MPO) and total thiols were the lowest in the SHR.Abstract Figure. Troponin T concentration evolution slope

The management of mental health in addition to physical health in patient with chronic obstructive pulmonary disease (COPD) is often overlooked.Many COPD patients report anxiety and depression in relation to their respiratory condition.Mindfulness-based approaches has accrued a robust evidence base in improving mental health outcomes in patients with chronic diseases.We conducted a study to evaluate the effects of the Mindfulness-Based Stress Reduction (MBSR) program in COPD patients who additionally participate to a pulmonary rehabilitation program in comparaison with a control group.

Wprowadzenie: Szeroki wybor metod leczenia choroby zwyrodnieniowej stawow obejmuje obecnie kilka wyciągow z kurkumy, w tym Flexofytol®, biologicznie zoptymalizowany wyciąg z Curcuma longa. Jednak u starszych pacjentow wskazania do leczenia mogą byc ograniczone przez choroby wspolistniejące i polifarmakoterapie. Dlatego tez oceniono korzyści i ryzyka stosowania Flexofytolu® w populacji osob starszych, u ktorych wystepują choroby wspolistniejące. Material i metody: To retrospektywne badanie obserwacyjne objelo 31 pacjentow w wieku powyzej 70 lat (mediana wieku: 77 lat, przedzial 71–81 lat), ktorzy byli leczeni Flexofytolem® z powodu bolesnej choroby zwyrodnieniowej stawow kolanowych lub kregoslupa ledźwiowego. Pacjenci mieli choroby wspolistniejące, takie jak cukrzyca (48%) i/lub niewydolnośc nerek (71%), lub przyjmowali leki przeciwzakrzepowe (35%). Efekty dzialania Flexofytol® oceniono po 0, 6 i 12 tygodniach za pomocą wizualnej skali analogowej VAS bolu i niepelnosprawności oraz kwestionariusza oceny jakości zycia SF-12. Oceniano dzialania niepoządane Flexofytolu® oraz mozliwe interakcje z innymi lekami. W szczegolności oceniano czynnośc nerek, parametry cukrzycy oraz testy krzepliwości. Dane analizowano za pomocą nieparametrycznych testow Kruskala-Wallisa i Manna-Whitneya-Wilcoxona. Wyniki: Pacjenci otrzymujący Flexofytol® wykazali znaczną poprawe: bol zmniejszyl sie o 50% (p = 0,0002), a stopien niepelnosprawności o 33% (p = 0,0075). Szereg parametrow jakości zycia uleglo poprawie w ciągu pierwszych 6 tygodni leczenia i przez 3 miesiące nie bylo wplywu na czynnośc nerek, parametry metaboliczne czy testy krzepliwości. Nie zaobserwowano zadnych istotnych dzialan niepoządanych. Wnioski: Podsumowując, otrzymane wyniki sugerują, ze Flexofytol® moze byc przydatny w leczeniu bolesnej choroby zwyrodnieniowej stawow, szczegolnie u starszych pacjentow, ktorzy są obciązeni chorobami wspolistniejącymi i polifarmakoterapią. Otrzymane wstepne wyniki powinny zostac zweryfikowane w przyszlych badaniach.

Background: Many patients with COPD report anxiety and depression in relation to their respiratory condition with a profound impact in the management of their disease and poor quality of life. Mindfulness-based intervention reduce stress, anxiety and depression in chronic diseases. This study evaluated the feasibility, compliance and effects of the Mindfulness-Based Stress Reduction (MBSR) program on COPD patients regarding quality of life, psychological distress and lung function. Methods: 28 COPD patients were included: 18 patients in a 8-weeks MBSR group and 10 patients in a control group. Primary outcomes were quality of life and psychological distress. Secondary outcomes were lung function and medication adherence measure. The primary and secondary measures were made at baseline, 10 weeks, 6 months and 12 months. Results: Concerning feasibility and compliance, a review of class attendance revealed that 78% of participants completed the standard 8-week program and 85% attended 8 or more meditation classes. The emotional function of Chronic Respiratory Disease Questionary showed a trend toward an effect in the meditation group. At 12 months, MBSR resulted in significant improvements from baseline in Hospital Anxiety and Depression Scale in the meditation group as opposed to the control group (differential change of 2.41; p=0.04), in the State-Trait Anxiety Inventory ( differential change for MBSR vs control: -3.35 to + 3,13; p=0,01). There was no significant difference in Perceived Stress Scale, functional tests and medication adhesion. Conclusions: This study shows feasibility and a good compliance for a MBSR program in COPD patients with significant long term effect on psychological distress.

Objectives The aim of this study was i) to analyse the effect of repeat surgeries on the survival of patients with focally recurrent glioblastoma who have benefited from temozolomide treatment and ii) to identify potential prognostic factors for survival. Patients and methods Cases from 2005 to 2014 in the glioblastoma database of our department were retrospectively reviewed. The Kaplan-Meier method was used to estimate overall survival (OS) as a function of time after one, two and three surgical resections. All patients received the standard of care after the first surgery (temozolomide during and after radiotherapy) and adjuvant treatment after repeat surgeries. Results One hundred-thirty-two glioblastoma patients (median age: 57 years) were included in the study. Among them, 68, 53 and 11 patients underwent one, two and three surgical resections, respectively. The median OS was 11, 16 and 18 months, respectively, for patients who underwent one, two and three surgical resections. Patients who underwent two (p < 0.001) or three (p < 0.01) surgeries survived significantly longer than patients who underwent only one. No significant difference was observed between patients who underwent two versus three surgeries (p = 0.76). A second resection performed >6 months after the initial resection was the only factor associated with prolonged survival (p = 0.008). Conclusion Glioblastoma patients who benefited from temozolomide treatment and underwent surgery for recurrent glioblastoma exhibited a significant increase in survival compared with patients who did not undergo a second surgery. By contrast, a third surgery for a second recurrence did not contribute to any significant survival benefit.

Abstract Objectives: Pulmonary homografts are standard alternatives to right ventricular outflow tract reconstruction in congenital heart surgery. Unfortunately, shortage and conduit failure by early calcifications and shrinking are observed for small-sized homografts in younger patients. In neonates, Contegra® 12 mm (Medtronic Inc., Minneapolis, Minnesota, United States of America) could be a valuable alternative, but conflicting evidence exists. There is no published study considering only newborns with heterogeneous pathologies. We retrospectively compared the outcomes of these two conduits in this challenging population. Methods: Patients who underwent a right ventricular outflow tract reconstruction between January 1992 and December 2014 at the Hôpital Universitaire des Enfants Reine Fabiola were included. We retrospectively collected and analysed demographic, echocardiographic, surgical, and follow-up data. Results: Of the 53 newborns who benefited from a right ventricular outflow tract reconstruction during the considered period, 30 received a Contegra 12 mm (mean age 15 ± 8 days), and 23 a small (9–14 mm) pulmonary homograft (mean age 10 ± 7 days). Overall mortality was 16.6% with Contegra versus 17.4% in the pulmonary homograft group (p = 0.98 log-rank). Operative morbidity and early re-operation for conduit failure were not significantly different between the two groups. Mean follow-up in this study is 121 ± 74 months. Survival free from re-operation was not different between the two groups (p = 0.15). Multivariable analysis showed that weight and significant early gradient were factors associated with anticipated conduit failure. Conclusions: Contegra 12 mm is a valid alternative to small pulmonary homografts in a newborn patient population. Trial registration: NCT03348397.

Background: Patients evaluated in our emergency department (ED) often receive nonsteroidal anti-inflammatory drugs (NSAIDs) without any determination of their renal function, despite the known nephrotoxicity of NSAIDs. Guidelines recommend NSAID avoidance in patients with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m(2), and long-lasting therapy is not recommended in people with chronic kidney disease. Objective: We aimed to highlight the influence of a rapid measurement of the eGFR on NSAID prescriptions in patients at risk of impaired renal function using a point-of-care (POC) device. Our goal was to prevent the potential nephrotoxicity of NSAIDs by allowing the physicians to modify their treatments after eGFR determination, while avoiding a standard blood test for patients that would extend the duration of stay in the ED. Methods: We included 192 patients evaluated in the ED for minor trauma or injury, with an indication of treatment with NSAIDs and no known contraindication to NSAIDs. Emergency physicians were asked to register their intention to actually prescribe NSAIDs based on their clinical gestalt with specific regard to kidney function. Immediately after, the creatinine level was measured in capillary blood and eGFR was calculated using the POC device (StatSensor Creatinine; Nova Biomedical, Waltham, MA). Our physicians avoided NSAID prescriptions when eGFR was < 30 mL/min/1.73 m(2), and prescribed a shorter NSAID regimen therapy in patient with eGFR < 45 mL/min/1.73 m(2), with a reminder to assure hydration. The decision based on eGFR was compared with original clinician intention. Results: The clinicians intended to treat 164 patients with NSAIDs (group 1) and defer NSAIDs in 28 patients (group 2). In the first group, eGFR results supported no change in intended NSAID use in 144 patients, highlighted the need for a short regimen in 17 patients, and indicated contraindication to NSAIDs in 3 patients. In group 2, eGFR determination allowed prescription of NSAIDs in 21 patients, allowed utilization of NSAIDs with a short course in 5 patients, and supported the clinician decision to avoid NSAIDs in 2 patients. Conclusions: POC measurement of creatinine with eGFR estimation changed the prescription of NSAIDs in almost 25% of patients with previously unknown renal function. (C) 2019 Elsevier Inc. All rights reserved.

OBJECTIVE:Hypotension, defined as a mean arterial pressure of maximum 70 mmHg, is associated with significant morbidity and mortality. The objective of this study was to determine in initially non-critical hypotensive adult patients the proportion of sepsis and if septic patients had different outcome and clinical factors than non-septic patients. METHODS:This retrospective observational study was conducted over a year on adult hypotensive emergency department patients initially considered by triage as non-critical. Patients were separated into three groups: hypotensive septic patients (HSP), hypotensive non-septic infected patients (HNSIP), and other hypotensive patients (OHP). Clinical scores, signs, length of stay (LOS), and mortality were compared using analysis of variance for continuous variables and chi-square analysis for categorical variables. RESULTS:There were 136 (35.5%) septic patients, 37 (9.7%) with non-septic infection, and 210 (54.8%) with another cause of hypotension. Overall in-hospital mortality was 12.0% and total mortality was greater in HSP than in HNSIP (20.6% vs. 5.4%, p = 0.031) or OHP (20.6 vs. 7.6%, p < 0.001). LOS was greater for HSP when compared to HNSIP (median(IQR): 9(6-17) vs. 6(1-13), p = 0.004) and OHP (median(IQR): 9(6-17) vs. 3(1-8) days, p < 0.0001). CONCLUSION:Sepsis in a priori non-critical hypotensive adult patients, when compared with other causes of hypotension, is associated with significantly higher mortality and increased LOS. Patients that present to the emergency department and have a MAP of 70mmHg or less must be rigorously evaluated and have consistent follow-up.

Background: Anaemia is often multifactorial in the elderly, with a frequent association between iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD). The primary objective of our study was to investigate whether baseline hepcidin measurement could be useful for identifying iron deficiency (ID) in anaemic elderly patients. The secondary objective was to assess whether baseline hepcidin concentrations correlated with the relative increase of transferrin saturation (TS) after an oral iron absorption test (OIAT). Methods: Blood samples were collected between 7:30 am and 10:00 am in 328 geriatric outpatients, 102 underwent the OIAT. Types of anaemia were classified according biochemical and clinical criteria. TS and hepcidin were measured at baseline and 4 h after the iron dose. The ability of baseline hepcidin measurement to highlight ID in elderly anaemic patients was assessed using a receiver operator curve (ROC) analysis. Correlations between baseline hepcidin levels and the increment of TS following the OIAT were investigated using the Spearman coefficient. Results: Among 328 included patients, 78 (23.8%) suffered from anaemia; 13 (4.0%), 19 (5.8%), 27 (8.2%) and 19 (5.8%) patients fulfilled criteria for IDA, IDA/ACD, ACD and unexplained anaemia, respectively. By multivariable analysis, creatinine, C-reactive protein, ferritin, Delta TS and Delta hepcidin were independently associated with baseline hepcidin concentrations. The area under the ROC curve (95% confidence interval) was 0.900 (0.830-0.970) for baseline hepcidin measurement. Baseline hepcidin levels correlated negatively with the relative increase in TS with a Spearman coefficient of -0.742. Conclusions: Baseline hepcidin levels could be a useful tool to identify ID in anaemic elderly patients and may predict acute iron response following OIAT.

Introduction > Despite the combined adjuvant treatment of radiotherapy plus chemotherapy with temozolomide (TMZ) followed by 6 cycles of temozolomide after surgery, the prognosis of patients with glioblastoma remains poor. We conducted a monocentric prospective study to explore the tolerance and potential efficacy of an early temozolomide cycle after surgery. Method > Patients with newly diagnosed glioblastoma (unmutated IDH1) and of poor prognosis (age > 50 years, biopsy or partial resection or unmethylated MGMT promoter) were prospectively included from June 2014 to 2017. They all received a cycle of 5 days of temozolomide between surgery and the combined adjuvant treatment. Results > Twelve patients of median age 64.5 years (45-73) were included in the study. The median doses of temozolomide administered were respectively 265 mg (225-300) for the early cycle; 130 mg (110-150) for the concomitant treatment and 310 mg (225-400) for the adjuvant one. Side effects during treatment were grade III lymphopenia, grade III neutropenia, fatigue and nausea/vomiting respectively in 4, 1, 7 and 5 patients. Progression-free survival and overall survival were respectively 90% and 91.7% at 6 months; 58.3 and 71.3% at 12 months; 31.1 and 71.3% at 18 months. Conclusion > Early postsurgical temozolomide treatment prior to standard adjuvant therapy for poor prognosis glioblastoma patients in our small prospective series presents toxicity and survival similar to those published in the literature for the general population of glioblastoma. These encouraging results should be confirmed by a multicentric study comparing this regiment with the standard treatment.

BACKGROUND:Bilateral internal mammary arteries (BIMAs) remain underused in coronary artery bypass grafting (CABG), especially in elderly, diabetic, and obese patients. This study investigated incidence of sternal wound infection (SWI), sternal instability (SI), and reintervention for bleeding (RIB) in this high-risk population.METHODS:A single-center retrospective observational study was performed in "Grand Hôpital de Charleroi, Gilly, Belgium." A total of 319 patients undergoing CABG from December 2011 to December 2015 were included. Three main outcome measures (SWI, SI, and RIB) were investigated in obese vs nonobese, diabetic vs nondiabetic, and elderly vs younger patients.RESULTS:In all, 14 SWI, 11 SI, and 6 RIB were discounted. Death rate was as follows: SWI: 2/14 vs 17/305 (P = .178), SI: 2/11 vs 17/308 (P = .081), and RIB: 2/6 vs 17/313 (P = .004). In obese (n = 113) vs nonobese (n = 206) patients, there was no difference for SWI (P = .263), SI (P = .565), and RIB (P = .332). In diabetic (n = 118) vs nondiabetic (n = 201) patients, there was no difference for SWI (P = .642), SI (P = .497), and RIB (P = .298). In elderly (n = 62) vs younger (n = 257) patients, there was no difference for SWI (P = .619), SI (P = .915), and RIB (P = .385).CONCLUSIONS:Obesity, age, and diabetes treated by insulin (or not) do not seem to be risk factors for developing SWI, SI, or RIB in patients receiving a CABG using BIMA. Nevertheless, mortality was higher in RIB group.