Poitiers University Research Articles

Comparative evaluation of minimally invasive ‘tibial tuberoplasty’ surgical technique versus conventional open surgery for Schatzker II–III tibial plateau fractures: design of a multicentre, randomised, controlled and blinded trial (TUBERIMPACT study)

IntroductionFractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports. The...

Does the implementation of a restrictive episiotomy policy for operative deliveries increase the risk of obstetric anal sphincter injury?

Our main objective was to investigate whether the implementation of a restrictive episiotomy policy in operative deliveries changes the incidence of obstetric anal sphincter injury (OASI). This is an observational study over an 11-year period in Poitiers University Maternity, France. We included women with vaginal operative deliveries after 34 gestational weeks for singleton births in cephalic presentation. We collected data on the mother and operative delivery characteristics: indication, instrument, epidural analgesia, labor length, episiotomy, OASI, and birthweight. We investigated the changes in the mediolateral episiotomy (MLE) and OASI rates and the association between MLE and OASI. The primary outcome was the evolution of the OASI and MLE rates. The secondary outcome was the occurrence of OASI during operative delivery with or without MLE. In total, 2357 operative deliveries were assessed, including 847 vacuum-, 1350 forceps- and 160 spatula-assisted deliveries. Of these, 950 were performed with MLE and 1407 without; 37 OASIs (3.9%) occurred in the MLE group, and 137 (9.7%) in the no-MLE group. Between 2005 and 2015, MLE use decreased from 78.5 to 16.2% and OASI occurrence increased from 3.1 to 12.7%. The increase in OASI occurrence was significant for forceps deliveries, but not for vacuum or spatula deliveries. Operative delivery with MLE was associated with a three times lower OASI occurrence than that without MLE (adjusted OR = 0.29, 95% CI [0.20-0.43]). Implementation of a restrictive MLE policy for operative delivery seems to be associated with an increase in OASI incidence with forceps, but not with vacuum.

Discharge of biocidal products from healthcare activities into a sewage system-a case study at a French university hospital.

This study focused on the presence of three biocidal products specific to healthcare facilities, i.e. chlorhexidine digluconate (CHD), bis(aminopropyl)laurylamine (BAPLA), and didecyldimethylammonium chloride (DDAC), in a hospital sewage system. Five sampling campaigns were conducted in 2016 and 2017 throughout the entire Poitiers University Hospital sewage system. DDAC concentrations ranging from 933 ± 119 to 3250 ± 482μg/L were detected in 24-h composite samples, while lower concentrations (both within the same range) were detected for the two other compounds (i.e. 25 ± 5 to 97 ± 39μg/L for CHD and 18 ± 3 to 142 ± 16μg/L for BAPLA). Based on these findings, a mass balance was determined for these discharged compounds to compare the quantities detected in discharges to the amounts used for healthcare in the hospital. Hence, 60-90% of the quantities of DDAC used were found to be present at the hospital sewage outfall. Higher percentages of CHD (100-242%) were noted because of the high presumably quantities used for antiseptic applications, which were not considered in mass balance calculation. Finally, only 10-30% of BAPLA quantities used were detected at the site outfall. Analysis of the results for the different sampling points revealed the nature of the emission sources. For surface applications of DDAC and BAPLA, management of hospital linen is thus a major source of discharged biocidal products, probably following the washing of biocide-soaked textiles used for hospital facility maintenance. Moreover, discharge of biocidal products from a healthcare establishment depends especially on biocide handling practices in the emitting establishment. For BAPLA, compliance with hospital recommended dosages and practices whereby operators are required to prepare tailored quantities of detergents and disinfectants for each specific task could largely explain the limited release of this compound.

Prevalence and outcome of patients referred for chest pain with high-sensitivity troponin elevation and no diagnosis at discharge.

Specialized chest pain units appear to increase the proportion of patients with acute chest pain who are properly evaluated, but some of them remain doubtful. The aim of this study was to evaluate the survival and occurrence of cardiovascular events in patients without diagnosis at the end of management of chest pain with high-sensitivity troponin (Tn) elevation. All consecutive patients who came to the cardiac emergency room of Poitiers University Hospital between January 1, 2014, and August 7, 2015, for chest pain and Tn elevation were included. The primary endpoint was the number of undiagnosed patients; secondary endpoints included survival and major adverse cardiac events. A total of 1001 patients (695 male; mean age, 68 ±16 years) who had chest pain and Tn elevation were included. Median follow-up was 24.5 (IQR, 14.7-29.5) months. Forty-seven (4.7%) patients remained without diagnosis. Compared with patients with diagnosis, these patients were younger (53.6 ±19.7 years; P < 0.0001) and had less hypertension (29.8%; P < 0.0001), diabetes (4.3%; P = 0.0016), and history of coronary artery disease (6.4%; P < 0.0001). No patients died or experienced MACE in 6-month follow-up. Survival curves showed the probability of survival was excellent, not only at 6 months, but also at 36 months (P = 0.0025). Less than 5% of patients referred for chest pain and with high-sensitivity Tn elevation remained without diagnosis after adapted care in the chest pain unit. Their 6-month prognosis was excellent.

Obstetrical anal sphincter injuries and symptoms after subsequent deliveries: A 60 patient study

IntroductionMore than half of women with a history of prior obstetric anal sphincter injuries (OASIS) will have another pregnancy. Currently, little is known concerning post-partum perineal symptoms in cases of a subsequent vaginal delivery. The aim of this study was to assess the frequency of perineal functional symptoms following a vaginal delivery after OASIS while comparing them to patients who did not have a subsequent delivery. Material and methodRetrospective cohort study between January 2000 and December 2011. A questionnaire was sent by post to all women who sustained an OASIS at the Poitiers University Hospital, France. Perineal functional symptoms and quality of life were assessed using validated self-administered questionnaires: Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale. Results159 women of 237 contacted (67%) responded to the questionnaire, on average 46 months after the delivery complicated with OASIS. 135 (85%) of women had a 3rd degree laceration and 24% a 4th degree laceration. 99 women (63%) did not have an ensuing delivery since the event (OASIS − No Subsequent Delivery: SD-). 60 women (37%) had a subsequent delivery (OASIS −Subsequent Delivery: SD + ), with 53 (88%) having a vaginal birth. Among these women, 3 (6%) experienced a recurrent OASIS. The mean score for perineal symptoms (FPFQ) was 6.95 in the OASIS-SD (−) group and 7.40 in the OASIS-SD (+) group (p = 0.64). No significant difference in quality of life (EuroQol 5D) was found between the two groups (p = 0.91). ConclusionWe did not observe a deterioration of perineal functional symptomatology after vaginal delivery in women with known prior OASIS, compared to women who did not have a subsequent delivery. Even if the risk of occurrence of these lesions is higher in women with history of previous OASIS compared to those without perineal injury, it is still comparable to incidence among primiparous women.

Real-Time Genetic Algorithms-Based MPPT: Study and Comparison (Theoretical an Experimental) with Conventional Methods

Maximum Power Point Tracking (MPPT) methods are used in photovoltaic (PV) systems to continually maximize the PV array output power, which strongly depends on both solar radiation and cell temperature. The PV power oscillations around the maximum power point (MPP) resulting from the conventional methods and complexity of the non-conventional ones are convincing reasons to look for novel MPPT methods. This paper deals with simple Genetic Algorithms (GAs) based MPPT method in order to improve the convergence, rapidity, and accuracy of the PV system. The proposed method can also efficiently track the global MPP, which is very useful for partial shading. At first, a review of the algorithm is given, followed with many test examples; then, a comparison by means Matlab/Simulink© (R2009b) is conducted between the proposed MPPT and, the popular Perturb and Observe (PO) and Incremental Conductance (IC) techniques. The results show clearly the superiority of the proposed controller. Indeed, with the proposed algorithm, oscillations around the MPP are dramatically minimized, a better stability is observed and increase in the output power efficiency is obtained. All these results are experimentally validated by a test bench developed at LIAS laboratory (Poitiers University, Poitiers, France) using real PV panels and a PV emulator which allows one to define a profile insolation model. In addition, the proposed method permits one to perform the test of linearity between the optimal current I mp (current at maximum power) and the short-circuit current I sc , and between the optimal voltage V mp and open-circuit voltage V oc , so the current and voltage factors can be easily obtained with our algorithm.

Predictors for myocardial recovery of patients implanted with an ECMO device following myocardial infarction

Extracorporeal membrane oxygenation (ECMO) has become the most widely used circulatory aid in refractory cardiogenic shock (CS). There is little data available on the predictive markers of a favorable outcome following myocardial infarction. To identify the factors predictive of the successful withdrawal of ECMO implanted for refractory CS of ischemic origin. This was an observational retrospective single-center study. The patients were distributed into two groups: successful (55%) or non successful (45%) ECMO weaning. Sixty-five patients were included between January 2008 and March 2017 in the Poitiers University Hospital (CHU). Complete coronary revascularisation was achieved mainly in the in the “successful weaning” group, P = 0.058. The 30-day survival rate was 43%. A history of myocardial infarction, [0.03–0.92, P = 0.039], initial ventricular rhythm disorders (RD) [1.33–19.17, P = 0.018] and the hemoglobin level [0.58–0.96, P = 0.021] were revealed as independent predictive factors for successful weaning from ECMO. The early use of ECMO is an effective rescue strategy which provides recovery of myocardial function in close to 55% of cases. The occurrence of de ventricular RD (OR = 5) on admission is predictive of greater survival.

Multicentre randomised controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol

IntroductionSevere trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated...

Does resting heart rate measured by the physician reflect the patient’s true resting heart rate? White-coat heart rate

ObjectivesIn cardiology, resting heart rate (HR) and blood pressure (BP) are key elements and are used to adapt treatment. However HR measured in consultation may not reflect true resting HR. We hypothesize that there may be a “white-coat” effect like with BP and that there may be an association between HR variations and BP variations. MethodsThis prospective, monocentric, observational, pilot study (January-April 2016) included 57 consecutive ambulatory patients at Poitiers University Hospital, France (58% male, mean age 64 years). Patients’ resting HR and BP were recorded with the same automated blood pressure sphygmomanometer in consultation by the physician then with self-measurement at home. ResultsIn the overall cohort, we found that HR was significantly higher in consultation (70.5bpm±12.6 vs. 68.1bpm±10.1, p=0.034). HR also correlated with diastolic BP (r=0.45, p=0.001).Patients were divided into three groups to look for associations with BP: masked HR, (higher HR at home, 38.6%), white-coat HR, (lower HR at home 52.6%) and iso HR, (no change between HR at home and consultation, 8.8%).Although there was no difference between groups in diastolic BP measured in consultation, home diastolic BP was lower in the white-coat HR group (74.3mmHg±9.8 vs. 77.9mmHg±7.5, p=0.016). ConclusionsOur study brings to light an exciting idea that could have a major therapeutic and maybe prognostic impact in cardiology: resting HR measured by the physician in consultation does not reflect true resting HR. This must be taken into account to adapt treatment.

Evaluation of long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI) at least one year after delivery: A retrospective cohort study of 159 cases

ObjectivesThe aim of this study was to assess long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI). MethodsThis retrospective cohort study included 237 cases of OASI (0.86% of deliveries) identified at Poitiers University Hospital between 2000 and 2011. Symptoms were assessed using validated self-administered questionnaires, including Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale (VAS). ResultsOne hundred and sixty women (67%) filled out the questionnaires, on average 46 months after delivery (8–152). Among them, 93 (54%) reported at least one symptom occurring “frequently” (the most common being dyspareunia), and 45 (28%) a symptom occurring “daily” (the most common being flatus incontinence). Anal incontinence was reported by 32 (20%) women, flatus incontinence “frequently” or “daily” by 28 (18%), and stool incontinence “frequently” or “daily” by 9 (6%). Urinary incontinence was reported “frequently” or “daily” by 27 women (17%) at stress, 17 (11%) at urge, and 11 (7%) at mixed circumstances. Prolapse symptoms were reported “frequently” or “daily” by 6 women (4%). Pain during intercourse was reported “frequently” or “daily” by 17 women (11%). Twenty-four women (18%) reported chronic pelvic pain (VAS score≥4/10). Ninety-five percent of women reported a normal quality of life for mobility, self-care, and usual activities; however, alterations in pain/discomfort (32%) and anxiety/depression (33%) domains were frequently reported. ConclusionPelvic floor symptoms 4 years after OASI were highly prevalent.

Multicolumn Spinal Cord Stimulation for Significant Low Back Pain in Failed Back Surgery Syndrome: A National, Multicentre, Randomized, Controlled Health Economics Study (Estimet)

Introduction Many studies have demonstrated the efficacy of spinal cord stimulation (SCS) for chronic neuropathic radicular pain over recent decades. But despite global favorable outcomes in Failed Back Surgery Syndrome (FBSS) with leg pain, the back pain component remains poorly controlled by neurostimulation. Technological and scientific progress has led to the development of new SCS leads, comprising a multicolumn design and a greater number of contacts. Their efficacy of multicolumn SCS lead configurations for the treatment of the back pain component of FBSS has recently been suggested by pilot studies. However, a randomized controlled trial must be conducted to confirm the efficacy of new generation multicolumn SCS. ESTIMET is a multicentre, randomized study designed to compare the clinical efficacy and health economics aspects of mono vs multicolumn SCS lead programming in FBSS patients with radicular pain and significant back pain. Material and Methods FBSS patients with a radicular pain VAS score ≥ 50mm, associated with a significant back pain component were recruited in 14 centers in France and implanted with multicolumn SCS. Before the lead implantation procedure, they were 1:1 randomized to monocolumn SCS (group 1) or multicolumn SCS (group 2). Programming was performed using only one column for group 1 and full use of the 3 columns for group 2. Outcome assessment was performed at baseline (pre-implantation), and 1, 3, 6 and 12 months post-implantation. The primary outcome measure was a reduction of the severity of low back pain (bVAS reduction ≥ 50%) at the 6-month visit. Additional outcome measures were changes in global pain, leg pain, paraesthesia coverage mapping, functional capacities, quality of life, neuropsychological aspects, patient satisfaction and healthcare resource consumption. Results Trial recruitment started in May 2012 and closed in October 2013. The 14 study centers have been initiated. The last visit last subject was performed in January 2015. This study received funding in 2012 from the French government NHS program “PSTIC 2011” (Program de Soutien aux Techniques Innovantes et Coûteuses). Each patient provided informed consent and approval was requested and obtained from the Poitiers University Hospital Ethics Committee (CPP Ouest III), the French National Agency for Medicines and Health Products Safety (ANSM) and the French Data Protection Authority (CNIL, No. 70108724P). Conclusion Preliminary results are expected to be analyze for the end of 2015 and published at the start of 2016.

A Novel, Objective, Quantitative Method of Evaluation of the Pain Component and Paresthesia Coverage using Comparative Computerized Multiparametric Tactile Mapping and Database Analysis: The “Neuro-Mapping-Tools” Software (N3MT)

Introduction One of the major challenges of neurostimulation is actually to address the back pain component in patients suffering from refractory chronic back and leg pain. Facing a tremendous expansion of neurostimulation techniques and available devices, implanters, patients and even industrial companies can still remain confused as they need to select the right tool for the right indication. To be able to evaluate and compare objectively patient outcomes, depending on therapeutical strategies, it appears essential to develop a rational and quantitative approach to pain assessement and neurostimulation outcomes for those who undergo neurostimulation implantation. Material and Methods Our neuroinformatics laboratory (N3Laboratory) located in Poitiers University Hospital, Department of Neurosurgery, enabled us to develop the Neuro-Mapping Tools software (N3MT) (Inter Deposit Digital Number: IDDN FR 001–1600002–000-R-P-2013–000–31230; Patent Applications n°PCT/EP2014/067231, n°PCT/FR 14/000 186 and n°PCT/FR 14/000 187). This tool consists of touch screen mapping, allowing the patient and/or the physician to interact by means of a tablet computer to delineate painful zones and paraesthesia coverage in the thoracolumbar region and legs. Results The Neuro-Mapping Tools software (N3MT) (Neuro-Pain'T, the Neuro-Mapping Locator and the Neuro-Data-Base) have been put together and used in more than 190 patients since 2012, leading us to describe new measurement parameters, divided into two categories: (1) Technical parameters, evaluating the implanted device itself, as “Device Performance, XP,” “Device Specificity, XS” and “Persistence of the Paresthesia Perception” on the long term (XP3). (2) Clinical parameters, evaluating patient response to the therapy: (a) pain surface reduction. This parameter is called YS. (b) pain intensity reduction. This parameter is called YI. (c) pain characteristics redistribution after implantation. This parameter is called YPC. Conclusion The N3MT software could help to guide tomorrow's treatment options by transforming personal convictions into a more robust scientific rationale based on data collection and data mining techniques.

0025 : Myocardial revascularization modalities in 200 patients with venous coronary artery bypass graft failure

The therapeutic management of bypass failure has been little studied. Compare prognosis and the occurrence of cardiovascular events at 2 years in patients with venous bypass graft failure by differentiating between three patient groups: medical therapy, percutaneous coronary intervention (PCI) in native vessels (native PCI), and PCI in coronary artery bypass grafts (PCI-CABG). Retrospective observational study in patients with bypass graft failure diagnosed between February 2009 and September 2013 at Poitiers University Hospital, France. Follow-up data at 1 year and at 2 years regarding major adverse cardiac events (MACEs), defined as death, acute coronary syndrome (ACS) or revascularization, were collected during patient visits to the department. From a series of 320 CABG patients examined using coronary angiography, all patients with bypass graft failure were included in the study (200 patients). Mean age was 69 years (+/- 11). Coronary angiography was performed a mean of 117 months after bypass surgery. Medical therapy alone was chosen in 88 patients, 75 patients underwent native PCI, and 37 patients underwent PCI-CABG. Patients in the PCI-CABG group were older (73.6 years; p = 0.027) and had significantly older bypass grafts (22% for a period of more than 10 years; p = 0.018), and their typical clinical presentation was one of ACS without ST-segment elevation (41%; p = 0.006). The groups were comparable in terms of hospital complications, except for vascular complications, which were more common in the PCI-CABG group (8%; p =0.01). At 1 year, no significant difference in terms of MACEs was found, but there was a trend towards an increase in ACS without ST-segment elevation (11%; p =0.06) in the PCI-CABG group, and towards an increase in ACS with STsegment elevation (7%; p = 0.06) in the medical therapy group. At 2 years, the medical therapy group stood out by virtue of a significant increase in MACEs compared with the other two groups (63%; p = 0.02). The native PCI group presented both fewer MACEs and fewer vascular complications. MACEs were common and more severe in the medical therapy group. When coronary lesions are amenable to PCI, PCI in native vessels should be proposed as first-line treatment. PCI of CABG is performed in a riskier setting and has poorer prognosis.

Performance du diagnostic anténatal et évolution postnatale des malformations pulmonaires congénitales

ObjectivesFor many diseases, the comparison of prenatal diagnosis with a histopathological reality is not always possible. Fetal lung pathology, with its high rate of surgery in postnatal, allows this assessment. This study proposes an approach to the reliability of prenatal diagnosis and analysis of the postnatal development of all children in care for congenital pulmonary malformation (CPM). MethodsThis is a retrospective study of all cases of CPM diagnosed in Poitiers University Hospital from 1995 to 2011. Cases diagnosed prenatally were identified and the diagnostic accuracy was studied by histology when cases had surgery. The postnatal development of prenatally diagnosed cases is described and compared to children who did not receive prenatal diagnosis. ResultsAmong the 45 cases of CPM supported at the Poitiers University Hospital, 30 had received prenatal diagnosis of isolated CPM. The diagnostic concordance between antenatal ultrasound and the final diagnosis is κ=0.67 (CI95% [0.38 to 0.94]). The sensitivity of ultrasound was 90% (CI95% [55–99.7]) in our series for the diagnosis of CAMP (cystic adenomatoid malformation pulmonary). We found a sonographic disappearance of lesions in 4 children, 1 child in regression, stable lesions in 21 cases. Four children showed an increase in volume of the malformation, with signs of poor tolerance in 3 cases. After birth, children who received a prenatal diagnosis were no more symptomatic than those whose diagnosis was made postnatal: 21 (70%) versus 11 (73%; P=1) respectively. Similarly, they often received prophylactic surgery: 18 (60%) versus 2 (13%) respectively (P<0.01) and less often suffered post-surgery complication: 3 (10%) versus 10 (67%) respectively (P<0.01). The number of children monitored was not significantly different in the two groups. ConclusionPrenatal diagnosis allows for the precise nature of the lesion in 90% of cases in 2013 and had no impact on symptomatology at birth. When prenatal diagnosis is possible, preventive surgery probably reduces the occurrence of emergency surgery.

A novel, objective, quantitative method of evaluation of the back pain component using comparative computerized multi-parametric tactile mapping before/after spinal cord stimulation and database analysis: The “Neuro-Pain’t” software

IntroductionOne of the major challenges of neurostimulation is actually to address the back pain component in patients suffering from refractory chronic back and leg pain. Facing a tremendous expansion of neurostimulation techniques and available devices, implanters and patients can still remain confused as they need to select the right tool for the right indication. To be able to evaluate and compare objectively patient outcomes, depending on therapeutical strategies, it appears essential to develop a rational and quantitative approach to pain assessment for those who undergo neurostimulation implantation. Objectives, material and methodsWe developed a touch screen interface, in Poitiers University Hospital and N3Lab, called the “Neuro-Pain’T”, to detect, record and quantify the painful area surface and intensity changes in an implanted patient within time. The second aim of this software is to analyse the link between a paraesthesia coverage generated by a type of neurostimulation and a potential analgesic effect, measured by pain surface reduction, pain intensity reduction within the painful surface and local change in pain characteristics distribution. The third aim of Neuro-Pain’T is to correlate these clinical parameters to global patient data and functional outcome analysis, via a network database (Neuro-Database), to be able to provide a concise but objective approach of the neurostimulation efficacy, summarized by an index called “RFG Index”. Results and discussionThis software has been used in more than 190 patients since 2012, leading us to define three clinical parameters grouped as a clinical component of the RFG Index, which might be helpful to assess neurostimulation efficacy and compare implanted devices. ConclusionThe Neuro-Pain’T is an original software designed to objectively and quantitatively characterize reduction of a painful area in a given individual, in terms of intensity, surface and pain typology, in response to a treatment strategy or implantation of an analgesic device. Because pain is a physical sensation, which integrates a psychological dimension, its assessment justifies the use of multidimensional and global evaluation scales. However, in the context of neurostimulation and comparative clinical trials designed to test the technical efficacy of a given device, a simple, objective and quantitative evaluation tool could help to guide tomorrow's treatment options by transforming personal convictions into a more robust scientific rationale based on data collection and data mining techniques.

The “neuro-mapping locator” software. A real-time intraoperative objective paraesthesia mapping tool to evaluate paraesthesia coverage of the painful zone in patients undergoing spinal cord stimulation lead implantation

IntroductionConventional spinal cord stimulation (SCS) generates paraesthesia, as the efficacy of this technique is based on the relationship between the paraesthesia provided by SCS on the painful zone and an analgesic effect on the stimulated zone. Although this basic postulate is based on clinical evidence, it is clear that this relationship has never been formally demonstrated by scientific studies. There is a need for objective evaluation tools (“transducers”) to transpose electrical signals to clinical effects and to guide therapeutic choices. Material and methodsWe have developed a software at Poitiers University hospital allowing real-time objective mapping of the paraesthesia generated by SCS lead placement and programming during the implantation procedure itself, on a touch screen interface. ObjectivesThe purpose of this article is to describe this intraoperative mapping software, in terms of its concept and technical aspects. Results and discussionThe Neuro-Mapping Locator (NML) software is dedicated to patients with failed back surgery syndrome, candidates for SCS lead implantation, to actively participate in the implantation procedure. Real-time geographical localization of the paraesthesia generated by percutaneous or multicolumn surgical SCS lead implanted under awake anaesthesia allows intraoperative lead programming and possibly lead positioning to be modified with the patient's cooperation. Software updates should enable us to refine objectives related to the use of this tool and minimize observational biases. The ultimate goals of NML software should not be limited to optimize one specific device implantation in a patient but also allow to compare instantaneously various stimulation strategies, by characterizing new technical parameters as “coverage efficacy” and “device specificity” on selected subgroups of patients. Another longer-term objective would be to organize these predictive factors into computer science ontologies, which could constitute robust and helpful data for device selection and programming of tomorrow's neurostimulators.

High plasma levels of the pro-inflammatory cytokine IL-22 and the anti-inflammatory cytokines IL-10 and IL-1ra in acute pancreatitis

Background/objectivesPancreatic acinar cells are major targets of IL-22. Our aim is to study early plasma levels of IL-22, of pro- and anti-inflammatory cytokines in acute pancreatitis, and their association with severity or necrosis infection. MethodsConsecutive patients admitted to the Department of Hepato-Gastroenterology at Poitiers University of Medicine Hospital (France) with a diagnosis of AP were prospectively enrolled. Plasma concentrations of IL-22, IL-6, IL-8, IL-1 α, IL-1β, TNF- α, IFN-γ, IL-17A, IL-10, IL-1ra and IL-4 were assessed by multiple immunoassay at the admission time. A thoracoabdominal contrast-enhanced CT scan was performed at day 2. ResultsSixty-two patients were included; 13 patients (21%) had a severe acute pancreatitis, 5 patients (8%) developed necrosis infection and 29 patients (47%) had pleural effusion. Plasma levels of IL-22 were high in AP (135 ± 31 vs 4.2 ± 1.8 pg/ml for controls, p < 0.05), but did not correlate with the severity of the disease, whereas IL-6, IL-10 and IL-1ra where enhanced in patients with severe acute pancreatitis and with pleural effusion. Patients who further developed necrosis infection had higher levels of IL-1ra at admission (p = 0.0004). ConclusionIn acute pancreatitis, high plasma levels of IL-22 are observed, regardless the severity of the disease. In contrast, severe forms were associated with increased levels of IL-6, IL-10 and IL-1ra. The beneficial or deleterious role of IL-22 in AP remains to be further studied.

A Remarkable Catalyst Combination to Widen the Operating Temperature Window of the Selective Catalytic Reduction of NO by NH3

The front cover artwork for issue 08/2014 is a collaboration between Beijing University of Chemical Technology (P.R. China) and Poitiers University (France). The image shows the principle on catalyst combination for an ideal autoexhaust control covering a broad temperature range. See the Full Paper itself at dx.doi.org/10.1002/cctc.201402514.

EGFR, KRAS, BRAF, and HER‐2 molecular status in brain metastases from 77 NSCLC patients

The aim of this study was to determine the frequency of EGFR, KRAS, BRAF, and HER-2 mutations in brain metastases from non-small cell lung carcinomas (BM-NSCLC). A total of 77 samples of BM-NSCLC were included and 19 samples of BM from breast, kidney, and colorectal tumors were also studied as controls. These samples were collected from patients followed between 2008 and 2011 at Poitiers and Nice University Hospitals in France. The frequencies of EGFR, KRAS, BRAF, and HER-2 mutations in BM-NSCLC were 2.6, 38.5, 0, and 0% respectively. The incidence of KRAS mutation was significantly higher in female and younger patients (P < 0.05). No mutations of the four genes were found in BM from breast or kidney. However, among six BM from colorectal tumors, we identified KRAS mutations in three cases and BRAF mutations in two other cases. This study is the largest analysis on genetic alterations in BM-NSCLC performed to date. Our results suggest a low frequency of EGFR mutations in BM-NSCLC whereas KRAS mutations are as frequent in BM-NSCLC as in primitive NSCLC. These results raise the question of the variability of the brain metastatic potential of NSCLC cells in relation to the mutation pattern.

Experience in Poitiers University

Experience in Poitiers University