[Study on the integration of emergency IPAs in Nord-Pas-de-Calais: supervisors' perspectives].

In the context of the introduction of advanced practice nurses in emergency departments (APNs), the Collège de Médecine d'Urgence du Nord-Pas-de-Calais teamed up with the Unité de Formation et de Recherche des Sciences de la Santé et du Sport at the University of Lille to conduct a survey of emergency department management teams, with the aim of gaining a better understanding of their needs. The results revealed a number of obstacles and levers to the implementation of APNs, and led to a better understanding of the patient pathways in these departments. As a result, the content of the university teaching program could be reviewed with a view to meeting the needs expressed in the field.

A general synthesis of azetidines by copper-catalysed photoinduced anti-Baldwin radical cyclization of ynamides.

A general anti-Baldwin radical 4-exo-dig cyclization from nitrogen-substituted alkynes is reported. Upon reaction with a heteroleptic copper complex in the presence of an amine and under visible light irradiation, a range of ynamides were shown to smoothly cyclize to the corresponding azetidines, useful building blocks in natural product synthesis and medicinal chemistry, with full control of the regioselectivity of the cyclization resulting from a unique and underrated radical 4-exo-dig pathway.

Divergent Synthesis of α-Fluorinated Carbonyl and Carboxyl Derivatives by Double Electrophilic Activation of Amides.

A straightforward and divergent entry to α-fluorinated carbonyl and carboxyl derivatives is reported. Upon activation of amides with triflic anhydride and a 2-halo-pyridine and subsequent trapping of the resulting keteniminium ions with nucleophiles followed by a second electrophilic activation with NFSI and final hydrolysis, a range of amides can be transformed to α-fluorinated ketones, esters, and amides under mild conditions. Moreover, this reaction can be performed to yield enantioenriched products with a traceless chiral auxiliary.

Comparison of Specific Prediction Equations to Estimate Peak Oxygen Uptake in Obese Women.

The aim of the current study was to compare 2 equations to predict peak oxygen uptake (V̇Opeak) in obese women, according to their obesity class. 92 maximal cardiopulmonary exercise testing sets (CPET with initial and subsequent increments set to achieve an exercise duration between 8-12 min) were retrospectively analysed. These CPET were divided into 3 groups according to the women body mass indexes (BMI): class 1 (30 kg.

Total Synthesis of Neomarchantin A: Key Bond Constructions Performed Using Continuous Flow Methods.

A synthesis of neomarchantin A has been achieved wherein key bond constructions involving C-O or C-C bond formations were augmented via continuous flow techniques. Of note, the synthesis of neomarchantin A represents the first demonstration of catalytic macrocyclic olefin metathesis as a key step for the synthesis of a macrocyclic bisbibenzyl natural product.

Late diagnosis of isolated congenitally corrected transposition of the great arteries in a 92-year old woman.

We report the case of a 92-year old woman with congenitally corrected transposition of the great arteries (CCTGA). The case is remarkable as the CCTGA had remained undiagnosed until the diagnosis was made when the patient was aged 70 years, and had 10 pregnancies without heart failure.

Risk factors associated with a thrombotic or bleeding event in patients treated with vitamin K antagonists.

Aim: To identify, in a case-control study, the risk factors associated with a thrombotic or bleeding event in patients treated with vitamin K antagonists.

Materials And Methods: We performed a single-centre observational study during a three-month period where we consecutively included patients admitted to the emergency department of a secondary-level hospital and treated with vitamin K antagonists, regardless the reason for admission. Patients admitted for a thrombotic or bleeding event were included as cases and the other patients served as controls.

Emergency reversal of anticoagulation: the real use of prothrombin complex concentrates: a prospective multicenter two year French study from 2006 to 2008.

Introduction: Prothrombin complex concentrate (PCC) for reversal of vitamin K antagonist (VKA) is the main therapeutic option in cases of life-threatening bleeding. Clinical use of PCC is poorly documented.

Methods: We prospectively assessed PCC use in four French emergency departments during a two year period 2006-2008 before publication of French Guidelines.

Prediction of peak oxygen uptake from age and power output at RPE 15 in obese women.

The purpose of this study was to develop a simple, convenient and indirect method for predicting peak oxygen uptake (VO2peak) from a sub-maximal graded exercise test (GXT), in obese women. Thirty obese women performed GXT to volitional exhaustion. During GXT, oxygen uptake and the power at RPE 15 (VO2peak) were measured, and VO2peak was determined.

A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial.

Background: Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines.

Objective: To assess the effectiveness of a handheld clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department.

Design: Cluster randomized trial.

Prediction of peak oxygen uptake from sub-maximal ratings of perceived exertion elicited during a graded exercise test in obese women.

The purpose was to assess the validity of predicting peak oxygen uptake (.VO(2)peak) from Ratings of Perceived Exertion (RPE)< or =15, during a graded exercise test (GXT), in obese women. Forty-three obese women performed GXT to volitional exhaustion.

Intermittent versus continuous exercise: effects of perceptually lower exercise in obese women.

Introduction: Exercise has beneficial effects on obesity and diabetes treatments. However, obese subjects do not closely adhere to training programs probably because of the monotony of the continuous exercise that is frequently proposed. To increase adherence to training programs, intermittent exercise, which is less monotonous, may be more appropriate.

Silencing of OB-RGRP in mouse hypothalamic arcuate nucleus increases leptin receptor signaling and prevents diet-induced obesity.

Obesity is a major public health problem and is often associated with type 2 diabetes mellitus, cardiovascular disease, and metabolic syndrome. Leptin is the crucial adipostatic hormone that controls food intake and body weight through the activation of specific leptin receptors (OB-R) in the hypothalamic arcuate nucleus (ARC). However, in most obese patients, high circulating levels of leptin fail to bring about weight loss.

Real-time myocardial perfusion imaging for pharmacologic stress testing: added value to single photon emission computed tomography.

Background: Little is known about the incremental value of real-time myocardial contrast echocardiography (MCE) as an adjunct to pharmacologic stress testing. This study was performed to evaluate the diagnostic value of MCE to detect abnormal myocardial perfusion by technetium Tc 99m sestamibi-single photon emission computed tomography (SPECT) and anatomically significant coronary artery disease (CAD) by angiography.

Methods: Myocardial contrast echocardiography was performed at rest and during vasodilator stress in consecutive patients (N = 120) undergoing SPECT imaging for known or suspected CAD.

[Contrast echocardiography: from diagnosis to treatment].

Contrast echocardiography is widely used in echocardiographic laboratories. When used at rest or with a stress test, it provides complementary information concerning myocardial perfusion not available with conventional imaging. Its applications in the evaluation of left ventricular ejection fraction, the detection of coronary stenosis and the no reflow phenomenon in acute myocardial infarction have been validated.

Real-time myocardial contrast echocardiography for the detection of stress-induced myocardial ischemia. Comparison with 99mTc-sestamibi single photon emission computed tomography.

Background: Real-time contrast echocardiography (MCE) is a new promising technique for assessing myocardial perfusion. The purpose of this study was to test whether realtime MCE can be used to detect functionally significant coronary artery stenosis in patients with known or suspected coronary artery disease. Myocardial contrast echocardiographic studies were compared with nearly simultaneous 99mTc-sestamibi single photon emission computed tomography (SPECT) as a clinical standard reference to evaluate regional myocardial perfusion defects.

Real-time myocardial contrast echocardiography for pharmacologic stress testing: is quantitative estimation of myocardial blood flow reserve necessary?

Background: Little is known about the diagnostic accuracy of quantitative real-time myocardial contrast echocardiography (MCE) as an adjunct to stress testing. This study was performed to evaluate the agreement between MCE and technetium 99m-sestamibi single photon emission computed tomography (SPECT) for detection of perfusion defects and to investigate whether quantitative assessment of myocardial perfusion can increase the diagnostic value of MCE.

Methods: MCE was performed at rest and during peak adenosine stress in 50 unselected patients undergoing SPECT imaging.

Identification of new drug sensitivity genes using genetic suppressor elements: protein arginine N-methyltransferase mediates cell sensitivity to DNA-damaging agents.

Genetic suppressor elements (GSEs) are cDNA fragments encoding either truncated proteins, acting as dominant-negative mutants, or inhibitory antisense RNA segments counteracting with the gene from which they are derived. To identify genes controlling the cell response to cytotoxic agents, a normalized retroviral library of randomly fragmented cDNAs from Chinese hamster cell line DC-3F was screened for GSEs conferring resistance to the topoisomerase II inhibitor 9-OH-ellipticine. From 218 cDNA fragments isolated, 11 functional GSEs, corresponding to at least 8 independent genes, were selected.

Cyclic variation of myocardial signal intensity in real-time myocardial perfusion imaging.

Background: The presence of cyclic intensity variation during real-time myocardial perfusion imaging (RTPI) has been controversially discussed. We investigated whether cyclic intensity variation is systematically found during RTPI and whether such variations are related to regional functional parameters.

Methods: Intraoperative RTPI were obtained in 12 pigs before, during, and after left descending coronary artery occlusion with 60 mL/h SonoVue infusion.

Expression of a foreign protein in human megakaryocytes and platelets by retrovirally mediated gene transfer.

Recent progress in the culture of human megakaryocytes (MKs) has led to the capacity to produce platelets in vitro. This capability enables investigation into the possibility of modifying platelet structure and/or function by genetically altering the MK. To this end, a cDNA for the murine CD9 (mCD9) cell surface protein was introduced into MK progenitors by retrovirally mediated gene transfer and subsequently detected in cultured MKs with a monoclonal antibody (MoAb) that specifically recognizes the murine protein.

Retrovirus-mediated gene transfer into human CD34+38low primitive cells capable of reconstituting long-term cultures in vitro and nonobese diabetic-severe combined immunodeficiency mice in vivo.

Factors that may improve retroviral transduction of primitive human hematopoietic cells were studied using MFG-based vectors containing a LacZ gene and produced either by a murine (psi-Crip) or a human (Tasaf) cell line. Cord blood (CB) or bone marrow (BM) CD34+ cells were stimulated and transduced in the presence of three cytokines (interleukin 3 [IL-3], IL-6, and stem cell factor [SCF; c-Kit Ligand]). In the supernatant infection protocol, hematopoietic progenitor cells as measured by X-Gal staining of colony-forming unit cells (CFU-Cs) were transduced more effectively with Tasaf (20%) than with psi-Crip (8%).

Ectopic expression of the erythropoietin receptor in a murine interleukin-6-dependent plasmacytoma cell line (TEPC-2027) confers proliferative responsiveness to erythropoietin.

To compare the signal transduction pathways used by erythropoietin (Epo) and interleukin-6 (IL-6), the cDNA for the murine Epo receptor (Epo-R) was introduced into an IL-6-responsive plasmacytoma cell line (TEPC-2027) by retrovirally mediated gene transfer. G418-resistant clones were amplified in IL-6 and studied for their ability to grow and differentiate in response to Epo. Epo-R synthesized from the viral gene showed the same affinity for Epo as did the receptor on erythroid cells; however, the numbers of Epo receptors expressed on the cell membrane varied among clones.

Stromal cells maintain the radioprotective capacity of CFU-S during retroviral infection.

Retroviral vectors provide an efficient means to introduce genes into hematopoietic stem cells. In order to develop retroviral infection protocols which preserve the radioprotective capacity of CFU-S, we designed a clonal hematopoietic reconstitution assay. In this assay, single CFU-S-derived derived colonies from bone marrow cells of 5-FU-treated mice were tested for their capacity to prevent radiation-induced mortality.