The Role of ACTH and Corticosteroids for Sepsis and Septic Shock: An Update.

Sepsis is a common disorder associated with high morbidity and mortality. It is now defined as an abnormal host response to infection, resulting in life-threatening dysfunction of organs. There is evidence from in vitro and in vivo experiments in various animal models and in patients that endotoxin or sepsis may directly and indirectly alter the hypothalamic-pituitary-adrenal response to severe infection.

Tenofovir pharmacokinetic after sleeve-gastrectomy in four severely obese patients living with HIV.

There are many unsolved questions about safety of bariatric surgery in the context of severely obese patients living with human immunodeficiency virus (HIV) and notably on antiretroviral therapy (ART) absorption. Here, we provide the first case series of tenofovir disoproxil fumarate (TDF) pharmacokinetic in four HIV-infected patients before and after sleeve-gastrectomy. Our case-series showed a transient and reversible decrease of TDF bioavailability one month after sleeve-gastrectomy without any consequences on CD4 cells and HIV viral load.

Anterior approach for total hip arthroplasty conversion of hip fusion.

Purpose: Hip fusion conversion has shown mixed results, in particular a higher rate of failure than primary total hip replacement. Conversion is usually carried out by a lateral approach.

Methods: We reported a series of 37 hip fusion conversions performed by an anterior approach.

Transcranial direct-current stimulation reduced the excitability of diaphragmatic corticospinal pathways whatever the polarity used.

We investigated effects of transcranial direct-current stimulation (tDCS) on the diaphragmatic corticospinal pathways in healthy human. Anodal, cathodal, and sham tDCS were randomly applied upon the left diaphragmatic motor cortex in twelve healthy right-handed men. Corticospinal pathways excitability was assessed by means of transcranial magnetic stimulation (TMS) elicited motor-evoked-potential (MEP).

StO₂ guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial.

The scientific community has agreed upon developing accurate monitoring of tissue perfusion and oxygenation to improve the management of subjects with sepsis. This pilot study aimed to investigate the feasibility of targeting tissue oxygen saturation (StO₂) in addition to the currently recommended resuscitation goals, central venous pressure, mean arterial pressure and central venous oxygen saturation, in patients with severe sepsis or septic shock. A pilot, single-centre, randomised, non-blinded trial recruited 30 subjects with severe sepsis upon intensive care unit admission at an academic medical centre in France.

Masseter tissue oxygen saturation predicts normal central venous oxygen saturation during early goal-directed therapy and predicts mortality in patients with severe sepsis.

Objective: This study aimed to investigate, in patients with severe sepsis, the correlation between central venous oxygen saturation and tissue oxygen saturation at different levels.

Design: Prospective observational study.

Setting: General intensive care unit at an academic medical center in France.

Corticosteroids for severe sepsis: an evidence-based guide for physicians.

Septic shock is characterized by uncontrolled systemic inflammation that contributes to the progression of organ failures and eventually death. There is now ample evidence that the inability of the host to mount an appropriate hypothalamic-pituitary and adrenal axis response plays a major in overwhelming systemic inflammation during infections. Proinflammatory mediators released in the inflamed sites oppose to the anti-inflammatory response, an effect that may be reversed by exogenous corticosteroids.

Adjunct therapy for sepsis: how early?

Sepsis is a leading cause of death worldwide. The management of patients is primarily based on curing the infectious process with anti-infective drugs and/or surgical drainage. Simultaneously, treatment includes optimization of oxygen use by tissues via appropriate oxygen therapy and respiratory and hemodynamic management.

Human and experimental septic shock are characterized by depletion of lipid droplets in the adrenals.

Rationale: Cholesteryl ester deficiency which results in adrenal lipid store depletion has been proposed as a potential mechanism of sepsis associated adrenal insufficiency.

Objective: We investigated histological abnormalities associated with sepsis in human and mice adrenals.

Methods: From January 2006 to 2008, seven patients who died of septic shock and seven patients with rapidly fatal nonseptic illness were included.

Masseter muscle oxygen saturation is associated with central venous oxygen saturation in patients with severe sepsis.

Objective: This monocentric prospective study was conducted to determine if tissue oxygen saturation measured non invasively over masseter muscle site (Masseter-StO2) can predict the central venous oxygen saturation (ScvO2) level in severe sepsis and septic shock.

Methods: Sixteen consecutive patients with severe sepsis (n = 10) or septic shock (n = 6) were included in this study. ScvO2 was measured on blood samples taken from the superior vena cava via the distal line of a central venous catheter.

Mechanisms of brain signaling during sepsis.

Brain signaling is a crucial event for the body to mount an appropriate response to invading microorganisms. Pro-inflammatory cytokines are released from infected tissues and reach key structures in the brain via the circumventricular organs, areas of damaged blood brain barrier or they cross actively the blood brain barrier using specific carriers. Alternately, cytokines may activate brain endothelial cells or microglial to produce prostaglandins which then diffuse into the brain to activate neurons.

Long-term outcome of iatrogenic gas embolism.

Objective: To establish the incidence and long-term prognosis of iatrogenic gas embolism.

Methods: This was a prospective inception cohort. We included all consecutive adults with proven iatrogenic gas embolism admitted to the sole referral academic hyperbaric center in Paris.

Sepsis-associated delirium: the pro and con of C5a blockade.

The intimate mechanisms of sepsis-induced delirium are unknown. Among the potential contributing factors, the breakdown of the blood-brain barrier is considered a key determinant of brain dysfunction. The complement activation is paramount to an appropriate activation of the central nervous system during stress.

Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial.

Background: International guidelines for management of septic shock recommend that dopamine or norepinephrine are preferable to epinephrine. However, no large comparative trial has yet been done. We aimed to compare the efficacy and safety of norepinephrine plus dobutamine (whenever needed) with those of epinephrine alone in septic shock.

Hyperphagia contributes to the normal body composition and protein-energy balance in HIV-infected asymptomatic men.

Wasting can occur at an early stage of HIV infection. Both reduced energy intake and increased resting energy expenditure (REE) have been considered as factors in wasting with predominant lean body mass loss, suggesting disturbances of protein metabolism. Our aim was to study protein-energy metabolism in relation to body composition and oral energy intake in asymptomatic patients with HIV infection but receiving no active antiretroviral therapy.