Hepatopulmonary Syndrome and Post-Liver Transplantation Complications: A Case-Control Study.

BACKGROUND: Although liver transplantation (LT) improves survival in cirrhotic patients with hepatopulmonary syndrome (HPS), few data exist concerning post-operative complications in these patients. OBJECTIVE: To compare complications after LT between patients with and without HPS. METHODS: In a case-control study, we retrospectively analyzed all patients who underwent LT in our center from January 2010 to July 2016. We compared cases of identified HPS to controls matched for age, MELD score, comorbidities, red blood cells transfused, and highest dosage of norepinephrine perfused during transplantation. RESULTS: Among 451 transplanted patients, we identified 71 patients with HPS who could be analyzed. We found a significantly (p<0.001) higher number of post-operative complications in patients with HPS (median 5 vs 3), with more occurrence of cardiac, infectious and surgical complications than in the controls: 39.4% vs 12.7% (p<0.001), 81.7% vs 49.3% (p<0.001), and 59.2% vs 40.1% (p<0.029), respectively. There were also more ICU readmissions at 1 month among HPS patients (10 vs 1, p=0.01). There was no significant difference concerning ventilation data, lengths of ICU or hospital stay (8.5 [range 3-232] and 32 [14-276] days, respectively on the whole cohort) and death in the ICU (4.2% on the whole cohort). The 1-year survival was higher in HPS patients (94.4% vs 81.1%, p=0.034); there was no difference in 5-year survival. CONCLUSION: HPS patients seem to have a higher number of complications in the first month following LT.

[Cerebral air embolism complicating talc pleurodesis: case report]. / Embolie gazeuse cérébrale compliquant une pleurodèse au talc : à propos d'un cas.

Cerebral air embolism is a severe complication which can occur during many invasive medical procedures. Its prognosis depends on early diagnosis and hyperbaric oxygen therapy. We report a case of cerebral air embolism which occurred during a talc pleurodesis within a chest tube, in chest postoperative period. After early and appropriate treatment, we observed a significant functional recovery.

Evaluation of perioperative risk in elderly patients.

From a medical point of view, aging is characterized by a potential failure to maintain homeostasis under conditions of physiological stress. This failure is associated with an increase in vulnerability. Physiological changes associated with aging are progressive but concomitant injury or diseases may rapidly worsen the health status of the patient. Increasing age independently predicts morbidity and mortality. Hypertension and dyspnea are probably two of the most frequent risk factors in elderly patients. The history of the elderly patient should assess functional status, including cardiovascular reserve sufficient to withstand very stressful operations. The type of surgery has important implications for perioperative risk and emergency surgery, particularly in the elderly, is associated with a high risk of morbidity. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on their age and concerns for postoperative renal, cardiovascular, cognitive or pulmonary complications. Renal impairment becomes more prevalent with advancing age as the glomerular filtration rate decreases. The surgical site is the single most important predictor of pulmonary complications. Concerning postoperative comfort and neurological complications, age is the highest risk factor for developing dementia. Pain is underassessed and undermanaged. The elderly are at higher risk of adverse consequences from unrelieved or undertreated pain.

[Agreement between lung ultrasonography and chest radiography in the intensive care unit]. / Analyse de concordance entre l'échographie pulmonaire et la radiographie thoracique en réanimation.

OBJECTIVE: Because the chest radiograph currently remains the routine choice of imaging for the examination of the chest in the intensive care unit, we compared lung ultrasonography with chest radiography. STUDY DESIGN: Observational prospective study. METHODS: An ultrasound examination and chest radiography were simultaneously ordered in 50 patients whose clinical exam justified a lung exploration. Each exam was interpreted independently by an intensivist. The abnormalities found were classified into interstitial syndrome, alveolar consolidation, and pleural effusion. An agreement analysis was performed between the results of the two techniques. The delay between the order and interpretation of both investigations, and the degree of interobserver agreement were also collected. RESULTS: The kappa agreement between lung ultrasonography and chest radiography was 0.42. In total, 329 total abnormalities were detected, 156 abnormalities were found by both techniques, 31 by radiography alone, and 142 by ultrasonography alone. The interobserver agreement was 0.86. Ultrasonography was performed with a shorter delay (14.8 ± 6.9 min vs 44.2 ± 21.4 min). CONCLUSION: There was only moderate agreement between lung ultrasonography and chest radiography for the diagnosis of interstitial syndrome, alveolar consolidation and pleural effusion in intensive care unit. This result is mainly explained by the higher number of ultrasound abnormalities. With the ability to provide fast diagnosis, good reproducibility and high feasibility, ultrasound scan could represent an alternative exam for chest exploration in intensive care unit.

O-glycosylation potential of lepidopteran insect cell lines.

The enzyme activities involved in O-glycosylation have been studied in three insect cell lines, Spodoptera frugiperda (Sf-9), Mamestra brassicae (Mb) and Trichoplusia ni (Tn) cultured in two different serum-free media. The structural features of O-glycoproteins in these insect cells were investigated using a panel of lectins and the glycosyltransferase activities involved in O-glycan biosynthesis of insect cells were measured (i.e., UDP-GalNAc:polypeptide N-acetylgalactosaminyltransferase, UDP-Gal:core-1 beta1, 3-galactosyltransferase, CMP-NeuAc:Galbeta1-3GalNAc alpha2, 3-sialyltransferase, and UDP-Gal:Galbeta1-3GalNAc alpha1, 4-galactosyltransferase activities). First, we show that O-glycosylation potential depends on cell type. All three lepidopteran cell lines express GalNAcalpha-O-Ser/Thr antigen, which is recognized by soy bean agglutinin and reflects high UDP-GalNAc:polypeptide N-acetylgalactosaminyltransferase activity. Capillary electrophoresis and mass spectrometry studies revealed the presence of at least two different UDP-GalNAc:polypeptide N-acetylgalactosaminyltransferases in these insect cells. Only some O-linked GalNAc residues are further processed by the addition of beta1,3-linked Gal residues to form T-antigen, as shown by the binding of peanut agglutinin. This reflects relative low levels of UDP-Gal:core-1 beta1,3-galactosyltransferase in insect cells, as compared to those observed in mammalian control cells. In addition, we detected strong binding of Bandeiraea simplicifolia lectin-I isolectin B4 to Mamestra brassicae endogenous glycoproteins, which suggests a high activity of a UDP-Gal:Galbeta1-3GalNAc alpha1, 4-galactosyltransferase. This explains the absence of PNA binding to Mamestra brassicae glycoproteins. Furthermore, our results substantiated that there is no sialyltransferase activity and, therefore, no terminal sialic acid production by these cell lines. Finally, we found that the culture medium influences the O-glycosylation potential of each cell line.

Characterization of a UDP-Gal:Galbeta1-3GalNAc alpha1, 4-galactosyltransferase activity in a Mamestra brassicae cell line.

The binding of Bandeiraea simplicifolia lectin-I isolectin B4 on the endogenous glycoproteins of different insect cell lines led us to characterize for the first time a UDP-Gal:Galbeta1-3GalNAc alpha1, 4-galactosyltransferase in a Mamestra brassicae cell line (Mb). The study of the acceptor specificity indicated that the Mb alpha-galactosyltransferase prefers Galbeta1-3-R as acceptor, and among such glycans, the relative substrate activity Vmax/Km was equal to 20 microliters.mg-1.h-1 for Galbetal-3GlcNAcbeta1-O-octyl and to 330 microliters.mg-1.h-1 for Galbeta1-3GalNAcalpha-1-O-benzyl, showing clearly that Galbeta1-3GalNAc disaccharide was the more suitable acceptor substrate for Mb alpha-galactosyltransferase activity. Nuclear magnetic resonance and mass spectrometry data allowed us to establish that the Mb alpha-galactosyltransferase synthesizes one unique product, Galalpha1-4Galbeta1-3GalNAcalpha1-O-benzyl. The Galbeta1-3GalNAc disaccharide is usually present on O-glycosylation sites of numerous asialoglycoproteins and at the nonreducing end of some glycolipids. We observed that Mb alpha1,4-galactosyltransferase catalyzed the transfer of galactose onto both natural acceptors. Finally, we demonstrated that the trisaccharide Galalpha1-4Galbeta1-3GalNAcalpha1-O-benzyl was able to inhibit anti-PK monoclonal antibody-mediated hemagglutination of human blood group PK1 and PK2 erythrocytes.