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    ABSTRACT: /st>The optimal resuscitation fluid for the early treatment of severe bleeding patients remains highly debated. The objective of this experimental study was to compare the rapidity of shock reversal with lactated Ringer (LR) or hydroxyethyl starch (HES) 130/0.4 at the early phase of controlled haemorrhagic shock. To assess the influence of vascular permeability in this model, we measured plasma vascular endothelial growth factor (VEGF) levels during the experiment. /st>Thirty-six anaesthetized and mechanically ventilated piglets were bled (<30 ml kg(-1)) to hold mean arterial pressure (MAP) at 40 mm Hg for more than 30 min and were resuscitated in two randomized groups: LR (n=14) or HES (n=14) at 1 ml kg(-1) min(-1) until MAP reached its baseline value of ±10%. MAP was maintained at its baseline value for 1 h. The time and fluid volume necessary to restore the baseline MAP value were measured. /st>The time to restore the baseline MAP value of ±10% was significantly lower in the HES group (P<0.001). During the initial resuscitation phase, the infused volume was 279 (119) ml in the HES group and 1011 (561) ml in the LR group (P<0.0001). During the stabilization phase, the infused volume was 119 (124) ml in the HES group and 541 (506) ml in the LR group. Biological data and plasma VEGF levels were similar between the groups. /st>Restoration of MAP was four times faster with HES than with LR in the early phase of controlled haemorrhagic shock. However, there was no evidence of increased vascular permeability.
    BJA British Journal of Anaesthesia 11/2013; 112(6). DOI:10.1093/bja/aet375
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    ABSTRACT: The incidence of pregnancy outcomes in women with constitutive thrombophilia is uncertain. We observed women with no history of thrombotic events (non-thrombotic), who had experienced three consecutive spontaneous abortions before the 10th week of gestation or one fetal death at or beyond the 10th week of gestation. We compared the frequencies of complications during a new pregnancy attempt among women carrying the F5 rs6025 or F2 rs1799963 polymorphism (n=279; LMWH treatment during pregnancy only in case of prior fetal death), and women with negative thrombophilia screening results as control women (n=796; no treatment). Among women with prior recurrent abortions, thrombophilic women were at increased risk of fetal death. Among women with prior fetal death, thrombophilic women experienced less fetal death recurrences, less preterm births and pre-eclampsia, and more live births as they were treated with LMWH. In non-thrombotic F5 rs6025 or F2 rs1799963 heterozygous women with prior pregnancy loss, fetal loss may indicate a clinical subgroup in which future therapeutic randomized controlled trials testing the effect of LMWH prophylaxis are required in priority.
    Blood 11/2013; 123(3). DOI:10.1182/blood-2013-09-525014
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    ABSTRACT: The incidence of pregnancy outcomes for women with the purely obstetric form of antiphospholipid syndrome (APS) treated with prophylactic low-molecular weight heparin LMWH plus low-dose aspirin LDA has not been documented. We observed women without a history of thrombosis, who had experienced three consecutive spontaneous abortions before the 10th week of gestation or one fetal loss at or beyond the 10th week. We compared the frequencies of complications during new pregnancies between treated women with APS (n=513; LMWH+LDA) and women negative for antiphospholipid antibodies as controls (n=791; no treatment). Among APS women, prior fetal loss was a risk factor for fetal loss, pre-eclampsia (PE), premature birth and the occurrence of any placenta-mediated complication. Being positive for anticardiolipin-IgM antibodies was a risk factor for any placenta-mediated complication. Among women with a history of recurrent abortion, APS women were at a higher risk than other women of PE, placenta-mediated complications and neonatal mortality. Among women with prior fetal loss, LMWH+LDA-treated APS women had lower pregnancy loss rates but higher PE rates than other women. Improved therapies, in particular better prophylaxis of late pregnancy complications, are urgently needed for obstetric APS and should be evaluated according to the type of pregnancy loss.
    Blood 11/2013; 123(3). DOI:10.1182/blood-2013-08-522623

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Revue Européenne de Psychologie Appliquée 09/2004; 54(3):173-177. DOI:10.1016/j.erap.2003.10.001
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