Cédric Gaxatte

Soluble receptor for advanced glycation end products: a new biomarker in diagnosis and prognosis of chronic inflammatory diseases

The formation of advanced glycation end products (AGEs) is a result of the non-enzymatic reaction between sugars and free amino groups of proteins. AGEs, through interacting with their specific receptor for AGEs (RAGE), result in activation of pro-inflammatory states and are involved in numerous pathologic situations. The soluble form of RAGE (sRAGE) is able to act as a decoy to avoid interaction of RAGE with its pro-inflammatory ligands (AGEs, HMGB1, S100 proteins). sRAGE levels have been found to be decreased in chronic inflammatory diseases including atherosclerosis, diabetes, renal failure and the aging process. The use of measuring circulating sRAGEs may prove to be a valuable vascular biomarker and in this review, we describe the implications of sRAGE in inflammation and propose that this molecule may represent a future therapeutic target in chronic inflammatory diseases.

Vieillissement rénal : facteurs de risque et néphroprotection

Renal failure in the elderly is currently underestimated and presents a real challenge for the public health system. Kidney function must be routinely assessed by creatinine clearance, estimated with either the Cockcroft and Gault formula or the simplified MDRD formula, which appears especially appropriate for the elderly. Normal kidney aging is related to tissue and functional changes that make older patients very vulnerable to environmental modifications. Numerous factors can accelerate the impairment of rental function during aging. Some of them cannot be modified: sex, genome, and initial kidney disease. Most of them can be managed or treated: hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, proteinuria, and the presence of oxidation and glycation products. Chronic renal failure in the elderly must be managed early with strict treatment targets to avoid the development of end-stage renal disease. Inhibitors of the renin-angiotensin-aldosterone system play an essential role in optimizing nephroprotection: control of hypertension, diabetes complications, and proteinuria. They should be prescribed very carefully in older patients. Age is not a prerequisite for consultations with nephrologists, which should take place early so that nephroprotection can still be useful.

Syndrome de la tour de Pise : relation avec les inhibiteurs de l’acétylcholine estérase chez des patients âgés atteints de la maladie d’Alzheimer

Nicolas Girard, Vincent Cottin, Marie-George Lapalus, François Tronc, Jean-François Cordier Pneumology department, Pilot Unit for Rare Thoracic Malignant Tumors, Louis Pradel Hospital, Hospices civils de Lyon, Lyon I University, Lyon, F-69677 Lyon (Bron) Cedex, France Digestive specialities federation, Edouard Herriot hospital, Hospices Civils de Lyon, F-69437 Lyon Cedex 03, France Thoracic surgery department, Louis Pradel hospital, Hospices Civils de Lyon, F-69677 Lyon (Bron) Cedex, France

Cas cliniqueSyndrome de la tour de Pise : relation avec les inhibiteurs de l’acétylcholine estérase chez des patients âgés atteints de la maladie d’AlzheimerRelation between Pisa syndrome and choline esterase inhibitors in a cohort of Alzheimer’s disease patients

Nicolas Girard, Vincent Cottin, Marie-George Lapalus, François Tronc, Jean-François Cordier Pneumology department, Pilot Unit for Rare Thoracic Malignant Tumors, Louis Pradel Hospital, Hospices civils de Lyon, Lyon I University, Lyon, F-69677 Lyon (Bron) Cedex, France Digestive specialities federation, Edouard Herriot hospital, Hospices Civils de Lyon, F-69437 Lyon Cedex 03, France Thoracic surgery department, Louis Pradel hospital, Hospices Civils de Lyon, F-69677 Lyon (Bron) Cedex, France

Retour en EHPAD après une hospitalisation : modalités et qualité des transmissions

CONTEXT Nursing home residents are very old, with multiple comorbidities and disabled for activities of daily living (ADLs). Therefore, they have a higher risk of accidents as falls or fractures or acute diseases as infections, which require hospitalization. Cares coordination and sharing of informations between hospitals and nursing homes are often insufficient even with agreements. Thus, discharge to nursing homes after hospitalization may be difficult for old patients because of incomplete oral or written transmissions. OBJECTIVE To examine both protocols and the quality of the return to the nursing homes after an hospitalization for old residents. METHOD A prospective multicenter study done by collecting data about consecutive returns into their nursing home after an hospitalization of more than 24 hours of nursing home residents aged 65 years and more. RESULTS Twenty-eight nursing homes of the North of France were enrolled in the study. During the 3 months period of the study, 246 discharges after an hospitalization of 24 hours or more were registered. 225 residents (165 women and 60 men), mean age 85.0 ± 7.2, were concerned. Most of them were ADLs disabled, with a dementia for 47.1% of them. The average length of hospitalization was 11.6 days. At the end of hospitalization, the notification of return, which was made only in 82% of cases, was announced in average 1.3 days before the discharge. Unfortunately, in 32% of cases, the notification was made the day of the discharge. Residents went back home indifferently any day of the week but more often the Friday and less often the weekend. The day and the hour of the planned discharge were respected in 79.1% of cases. In most cases, nursing home caregivers have considered that the clinical status was stable or improved compared to the previous one. However in 28% of cases, a loss of autonomy was found. Medical doctors wrote a letter of discharge in 85.8% of cases. Nurses gave written transmissions only in 41.9% of cases. CONCLUSION Many points concerning discharge from hospital, about old people living in nursing home, have to be improved: oral transmissions about patients status, notification of the return, discharges letter, nurses transmissions and assessment of the loss of autonomy.