Absence of inspiratory laryngeal constrictor muscle activity during nasal neurally adjusted ventilatory assist in newborn lambs

It has been demonstrated that a progressive increase in nasal pressure support ventilation (nPSV) leads to an active inspiratory glottal closure in non-sedated newborn lambs, which limits lung ventilation (24, 33). Unlike nPSV, the pressure delivered during nasal Neurally Adjusted Ventilatory Assist (nNAVA) is synchronized to the diaphragm electrical activity on inspiration (36). Given the tight neural integration of the glottal dilators and constrictors with diaphragm activity on inspiration and expiration respectively, the aim of the present study was to test the hypothesis that inspiratory glottal closure does not develop during nNAVA. Polysomnographic recordings were performed in eight non-sedated, chronically instrumented lambs, which were ventilated with progressively increasing levels of nPSV and nNAVA, in random order. States of alertness, diaphragm and glottal muscle electrical activity, tracheal pressure, SpO2, tracheal PETCO2 and respiratory inductive plethysmography were continuously recorded. While phasic inspiratory glottal constrictor electrical activity appeared with increasing levels of nPSV in 5 out of 8 lambs, it was never observed at any nNAVA level in any lamb, even at maximal achievable nNAVA levels. In addition, a decrease in arterial PCO2 was neither necessary nor sufficient for the development of phasic inspiratory glottal constrictor activity. In conclusion, nNAVA does not induce active glottal closure in non-sedated newborn lambs at high-pressure levels, in contrast to nPSV

Improving the usefulness of evidence concerning the effectiveness of implementation strategies for knowledge products in primary healthcare: protocol for a series of systematic reviews

The literature on the implementation of knowledge products is extensive. However, this literature is still difficult to interpret for policymakers and other stakeholders when faced with choosing implementation strategies likely to bring about successful change in their health systems. This work has the particularity to examine the scope of this literature, and to clarify the effectiveness of implementation strategies for different knowledge products. Consequently, we aim to (1) determine the strengths and weaknesses of existing literature overviews; (2) produce a detailed portrait of the literature on implementation strategies for various knowledge products; and (3) assess the effectiveness of implementation strategies for each knowledge product identified and classify them

Integrated immunovirological profiling validates plasma SARS-CoV-2 RNA as an early predictor of COVID-19 mortality.

peer reviewedDespite advances in COVID-19 management, identifying patients evolving toward death remains challenging. To identify early predictors of mortality within 60 days of symptom onset (DSO), we performed immunovirological assessments on plasma from 279 individuals. On samples collected at DSO11 in a discovery cohort, high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA (vRNA), low receptor binding domain–specific immunoglobulin G and antibody-dependent cellular cytotoxicity, and elevated cytokines and tissue injury markers were strongly associated with mortality, including in patients on mechanical ventilation. A three-variable model of vRNA, with predefined adjustment by age and sex, robustly identified patients with fatal outcome (adjusted hazard ratio for log-transformed vRNA = 3.5). This model remained robust in independent validation and confirmation cohorts. Since plasma vRNA’s predictive accuracy was maintained at earlier time points, its quantitation can help us understand disease heterogeneity and identify patients who may benefit from new therapies

Évaluation de l’importance écologique de 9 étangs vernaux dans Gatineau, Québec

Nous avons évalué l’importance écologique de 9 étangs vernaux de Gatineau (Québec) en utilisant la méthode proposée par Calhoun et collab. (2005). L’un d’eux, situé au nord de la forêt Boucher, s’est démarqué par la richesse et l’abondance de sa faune amphibienne ainsi que par la présence de 4 espèces en situation précaire ou préoccupante. Cet étang atteint la valeur biologique maximale selon la grille d’évaluation utilisée. Nous formulons des recommandations de gestion dans un contexte d’urbanisation.During the present study, 9 vernal pools situated in Gatineau (Québec, Canada) were assessed for their ecological value using the method proposed by Calhoun et al. (2005). One of the pools, which was located to the north of Boucher Forest, stood out in terms of the richness and abundance of the amphibians present, and included 4 species at risk or of special concern. This pool obtained the highest biological value based on the assessment criteria used. Management recommendations in the context of urban development are provided

Évaluation de l’importance écologique de 9 étangs vernaux dans Gatineau, Québec

Nous avons évalué l’importance écologique de 9 étangs vernaux de Gatineau (Québec) en utilisant la méthode proposée par Calhoun et collab. (2005). L’un d’eux, situé au nord de la forêt Boucher, s’est démarqué par la richesse et l’abondance de sa faune amphibienne ainsi que par la présence de 4 espèces en situation précaire ou préoccupante. Cet étang atteint la valeur biologique maximale selon la grille d’évaluation utilisée. Nous formulons des recommandations de gestion dans un contexte d’urbanisation.During the present study, 9 vernal pools situated in Gatineau (Québec, Canada) were assessed for their ecological value using the method proposed by Calhoun et al. (2005). One of the pools, which was located to the north of Boucher Forest, stood out in terms of the richness and abundance of the amphibians present, and included 4 species at risk or of special concern. This pool obtained the highest biological value based on the assessment criteria used. Management recommendations in the context of urban development are provided

Gestion des activités du programme d’accès spécial en établissement de santé : trois exemples

Résumé Santé Canada doit autoriser l’importation de médicaments qui ne détiennent pas d’avis de conformité sur le marché canadien. Cette procédure requiert la collaboration des médecins, des pharmaciens et du personnel de soutien en pharmacie. L’objectif de cet article est de présenter les modalités de gestion de ce programme au sein de trois établissements de santé québécois. Abstract Health Canada must approve the importation of drugs that do not have a notice of compliance on the canadian market. This procedure requires the collaboration of physicians, pharmacists and nonprofessional pharmacy staff. The goal of this article is to describe the terms and conditions of this program in three Quebec health care facilities

Topographic characteristics of keratoconus among a sample of Jordanian patients

<b>AIM:</b>To identify topographic characteristics of keratoconus in a Jordanian sample.<b>METHODS</b>:This study characterized 210 corneas affected with keratoconus presenting to Jordan University Hospital. Patients were diagnosed based on clinical examinations and Pentacam imaging. Eyes of males (<i>n=</i>101) were of a similar proportion to females (<i>n=</i>109). All of the 111 patients were affected bilaterally. Ages ranged between 13 and 44y with a mean age of 25.2y.<b>RESULTS</b>:Results revealed significant differences between males and females at the level of the flat curvature power, basement membrane thickness and size of the anterior chamber. Eyes were arranged in three groups based on severity levels:mild, moderate and severe determined by the mean curvature power (Km). Results show that the flat (K1) and steep (K2) curvature powers, corneal asphericity coefficient (QV), thinnest point, pachy apex and basement membrane thickness are significantly different among the three groups, but not the corneal and anterior chamber volumes. Morphological analyses, based on sagittal maps, show no differences in keratometric values between eyes with different sagittal patterns except for the vertical location of the pachy apex relative to the pupil center and the thinnest point. Eyes with the island front elevation map are significantly more affected than eyes with the U shape and the ridge pattern.<b>CONCLUSION</b>:All keratometric values measured except for corneal and anterior chamber volumes vary significantly with disease severity. The vertical pachy apex location correlates well with severity levels while the horizontal location seems to have no effect. Our study also indicates that front elevation maps may be a better predictor of the severity of keratoconus than sagittal maps

Dynamic contrast enhanced magnetic resonance imaging: A review of its application in the assessment of placental function

International audienceIt is important to develop a better understanding of placental insufficiency given its role in common maternofetal complications such as preeclampsia and fetal growth restriction. Functional magnetic resonance imaging offers unprecedented techniques for exploring the placenta under both normal and pathological physiological conditions. Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is an established and very robust method to investigate the microcirculatory parameters of an organ and more specifically its perfusion. It is currently a gold standard in the physiological and circulatory evaluation of an organ. Its application to the human placenta could enable to access many microcirculatory parameters relevant to the placental function such as organ blood flow, fractional blood volume, and permeability surface area, by the acquisition of serial images, before, during, and after administration of an intravenous contrast agent. Widely used in animal models with gadolinium-based contrast agents, its application to the human placenta could be possible if the safety of contrast agents in pregnancy is established or they are confirmed to not cross the placenta

Impact of COVID-19-Related Lockdown on Delivery and Perinatal Outcomes: A Retrospective Cohort Study

International audienceObjective: The magnitude and direction of effects on pregnancy outcomes of the lockdown imposed during COVID-19 have been uncertain and debated. Therefore, we aimed to quantify delivery and perinatal outcomes during the first nationwide lockdown due to the COVID-19 pandemic compared with the same durations of time for the pre-and post-lockdown periods.Study design: This was a retrospective cohort study of six university hospital maternity units distributed across France, each of which serves as the obstetric care referral unit within its respective perinatal network. Maternal and perinatal outcomes were compared between the lockdown period and same-duration (i.e., 55-day) periods before and after the 2020 lockdown (pre-lockdown: 22 January– 16 March; lockdown: 17 March–10 May; post-lockdown: 11 May–4 July). We compared the overall rates of Caesarean delivery (CD), pre-labor CD, labor induction, operative vaginal delivery, severe postpartum hemorrhage (≥1 L), severe perineal tear, maternal transfusion, and neonatal mortality and morbidity (1-and 5-min Apgar scores < 7), hypoxia and anoxia (umbilical arterial pH < 7.20 or <7.10, respectively), and admission to a neonatal intensive care unit before discharge. Adjusted odds ratios were estimated using logistic regression, controlling for region of birth, maternal age category, multiparity, multiple pregnancies, diabetes, and hypertensive disorders.Results: The study sample consisted of 11,929 women who delivered consecutively at one of the six maternity units studied (4093 pre-lockdown, 3829 during lockdown, and 4007 post-lockdown) and their 12,179 neonates (4169 pre-lockdown, 3905 during lockdown, and 4105 post-lockdown). The maternal and obstetric characteristics of the women delivering during the lockdown period were alike those delivering pre-and post-lockdown on maternal age, parity, body mass index, rate of complication by hypertensive disorders or insulin-treated diabetes, and gestational age at delivery. Overall CD rates were similar during the three periods (23.6%, 24.8%, and 24.3% pre-lockdown, lockdown, and post-lockdown, respectively) and no outcome differed significantly during lockdown compared to pre-and post-lockdown. These findings were consistent across maternity units.Conclusion: The maternal and perinatal outcomes are reassuring regarding the performance of the health-care system during the COVID-19 lockdown studied. Such information is crucial, because additional COVID-19-related lockdowns might still be needed. They are also instructive regarding potential future pandemics