Caractéristiques mécaniques d’échantillons d’os cortical du fémur du chien : étude sur quatre groupes morphologiques représentatifs de l’espèce canine

Quatre fémurs de chien (caniche toy, caniche moyen, braque allemand et doberman) représentatifs des diverses tailles de l’espèce canine ont été utilisés dans cette étude biomécanique pour déterminer le module d’élasticité de l’os cortical. Il a été mesuré par la technique de flexion en trois points sur des échantillons standardisés de diaphyses fémorales permettant de calculer le module de Young par le rapport contrainte / déformation. L’étude a montré que l’élasticité de l’os cortical était constante dans les quatre groupes étudiés et plus élevée en face crâniale que caudale. La contrainte à la limite élastique du caniche toy était plus élevée que celles du caniche et du braque et la déformation plus élevée que celles des trois autres clusters. Les paramètres à la rupture du caniche toy étaient plus élevés que ceux du caniche moyen

Effective mechanical properties of diaphyseal cortical bone in the canine femur

The effective elastic modulus, yield strength, yield strain, ultimate strength, ultimate strain, strain energy density at yield and strain energy density at ultimate failure of femoral diaphyseal cortical bone were investigated on canine femurs. Four femurs representative of the canine population were selected from four statistically-determined clusters based on increasing size and weight comprising the Toy poodle (5 kg), Poodle (12 kg), German shorthaired pointer (25 kg) and Doberman (50 kg). The zones of interest were the lateral, medial, cranial, and caudal quadrants of the mid-diaphysis. Effective mechanical properties were measured using quasi-static three-point bending tests on strips. The averages +/- SD were 15.6 +/- 2.6 GPa for effective elastic modulus, 1743 +/- 32.1 MPa for yield strength, 0.012 +/- 0.003 for yield strain, 251.0 +/- 49.1 MPa for ultimate strength, 0.021 +/- 0.005 for ultimate strain, 10.7 +/- 4.0 J m(-3) x 10(5) for strain energy density at Yield and 33.0 +/- 14.1 J M-3 X 10(5) for strain energy density at ultimate failure. Significant differences were found between dogs and the effective elastic modulus increased with breed weight and size (13.9 GPa for the Toy poodle to 17.2 GPa for the Doberman). The ultimate strength sigma(u) and strain energy density at ultimate failure U-u were significantly lower in the Toy poodle than in the Poodle and German shorthaired pointer indicating that the cortical bone material in the Toy poodle differed from that of the other dogs. Examination of the zones of interest revealed that the cranial quadrant showed the greatest stiffness, whereas strength was highest at the medial site. The caudal cortex was less stiff and strong than the cranial cortex

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Caractéristiques mécaniques d'échantillons d'os cortical du fémur du chien (étude sur quatre groupes morphologiques représentatifs de l'espèce canine)

Quatre fémurs de chien (caniche toy, caniche moyen, braque allemand et doberman) représentatifs des diverses tailles de l'espèce canine ont été utilisés dans cette étude biomécanique pour déterminer le module d'élasticité de l'os cortical. Il a été mesuré par la technique de flexion en trois points sur des échantillons standardisés de diaphyses fémorales permettant de calculer le module de Young par le rapport contrainte / déformation. L'étude a montré que l'élasticité de l'os cortical était constante dans les quatre groupes étudiés et plus élevée en face crâniale que caudale. La contrainte à la limite élastique du caniche toy était plus élevée que celles du caniche et du braque et la déformation plus élevée que celles des trois autres clusters. Les paramètres à la rupture du caniche toy étaient plus élevés que ceux du caniche moyen.TOULOUSE-EN Vétérinaire (315552301) / SudocTOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Abstract P2-16-14: HER2-positive breast cancer: Combined 18 F-FDG PET and CGFL/Curie nomogram to predict pathologic complete response after preoperative chemotherapy with trastuzumab

International audienc

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis

International audienc

Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study

International audienceBackground: The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (&gt; 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods: Characteristics, management, and prognosis of critically ill old patients (&gt; 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. Results: The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO2/FiO2 ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27; p &lt; 0·001). Conclusion: Patients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission

Benefits and risks of noninvasive oxygenation strategy in COVID-19: a multicenter, prospective cohort study (COVID-ICU) in 137 hospitals

International audienceAbstract Rational To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs). Methods Multicenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day-90 mortality were assessed using multivariate logistic regression. Results From February 25 to May 4, 2020, 4754 patients were admitted in ICU. Of these, 1491 patients were not intubated on the day of ICU admission and received standard oxygen therapy (51%), HFNC (38%), or NIV (11%) ( P < 0.001). Oxygenation failure occurred in 739 (50%) patients (678 intubation and 61 death). For standard oxygen, HFNC, and NIV, oxygenation failure rate was 49%, 48%, and 60% ( P < 0.001). By multivariate analysis, HFNC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.36–0.99, P = 0.013) but not NIV (OR 1.57, 95% CI 0.78–3.21) was associated with a reduction in oxygenation failure). Overall 90-day mortality was 21%. By multivariable analysis, HFNC was not associated with a change in mortality (OR 0.90, 95% CI 0.61–1.33), while NIV was associated with increased mortality (OR 2.75, 95% CI 1.79–4.21, P < 0.001). Conclusion In patients with COVID-19, HFNC was associated with a reduction in oxygenation failure without improvement in 90-day mortality, whereas NIV was associated with a higher mortality in these patients. Randomized controlled trials are needed

Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study

International audienc

Predicting 90-day survival of patients with COVID-19: Survival of Severely Ill COVID (SOSIC) scores

International audienceBackground Predicting outcomes of critically ill intensive care unit (ICU) patients with coronavirus-19 disease (COVID-19) is a major challenge to avoid futile, and prolonged ICU stays. Methods The objective was to develop predictive survival models for patients with COVID-19 after 1-to-2 weeks in ICU. Based on the COVID–ICU cohort, which prospectively collected characteristics, management, and outcomes of critically ill patients with COVID-19. Machine learning was used to develop dynamic, clinically useful models able to predict 90-day mortality using ICU data collected on day (D) 1, D7 or D14. Results Survival of Severely Ill COVID (SOSIC)-1, SOSIC-7, and SOSIC-14 scores were constructed with 4244, 2877, and 1349 patients, respectively, randomly assigned to development or test datasets. The three models selected 15 ICU-entry variables recorded on D1, D7, or D14. Cardiovascular, renal, and pulmonary functions on prediction D7 or D14 were among the most heavily weighted inputs for both models. For the test dataset, SOSIC-7’s area under the ROC curve was slightly higher (0.80 [0.74–0.86]) than those for SOSIC-1 (0.76 [0.71–0.81]) and SOSIC-14 (0.76 [0.68–0.83]). Similarly, SOSIC-1 and SOSIC-7 had excellent calibration curves, with similar Brier scores for the three models. Conclusion The SOSIC scores showed that entering 15 to 27 baseline and dynamic clinical parameters into an automatable XGBoost algorithm can potentially accurately predict the likely 90-day mortality post-ICU admission (sosic.shinyapps.io/shiny). Although external SOSIC-score validation is still needed, it is an additional tool to strengthen decisions about life-sustaining treatments and informing family members of likely prognosis