UNICORN Babies: Understanding Circulating and Cerebral Creatine Levels of the Preterm Infant. An Observational Study Protocol

Creatine is an essential metabolite for brain function, with a fundamental role in cellular (ATP) energy homeostasis. It is hypothesized that preterm infants will become creatine deplete in the early postnatal period, due to premature delivery from a maternal source of creatine and a limited supply of creatine in newborn nutrition. This potential alteration to brain metabolism may contribute to, or compound, poor neurological outcomes in this high-risk population. Understanding Creatine for Neurological Health in Babies (UNICORN) is an observational study of circulating and cerebral creatine levels in preterm infants. We will recruit preterm infants at gestational ages 23+0–26+6, 27+0–29+6, 30+0–32+6, 33+0–36+6, and a term reference group at 39+0–40+6 weeks of gestation, with 20 infants in each gestational age group. At birth, a maternal capillary blood sample, as well as a venous cord blood sample, will be collected. For preterm infants, serial infant plasma (heel prick), urine, and nutrition samples [total parenteral nutrition (TPN), breast milk, or formula] will be collected between birth and term “due date.” Key fetomaternal information, including demographics, smoking status, and maternal diet, will also be collected. At term corrected postnatal age (CPA), each infant will undergo an MRI/1H-MRS scan to evaluate brain structure and measure cerebral creatine content. A general movements assessment (GMA) will also be conducted. At 3 months of CPA, infants will undergo a second GMA as well as further neurodevelopmental evaluation using the Developmental Assessment of Young Children – Second Edition (DAYC-2) assessment tool. The primary outcome measures for this study are cerebral creatine content at CPA and plasma and urine creatine and guanidinoacetate (creatine precursor) concentrations in the early postnatal period. We will also determine associations between (1) creatine levels at term CPA and neurodevelopmental outcomes (MRI, GMA, and DAY-C); (2) dietary creatine intake and circulating and cerebral creatine content; and (3) creatine levels and maternal characteristics. Novel approaches are needed to try and improve preterm-associated brain injury. Inclusion of creatine in preterm nutrition may better support ex utero brain development through improved cerebral cellular energy availability during a period of significant brain growth and development.Ethics Ref: HDEC 18/CEN/7 New Zealand.ACTRN: ACTRN12618000871246

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Trouble d'anxiété généralisée chez les adolescents (recherches épidémiologique et clinique)

TOULOUSE2-BUC Mirail (315552102) / SudocSudocFranceF

État de stress post-traumatique (ESPT) et accouchement

TOULOUSE2-BUC Mirail (315552102) / SudocSudocFranceF

La psychopathologie et les cognitions dans la douleur chronique

La douleur chronique est souvent associée à la dépression et l anxiété. Ces pathologies entretiennent des liens complexes qui ont été largement étudiés. Cependant en France, nous manquons d informations permettant d améliorer la prise en charge psychothérapeutique de ces patients. Le but de ce travail est d améliorer la compréhension de l influence des facteurs psychopathologiques et cognitifs dans la douleur chronique.Étude 1 : Une étude quantitative a été réalisée auprès d un échantillon de 228 étudiants. L analyse des croyances associées à la douleur a permis de mettre en lumière une perception positive du vécu de la sensation douloureuse. Ainsi, ils ne perçoivent pas la douleur comme étant un phénomène stable dans le temps ou mystérieux ; de plus, ils ne manifestent pas de sentiment de culpabilité lié à la douleur. Les résultats indiquent également que les participants ont des perceptions rationnelles des médicaments. Ils considèrent cependant qu il y a une surconsommation des médicaments. Étude 2 : Une étude quantitative a été réalisée auprès d un échantillon de 247 personnes atteintes de fibromyalgie. Dans cette étude, 93 % des participants présentaient des symptômes dépressifs, et 94 % présentaient des symptômes anxieux. En outre, des symptômes dépressifs sévères sont retrouvés dans 25 % des cas et 43 % des participants présentent une anxiété sévère. Les différentes analyses de régression réalisées ont montré que la relation entre la symptomatologie anxio-dépressive et la douleur est partiellement médiatisée par les croyances associées à la douleur.Étude 3 : Une étude quantitative a été menée auprès de 247 personnes atteintes de fibromyalgie. Les analyses de corrélation ont montré un lien entre la symptomatologie anxio-dépressive, les mesures relatives à la douleur, les croyances associées à la douleur, la dramatisation, la flexibilité psychologique et l optimisme. L analyse de régression multiple indique que les croyances associées à la douleur, l optimisme et la flexibilité psychologique prédisent 58 % de la variance des scores de dramatisation. Une analyse en cluster a permis de mettre en évidence trois profils cognitifs : les catastrophistes, les modérés et les flexibles optimistes. Des analyses de variance ont montré que ces clusters se différenciaient au niveau des scores de dépression, d anxiété, d intensité et d impact de la douleur. Le profil catastrophiste obtenait les scores les plus élevés à ces différentes mesures.Chronic pain is often associated with depression and anxiety. These pathologies have complex links that have been widely studied. In France, however, there are few studies that provide information on psychotherapeutic treatment of these patients. The overall objective of this work is to improve understanding of psychopathological and cognitive factors linked to chronic pain. Study 1: A quantitative study was carried out on a sample of 228 students. An analysis of beliefs associated to pain provided insight into the concept of pain sensation. The participants perceived pain as an instable phenomenon over time, were not likely to associate pain with mysterious origins, and did not link pain to feelings of guilt. The results also showed that the participants had rational beliefs about medication, although they tended to believe that medication was overused. Study 2: A quantitative study was conducted on a sample of 247 fibromyalgia sufferers. In this study, 93 % of participants presented depressive symptoms, and 94 % presented anxiety symptoms. Severe depressive symptoms were found in 25 % of cases, and 43 % of participants reported severe anxiety. Regressions analyses showed that the relationship between depressive symptoms, anxiety and pain is partially mediated by beliefs associated with pain.Study 3: A quantitative study was conducted on a sample of 247 people suffering from fibromyalgia. Correlation analyses showed a link between anxio-depressive symptoms, measures related to pain, pain-related beliefs, dramatization, psychological flexibility, and optimism. A multiple regression analysis indicated that beliefs associated with pain, optimism and psychological flexibility predicted 58 % of the variance in scores of dramatization. A cluster analysis highlighted three cognitive profiles in these patients: catastrophics , moderates and flexible optimistics . Analyses of variance showed that cluster groups differed in levels of depression, anxiety, intensity, and impact of pain. Catastrophics had higher scores on these measures.TOULOUSE2-SCD-Bib. electronique (315559903) / SudocSudocFranceF

L'activation des schémas cognitifs dans la douleur, la représentation du corps, la périnatalité et en lien avec le contrôle du moi et le coping

Les schémas précoces inadaptés sont associés à différentes pathologies psychologiques et en sont parfois à l'origine et/ou la cause de leur maintien. Cependant, les schémas précoces inadaptés ne sont pas les seuls à l'œuvre en fonction des pathologies ; ils sont en lien avec le coping, le contrôle du moi et les croyances. Le but de ce travail est l'amélioration de la compréhension de l'activation des schémas précoces inadaptés ainsi que l'influence des facteurs psychopathologiques et cognitifs dans une population générale, chez les douloureux chroniques, chez les futurs parents et dans une population souffrant de troubles du comportement alimentaire. Une première étude quantitative a été réalisée afin de mettre en évidence l'activation des schémas précoces inadaptés et leurs relations avec les stratégies de coping et contrôle du moi auprès d'une population générale. Une seconde étude a été réalisée dans le but de mettre en évidence l'activation des schémas précoces inadaptés et leurs liens avec les stratégies de coping et le contrôle du moi chez les futurs parents. Une troisième étude a été menée afin de démontrer l'activation des schémas précoces inadaptés en relation avec la représentation du corps et les troubles alimentaires. Et une quatrième étude a été élaborée dans le but de tester l'hypothèse d'une activation des schémas précoces inadaptés en relation avec la représentation de la douleur dans une population tunisienne. Des corrélations significatives ont été observées entre les stratégies de coping et les schémas précoces inadaptés ainsi qu'entre le contrôle du moi et les schémas précoces inadaptés et aussi entre les stratégies de coping et le contrôle du moi.Early maladaptive schemas (EMS) are associated with different forms of psychopathology being not only a source of its manifestation but also a means for maintaining maladaptive behaviour. It is likely that EMS are not the only element linked to psychopathology; coping, irrational beliefs, and ego control are likely linked to both schemas and maladaptive behaviour. The objective of this work was to better understand activation of EMS as well as the influence of cognitive and psychopathological factors in the general population, in individuals suffering from chronic debilitating pain, in future parents, and in those suffering from eating disorders. The objective of the first study is the EMS activation and their relationship to coping strategies and ego control in the general population. The second study explores the expression of EMS in future parents and identify the relationship between EMS, coping, and ego control. The third study is about the EMS activation in relationship to body image and the manifestation of eating disorder sand. The fourth one studies EMS in relationship to chronic pain in a Tunisian sample. Significant and meaningful correlations were found between coping strategies, ego control and EMS. Gender differences were also identified and explored.TOULOUSE2-SCD-Bib. electronique (315559903) / SudocSudocFranceF

Traiter la dépréciation de soi - Le syndrome de l'imposteur

National audienc