La neuro-oncologie des adolescents et adultes jeunes (AJAS) : place d’une RCP nationale. Au nom de l’ANOCEF, GO-AJA et de la SFCE

International audienceThe skills of adult versus pediatric neuro-oncologists are not completely similar though additive. Because the tumors and their protocols are different and the tolerance and expected sequelae are specific. Multidisciplinary meetings including adult and pediatric neuro-oncologists are warranted to share expertise. Since 2008, a weekly national web based conference was held in France. Any patient with the following criteria could be discussed: Adolescent and Young Adults aged between 15 and 25 years, and any adult with a pediatric type pathology, including medulloblastoma, germ cell tumors, embryonic tumors, ependymoma, pilocytic astrocytoma.ResultsAttendance during the year 2015 was as follows: 42 meetings were held; the median number of cases discussed at each meeting was 4 (1 to 8); the mean number of attendants was 7 (2 to 12). One hundred and sixty-eight cases concerning 121 patients were discussed. Mean age was 30 years old (7 to 67). Forty-eight percent were discussed at diagnosis. The patients had mostly medulloblastomas (40%), germ cell tumors (11%), ependymomas (11%), pineal tumors (7%) and embryonal tumors (8%). The rate of inclusion in protocols was increased since the opening of this web conference, especially for the germ cell tumor SIOP protocol that is opened without age restriction, and in RSMA standard risk or MEVITEM relapse adult medulloblastoma protocols.ConclusionMultidisciplinary Web conference for AYAs is feasible and increases the inclusion rate in protocols. It should be developed further.Les compétences en neuro-oncologie pédiatrique et adulte sont différentes mais complémentaires car les histologies, les protocoles thérapeutiques, la tolérance à court et moyen termes et les séquelles tardives attendues sont spécifiques à chaque tranche d’âge. Depuis 2008, ont été mises en place des réunions virtuelles nationales de concertation pluridisciplinaires hebdomadaires initialement dédiées aux adolescents et jeunes adultes (AJA) (15–25 ans) suspects ou porteurs d’une tumeur du système nerveux central dont l’incidence et l’expertise sont plus importantes en milieu pédiatrique. L’expertise a par la suite aussi bénéficié aux adultes plus âgés porteurs de ces affections. En 2015, 168 cas concernant 121 patients ont été discutés lors de 46 réunions. Le nombre moyen de dossiers discutés était de 4 (1 à 8). L’âge moyen de patients présentés était de 30 ans (7 à 67). Dans 48 % des cas, la discussion portait sur la prise en charge initiale. Le nombre moyen de thérapeutes présents était de 7 (2 à 12). Les histologies concernaient principalement des médulloblastomes 40 %, tumeurs germinales malignes 11 %, épendymomes 11 %, tumeurs pinétumeurs embryonnaires 8 %. La RCP AJA a donc prouvé la faisabilité et l’intérêt d’un échange centré sur cette sous-population, entre spécialistes de la neuro-oncologie d’origine diverses. Elle a permis d’optimiser la prise en charge de ces maladies orphelines, et l’inclusion dans des protocoles nationaux et internationaux, en particulier pour les tumeurs germinales malignes intracrâniennes ouverts à tous âges, et les protocoles s’adressant aux médulloblastomes en première ligne (RSMA) ou en rechute (MEVITEM)

Safety and Efficacy of Ceftaroline in Neonates With Staphylococcal Late-onset Sepsis: A Case Series Analysis

International audienceTreatment of late-onset neonatal staphylococcal sepsis is sometimes challenging with feared side effects of vancomycin, increasing minimal inhibitory concentrations and questions about catheter management. In case of failure, ceftaroline was administered as a compassionate treatment in 16 infants (gestational age of less than 32 weeks and less than 28 postnatal days), whose first-line treatment failed. We report 11 successes and no severe adverse drug reactions. Larger data are required to confirm these encouraging results

Performance of 11 host biomarkers alone or in combination in the diagnosis of late-onset sepsis in hospitalized neonates: the prospective EMERAUDE study

International audienceAbstract Background : Despite the high prevalence of late-onset sepsis (LOS) in neonatal intensive care units (NICUs), a reliable diagnosis remains difficult. The time needed to obtain laboratory results of biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) and blood culture explains why an unjustified antibiotic use is observed in numerous hospitalized neonates. This results in an increased frequency of antibiotic resistance, microbiota modification, and neonatal complications. The objective of EMERAUDE study was to identify biomarkers (alone or in combination) to early exclude the diagnosis of LOS in neonates with suggestive clinical signs. Methods : A prospective, multicenter cohort study (EMERAUDE)was conducted in 2 French NICUs. The participants were hospitalized neonates at ≥7 days of life with signs of suspected LOS enrolled from November 2017 to November 2020. Serum samples were collected during the venipuncture prescribed for blood culture. Eleven biomarkers were measured using customized multiplexed assays in the ELLA Automated Immunoassay System (ProteinSimple, San Jose, CA, USA) for PCT, IP-10, IL-6, IL-10, NGAL, PTX3, presepsin and LBP, and using conventional ELISA for calprotectin (R&D Systems, Minneapolis, MN, USA), gelsolin(Elabsciences, Houston, TX, USA) and IL-27(R&D Systems, Minneapolis, MN, USA). An independent adjudication committee, blind to biomarkers, assigned each patient to either infected, not infected or unclassified groups. Performances of biomarkers were assessed considering a sensitivity of at least 0.898. Results : A total of 230 patients were analyzed. They were mainly preterm (80%) with a median gestational age of 27 weeks and a median birth weight of 940 grams. The adjudication committee classified 22% of patients (51/230) as infected and all of these received antibiotics. Among patients of the not infected group, 27% (42/153) also received antibiotics. The best biomarkers alone were IL-6, IL-10 and NGAL; the area under the curve [95%CI] was, respectively, 0.864 [0.798-0.929], 0.845 [0.777-0.914], and 0.829 [0.760-0.898]. Combinations of up to 4 biomarkers were analyzed and the best were PCT/IL-10, PTX3/NGAL, and PTX3/NGAL/gelsolin. The best models of biomarkers could avoid up to 64% of unjustified antibiotics. Conclusions : At the onset of clinical suspicion of LOS, the dosing of additional biomarkers could help the clinician in identifying not infected patients. Trial registration : ClinicalTrials.gov ID: NCT03299751. Registered 3 October 2017

Performance of 11 Host Biomarkers Alone or in Combination in the Diagnosis of Late-Onset Sepsis in Hospitalized Neonates: The Prospective EMERAUDE Study

International audienceDespite the high prevalence of late-onset sepsis (LOS) in neonatal intensive care units, a reliable diagnosis remains difficult. This prospective, multicenter cohort study aimed to identify biomarkers early to rule out the diagnosis of LOS in 230 neonates ≥7 days of life with signs of suspected LOS. Blood levels of eleven protein biomarkers (PCT, IL-10, IL-6, NGAL, IP-10, PTX3, CD14, LBP, IL-27, gelsolin, and calprotectin) were measured. Patients received standard of care blinded to biomarker results, and an independent adjudication committee blinded to biomarker results assigned each patient to either infected, not infected, or unclassified groups. Performances of biomarkers were assessed considering a sensitivity of at least 0.898. The adjudication committee classified 22% of patients as infected and all of these received antibiotics. A total of 27% of the not infected group also received antibiotics. The best biomarkers alone were IL-6, IL-10, and NGAL with an area under the curve (95% confidence interval) of 0.864 (0.798–0.929), 0.845 (0.777–0.914), and 0.829 (0.760–0.898), respectively. The best combinations of up to four biomarkers were PCT/IL-10, PTX3/NGAL, and PTX3/NGAL/gelsolin. The best models of biomarkers could have identified not infected patients early on and avoided up to 64% of unjustified antibiotics. At the onset of clinical suspicion of LOS, additional biomarkers could help the clinician in identifying non-infected patients

A general framework for propagule dispersal in mangroves

Dispersal allows species to shift their distributions in response to changing climate conditions. As a result, dispersal is considered a key process contributing to a species' long-term persistence. For many passive dispersers, fluid dynamics of wind and water fuel these movements and different species have developed remarkable adaptations for utilizing this energy to reach and colonize suitable habitats. The seafaring propagules (fruits and seeds) of mangroves represent an excellent example of such passive dispersal. Mangroves are halophytic woody plants that grow in the intertidal zones along tropical and subtropical shorelines and produce hydrochorous propagules with high dispersal potential. This results in exceptionally large coastal ranges across vast expanses of ocean and allows species to shift geographically and track the conditions to which they are adapted. This is particularly relevant given the challenges presented by rapid sea-level rise, higher frequency and intensity of storms, and changes in regional precipitation and temperature regimes. However, despite its importance, the underlying drivers of mangrove dispersal have typically been studied in isolation, and a conceptual synthesis of mangrove oceanic dispersal across spatial scales is lacking. Here, we review current knowledge on mangrove propagule dispersal across the various stages of the dispersal process. Using a general framework, we outline the mechanisms and ecological processes that are known to modulate the spatial patterns of mangrove dispersal. We show that important dispersal factors remain understudied and that adequate empirical data on the determinants of dispersal are missing for most mangrove species. This review particularly aims to provide a baseline for developing future research agendas and field campaigns, filling current knowledge gaps and increasing our understanding of the processes that shape global mangrove distributions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201