Distribution et productivité de deux champignons ectomycorhiziens (Cantharellus cibarius var. roseocanus et Hypomyces lactifluorum/ Russula brevipes) en peuplements de Pin gris de l'Est du Canada

Les champignons ectomycorhiziens forment des symbioses racinaires avec des arbres des forêts boréales. Malgré leur importance dans cet écosystème, leurs exigences en matière d’habitat demeurent mal connues. Deux champignons comestibles, une chanterelle (Cantharellus cibarius var. roseocanus Redhead, Norvell & Danell) et la dermatose des russules (Hypomyces lactifluorum (Schwein.) Tul. & C.Tul. / Russula brevipes Peck.), ont été étudiés dans cette thèse. Trois expériences ont été menées en peuplements aménagés et non aménagés de pin gris (Pinus banksiana Lamb.). Cette étude visait à caractériser les paramètres environnementaux qui influencent la production de carpophores chez ces champignons, à déterminer l’impact d’une peturbation forestière sur ces derniers et à préciser l’importance de la phénologie du pin gris pour la fructification de C. cibarius var. roseocanus. Les résultats relient la distribution (présence/absence des carpophores) et la productivité (biomasse fraîche et densité des carpophores) de ces champignons à des paramètres du sol, du peuplement, de la végétation et du climat. L’aménagement de sentiers n’a pas augmenté la production de carpophores de dermatose des russules, mais l’a maintenu durant les périodes de faibles précipitations. La productivité de ce champignon présente des corrélations positives avec l’abondance de plantes intolérantes à l’ombre et l’ammonium extractible et négatives avec le pH du sol. La productivité de C. cibarius var. roseocanus s’équivaut entre le peuplement aménagé et non aménagé malgré l’absence de carpophores dans les sentiers du peuplement aménagé. L’association végétale Solidago puberula – Comptonia peregrina – Pinus banksiana et la présence de mousses représente un habitat propice à la fructification de cette chanterelle, alors que la présence de plantes éricacées la défavoriserait. Les précipitations et la température de l’air ont aussi un impact sur la quantité de carpophores. Le pic de fructification de C. cibarius var. roseocanus suit la transition du bois juvénile vers le bois mature. Durant la saison de croissance, la respiration du carpophore est synchronisée avec la respiration totale du sol et ces deux respirations sont corrélées avec les variations de températures du sol. Les résultats permettront de mieux prédire la distribution et la productivité de ces espèces en peuplements de pin gris. Ces connaissances contribueront au développement et à l’exploitation durable de cette ressource.Ectomycorrhizal fungi form root symbioses with boreal tree species. Despite their importance in that ecosystem, their requirements in term of habitat remain unknown. Two edible mushrooms, a chanterelle (Cantharellus cibarius var. roseocanus Redhead, Norvell & Danell) and the lobster mushroom (Hypomyces lactifluorum (Schwein.) Tul. & C.Tul. / Russula brevipes Peck.) were studied in this thesis. Three experiments were conducted in managed and unmanaged jack pine (Pinus banksiana Lamb.) stands. This research aimed to characterize the ecological parameters related to the production of sporocarps of these fungi, to determine the impact of a specific forest disturbance on the latter and to specify the importance of jack pine phenology on the pattern of C. cibarius var. roseocanus carpophore production. Results allowed us to link the mushroom distribution (sporocarp presence/absence) and the productivity (fresh sporocarp biomass and sporocarp density) to specific soil, stand, plant and meteorological parameters. Trail management did not increase lobster mushroom carpophore production but maintained it during periods of reduced precipitation. Productivity of this fungus was positively related to the abundance of shade-intolerant plant species and to extractable ammonium concentration, and negatively related to soil pH. C. cibarius var. roseocanus sporocarp productivity was similar for the managed and the unmanaged stands despite the absence of carpophore on trails of the managed stand. The Solidago puberula – Comptonia peregrina– Pinus banksiana association and mosses presence indicated high-quality environments for chanterelle fructification, whereas ericaceous species presence restricted it. Rainfall and air temperature also had an impact on the carpophore productivity. The C. cibarius var. roseocanus fructification peak followed the earlywood–latewood transition within days. Over the growing season the carpophore respiration was in synchrony with the total soil respiration and these respirations were correlated to the soil temperature patterns. Results will enable the prediction of the distribution and the productivity of these species in jack pine stands. This knowledge will contribute to the sustainable development and use of this natural resource

Differential effects of speech and Language therapy and rTMS in chronic versus subacute post-stroke aphasia: Results of the NORTHSTAR-CA trial

Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (\u3e6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results: Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P \u3c.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR =.77) than chronic patients (Mdn =.15/IQR = 1.68/P =.015). There was no significant rTMS effect in the chronic aphasia group. Conclusions: The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR trial registration: https://clinicaltrials.gov/ct2/show/NCT02020421

Antenatal screening for Group B Streptococcus: A diagnostic cohort study

BACKGROUND: A range of strategies have been adopted to prevent early onset Group B Streptococcal (EOGBS) sepsis, as a consequence of Group B Streptococcal (GBS) vertically acquired infection. This study was designed to provide a scientific basis for optimum timing and method of GBS screening in an Australian setting, to determine whether screening for GBS infection at 35–37 weeks gestation has better predictive values for colonisation at birth than screening at 31–33 weeks, to examine the test characteristics of a risk factor strategy and to determine the test characteristics of low vaginal swabs alone compared with a combination of perianal plus low vaginal swabs per colonisation during labour. METHODS: Consented women received vaginal and perianal swabs at 31–33 weeks gestation, 35–38 weeks gestation and during labour. Swabs were cultured on layered horse blood agar and inoculated into selective broth prior to analysis. Test characteristics were calculated with exact confidence intervals for a high risk strategy and for antenatal screening at 31–33 and 35–37 weeks gestation for vaginal cultures alone, perianal cultures alone and combined low vaginal and perianal cultures. RESULTS: The high risk strategy was not informative in predicting GBS status during labour. There is an unequivocal benefit for the identification of women colonised with GBS during labour associated with delaying screening until 36 weeks however the results for method of screening were less definitive with no clear advantage in using a combined low vaginal and perianal swabbing regimen over the use of a low vaginal swab alone. CONCLUSION: This study can contribute to the development of prevention strategies in that it provides clear evidence for optimal timing of swabs. The addition of a perianal swab does not confer clear benefit. The quantification of advantages and disadvantages provided in this study will facilitate communication with clinicians and pregnant women alike

A thematic analysis of factors influencing recruitment to maternal and perinatal trials

Background: Recruitment of eligible participants remains one of the biggest challenges to successful completion of randomised controlled trials (RCTs). Only one third of trials recruit on time, often requiring a lengthy extension to the recruitment period. We identified factors influencing recruitment success and potentially effective recruitment strategies. Methods: We searched MEDLINE and EMBASE from 1966 to December Week 2, 2006, the Cochrane Library Methodology Register in December 2006, and hand searched reference lists for studies of any design which focused on recruitment to maternal/perinatal trials, or if no studies of maternal or perinatal research could be identified, other areas of healthcare. Studies of nurses' and midwives' attitudes to research were included as none specifically about trials were located. We synthesised the data narratively, using a basic thematic analysis, with themes derived from the literature and after discussion between the authors. Results: Around half of the included papers (29/53) were specific to maternal and perinatal healthcare. Only one study was identified which focused on factors for maternal and perinatal clinicians and only seven studies considered recruitment strategies specific to perinatal research. Themes included: participant assessment of risk; recruitment process; participant understanding of research; patient characteristics; clinician attitudes to research and trials; protocol issues; and institutional or organisational issues. While no reliable evidence base for strategies to enhance recruitment was identified in any of the review studies, four maternal/perinatal primary studies suggest that specialised recruitment staff, mass mailings, physician referrals and strategies targeting minority women may increase recruitment. However these findings may only be applicable to the particular trials and settings studied. Conclusion: Although factors reported by both participants and clinicians which influence recruitment were quite consistent across the included studies, studies comparing different recruitment strategies were largely missing. Trials of different recruitment strategies could be embedded in large multicentre RCTs, with strategies tailored to the factors specific to the trial and institution.Rebecca L Tooher, Philippa F Middleton and Caroline A Crowthe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

HYPOMYCES LACTIFLUORUM/RUSSULA BREVIPES) EN PEUPLEMENTS DE PIN GRIS DE

à la Faculté des études supérieures et postdoctorales de l’Université Laval dans le cadre du programme de doctorat en sciences forestières pour l’obtention du grade de Philosophiae Doctor (Ph.D.

Surgical dilemma: liver resection or liver transplantation for hepatocellular carcinoma and cirrhosis. Intention-to-treat analysis in patients within and outwith Milan criteria

AbstractBackgroundThe optimal role of surgery in the management of hepatocellular carcinoma (HCC) is in continuous evolution.ObjectiveThe objective of this study was to analyse survival rates after liver resection (LR) and orthotopic liver transplantation (OLT) for HCC within and outwith Milan criteria in an intention-to-treat analysis.MethodsDuring 1997–2007, 179 patients with cirrhosis and HCC either underwent LR (n= 60) or were listed for OLT (n= 119). Patients with incidental HCC after OLT, preoperative macrovascular invasion before LR, non-cirrhosis and Child–Pugh class C cirrhosis prior to OLT were eliminated, leaving 51 patients primarily treated with LR and 106 patients listed for primary OLT (84 of whom were transplanted) to be included in this analysis. A total of 66 patients fell outwith Milan criteria (26 LR, 40 OLT) and 91 continued to meet Milan criteria (25 LR, 66 OLT).ResultsThe median length of follow-up was 26 months. The mean waiting time for OLT was 7 months. During that time, 21 patients were removed from the waiting list as a result of tumour progression. Probabilities of dropout were 2% and 13% at 6 and 12 months, respectively, for patients within Milan criteria, and 34% and 57% at 6 and 12 months, respectively, for patients outwith Milan criteria (P < 0.01). Tumour size >3cm was found to be the independent factor associated with dropout (hazard ratio [HR] 6.0). Postoperative survival was slightly higher after OLT, but this was not statistically significant (64% for OLT vs. 57% for LR). Overall survival from time of listing for OLT or LR did not differ between the two groups (P= 0.9); for patients within Milan criteria, 1- and 4-year survival rates after LR were 88% and 61%, respectively, compared with 92% and 62%, respectively, after OLT (P= 0.54). For patients outwith Milan criteria, 1- and 4-year survival rates after LR were 69% and 54%, respectively, compared with 65% and 40%, respectively, after OLT (P= 0.42). Tumour size >3cm was again found to be an independent factor for poor outcome (HR 2.4) in the intention-to-treat analysis.ConclusionsSurvival rates for patients with HCC are similar in LR and OLT. Liver resection can potentially decrease the dropout rate and serve as a bridge for future salvage LT, particularly in patients with tumours >3cm