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/)

Coexistence of annular pancreas with carcinoma in the dorsal part of pancreas divisum: diagnostic value of magnetic resonance cholangiopancreatography.

International audienceWe report on the incidental observation of a pancreas divisum coexistent with an annular pancreas in a 88-year-old woman presenting with jaundice due to a pancreatic carcinoma. This case report discusses the embryologic hypotheses underlying this peculiar association, highlights the capacities of imaging techniques to depict them, and enhances the performance of magnetic resonance imaging

Acute Myocarditis Revealing Adult-Onset Still’s Disease

International audienceA 34-year-old man presented with fever, palpitations, maculopapular rash, pharyngitis, left cheilitis, and bilateral gonalgia. High-sensitivity troponin I concentration was 4,900 ng/l. Transthoracic echocardiogram revealed reduced global longitudinal strain. Cardiac magnetic resonance imaging showed acute myocarditis. Adult-onset Still’s disease was diagnosed, and treatment with intravenous corticosteroids and tocilizumab was initiated. (Level of Difficulty: Beginner.

Contrôles microbiologiques des endoscopes au centre hospitalier régional de Brest du 1er janvier 2007 au 31 décembre 2009. [Microbiological investigation of endoscopes at Brest Hospital over a period from 2007 to 2009].

International audienceOBJECTIVES: The aim of this study is to evaluate the quality of disinfection of endoscopes at Brest hospital over a period from 2007 to 2009. PATIENTS AND METHODS: Retrospective study of microbiological investigations of endoscopes done at Brest hospital from 2007 to 2009. The interpretation of the microbiological investigations is based on the recommendations of the Comité technique national des infections nosocomiales et infections liées aux soins (CTINILS) of 2007. RESULTS: Most of the controls realized over the period deal with gastroenterological endoscopes (63.4 %) and bronchial endoscopes (21.8 %). Most of the controls (66.8 %) are conformed to the target level. Only 26.7 % of the controls get the level of action. Globally, the rate of level of action significantly increases (p=0.004) from 2007 (21.2 %) to 2009 (35.6 %). This increase is relatively important in gastroenterology endoscopy (46.8 % in 2009 versus 24.1 % in 2007) whereas the rate decreases in bronchial endoscopy (14.8 % in 2009 versus 25.9 % in 2007). In gastroenterological endoscopy, rates vary with the type of endoscopes and the context of controls, but there is no significant difference between manual disinfection and automated disinfection. The most frequent germ found in gastroenterological and bronchial endoscopies is Pseudomonas aeruginosa. CONCLUSION: Our results show that it is very difficult to insure a perfect disinfection of endoscopes. Difficulties met are certainly related with the complexity of the endoscopes and of the techniques of disinfection. Infections of patients are very infrequent in endoscopy, which takes the question of the pertinence of the threshold used for microbiological investigations

Measures to improve microbial quality surveillance of gastrointestinal endoscopes

International audienc

Efficacy and Safety of Tumor Necrosis Factor Antagonists in Treatment of Internal Fistulizing Crohn's Disease

International audienceBackground & aims - Few data are available on the effects of tumor necrosis factor (TNF) antagonist therapy for patients with internal fistulizing Crohn's disease (CD) and there is debate regarding the risk of abscess. We aimed to assess the long-term efficacy and safety of anti-TNF therapy for patients with internal fistulas. Methods - We performed a retrospective study of data collected from the Groupe d'Etude Thérapeutique des Affections Inflammatoires Digestives trial, from January 1, 2000, through December 31, 2017. Our final analysis included 156 patients who began treatment with an anti-TNF agent for CD with internal fistula (83 men; median disease duration, 4.9 y). The primary end point was the onset of a major abdominal surgery. Secondary analysis included disappearance of the fistula tract during follow-up evaluation and safety. The Kaplan-Meier method was used for statistical analysis. Results - After a median follow-up period of 3.5 years, 68 patients (43.6%) underwent a major abdominal surgery. The cumulative probabilities for being surgery-free were 83%, 64%, and 51% at 1, 3, and 5 years, respectively. A concentration of C-reactive protein >18 mg/L, an albumin concentration <36 g/L, the presence of an abscess at the fistula diagnosis, and the presence of a stricture were associated independently with the need for surgery. The cumulative probabilities of fistula healing, based on imaging analyses, were 15.4%, 32.3%, and 43.9% at 1, 3, and 5 years, respectively. Thirty-two patients (20.5%) developed an intestinal abscess and 4 patients died from malignancies (3 intestinal adenocarcinomas). One patient died from septic shock 3 months after initiation of anti-TNF therapy. Conclusions - In a retrospective analysis of data from a large clinical trial, we found that anti-TNF therapy delays or prevents surgery for almost half of patients with CD and luminal fistulas. However, anti-TNF therapy might increase the risk for sepsis-related death or gastrointestinal malignancies

Livre Blanc. Agriculture & numérique en Aquitaine

Le Livre Blanc « Agriculture et numérique en Aquitaine » est un état des lieux mais également un document repère pour l’action et un outil d’aide à la décision en Aquitaine. La particularité du Livre Blanc est que son contenu résulte d’une collaboration entre chercheurs et professionnels agricoles. Problématique du Livre Blanc : Comment les outils et dispositifs numériques se diffusent-ils et sont-ils appropriés par les agriculteurs et les organisations professionnelles ? Quels rôles jouent-ils dans les mutations des métiers et des pratiques professionnelles ?Objectifs du Livre Blanc : Rendre compte des travaux menés pendant trois ans au sein du projet RAUDIN et valoriser les résultats des recherches de l’axe 4 : Mutation des pratiques et intégration des dispositifs numériques dans les organisations agricoles en Aquitaine.- Faire une analyse de situation des interactions « Agriculture » et « TIC » en Aquitaine, sur quelques problématiques concrètes pertinentes,- Rédiger des repères et recommandations pour l’action (outil d’aide à la décision publique).Les Ateliers : Le Livre Blanc « Agriculture et Numérique en Aquitaine » tente de répondre aux grandes problématiques du secteur agricole régional en lien avec l’équipement et l’usage des Technologies de l’Information et de la Communication (TIC).6 grandes thématiques identifiées construisent ce document final. Afin de confronter les regards, opinions et perceptions de plusieurs professions (chercheurs, professionnels du secteur agricole, institutionnels,…), nous avons mis en place (sur la période février-mars 2012) des ateliers thématiques dédiés à chacune des problématiques identifiées :1. Usages du numérique en agriculture2. Le numérique dans l’agriculture respectueuse de l’environnement3. Circuits courts, agritourisme et numérique4. La place du numérique en viticulture5. Formation agricole et numérique6. Conseil agricole et numériqueDéfinition des ateliers : Chaque atelier réunit un groupe de personnes concernées par la thématique abordée. Ces personnes sont rassemblées pour échanger points de vue et expériences sur une thématique, à partir d’un cadrage et d’un questionnement préalablement organisés et définis par l’équipe de recherche.Les échanges sont régulés et modérés par l’équipe du projet RAUDIN.Objectifs des ateliers- Inviter les personnes ressources intéressées afin d’alimenter le débat autour des grandes questions identifiées pour chaque thématique,- Enrichir le diagnostic de données factuelles complémentaires,- Réfléchir collectivement à des actions à mener sur des thématiques porteuses d’enjeux,- Collecter des données utilisables dans l’élaboration et la rédaction du document final : le Livre Blanc,- Faire évoluer le document en fonction de l’expérience et du vécu des acteurs présents,- Contribuer, de manière pertinente, à la production d’un document de recherche-action.Destinataires du Livre Blanc- Les financeurs et décideurs publics : Conseil Régional, UE (FEDER), État,- L’ensemble des acteurs du secteur agricole aquitain : organisations professionnelles agricoles, agriculteurs, salariés agricoles opérateurs et intervenants privés sur le secteur agricole,- Le grand public.Recherches Aquitaines sur les Usages pour le Développement des dIspositifs Numériques, RAUDIN, Fede

Efficacy and safety of endoscopic papillectomy: a multicenter, retrospective, cohort study on 227 patients

International audienceBACKGROUND: Endoscopic papillectomy is a minimally invasive treatment for benign tumors of the ampulla of Vater or early ampullary carcinoma. However, reported recurrence rates are significant and risk factors for recurrence are unclear. OBJECTIVE: The aims of this study were to evaluate the efficacy and safety of endoscopic papillectomy and to identify risk factors for recurrence and adverse events. METHODS: All patients who underwent endoscopic papillectomy at five tertiary referral centers between January 2008 and December 2018 were included. Recurrence was defined as the detection of residue on one of the follow-up endoscopies. Treatment success was defined as the absence of tumor residue on the last follow-up endoscopy. RESULTS: A total of 227 patients were included. The resections were en bloc in 64.8% of cases. The mean lesion size was 20 mm (range: 3-80) with lateral extension in 23.3% of cases. R0 resection was achieved in 45.3% of cases. The recurrence rate was 30.6%, and 60.7% of recurrences were successfully treated with additional endoscopic treatment. Finally, treatment success was achieved in 82.8% of patients with a median follow-up time of 22.3 months. R1 resection, intraductal invasion, and tumor size &gt; 2 cm were associated with local recurrence. Adverse events occurred in 36.6% of patients and included pancreatitis (17.6%), post-procedural hemorrhage (11.0%), perforation (5.2%), and biliary stenosis (2.6%). The mortality rate was 0.9%. CONCLUSION: Endoscopic papillectomy is an effective and relatively well-tolerated treatment for localized ampullary tumors. In this series, R1 resection, intraductal invasion, and lesion size &gt; 2 cm were associated with local recurrence