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/)

FICUS, a new in-situ probe for resistivity measurements in unconsolidated marine sediments

International audienc

Pathologie tumorale tumorale: Le point de vue du clinicien

info:eu-repo/semantics/publishe

Forward modelling of the physical properties of oceanic sediments: constraints from core and logs, with palaeoclimatic implications

International audienc

Mineralogical association and physical properties of sediments with palaeoclimatic implications (ODP Site 798B, Japan Sea): a comparative study from core and downhole measurements

International audienc

An AFM, XPS and wettability study of the surface heterogeneity of PS/PMMA-r-PMAA demixed thin films.

A series of homopolymer/random copolymer blends was used to produce heterogeneous surfaces by demixing in thin films. The chosen homopolymer is polystyrene (PS) and the random copolymer is poly(methyl methacrylate)-r-poly(methacrylic acid) (PMMA-r-PMAA), whose acidic functions could be used as reactive sites in view of further surface functionalization. The proportion of each polymer at the interface was deduced from X-ray photoelectron spectroscopy (XPS) data using, on the one hand, the O/C ratio, and on the other hand, decomposition of the carbon peak of the blends in two components corresponding to the carbon peaks of PS and PMMA-r-PMAA. Combining the information from XPS with atomic force microscopy (AFM) images, water contact angle measurements and PS selective dissolution, it appears that the surfaces obtained from blends with a high PS content (90/10 to 70/30) display pits with a bottom made of PMMA-r-PMAA, randomly distributed in a PS matrix. On the other hand, the surfaces obtained from blends with a low PS content (30/70 to 10/90) display randomly distributed PS islands surrounded by a PMMA-r-PMAA matrix. The characteristics of the heterogeneous films are thought to be governed by the higher affinity of PMMA-r-PMAA for the solvent (dioxane), which leads to the elevation of the PS phase compared to the PMMA-r-PMAA phase, and to surface enrichment in PMMA-r-PMAA

Submicrometer-scale heterogeneous surfaces by PS-PMMA demixing

Patterned surfaces were created using two polymers: polystyrene (PS) on the one hand, and either poly(methyl methacrylate) (PMMA) or poly(methyl methacrylate)-poly(methacrylic acid) (PMMA-PMAA) on the other hand. PMMA was dissolved in a solvent of PS; this solution was then spin-coated on a PS support that partially dissolved during the process. The materials were analyzed by water contact angle measurement, XPS, ToF-SIMS and AFM. The effect of the solvent on the final surface morphology was strongly marked. With chloroform, the acrylic polymer was the major surface constituent, possibly because of the high evaporation rate of this solvent. With toluene, which is a better solvent for PS compared to PMMA, the obtained surface was almost exclusively constituted of PS. The use of chlorobenzene provided inclusions of acrylic polymer in PS, both polymers being exposed at the outermost surface. The surface morphology presented rings, the interior of which consisted of the acrylic polymer, while the rest of the surface was made of PS. (C) 2004 Elsevier Ltd. All rights reserved

Near total thyroidectomy is an optimal treatment for graves' disease.

Surgical management of Graves' disease is still debated. We report our current experience with thyroidectomy for Graves' disease at a tertiary center. A retrospective database of 132 patients who underwent surgery for Graves' disease from January 1985 to December 2008 was collected. During that period, 16 patients underwent subtotal thyroidectomy and 116 patients underwent near total thyroidectomy. Eighty-seven patients (66%) underwent surgery for recurrent disease after medical therapy. Forty-five patients (34%) had surgery as a primary treatment, the indications were large goiter size in 22 (17%), patient preference in 19 (14%), and associated cold nodule in 3 (2%). The incidence of cancer was 4.4%. Permanent hypoparathyroidism was observed in one patient who underwent a second surgery for recurrence. Unilateral transitory vocal cord palsy was observed in nine patients (7%), bilateral transitory vocal cord palsy was observed in one patient, and no definitive vocal cord palsy was observed. Two patients (1.5%) experienced post-operative hemorrhagia requiring surgical revision. Near total thyroidectomy for Graves' disease provides an immediate and definitive treatment with a low complication rate. Near total thyroidectomy offers an appropriate treatment for coexisting malignancy. This procedure can be safely recommended as a primary treatment, in experienced hands.Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

A rough morphology of the adsorbed fibronectin layer favors adhesion of neuronal cells.

A range of substrates made of polystyrene (PS) and poly(methyl methacrylate)-poly(methacrylic acid) copolymer (PMMA-PMAA) containing 98 and 80% PMMA (PA98, PA80) and presenting a homogeneous or a patterned surface were used to study fibronectin adsorption and neuronal cell behavior. Fibronectin adsorption showed weak differences regarding the adsorbed amount (evaluated by XPS), but large differences in adsorbed layer morphology as observed by AFM. A fine granular morphology, with dimensions up to 8 nm height and 50-150 nm width, was observed on top of a thin adsorbed layer in the case of PS, PA98, and of a surface made of nanoscale inclusions of the latter in PS. In contrast, the layer adsorbed on PA80, which carries more ionizable groups, showed a higher roughness on the PA80 zones with differences in height up to 30 nm and characteristic lateral dimensions of 400 nm. On substrates of the former category, the cells formed large clusters, revealing poor interactions with the substrate. On PA80, the cells formed large networks with only a few small clusters. The adsorbed layer roughness, resulting from aggregation of fibronectin upon adsorption and from the substrate surface chemical composition, is responsible for neuronal cell spreading and growth. Its effect is not prevented by the presence of inclusions (< 30% of the surface) responsible for smoother areas of adsorbed fibronectin and for protrusions below 40 nm. (c) 2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2008

Longitudinal evaluation of the impact of immunosuppressive regimen on immune responses to COVID-19 vaccination in kidney transplant recipients.

International audienceImmunocompromised patients have a high risk of death from SARS-CoV-2 infection. Vaccination with an mRNA vaccine may protect these patients against severe COVID-19. Several studies have evaluated the impact of immune-suppressive drug regimens on cellular and humoral responses to SARS-CoV-2 variants of concern in this context. We performed a prospective longitudinal study assessing specific humoral (binding and neutralizing antibodies against spike (S) and T-lymphocyte (cytokine secretion and polyfunctionality) immune responses to anti-COVID-19 vaccination with at least two doses of BNT162b2 mRNA vaccine in stable kidney transplant recipients (KTR) on calcineurin inhibitor (CNI)- or belatacept-based treatment regimens. Fifty-two KTR−31 receiving CNI and 21 receiving belatacept—were enrolled in this study. After two doses of vaccine, 46.9% of patients developed anti-S IgG. Anti-spike IgG antibodies were produced in only 21.4% of the patients in the belatacept group, vs. 83.3% of those in the CNI group. The Beta and Delta variants and, more importantly, the Omicron variant, were less well neutralized than the Wuhan strain. T-cell functions were also much weaker in the belatacept group than in the CNI group. Renal transplant patients have an impaired humoral response to BNT162b2 vaccination. Belatacept-based regimens severely weaken both humoral and cellular vaccine responses. Clinically, careful evaluations of at least binding IgG responses, and prophylactic or post-exposure strategies are strongly recommended for transplant recipients on belatacept-based regimens