Veno-venous extracorporeal membrane oxygenation for pregnant women with acute respiratory distress syndrome : a narrative review

peer reviewedAcute respiratory distress syndrome remains an uncommon condition during pregnancy. In patients with severe acute respiratory distress syndrome, when oxygenation or ventilation cannot be supported sufficiently using best practice conventional mechanical ventilation and additional therapies, veno-venous extracorporeal membrane oxygenation may be considered. In the past two decades, there has been increasing adoption of this technique to support adult patients with refractory acute respiratory distress syndrome. However, its use for the management of pregnant women is rare and remains a challenge. This narrative review addresses acute respiratory distress syndrome and its management during pregnancy, and then focuses on indications, contraindications, challenges, potential complications, and outcomes of the use of veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the pregnant patien

Lésions interradiculaires (thérapeutiques résectrices versus thérapeutiques implantaires, pronostics)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pomphorhynchus laevis manipulates Gammarus pulex behaviour despite salt pollution

International audienceSalt pollution of freshwater ecosystems represents a major threat to biodiversity, and particularly to interactions between free-living species and their associated parasites. Acanthocephalan parasites are able to alter their intermediate host's phenotype to reach final hosts, but this process could be affected by salt pollution, thereby compromising survival of the parasite.2. We experimentally assessed the impact of salt on the extended phenotype of the parasite Pomphorhynchus laevis in their intermediate host, the amphipod Gammarus pulex, based on three amphipod behaviours: distance covered in flowing water, phototaxis, and geotaxis. We hypothesised that: (1) salt pollution negatively affected the behaviour of uninfected gammarids, and (2) that P. laevis could maintain their capacity to manipulate their host despite this pollution.3. All three amphipod behaviours were altered by P. laevis: infected G. pulex covered a greater distance, were less photophobic and were more attracted to the water surface than uninfected amphipods, in control or salt-polluted water. However, salinity reduced distance covered in flowing water and increased attraction to the water surface of uninfected and infected G. pulex. For the phototaxis behaviour, P. laevis enhanced this capacity of manipulation in salt-polluted water compared to control water.4. Pomphorhynchus laevis can still manipulate the behaviour of their intermediate host in salt-polluted water. Acanthocephalan parasites have not been known to be able to manipulate their intermediate host when under pollution stress. Trophic interactions, but not the chances of parasite transmission to their definitive host, appear to be affected by salt pollution.5. Our study indicates that behavioural modifications induced by complex lifecycle parasites should be more considered in the context of growing concentrations of chemical pollutants in some freshwater ecosystems. Interspecific interactions, and particularly host–parasite relationships, are a key component of ecosystem stability and their alteration could result in major changes in energy flow

Effects of temperature and a manipulative parasite on the swimming behaviour of Gammarus pulex in flowing water

International audienceNumerous freshwater acanthocephalans are able to alter the behaviour of their intermediate hosts to increase their predation risk by final hosts, thereby enhancing trophic transmission between their two hosts. Because temperature is widely expected to impact freshwater host-parasite interactions, we investigated how it can affect movements of both uninfected and Pomphorhynchus laevis-infected Gammarus pulex in an artificial stream in 5 cm/s water flow. We found that P. laevis infection of G. pulex induced both higher frequency and higher amplitude of movements along the artificial stream. Moreover, at warmer temperature (21°C), uninfected and P. laevis-infected G. pulex moved more in the artificial stream than at 15°C. In this regard, warmer temperature could then impact gammarids distribution and increase P. laevis transmission rate toward their definitive host in freshwater ecosystems. Firstly, this study provides new insights into how the key temperature factor influences gammarids species movements in the stream. Secondly, elevated temperature did not influence the intensity of P. laevis manipulation in G. pulex intermediate host. This work highlights that warmer temperature might affect the distribution and the behaviour of infected or uninfected freshwater gammarids with no direct effect on acanthocephalan trophic transmission through manipulation

Les parasites acanthocéphales reflètent le statut écologique des écosystèmes d'eau douce

International audienceAcanthocephalans’ position in food webs, in close interaction with free-living species, could provide valuable information about freshwater ecosystem health through the viability of the parasites’ host populations. We explored Pomphorhynchus laevis cystacanths’ and adults’ intensities of infection, and the prevalence of infected hosts respectively in their Gammarus pulex intermediate hosts and Squalius cephalus definitive hosts in a Mediterranean river. First, we analysed the relationship between P. laevis intensity of infection, its two hosts populations and the other acanthocephalan species found (Pomphorhynchus tereticollis and Polymorphus minutus). Second, we characterised the influence of bacteriological, physicochemical and biological water parameters on these acanthocephalans, and their intermediate and definitive hosts. This research highlights that P. laevis infection was closely related to their two preferential hosts population in the river. Moreover, P. laevis intensity of infection was positively correlated with organic pollution in the river but negatively correlated with biodiversity and with ecological indexes of quality. Pomphorhynchus laevis could thus benefit from moderate freshwater pollution, which promotes their tolerant intermediate and definitive hosts

GATA-4/-6 and HNF-1/-4 families of transcription factors control the transcriptional regulation of the murine Muc5ac mucin during stomach development and in epithelial cancer cells.: Regulation of Muc5ac by GATA-6 and HNF-4α

International audienceDuring human embryonic and fetal development of the gastrointestinal tract, the gene encoding the MUC5AC mucin has a spatio-temporal pattern of expression restricted to the stomach. In order to better understand the molecular mechanisms responsible for this restricted pattern of expression, we have studied Muc5ac expression in the developing stomach of the mouse and correlated it to that of transcription factors known to be involved in cell differentiation programs during development. Our results indicate that GATA-6 and HNF-4α expression increased concomitantly with the induction of Muc5ac expression in embryonic stomach. We then studied Muc5ac transcriptional regulation by these transcription factors and showed that they all transactivate Muc5ac promoter. We also identified several active GATA-4/-5/-6 and HNF-1/-4 cis-elements using gel shift assays, chromatin immunoprecipitation and site-directed mutagenesis. Among all Muc5ac regulators, only GATA-6 and HNF-4a expression was concomitant to that of Muc5ac in the developing stomach. This is thus in favor of an important role for these two transcription factors as regulators of expression of the Muc5ac mucin during stomach development and in epithelial cancer cells

Super-selective robot-assisted partial nephrectomy using near-infrared flurorescence versus early-unclamping of the renal artery: results of a prospective matched-pair analysis

International audienceIntroduction: Super-selective clamping of tumor-specific segmental arteries was developed to eliminate ischemia of the remnant kidney while limiting hemorrhage during partial nephrectomy. The objective is to evaluate the benefice of super-selective clamping on renal functional outcome, compared to early-unclamping of the renal artery. Materials and Methods: From March 2015 to July 2016, data from 30 patients undergoing super-selective robot-assisted PN (RAPN) for a solitary tumor by a single surgeon were prospectively collected. Tumor devascularization was assessed using indocyanine green near-infrared fluorescence. A matched-pair analysis with a retrospective cohort undergoing early-unclamping was conducted, adjusting on tumor complexity and pre-operative eGFR. Perioperative, oncologic and functional outcomes using DMSA-renal scintigraphy were assessed. Multivariate analysis was performed to identify predictors of postoperative renal function and de novo chronic kidney disease (CKD). Results: Super-selective RAPN was successful in 23/30 patients (76.7%), 5 requiring secondary main artery clamping due to persistent tumor fluorescence. Matched-pair analysis showed similar operating time, blood loss, positives margins and complication rates. Super-selective clamping was associated with an improved eGFR variation at discharge (p=0.002), 1-month (p=0.01) and 6-month post-op (-2%vs-16% p=0.001). It also led to a better relative function on scintigraphy (46%vs40% p=0.04) and homo-lateral eGFR (p=0.04), and fewer upstaging to CKD stage ≥3 (p=0.03). On multivariate analysis, super-selective clamping was a predictor of postoperative renal function. Conclusion: Super-selective RAPN leads to an improved preservation of renal function and a reduced risk of de novo CKD stage≥3, while keeping the benefit of main artery clamping on perioperative outcomes

How ionic pollution affect algae, macroinvertebrates and riparian vegetation in an urban freshwater stream

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Functional classification of artificial alluvial ponds driven by connectivity with the river: Consequences for restoration

International audienceChemical and biological functioning of artificial wetlands and lakes in alluvial plains is investigated based on the example of small artificial ponds located within dike fields along the Rhône River (France). The objective is to identify the diversity of metabolism in these artificial aquatic ecosystems and to propose a functional classification linked to the connectivity with the river. A comprehensive characterization of chemical and biological parameters in six shallow ponds was conducted, along with 4-month continuous monitoring of temperature and dissolved oxygen concentration, both in the sub-surface and at depth. Metabolism intensity is quantified using the diel oxygen method. Multivariate analysis of chemical and biological characteristics is performed to identify the functional heterogeneity between the ponds, which is shown to be consistent with the intensity of primary production (GPP) and ecosystem respiration (ER). Some ponds are permanently connected to the river, like backwater, and are very turbid, because of suspended matter and the presence of phytoplankton. The oxyge-nation is limited to the surface layer with anoxia rapidly building up at the bottom due to an intense ER. Ponds that are rarely connected become eutrophic with large concentration of phytoplankton and large GPP and ER values. Anoxia and even denitrification occur close to the bottom sediment. Finally, in the ponds with intermediate degree of connection with the river, macrophytes grow in clear water with limited amount of phyto-plankton, resulting in a gradient of GPP and ER values, controlled by nutrient availability. Rehabilitation of various connection patterns with the river is thus crucial to maintain a functional diversity in large river alluvial plains

Functional classification of artificial alluvial ponds driven by connectivity with the river: Consequences for restoration

International audienceChemical and biological functioning of artificial wetlands and lakes in alluvial plains is investigated based on the example of small artificial ponds located within dike fields along the Rhône River (France). The objective is to identify the diversity of metabolism in these artificial aquatic ecosystems and to propose a functional classification linked to the connectivity with the river. A comprehensive characterization of chemical and biological parameters in six shallow ponds was conducted, along with 4-month continuous monitoring of temperature and dissolved oxygen concentration, both in the sub-surface and at depth. Metabolism intensity is quantified using the diel oxygen method. Multivariate analysis of chemical and biological characteristics is performed to identify the functional heterogeneity between the ponds, which is shown to be consistent with the intensity of primary production (GPP) and ecosystem respiration (ER). Some ponds are permanently connected to the river, like backwater, and are very turbid, because of suspended matter and the presence of phytoplankton. The oxyge-nation is limited to the surface layer with anoxia rapidly building up at the bottom due to an intense ER. Ponds that are rarely connected become eutrophic with large concentration of phytoplankton and large GPP and ER values. Anoxia and even denitrification occur close to the bottom sediment. Finally, in the ponds with intermediate degree of connection with the river, macrophytes grow in clear water with limited amount of phyto-plankton, resulting in a gradient of GPP and ER values, controlled by nutrient availability. Rehabilitation of various connection patterns with the river is thus crucial to maintain a functional diversity in large river alluvial plains