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/)

The change on vertebral axial rotation after posterior instrumentation of idiopathic scoliosis

International audienceAgreement between the correction objectives and the instrumentation strategies remains controversial in idiopathic scoliosis. Most studies have focus on the frontal and sagittal plane. The goal of this study was to evaluate the change on vertebral axial rotation after posterior instrumentation in fused and unfused segments

Performances du positionnement de drone sous-marin autonome par communication acoustique

International audienc

Performances du positionnement de drone sous-marin autonome par communication acoustique

International audienc

Time to antibiotics administration and outcome in community-acquired pneumonia: Secondary analysis of a randomized controlled trial

BACKGROUND: The association between early antibiotic administration and outcomes remains controversial in patients hospitalized for community-acquired pneumonia. METHODS: We performed a secondary analysis of a randomized controlled trial comparing two antibiotic treatment strategies for patients hospitalized for moderately severe CAP. The univariate and multivariate associations between time to antibiotic administration (TTA) and time to clinical stability were assessed using a Cox proportional hazard model. Secondary outcomes were death, intensive care unit admission and hospital readmission up to 90days

Dustiness of 14 carbon nanotubes using the vortex shaker method

International audienceThe handling of carbon nanotube (CNT) powders is a plausible scenario during the course of the CNT life-cycle. However, related exposure data remain limited. In this context, information about the dustiness of CNT is therefore of great interest, for example for control banding or exposure modelling. Here, we investigate the dustiness of fourteen CNT powders using the Vortex Shaker (VS) method. The central component of the VS method is a stainless steel cylindrical tube, continuously shaken in a circular orbital motion, in which a small volume (0.5 cm 3) of the powder to be tested is placed. All samples were obtained through the NANoREG Nanomaterials Information and Web-Order system. The test procedure that we have developed is based on four principal components: (i) a respirable cyclone for gravimetric sampling, (ii) a CPC as a reference instrument for number concentration measurement, (iii) an MPS for collection of particles for EM observations/analysis, and (iv) an ELPI for size-resolved aerosol measurement. In this paper, the data were evaluated using two parameters: (i) the mass-based dustiness index in the respirable fraction; and (ii) the number-based dustiness index in the respirable fraction. The results indicate that the method leads to relatively accurate mass-and number-based dustiness indices. The indices obtained span wide ranges, of 2 and 3 orders of magnitude variation for mass and number respectively, suggesting a corresponding significant difference in terms of potential exposure. EM observations reveal that airborne CNTs are mostly released as bundles of different shapes ranging from a few tens of nanometers up to tens of micrometers in size.La manipulation de nanotubes de carbone (NTC) sous la forme d'une poudre est un scénario d'exposition plausible et qui peut être rencontré sur l'ensemble du cycle de vie des NTC. Néanmoins, les données d'exposition restent rares à ce jour. Dans ce contexte, connaître la pulvérulence (dustiness) des NTC est d'un grand intérêt pour les outils d'évaluation du risque (control banding) ou bien pour la modélisation des expositions. Dans ce travail, une méthode dite du Vortex Shaker (VS) pour caractériser la pulvérulence de NTC a été développée et mise en oeuvre sur une série de quatorze NTC fabriqués industriellement et issus de la banque de nanomatériaux de référence du Joint Research Centre (JRC). La procédure développée vise à déterminer différents indicateurs caractérisant la pulvérulence : indices de pulvérulence sur la fraction alvéolaire en masse et en nombre, taux d'émission en nombre et distribution granulométrique. Les résultats obtenus indiquent que les indices de pulvérulence (nombre et masse) couvrent une large gamme, sur 2 à 3 ordres de grandeur, ce qui suggère une différence significative en termes d'exposition potentielle. Les observations en microscopie électronique révèlent que les NTC émis le sont majoritairement sous forme de faisceaux ou pelotes de différentes formes et dimensions sur la gamme comprise entre quelques dizaines de nanomètres et plusieurs micromètres

Risks and benefits of urinary catheterisation during inpatient diuretic therapy for acute heart failure: a retrospective, non-inferiority, cohort study

Objectives Patients with acute congestive heart failure (HF) regularly undergo urinary catheterisation (UC) at hospital admission. We hypothesised that UC has no clinical benefits with regard to weight loss during inpatient diuretic therapy for acute congestive HF and increases the risk of urinary tract infection (UTI). Design Retrospective, non-inferiority study. Setting Geneva University Hospitals’ Department of Medicine, a tertiary centre. Participants In a cohort of HF patients, those catheterised within 24 hours of diuretic therapy (n=113) were compared with non-catheterised patients (n=346). Primary and secondary outcome measures The primary endpoint was weight loss 48 hours after starting diuretic therapy. Secondary endpoints were time needed to reach target weight, discontinuation of intravenous diuretics and resolution of respiratory failure. Complications included the time to a first UTI, first hospital readmission and death. Results A total of 48-hour weight loss was not statistically different between groups and the adjusted difference was below the non-inferiority boundary of 1 kg (0.43 kg (95% CI: −0.03 to 0.88) in favour of UC, p&lt;0.01 for non-inferiority). UC was not associated with time to reaching target weight (adjusted HR 1.0; 95% CI: 0.7 to 1.5), discontinuation of intravenous diuretics (aHR 0.9; 95% CI: 0.7 to 1.2) or resolution of respiratory failure (aHR 1.1; 95% CI: 0.5 to 2.4). UC increased the risk of UTI (aHR 2.5; 95% CI: 1.5 to 4.2) but was not associated with hospital readmission (aHR 1.1; 95% CI: 0.8 to 1.4) or 1-year mortality (aHR 1.4; 95% CI: 1.0 to 2.1). Conclusion In this retrospective study, with no obvious hourly diuresis-based diuretic adjustment strategy, weight loss without UC was not inferior to weight loss after UC within 24 hours of initiating diuretic treatment. UC had no impact on clinical improvement and increased the risk of UTI. This evidence, therefore, argues against the systematic use of UC during a diuretic therapy for HF.</p

Économies d'Asie et d'Amérique latine : changements de cap

Les auteurs de ce livre essaient de jeter un regard lucide sur plusieurs pays d’Asie et d’Amérique latine en pesant les atouts et les handicaps au-delà des phénomènes conjoncturels

Integrating population genetics to define conservation units from the core to the edge of Rhinolophus ferrumequinum western range

International audienceThe greater horseshoe bat (Rhinolophus ferrumequinum) is among the most widespread bat species in Europe but it has experienced severe declines, especially in Northern Europe. This species is listed Near Threatened in the European IUCN Red List of Threatened Animals, and it is considered to be highly sensitive to human activities and particularly to habitat fragmentation. Therefore, understanding the population boundaries and demographic history of populations of this species is of primary importance to assess relevant conservation strategies. In this study, we used 17 microsatellite markers to assess the genetic diversity, the genetic structure, and the demographic history of R. ferrumequinum colonies in the western part of its distribution. We identified one large population showing high levels of genetic diversity and large population size. Lower estimates were found in England and northern France. Analyses of clustering and isolation by distance suggested that the Channel and the Mediterranean seas could impede R. ferrumequinum gene flow. These results provide important information to improve the delineation of R. ferrumequinum management units. We suggest that a large management unit corresponding to the population ranging from Spanish Basque Country to northern France must be considered. Particular attention should be given to mating territories as they seem to play a key role in maintaining high levels of genetic mixing between colonies. Smaller management units corresponding to English and northern France colonies must also be implemented. These insular or peripheral colonies could be at higher risk of extinction in the near future

Modèles épidémiques développés pour étudier la transmission du COVID-19 durant la première vague de février à mai 2020 : une revue méthodologique

We review epidemiological models for the propagation of the COVID-19 pandemic during the early months of the outbreak: from February to May 2020. The aim is to propose a methodological review that highlights the following characteristics: (i) the epidemic propagation models, (ii) the modeling of intervention strategies, (iii) the models and estimation procedures of the epidemic parameters and (iv) the characteristics of the data used. We finally selected 80 articles from open access databases based on criteria such as the theoretical background, the reproducibility, the incorporation of interventions strategies, etc. It mainly resulted to phenomenological, compartmental and individual-level models. A digital companion including an online sheet, a Kibana interface and a markdown document is proposed. Finally, this work provides an opportunity to witness how the scientific community reacted to this unique situation