Nasal high flow in room air for hypoxemic bronchiolitis infants

Background: Bronchiolitis is the most common reason for hospital admission in infants, with one third requiring oxygen therapy due to hypoxemia. It is unknown what proportion of hypoxemic infants with bronchiolitis can be managed with nasal high-flow in room air and their resulting outcomes. Objectives and Settings: To assess the effect of nasal high-flow in room air in a subgroup of infants with bronchiolitis allocated to high-flow therapy in a recent multicenter randomized controlled trial. Patients and Interventions: Infants allocated to the high-flow arm of the trial were initially treated with room air high-flow if saturations were ≥85%. Subsequently, if oxygen saturations did not increase to ≥92%, oxygen was added and FiO2 was titrated to increase the oxygen saturations. In this planned sub-study, infants treated during their entire hospital stay with high-flow room air only were compared to infants receiving either standard-oxygen or high-flow with oxygen. Baseline characteristics, hospital length of stay and length of oxygen therapy were compared. Findings: In the per protocol analysis 64 (10%) of 630 infants commenced on high-flow room air remained in room air only during the entire stay in hospital. These infants on high-flow room air were on average older and presented with moderate hypoxemia at presentation to hospital. Their length of respiratory support and length of stay was also significantly shorter. No pre-enrolment factors could be identified in a multivariable analysis. Conclusions: In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only

Histopathological findings in hereditary motor and sensory neuropathy of axonal type with onset in early childhood associated with mitofusin 2 mutations.

International audienceNeuropathologic abnormalities can be sufficiently characteristic to suggest the genetic basis of some hereditary neuropathies such as those associated with mutations in MPZ, GJB1, GDAP1, MTMR2, SH3TC2, PRX, FGD4, and LMNA. We analyzed the morphologic features of 9 sural nerve biopsies from 6 patients with mutations of mitofusin 2. All patients presented in early childhood with axonal neuropathies designated as mild or severe motor and sensory neuropathy. In all cases, there was a marked decrease in density of myelinated fibers, mainly of large diameter fibers. These changes were more marked in the second biopsies of 3 patients that were performed from 7 to 19 years after the first biopsies. Neurophysiologic findings were most suggestive of axonal degeneration, but some onion bulbs were present in all cases. Axonal mitochondria were smaller than normal, were round, and were abnormally aggregated. These changes may result from abnormal mitochondrial fusion and fission. The results suggest that these clinical and pathological features may be sufficiently characteristic to suggest the diagnosis of mitofusin 2-related neuropathy

Antarctica and supercontinent evolution: historical perspectives, recent advances and unresolved issues

The Antarctic rock record spans some 3.5 billion years of history, and has made important contributions to our understanding of how Earth's continents assemble and disperse through time. Correlations between Antarctica and other southern continents were critical to the concept of Gondwana, the Palaeozoic supercontinent used to support early arguments for continental drift, while evidence for Proterozoic connections between Antarctica and North America led to the ‘SWEAT’ configuration (linking SW USA to East Antarctica) for an early Neoproterozoic supercontinent known as Rodinia. Antarctica also contains relicts of an older Palaeo- to Mesoproterozoic supercontinent known as Nuna, along with several Archaean fragments that belonged to one or more ‘supercratons’ in Neoarchaean times. It thus seems likely that Antarctica contains remnants of most, if not all, of Earth's supercontinents, and Antarctic research continues to provide insights into their palaeogeography and geological evolution. One area of research is the latest Neoproterozoic–Mesozoic active margin of Gondwana, preserved in Antarctica as the Ross Orogen and a number of outboard terranes that now form West Antarctica. Major episodes of magmatism, deformation and metamorphism along this palaeo-Pacific margin at 590–500 and 300–230 Ma can be linked to reduced convergence along the internal collisional orogens that formed Gondwana and Pangaea, respectively; indicating that accretionary systems are sensitive to changes in the global plate tectonic budget. Other research has focused on Grenville-age (c. 1.0 Ga) and Pan-African (c. 0.5 Ga) metamorphism in the East Antarctic Craton.These global-scale events record the amalgamation of Rodinia and Gondwana, respectively. Three coastal segments of Grenville-age metamorphism in the Indian Ocean sector of Antarctica are each linked to the c. 1.0 Ga collision between older cratons but are separated by two regions of pervasive Pan-African metamorphism ascribed to Neoproterozoic ocean closure. The tectonic setting of these events is poorly constrained given the sparse exposure, deep erosion level and likelihood that younger metamorphic events have reactivated older structures. The projection of these orogens under the ice is also controversial, but it is likely that at least one of the Pan-African orogens links up with the Shackleton Range on the palaeo-Pacific margin of the craton. Sedimentary detritus and glacial erratics at the edge of the ice sheet provide evidence for the c. 1.0 and 0.5 Ga orogenesis in the continental interior, while geophysical data reveal prominent geological boundaries under the ice, but there are insufficient data to trace these features to exposed structures of known age. Until we can resolve the subglacial geometry and tectonic setting of the c. 0.5 and 1.0 Ga metamorphism, there will be no consensus on the configuration of Rodinia, or the size and shape of the continents that existed immediately before and after this supercontinent. Given this uncertainty, it is premature to speculate on the role of Antarctica in earlier supercontinents, but it is likely that Antarctica will continue to provide important constraints when our attention shifts to these earlier events

Multicentre, randomised trial to investigate early nasal high—flow therapy in paediatric acute hypoxaemic respiratory failure: a protocol for a randomised controlled trial—a Paediatric Acute respiratory Intervention Study (PARIS 2)

Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment.The study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturatio