False-positive diagnosis of ascending aorta dissection by single-plane transesophageal echocardiography

n/

Steppes, savannahs, forests and phytodiversity reservoirs during the Pleistocene in the Iberian Peninsula

A palaeobotanical analysis of the Pleistocene floras and vegetation in the Iberian Peninsula shows the existence of patched landscapes with Pinus woodlands, deciduous and mixed forests, parklands (savannah-like), shrublands, steppes and grasslands. Extinctions of Arctotertiary woody taxa are recorded during the Early and Middle Pleistocene, but glacial refugia facilitated the survival of a number of temperate, Mediterranean and Ibero-North African woody angiosperms. The responses of Iberian vegetation to climatic changes during the Pleistocene have been spatially and temporarily complex, including rapid changes of vegetation in parallel to orbital and suborbital variability, and situations of multi-centennial resilience or accommodation to climatic changes. Regional characteristics emerged as soon as for the Middle Pleistocene, if not earlier: Ericaceae in the Atlantic coast indicating wetter climate, thermo-mediterranean elements in the south as currently, and broad-leaf trees in the northeastern. Overall, steppe landscapes and open Pinus woodlands prevailed over many continental regions during the cold spells of the Late Pleistocene. The maintenance of a high phytodiversity during the glacials was linked to several refuge zones in the coastal shelves of the Mediterranean and intramountainous valleys. Northern Iberia, especially on coastal areas, was also patched with populations of tree species, and this is not only documented by palaeobotanical data (pollen, charcoal) but also postulated by phylogeographical models

Disruptive viability selection on a black plumage trait associated with dominance.

Traits used in communication, such as colour signals, are expected to have positive consequences for reproductive success, but their associations with survival are little understood. Previous studies have mainly investigated linear relationships between signals and survival, but both hump-shaped and U-shaped relationships can also be predicted, depending on the main costs involved in trait expression. Furthermore, few studies have taken the plasticity of signals into account in viability selection analyses. The relationship between signal expression and survival is of particular interest in melanin-based traits, because their main costs are still debated. Here, we first determined the main factors explaining variability in a melanin-based trait linked to dominance: the bib size of a colonial bird, the sociable weaver Philetairus socius. We then used these analyses to obtain a measure representative of the individual mean expression of bib size. Finally, we used capture-recapture models to study how survival varied in relation to bib size. Variation in bib size was strongly affected by year and moderately affected by age, body condition and colony size. In addition, individuals bearing small and large bibs had higher survival than those with intermediate bibs, and this U-shaped relationship between survival and bib size appeared to be more pronounced in some years than others. These results constitute a rare example of disruptive viability selection, and point towards the potential importance of social costs incurred by the dominance signalling function of badges of status.Our research was funded by the DST-NRF Centre of Excellence at the Percy FitzPatrick Institute (University of Cape Town), the Portuguese Foundation for Science and Technology (FCT, PTDC/BIA-BEC/103818/2008) to RC, the region Languedoc Roussillon, the programme "Chercheur(se)s d’avenir" 2013 and ANR JC 09-JCJC-0050-01JCJC to CD, the Natural Environment Research Council (NERC, UK: NE/G018588/1 and NE/K015257/1) to BJH, and the University of Cape Town and St John’s College, Cambridge (UK) to CNS. This research was also supported by a Marie Curie-IRSES grant (FP7-PEOPLE-2012-IRSES; ‘Cooperation’ 318994) to all and was conducted within the CNRS-CIBIO International Associate Laboratory (LIA) ‘Biodiversity and Evolution’. RC was funded by a ‘Ciência 2008’ fellowship (FCT, Portugal) with further support from FEDER (Operational Programme for Competitiveness Factors – COMPETE, Project “Biodiversity, Ecology and Global Change” co-financed by North Portugal Regional Operational Programme 2007/2013 (ON.2), under the NSRF, ERDF.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1111/jeb.1271

Mountain strongholds for woody angiosperms during the Late Pleistocene in SE Iberia

Mediterranean mountains played an essential role during glacial periods as vegetation refugia. The SE Iberia Late Pleistocene woody angiosperm fossil and floristic evidences are reviewed in the context of phylogeographical studies aiming to identify (i) spatial patterns related to woody angiosperms glacial survival, (ii) structural and functional characteristics of montane refugia, and (iii) gaps in knowledge on the woody angiosperm patterns of survival in Mediterranean mountains. The distribution of palaeobotanical data for SE Iberia refugia has been found to be taphonomically biased due to the scarcity of available and/or studied high-altitude Late Pleistocene sites. However, Siles Lake data together with floristic inference provide evidences for woody angiosperms’ survival in a high-altitude Mediterranean area. The main features boosting survival at montane contexts are physiographic complexity and water availability. Phylogeography studies have mainly been conducted at a continental scale. Although they cohere with palaeobotanical data to a broad scale, a general lack of sampling of SE Iberian range-edge populations, as well as misconceptions about the origin of the populations sampled, impede to infer the proper location of woody angiosperms’ mountain refugia and their importance in the post-glacial European colonisation. We conclude that floristic, geobotanical, palaeobotanical, ethnographical and genetic evidence should be merged to gain a deeper understanding on the role played by Mediterranean mountains as glacial refugia in order to explain the current distribution of many plants and the large biodiversity levels encountered in Mediterranean mountain areas. This is hallmark for effective and efficient conservation and management

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Trials

BACKGROUND: Postoperative upper gastrointestinal fistula (PUGIF) is a devastating complication, leading to high mortality (reaching up to 80%), increased length of hospital stay, reduced health-related quality of life and increased health costs. Nutritional support is a key component of therapy in such cases, which is related to the high prevalence of malnutrition. In the prophylactic setting, enteral nutrition (EN) is associated with a shorter hospital stay, a lower incidence of severe infectious complications, lower severity of complications and decreased cost compared to total parenteral nutrition (TPN) following major upper gastrointestinal (GI) surgery. There is little evidence available for the curative setting after fistula occurrence. We hypothesize that EN increases the 30-day fistula closure rate in PUGIF, allowing better health-related quality of life without increasing the morbidity or mortality. METHODS/DESIGN: The NUTRILEAK trial is a multicenter, randomized, parallel-group, open-label phase III trial to assess the efficacy of EN (the experimental group) compared with TPN (the control group) in patients with PUGIF. The primary objective of the study is to compare EN versus TPN in the treatment of PUGIF (after esophagogastric resection including bariatric surgery, duodenojejunal resection or pancreatic resection with digestive tract violation) in terms of the 30-day fistula closure rate. Secondary objectives are to evaluate the 6-month postrandomization fistula closure rate, time of first fistula closure (in days), the medical- and surgical treatment-related complication rate at 6 months after randomization, the fistula-related complication rate at 6 months after randomization, the type and severity of early (30 days after randomization) and late fistula-related complications (over 30 days after randomization), 30-day and 6-month postrandomization mortality rate, nutritional status at day 30, day 60, day 90 and day 180 postrandomization, the mean length of hospital stay, the patient's health-related quality of life (by self-assessment questionnaire), oral feeding time and direct costs of treatment. A total of 321 patients will be enrolled. DISCUSSION: The two nutritional supports are already used in daily practice, but most surgeons are reluctant to use the enteral route in case of PUGIF. This study will be the first randomized trial testing the role of EN versus TPN in PUGIF. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03742752. Registered on 14 November 2018.This research program is funded by the French Ministry of Health through Programme Hospitalier de Recherche Clinique 2016

Rectopexie coelioscopique pour traitement de la rectocèle associée à un prolapsus rectal interne (étude de 28 cas)

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF

Rectopexie pour traitement des troubles de la statique rectale (à propos de 81 cas)

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF

Evaluation des résultats fonctionnels et de la qualité de vie après anastomose ileo-anale pour rectocolite ulcero-hémorragique

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge du cancer du rectum au CHU de Caen (évolution des pratiques et des résultats sur une série de 440 patients opérés de 1995 à 2011)

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF