International changes in end-of-life practices over time: a systematic review.

BACKGROUND: End-of-life policies are hotly debated in many countries, with international evidence frequently used to support or oppose legal reforms. Existing reviews are limited by their focus on specific practices or selected jurisdictions. The objective is to review international time trends in end-of-life practices. METHODS: We conducted a systematic review of empirical studies on medical end-of-life practices, including treatment withdrawal, the use of drugs for symptom management, and the intentional use of lethal drugs. A search strategy was conducted in MEDLINE, EMBASE, Web of Science, Sociological Abstracts, PAIS International, Worldwide Political Science Abstracts, International Bibliography of the Social Sciences and CINAHL. We included studies that described physicians' actual practices and estimated annual frequency at the jurisdictional level. End-of-life practice frequencies were analyzed for variations over time, using logit regression. RESULTS: Among 8183 references, 39 jurisdiction-wide surveys conducted between 1990 and 2010 were identified. Of those, 22 surveys used sufficiently similar research methods to allow further statistical analysis. Significant differences were found across surveys in the frequency of treatment withdrawal, use of opiates or sedatives and the intentional use of lethal drugs (X 2  > 1000, p < 0.001 for all). Regression analyses showed increased use of opiates and sedatives over time (p < 0.001), which could reflect more intense symptom management at the end of life, or increase in these drugs to intentionally cause patients' death. CONCLUSION: The use of opiates and sedatives appears to have significantly increased over time between 1990 and 2010. Better distinction between practices with different legal status is required to properly interpret the policy significance of these changes. Research on the effects of public policies should take a comprehensive look at trends in end-of-life practice patterns and their associations with policy changes

Asymptomatic carriers of COVID-19 in a confined adult community population in Quebec: a cross-sectional study

Several countries have undertaken social distancing measures to stop SARS-CoV-2 spread. Asymptomatic carriers’ prevalence is unknown and would provide essential information on hidden viral circulation. In our cross-sectional study, 1.82% of 330 asymptomatic confined individuals living in the community carried SARS-CoV-2 despite no contact with declared cases, raising concerns about unnoticed transmission

COVID-19 and Pasteurella multocida Pulmonary Coinfection: A Case Series

Objectives: In COVID-19 patients, bacterial and fungal pulmonary coinfections, such as Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, or Aspergillus, have been reported, but to our knowledge, no case has been reported due to Pasteurella multocida. Patients and methods: We describe three cases of Pasteurella multocida coinfections occurring during the 4th wave of COVID-19 in Martinique (French West Indies). Results: All three cases were fatal; thus, Pasteurella multocida has to be considered as a potentially severe coinfection agent. Conclusions: Alteration of the epithelial–endothelial barrier due to a SARS-CoV-2 infection probably promotes the expression of a Pasteurella infection. In addition, the SARS-CoV-2 infection induced immunosuppression, and an inflammatory cascade could explain the infection’s severity. The use of corticosteroids, which are part of the first-line therapeutic arsenal against COVID-19, may also promote the pathogenicity of this agent

Pharmacological characterization of low molecular weight biased agonists at the follicle stimulating hormone receptor

International audienceFollicle-stimulating hormone receptor (FSHR) plays a key role in reproduction through the activation of multiple signaling pathways. Low molecular weight (LMW) ligands composed of biased agonist properties are highly valuable tools to decipher complex signaling mechanisms as they allow selective activation of discrete signaling cascades. However, available LMW FSHR ligands have not been fully characterized yet. In this context, we explored the pharmacological diversity of three benzamide and two thiazolidinone derivatives compared to FSH. Concentration/activity curves were generated for Gαs, Gαq, Gαi, β-arrestin 2 recruitment, and cAMP production, using BRET assays in living cells. ERK phosphorylation was analyzed by Western blotting, and CRE-dependent transcription was assessed using a luciferase reporter assay. All assays were done in either wild-type, Gαs or β-arrestin 1/2 CRISPR knockout HEK293 cells. Bias factors were calculated for each pair of read-outs by using the operational model. Our results show that each ligand presented a discrete pharmacological efficacy compared to FSH, ranging from super-agonist for β-arrestin 2 recruitment to pure Gαs bias. Interestingly, LMW ligands generated kinetic profiles distinct from FSH (i.e., faster, slower or transient, depending on the ligand) and correlated with CRE-dependent transcription. In addition, clear system biases were observed in cells depleted of either Gαs or β-arrestin genes. Such LMW properties are useful pharmacological tools to better dissect the multiple signaling pathways activated by FSHR and assess their relative contributions at the cellular and physio-pathological level

Aspergillus Galactosaminogalactan Mediates Adherence to Host Constituents and Conceals Hyphal β-Glucan from the Immune System

International audienceAspergillus fumigatus is the most common cause of invasive mold disease in humans. The mechanisms underlying the adherence of this mold to host cells and macromolecules have remained elusive. Using mutants with different adhesive properties and comparative transcriptomics, we discovered that the gene uge3, encoding a fungal epimerase, is required for adherence through mediating the synthesis of galactosaminogalactan. Galactosaminogalactan functions as the dominant adhesin of A. fumigatus and mediates adherence to plastic, fibronectin, and epithelial cells. In addition, galactosaminogalactan suppresses host inflammatory responses in vitro and in vivo, in part through masking cell wall β-glucans from recognition by dectin-1. Finally, galactosaminogalactan is essential for full virulence in two murine models of invasive aspergillosis. Collectively these data establish a role for galactosaminogalactan as a pivotal bifunctional virulence factor in the pathogenesis of invasive aspergillosis

Dectin-1 blockade abrogates the increased TNFα secretion induced by the GAG deficient Δ<i>uge3</i> mutant.

<p>BMDDCs were infected with hyphae of the indicated strains for 6 h, after which the TNFα content of culture supernatants was determined by EIA. Dectin-1 recognition of β-glucan was inhibited by preincubating BMDDCs with a monoclonal anti-dectin 1 antibody or by preincubating hyphae with Fc-dectin-1. Results are mean ± SEM of duplicate experiments, each performed in triplicate. * indicates a significant reduction of TNFα production compared to BMDDCs exposed to the Δ<i>uge3</i> mutant without dectin-1 blocking, <i>p</i><0.05 by factor ANOVA.</p

Uge3 is required for full virulence in a highly immunosuppressed mouse model of IA.

<p>(A) Survival of highly immunosuppressed mice treated with cyclophosphamide and cortisone acetate and infected with the indicated <i>A. fumigatus</i> strains. * indicates significantly increased survival of mice infected with the Δ<i>uge3</i> mutant as compared with those infected with the wild-type, <i>p</i> = 0.002 by the log rank test (<i>n</i> = 12 mice per fungal strain). (B) Quantification of fungal DNA in lung homogenates of mice after 5 days of infection. Results are median ± interquartile range of 8 mice per strain. * indicates a significantly reduced fungal DNA content in lungs of mice infected with the Δ<i>uge3</i> mutant as compared with those infected with the wild-type strain, <i>p</i> = 0.11 by the Wilcoxon rank sum test. (C) Photomicrographs of Gomori menthenamine silver stained sections of mouse lungs obtained 4 days after infection with the wild-type strain Af293. No fungal lesions could be identified in the lungs of mice infected with the Δ<i>uge3</i> mutant strain. Magnification was ×100 and ×400. White arrows indicate hyphae. Note the lack of infiltrating leukocytes within fungal lesions.</p