0357 : Platypnea orthodeoxia syndrome: focus on predisposing anatomical factors

Platypnea orthodeoxia syndrome (POS) is a rare situation with hypoxia and breathlessness in the upright position recovering in the recumbent position. A mechanical inter-atrial septum distortion, causing redirection of flow from the right to the left atrium through a patent foramen ovale (PFO), despite normal pulmonary pressure, is suggested to explain POS. Prevalence of predisposing anatomical factors remain little knownMethodsAll patients who underwent a PFO closure for a POS were retrospectively included from 2 CHU. Predisposing anatomical factors were investigated.Results67 patients (Median age 72 y.o., interquartile range 61-80; 58.2% men) were included. All patients had dyspnea (76.2% NYHA III or IV, 53.7% under oxygen-therapy). The remaining patients had a refractory hypoxemia (38.2%) without POS. Most frequent predisposing anatomical factor was an enlarged or unwound aorta (n=29, 43.3% 95CI 31.2-56.0) with an aortic aneurysm in 25 patients (37.3%, 95CI 25.8-50.0). Other factors identified were pneumonectomy (n=8, 11.9% CI95 5.3-22.2), a history of cardiac surgery (n=7, 10.5%, 95CI 4.3-20.3), mechanical ventilation (n=6, 9.0% 95CI 3.4-18.5), kyphoscoliosis (n=4, 6.0% 95CI 1.7-14.6), hepatomegaly (n=4, 6.0% 95CI 1.7-14.6, 2 patients with hepato-renal polycystic disease, one hemochromatosis and one cirrhosis), right ventricle failure (n=2,3.0% 95CI 0.4-10.4), pericardial effusions (n=2,3.0% 95CI 0.4-10.4), right ventricle arrhythmogenic dysplasia (n=2,3.0% 95CI 0.4-10.4), diaphragmatic paralysis (n=1, 1.5% 95CI 0.1-8.0), carcinoid syndrome with tricuspid regurgitation (n=1, 1.5% 95CI 0.1-8.0), a right atrium pace-maker lead (n=1, 1.5% 95CI 0.1-8.0) and a tako-tsubo syndrome (n=1, 1.5% 95CI 0.1-8.0).ConclusionAortic aneurysm and pneumonectomy are the most frequent situation leading to a POS. Other causes were observed such as hepato-renal polycystic kidney, or atrial pacemaker probe that may be underdiagnosed in clinical practice

Metabolic adaptation to a high-fat diet is associated with a change in the gut microbiota

Objective The gut microbiota, which is considered a causal factor in metabolic diseases as shown best in animals, is under the dual influence of the host genome and nutritional environment. This study investigated whether the gut microbiota per se, aside from changes in genetic background and diet, could sign different metabolic phenotypes in mice. Methods The unique animal model of metabolic adaptation was used, whereby C57Bl/6 male mice fed a high-fat carbohydrate-free diet (HFD) became either diabetic (HFD diabetic, HFD-D) or resisted diabetes (HFD diabetes-resistant, HFD-DR). Pyrosequencing of the gut microbiota was carried out to profile the gut microbial community of different metabolic phenotypes. Inflammation, gut permeability, features of white adipose tissue, liver and skeletal muscle were studied. Furthermore, to modify the gut microbiota directly, an additional group of mice was given a glucooligosaccharide (GOS)-supplemented HFD (HFD+GOS). Results Despite the mice having the same genetic background and nutritional status, a gut microbial profile specific to each metabolic phenotype was identified. The HFD-D gut microbial profile was associated with increased gut permeability linked to increased endotoxaemia and to a dramatic increase in cell number in the stroma vascular fraction from visceral white adipose tissue. Most of the physiological characteristics of the HFD-fed mice were modulated when gut microbiota was intentionally modified by GOS dietary fibres. Conclusions The gut microbiota is a signature of the metabolic phenotypes independent of differences in host genetic background and diet

Coxiella burnetii Infection in Livestock, Pets, Wildlife, and Ticks in Latin America and the Caribbean: a Comprehensive Review of the Literature

Purpose of the Review Q fever , a bacterial zoonosis caused by Coxiella burnetii, is reported very heterogeneously in humans in Latin America. The objective of this study was to review the data on Coxiella burnetii Infection in animals in Latin America and the Caribbean. Recent Findings A comprehensive literature review was carried out in the 47 countries and territories of Latin America on various search engines and grouped into four groups: livestock, pets, wildlife, and ticks. Summary Thus, 113 studies were selected between 1950 and 2022. Among the 47 countries, only 25 (53%) had at least one publication related to C. burnetii infection in animals. The most productive country was Brazil (N = 51), followed by French Guiana (N = 21), and Colombia (N = 16). Studies in livestock from 20 countries have shown widely varying country-to-country rates of seroprevalence, ranging from 0 to 67%. Some studies from seven countries, especially French Guiana and Brazil, found antibodies and sometimes positive PCR in dogs and cats, generally in the context of investigations around human clustered cases. Knowledge remained fragmented about infection in wildlife from only five countries (Chile, Colombia, Brazil, French Guiana, and Uruguay). C. burnetii infection was identified by PCR in Chiroptera (7 species), Rodentia (6 species), Suina (2 species), Xenartha (1 species), Cingulata (1 species), and Perissodactyla (1 species). Studies on Coxiella sp. in ticks have been performed in 11 countries, mostly in Brazil, and mainly found Coxiella-like endosymbionts. Thus, data on C. burnetii infection in animals are sparse and incomplete in Latin America and the Caribbean, and more research is warranted

Front Psychiatry

OBJECTIVE: During the COVID-19 pandemic, older people and patients with psychiatric disorders had an increased risk of being isolated. The French National Authority for Health has recommended a reinforced follow-up of these patients. Cross-sectional studies reported an increased risk of developing anxiety and depression during pandemic. The aim of our study was to identify factors associated with higher anxiety during the pandemic in older patients with psychiatric disorders. METHODS: STERACOVID is a multicenter cohort study with 117 patients followed-up by phone in two French geriatric psychiatry units. In this work, we used cross-sectional data from a prospective follow-up conducted between January and May 2021. RESULTS: We found that coping strategies, personality, and living conditions were associated with general anxiety (GA) level during the pandemic period. Higher GA was associated with less positive thinking coping strategy, more avoidance strategies, a lower level of extraversion, a higher level of neuroticism, more time spent watching the news, a higher feeling of loneliness, and a lack of physical contact. FINDINGS: Our study identified factors associated with a poorer experience of pandemic crisis. Special attention should be paid to patients with a high level of neuroticism and a high feeling of loneliness. Support could aim to help patients use more functional strategies: reducing avoidance strategies and increasing positive thinking. Finally, reducing time watching news could also be an interesting prevention perspective. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, identifier NCT04760795

Euro Surveill

In September 2023, a severe outbreak of type B botulism with fifteen cases was linked to consumption of canned sardines at a restaurant in Bordeaux, France, during the Rugby World Cup. The cases were from seven countries. One death was recorded. Outbreak investigation using credit card data, rapid communication between health authorities of the affected countries and broad media communication allowed identification of cases and exposed persons and prevented further severe outcomes

Correction to: Use of MFM-20 to monitor SMA types 1 and 2 patients treated with nusinersen.

peer reviewe

Database of pleistocene periglacial featuresin France: description of the online version

A database of Pleistocene periglacial features in France has been compiled from a review of academic literature and reports of rescue archaeology, the analysis of aerial photographs and new field surveys. Polygons, soil stripes, ice-wedge pseudomorphs, sand wedges and composite wedge pseudomorphs are included in the database together with their geographic coordinates, geological context, description and associated references. It is hoped that this database, which aim is to be integrated in broader studies, will stimulate further work on past permafrost reconstruction and will favour greater understanding of the climatic events that lead to the formation of the periglacial features. The database is available online on the AFEQ-CNF INQUA website (https://afeqeng.hypotheses.org/487). A folder that contains photographs and sketches of the features is also available on request.Une base de données des structures périglaciaires pléistocènes de France a été créée à partir d’une revue de la littérature scientifique, de rapports d’archéologie préventive, de l’analyse de photographies aériennes et de nouvelles prospections de terrain. Les polygones, les sols striés, les pseudomorphoses de coin de glace, les coins de sable et les pseudomorphoses de coin composite ont été répertoriés dans la base de données avec leurs coordonnées géographiques, le contexte géologique, leur description et les références bibliographiques associées. Nous espérons que cette base de données, dont le but est d’être intégrée dans des études plus larges, stimulera de prochains travaux sur la reconstitution du pergélisol pléistocène et favorisera une plus grande compréhension des événements climatiques qui ont conduit à la formation de ces structures périglaciaires. La base de données est disponible en ligne sur le site de l’AFEQ-CNF INQUA (https://afeqeng.hypotheses.org/487). Un dossier contenant les photographies et dessins des structures périglaciaires est également disponible sur demande

Modelling the response to vaccine in non-human primates to define SARS-CoV-2 mechanistic correlates of protection

The definition of correlates of protection is critical for the development of next-generation SARS-CoV-2 vaccine platforms. Here, we propose a model-based approach for identifying mechanistic correlates of protection based on mathematical modelling of viral dynamics and data mining of immunological markers. The application to three different studies in non-human primates evaluating SARS-CoV-2 vaccines based on CD40-targeting, two-component spike nanoparticle and mRNA 1273 identifies and quantifies two main mechanisms that are a decrease of rate of cell infection and an increase in clearance of infected cells. Inhibition of RBD binding to ACE2 appears to be a robust mechanistic correlate of protection across the three vaccine platforms although not capturing the whole biological vaccine effect. The model shows that RBD/ACE2 binding inhibition represents a strong mechanism of protection which required significant reduction in blocking potency to effectively compromise the control of viral replication.Initiative for the creation of a Vaccine Research InstituteInfrastructure nationale pour la modélisation des maladies infectieuses humaine

BMC Med

BACKGROUND: Overall survival (OS) is the gold standard endpoint to assess treatment efficacy in cancer clinical trials. In metastatic breast cancer (mBC), progression-free survival (PFS) is commonly used as an intermediate endpoint. Evidence remains scarce regarding the degree of association between PFS and OS. Our study aimed to describe the individual-level association between real-world PFS (rwPFS) and OS according to first-line treatment in female patients with mBC managed in real-world setting for each BC subtype (defined by status for both hormone-receptor [HR] expression and HER2 protein expression/gene amplification). METHODS: We extracted data from the ESME mBC database (NCT03275311) which gathers deidentified data from consecutive patients managed in 18 French Comprehensive Cancer Centers. Adult women diagnosed with mBC between 2008 and 2017 were included. Endpoints (PFS, OS) were described using the Kaplan-Meier method. Individual-level associations between rwPFS and OS were estimated using the Spearman's correlation coefficient. Analyses were conducted by tumor subtype. RESULTS: 20,033 women were eligible. Median age was 60.0 years. Median follow-up duration was 62.3 months. Median rwPFS ranged from 6.0 months (95% CI 5.8-6.2) for HR-/HER2 - subtype to 13.3 months (36% CI 12.7-14.3) for HR + /HER2 + subtype. Correlation coefficients were highly variable across subtypes and first-line (L1) treatments. Among patients with HR - /HER2 - mBC, correlation coefficients ranged from 0.73 to 0.81, suggesting a strong rwPFS/OS association. For HR + /HER2 + mBC patients, the individual-level associations were weak to strong with coefficients ranging from 0.33 to 0.43 for monotherapy and from 0.67 to 0.78 for combined therapies. CONCLUSIONS: Our study provides comprehensive information on individual-level association between rwPFS and OS for L1 treatments in mBC women managed in real-life practice. Our results could be used as a basis for future research dedicated to surrogate endpoint candidates

Evenness mediates the global relationship between forest productivity and richness

1. Biodiversity is an important component of natural ecosystems, with higher species richness often correlating with an increase in ecosystem productivity. Yet, this relationship varies substantially across environments, typically becoming less pronounced at high levels of species richness. However, species richness alone cannot reflect all important properties of a community, including community evenness, which may mediate the relationship between biodiversity and productivity. If the evenness of a community correlates negatively with richness across forests globally, then a greater number of species may not always increase overall diversity and productivity of the system. Theoretical work and local empirical studies have shown that the effect of evenness on ecosystem functioning may be especially strong at high richness levels, yet the consistency of this remains untested at a global scale. 2. Here, we used a dataset of forests from across the globe, which includes composition, biomass accumulation and net primary productivity, to explore whether productivity correlates with community evenness and richness in a way that evenness appears to buffer the effect of richness. Specifically, we evaluated whether low levels of evenness in speciose communities correlate with the attenuation of the richness–productivity relationship. 3. We found that tree species richness and evenness are negatively correlated across forests globally, with highly speciose forests typically comprising a few dominant and many rare species. Furthermore, we found that the correlation between diversity and productivity changes with evenness: at low richness, uneven communities are more productive, while at high richness, even communities are more productive. 4. Synthesis. Collectively, these results demonstrate that evenness is an integral component of the relationship between biodiversity and productivity, and that the attenuating effect of richness on forest productivity might be partly explained by low evenness in speciose communities. Productivity generally increases with species richness, until reduced evenness limits the overall increases in community diversity. Our research suggests that evenness is a fundamental component of biodiversity–ecosystem function relationships, and is of critical importance for guiding conservation and sustainable ecosystem management decisions