Modeling of flow limitation phenomena in the human respiratory tract during forced expiration

International audienc

Modeling of the air flow in the human respiratory tract

International audienc

In vivo estimates of NO and CO conductance for haemoglobin and for lung transfer in humans

International audienceMembrane conductance (Dm) and capillary lung volume (Vc) derived from NO and CO lung transfer measurements in humans depend on the blood conductance (θ) values of both gases. Many θ values have been proposed in the literature. In the present study, measurements of CO and NO transfer while breathing 15% or 21% O2 allowed the estimation of θNO and the calculation of the optimal equation relating 1/θCO to pulmonary capillary oxygen pressure (PcapO2). In 10 healthy subjects, the mean calculated θNO value was similar to the θNO value previously reported in the literature (4.5mmHgmin(-1)) provided that one among three θCO equations from the literature was chosen. Setting 1/θCO=a·PcapO2+b, optimal values of a and b could be chosen using two methods: 1) by minimizing the difference between Dm/Vc ratios for any PcapO2, 2) by establishing a linear equation relating a and b. Using these methods, we are proposing the equation 1/θCO=0.0062·PcapO2+1.16, which is similar to two equations previously reported in the literature. With this set of θ values, DmCO reached the morphometric range

Hydrological extreme event occurrences and impacts linked with climate variations in coastal waters of western Europe

The dynamics of physico-chemical processes in the bay of Brest are studied to better understand the impact of local events on the coastal ocean. We are analyzing long-term in situ data (since 2000), high and low frequencies, from the COAST-HF (buoy Marel Iroise) and SOMLIT sites, located at the entrance to the bay of Brest. This study is divided into two main stages: the detection and characterization of extreme events, followed by a numerical simulation of these events to understand the underlying oceanic processes. The focus is on desalination events during the winter months (December, January, February and March), considering the season with the greatest number of extreme events. We show the relationship between local extreme events and variability at larger scales, considering climate indices such as the North Atlantic Oscillation (NAO). A comparison between the low frequency data of the SOMLIT program and the high frequency data of the Marel buoy is carried out, highlighting the interest of high frequency measurements for the detection of extreme events. A comparison between in situ data and two numerical simulations of different resolutions is also performed over salinity time series. This study also show an interannual variability of extreme events interesting in a context of climate change. We make the link between these extreme desalination and the nitrate level in the bay of Brest. To finally study the relationship between nutrients and chlorophyll in order to look at the correlation that it can exists between extreme events and biology in the coastal environment.

Extreme coastal events linked with climate variation. Understanding low salinity episodes in the Bay of Brest, north-eastern Atlantic

Aims - To detect and characterise extreme events in a coastal ecosystem by combining in situ high-frequency observations and high-resolution numerical simulations -To describe the interannual variability of extreme events in a context of climate change  -To quantify the links between extreme low salinity episodes and both large and local scale processes, using weather regimes, precipitations and river runoffs as proxies of hydro-climate forcin

Unraveling Salinity Extreme Events in Coastal Environments: A Winter Focus on the Bay of Brest

Extreme weather events affect coastal marine ecosystems. The increase in intensity and occurrence of such events drive modifications in coastal hydrology and hydrodynamics. Here, focusing on the winter period (from December to March), we investigated multi-decade (2000–2018) changes in the hydrological properties of the Bay of Brest (French Atlantic coast) as an example of the response of a semi-enclosed bay to extreme weather episodes and large-scale atmospheric circulation patterns. The relationships between extreme weather events and severe low salinity conditions (as a proxy for changes in water density) were investigated using high-frequency in situ observations and high-resolution numerical simulations. The identification of intense episodes was based on the timing, duration, and annual occurrence of extreme events. By examining the interannual variability of extreme low salinity events, we detect a patent influence of local and regional weather conditions on atmospheric and oceanic circulation patterns, precipitation, and river runoff. We revealed that low salinity events in Brittany were controlled by large-scale forcings: they prevailed during the positive phase of the North Atlantic Oscillation and periods of low occurrences of the Atlantic Ridge weather regime. The increase in severe storms observed in western France since 2010 has led to a doubling of the occurrence and duration of extreme low salinity events in Brittany

Retrospective survey on the prevalence and outcome of prior autoimmune diseases in patients with aplastic anemia reported to the registry of the European group for blood and marrow transplantation

Aplastic anemia (AA) is rarely described after a diagnosis of autoimmune disease (aID)

Subtotal Pleurectomy with Intrathoracic Chemo Hyperthermia (HITHOC) for IVa Thymomas: De Novo Versus Recurrent Pleural Disease

Introduction: Stage IVa thymoma is a rare disease without a standard of care. Subtotal pleurectomy and HITHOC introduced in highly selected patients may provide interesting oncologic results. The purpose of this study was to distinguish de novo stage IVa tumors (DNT) from distant relapse (DR) with respect to post-operative and long-term outcomes to provide the procedure efficacy. Methods: From July 1997–December 2021, 40 patients with IVa pleural involvement were retrospectively analyzed. The surgical procedure was subtotal pleurectomy and HITHOC (cisplatin 50 mg/m2, mitomycin 25 mg/m2, 42 °C, 90 min). The post-operative outcome, disease-free interval (DFI) and overall survival (OS) were analyzed. Results: Mean age was 52 ± 12 years. B2 and B3 thymomas were preponderant (27; 67.5%). The median number of pleural nodes were nine (4–81) vs. five (1–36); p = 0.004 * in DNT and DR, respectively. Hospital mortality rate was 2.5%. There were four specific HITHOC complications (10%). DFI were 49 and 85 months (p = 0.02 *), OS were 94 and 118 months (NS), in DNT and DR, respectively. Conclusions: Subtotal pleurectomy with HITHOC in IVa offers satisfying results in highly selected patients, for both DNT and DR. Due to the disease rarity, multicentric studies are needed to define HITHOC as a standard of care

Peripheral Tissue Hypoperfusion Predicts Post Intubation Hemodynamic Instability

International audienceBackground Tracheal intubation and invasive mechanical ventilation initiation is a procedure at high risk for arterial hypotension in intensive care unit. However, little is known about the relationship between pre-existing peripheral microvascular alteration and post-intubation hemodynamic instability (PIHI). Methods Prospective observational monocenter study conducted in an 18-bed medical ICU. Consecutive patients requiring tracheal intubation were eligible for the study. Global hemodynamic parameters (blood pressure, heart rate, cardiac function) and tissue perfusion parameters (arterial lactate, mottling score, capillary refill time [CRT], toe-to-room gradient temperature) were recorded before, 5~min and 2~h after tracheal intubation (TI). Post intubation hemodynamic instability (PIHI) was defined as any hemodynamic event requiring therapeutic intervention. Results During 1 year, 120 patients were included, mainly male (59%) with a median age of 68 [57\textendash 77]. The median SOFA score and SAPS II were 6 [4\textendash 9] and 47 [37\textendash 63], respectively. The main indications for tracheal intubation were hypoxemia (51%), hypercapnia (13%), and coma (29%). In addition, 48% of patients had sepsis and 16% septic shock. Fifty-one (42%) patients develop PIHI. Univariate analysis identified several baseline factors associated with PIHI, including norepinephrine prior to TI, sepsis, tachycardia, fever, higher SOFA and high SAPSII score, mottling score\,≥q\,3, high lactate level and prolonged knee CRT. By contrast, mean arterial pressure, baseline cardiac index, and ejection fraction were not different between PIHI and No-PIHI groups. After adjustment on potential confounders, the mottling score was associated with a higher risk for PIHI (adjusted OR: 1.84 [1.21\textendash 2.82] per 1 point increased; p \,=\,0.005). Among both global haemodynamics and tissue perfusion parameters, baseline mottling score was the best predictor of PIHI (AUC: 0.72 (CI 95% [0.62\textendash 0.81]). Conclusions In non-selected critically ill patients requiring invasive mechanical ventilation, tissue hypoperfusion parameters, especially the mottling score, could be helpful to predict PIHI