Ultrasmall superparamagnetic iron oxide nanoparticles coated with fucoidan for molecular MRI of intraluminal thrombus

International audienc

Outcomes of extended resection for locally advanced thymic malignancies

International audienc

Right Ventricle Remodeling Metabolic Signature in Experimental Pulmonary Hypertension Models of Chronic Hypoxia and Monocrotaline Exposure

Introduction: Over time and despite optimal medical management of patients with pulmonary hypertension (PH), the right ventricle (RV) function deteriorates from an adaptive to maladaptive phenotype, leading to RV failure (RVF). Although RV function is well recognized as a prognostic factor of PH, no predictive factor of RVF episodes has been elucidated so far. We hypothesized that determining RV metabolic alterations could help to understand the mechanism link to the deterioration of RV function as well as help to identify new biomarkers of RV failure. Methods: In the current study, we aimed to characterize the metabolic reprogramming associated with the RV remodeling phenotype during experimental PH induced by chronic-hypoxia-(CH) exposure or monocrotaline-(MCT) exposure in rats. Three weeks after PH initiation, we hemodynamically characterized PH (echocardiography and RV catheterization), and then we used an untargeted metabolomics approach based on liquid chromatography coupled to high-resolution mass spectrometry to analyze RV and LV tissues in addition to plasma samples from MCT-PH and CH-PH rat models. Results: CH exposure induced adaptive RV phenotype as opposed to MCT exposure which induced maladaptive RV phenotype. We found that predominant alterations of arginine, pyrimidine, purine, and tryptophan metabolic pathways were detected on the heart (LV+RV) and plasma samples regardless of the PH model. Acetylspermidine, putrescine, guanidinoacetate RV biopsy levels, and cytosine, deoxycytidine, deoxyuridine, and plasmatic thymidine levels were correlated to RV function in the CH-PH model. It was less likely correlated in the MCT model. These pathways are well described to regulate cell proliferation, cell hypertrophy, and cardioprotection. These findings open novel research perspectives to find biomarkers for early detection of RV failure in PH

Right Ventricle Remodeling Metabolic Signature in Experimental Pulmonary Hypertension Models of Chronic Hypoxia and Monocrotaline Exposure

Introduction: Over time and despite optimal medical management of patients with pulmonary hypertension (PH), the right ventricle (RV) function deteriorates from an adaptive to maladaptive phenotype, leading to RV failure (RVF). Although RV function is well recognized as a prognostic factor of PH, no predictive factor of RVF episodes has been elucidated so far. We hypothesized that determining RV metabolic alterations could help to understand the mechanism link to the deterioration of RV function as well as help to identify new biomarkers of RV failure. Methods: In the current study, we aimed to characterize the metabolic reprogramming associated with the RV remodeling phenotype during experimental PH induced by chronic-hypoxia-(CH) exposure or monocrotaline-(MCT) exposure in rats. Three weeks after PH initiation, we hemodynamically characterized PH (echocardiography and RV catheterization), and then we used an untargeted metabolomics approach based on liquid chromatography coupled to high-resolution mass spectrometry to analyze RV and LV tissues in addition to plasma samples from MCT-PH and CH-PH rat models. Results: CH exposure induced adaptive RV phenotype as opposed to MCT exposure which induced maladaptive RV phenotype. We found that predominant alterations of arginine, pyrimidine, purine, and tryptophan metabolic pathways were detected on the heart (LV+RV) and plasma samples regardless of the PH model. Acetylspermidine, putrescine, guanidinoacetate RV biopsy levels, and cytosine, deoxycytidine, deoxyuridine, and plasmatic thymidine levels were correlated to RV function in the CH-PH model. It was less likely correlated in the MCT model. These pathways are well described to regulate cell proliferation, cell hypertrophy, and cardioprotection. These findings open novel research perspectives to find biomarkers for early detection of RV failure in PH

Bulletin bibliographique

Attentive depuis longtemps aux travaux de Jacques Le Brun, comme en témoignait encore le précédent « Bulletin bibliographique » (no 188), les Archives rappellent l’œuvre de ce grand maître de l’histoire de la spiritualité et des institutions chrétiennes à l’époque moderne, récemment disparu. La rubrique « L’atelier des sciences sociales du religieux » accueille trois articles consacrés au livre de Wiktor Stoczkowski, La science sociale comme vision du monde. Émile Durkheim et le mirage du salut (Gallimard, 2019). Bien relayé dans les médias culturels mais objet de nombreuses objections parmi les spécialistes, cet ouvrage est l’occasion d’un retour réflexif et critique sur la tradition durkheimienne et ses relectures. Cinq « notes critiques » entraînent le lecteur de la laïcité et la gestion de l’altérité religieuse en France, au Maghreb et au Québec, à l’hindouisme et à la « religion chinoise », en passant par les enjeux de l’autobiographie en sciences sociales des religions. Trois « lectures croisées » sont consacrées au dernier livre de Pierre Lassave, La sociologie des religions (Éditions de l’EHESS, 2019). Plus de cent recensions attestent enfin de la vitalité éditoriale des sciences sociales des religions et de leur ouverture à l’ensemble des sciences sociales. Cette livraison témoigne ainsi de la fidélité des Archives à une conviction de longue haleine : l’édition scientifique est un espace de rencontre, de controverse et de dialogue, plus précieux encore dans les temps que nous traversons. Our journal has long been attentive to the work of Jacques Le Brun, as the previous "Bulletin bibliographique" (no. 188) testified, and it recalls the work of this great master of the history of Christian spirituality and institutions in modern times, who has recently passed away. Within "The Workshop of the Social Sciences of Religion", three articles look at Wiktor Stoczkowski's book, La science sociale comme vision du monde. Émile Durkheim et le mirage du salut (Gallimard, 2019). If the book has been positively reviewed by the press, numerous objections have been raised by some specialists. Thus, this work is an opportunity for a thoughtful and critical return to the Durkheimian tradition and its rereadings. Five "critical notes" lead the reader from secularism and the management of religious otherness in France, the Maghreb and Quebec, to Hinduism and the "Chinese religion", through the issues of autobiography in the social sciences of religions. Three "cross-readings" are devoted to Pierre Lassave's latest book, La sociologie des religions (Éditions de l'EHESS, 2019). Finally, more than one hundred reviews attest to the editorial vitality of the social sciences of religions and their openness to the social sciences as a whole. This issue thus testifies to the Archives' fidelity to a long-term conviction: scientific publishing is a space for encounters, controversy, and dialogue, which is even more precious in the times we live in. Los Archives han estado atentos durante mucho tiempo a la obra de Jacques Le Brun, como atestiguaba el anterior "Bulletin bibliographique" (nº 188), y recuerdan la obra de este gran maestro de la historia de la espiritualidad y de las instituciones cristianas de los tiempos modernos, recientemente fallecido. En el "Taller de Ciencias Sociales Religiosas", tres artículos están dedicados al libro de Wiktor Stoczkowski, La science sociale comme vision du monde. Émile Durkheim et le mirage du salut (Gallimard, 2019). Bien difundida en los medios culturales pero objeto de muchas objeciones entre los especialistas, esta obra es una oportunidad para un retorno reflexivo y crítico sobre la tradición durkheimiana y sus relecturas. Cinco "notas críticas" conducen al lector desde el laicismo y la gestión de la alteridad religiosa en Francia, el Magreb y Quebec, al hinduismo y la "religión china", y a las cuestiones de la autobiografía en las ciencias sociales de las religiones. Tres "lecturas cruzadas" están dedicadas al último libro de Pierre Lassave, La sociologie des religions (Éditions de l'EHESS, 2019). Por último, más de un centenar de reseñas atestiguan la vitalidad editorial de las ciencias sociales de las religiones y su apertura al conjunto de las ciencias sociales. Este número atestigua así la fidelidad de los Archivos a una convicción a largo plazo: la publicación científica es un espacio de encuentro, de controversia y de diálogo, que es aún más precioso en los tiempos que vivimos. La nostra rivista è da tempo attenta all'opera di Jacques Le Brun, come testimonia il precedente "Bulletin bibliographique" (n. 188), e ricorda l'opera di questo grande maestro della storia della spiritualità e delle istituzioni cristiane della modernità, recentemente scomparso. La rubrica "Laboratorio delle scienze sociali delle religioni" accoglie tre articoli dedicati al libro di Wiktor Stoczkowski, La science sociale comme vision du monde. Émile Durkheim et le mirage du salut (Gallimard, 2019). Commentato positivamente dai media culturali ma oggetto di molte obiezioni da parte degli specialisti, questo lavoro è l'occasione per un ritorno riflessivo e critico sulla tradizione di Durkheimian e sulle sue riletture. Cinque "note critiche" conducono il lettore dal laicismo e dalla gestione dell'alterità religiosa in Francia, nel Maghreb e nel Québec, all'induismo e alla "religione cinese", fino ai limiti e le opportunità dell'autobiografia nelle scienze sociali delle religioni. Tre "letture incrociate" sono dedicate all'ultimo libro di Pierre Lassave, La sociologie des religions (Éditions de l'EHESS, 2019). Infine, più di cento recensioni attestano la vitalità editoriale delle scienze sociali delle religioni e la loro apertura alle scienze sociali nel loro insieme. Questo numero testimonia così la fedeltà degli Archives a una convinzione di lungo corso: l'editoria scientifica è uno spazio di incontro, di polemica e di dialogo, ancor più prezioso oggi

Veno-Arterial Extracorporeal Membrane Oxygenation for Circulatory Failure in COVID-19 Patients: Insights from the ECMOSARS Registry

International audienceObjectives: The clinical profile and outcomes of patients with Covid-19 who require veno-arterial or veno-venous-arterial extracorporeal membrane oxygenation (VA-ECMO - VAV-ECMO) are poorly understood. We aimed to describe the characteristics and outcomes of these patients and to identify predictors of both favorable and unfavorable outcomes.Methods: ECMOSARS is a multicenter, prospective, nationwide French registry enrolling patients who require VV/VA-ECMO in the context of Covid-19 infection (652 patients at 41 centers). We focused on 47 patients supported with VA- or VAV-ECMO for refractory cardiogenic shock.Results: Median age was 49. 14% of patients had a prior diagnosis of heart failure. The most common etiologies of cardiogenic shock were acute pulmonary embolism (30%), myocarditis (28%), and acute coronary syndrome (4%). E-CPR (Extracorporeal Cardiopulmonary Resuscitation) occurred in 38%. In-hospital survival was 28% in the whole cohort, and 43% when E-CPR patients were excluded. ECMO cannulation was associated with significant improvements in pH and FiO2 on day one, but non-survivors showed significantly more severe acidosis and higher FiO2 than survivors at this point (p = 0.030 and p = 0.006). Other factors associated with death were greater age (p = 0.02), higher BMI (p = 0.03), E-CPR (p = 0.001), non-myocarditis etiology (p = 0.02), higher serum lactates (p = 0.004), epinephrine (but not noradrenaline) use before initiation of ECMO (p = 0.003), hemorrhagic complications (p = 0.001), greater transfusion requirements (p = 0.001), and more severe SAVE and SAFE scores (p = 0.01 and p = 0.03).Conclusions: We report the largest focused analysis of VA- and VAV-ECMO recipients in Covid-19. Although relatively rare, the need for temporary mechanical circulatory support in these patients is associated with poor prognosis. However, VA-ECMO remains a viable solution to rescue carefully selected patients. We identified factors associated with poor prognosis and suggest that E-CPR is not a reasonable indication for VA-ECMO in this population

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

International audiencePurpose: To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on in-hospital mortality.Methods: The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models.Results: Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2.91[1.94-4.4]) but not thrombotic events (adjOR = 1.02[0.68-1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality (adjOR = 13.5[4.4-41.5]). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support.Conclusions: In a nationwide cohort of COVID-19 patients supported by ECMO, bleeding incidence was high and associated with mortality. Intracranial hemorrhage incidence was higher than reported for non-COVID patients and carried the highest risk of death. Thrombotic events were less frequent and not associated with mortality. Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration

Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

International audienceBackground Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality. Methods For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France. Results Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79–1.26], p = 0.986). Conclusions In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020)