The influence of hay steaming on clinical signs and airway immune response in severe asthmatic horses

ackground Avoidance of antigenic stimuli was found to significantly reverse airway obstruction of horses with severe equine asthma (sEA). To date, no published study investigated the influence of steaming hay on lower airway condition of sEA-affected horses. The objectives were to determine the clinical, cytological and cytokine respiratory responses of both sEA and control (CTL) horses experimentally exposed to steamed or dry hay. Results A cohort of 6 sEA horses and 6 CTL horses was involved in this field study. On day 0, both groups were fed with steamed hay for 5 consecutive days, followed by a wash-out period of 26 days prior to be fed with dry hay for 5 consecutive days. Investigations performed 2 days prior to and 5 days after each challenge included clinical score, tracheal mucus accumulation, and bronchoalveolar lavage fluid (BALF) cytology and cytokine mRNA expression. Feeding steamed hay significantly decreased its mould content (P < 0.001). Mucus score significantly increased when feeding dry hay (P = 0.01). No significant influence of challenge type was found on clinical score. Percentages of neutrophils (P < 0.001) as well as mRNA expression of IL-1β (P = 0.024), IL-6R (P = 0.021), IL-18 (P = 0.009) and IL-23 (P = 0.036) in BALF of sEA affected horses were significantly increased after both (steamed and dry hay) challenges. Relative mRNA expression of IL-1β, IL-6R and IL-23 in BALF were also significantly correlated to neutrophil percentages and both clinical and tracheal mucus score. Conclusions Steaming significantly decreased mould content but inconsistently influenced the respiratory response of sEA affected horses when fed hay. Based on BALF cytology and cytokine profiles, its relevance might be controversial as a non-medicinal therapy for sEA-affected horses

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

L'écoute réflective : un nouvel usage en psychothérapie, spécificités de l'entretien motivationnel

International audienceReflection, a key element of empathic listening, initially developed by Carl Rogers, has found new purposes and applications in modern psychotherapy. The aim of this article is to explain this technique in more depth and to examine its role and main forms in Rogers’ client-centered therapy and motivational interviewing (MI), and to review empirical studies based on the influence of reflection and empathy in the effectiveness of empirically validated psychotherapies, and in particular MI. In fact, in the Rogers’ approach, (Rogers et Kinget, 1962 [2]), as well as in MI and in CBT, in spite of their orientation towards change and a certain directivity, reflection is considered as the main way to express accurate empathy. Empathy is a central feature in several therapeutic approaches and has been particularly associated with positive results in the treatment of various problems (Miller et Rollnick, 2002; Miller et Baca, 1982; Greenberb et al., 2001 [8], [9], [10]). This therapeutic attitude, widely used by Rogers (1951, 1959, 1968 [11], [12], [13]), has been adopted by the authors of MI, Miller et Rollnick (2002, 1991 [4], [8]), as well as by other forms of effective psychotherapies. Reflective listening plays a central role in both MI and the Rogers's client-centered approach; in MI, it was adopted and enriched with new, more complex forms, as well as with objectives which differ from Rogers’ approach. In MI, the client's talk which reflect their intentions to change (change-talk) are predominantly reflected upon. MI requires thus a selective method of response to the client's speech to reduce ambivalence and guide the person towards change. Four sub-categories, including cognitive, emotional and behavioral dimensions of commitment to change, constitute the preparatory change-talk: the desire, ability, reason and need to change, “commitment” and the “first steps”. The sustain talk consists of statements opposing change, and resistance talk consists of interruptions and disagreements with the therapist. According to Miller et Rose (2009 [18]), the effectiveness of MI is based on its influence on change-talk. These authors hypothesized that behavioral change is directly linked to client change-talk during MI sessions, and that it is inversely linked to sustain talk. According to those authors, the effective use of the MI technique increases change-talk in clients and reduces sustain talk, which predicts effective change in behavior. Studies comparing MI to more traditional treatment models or minimal intervention show the links between MI-consistent behaviors and the emergence of more change-talk compared with other approaches or minimal intervention (Apodaca et Longabaugh, 2009; Moyers et al., 2007 [23], [24]). Current research by Amrhein et al. (Amrhein et al., 2003; Amrhein, 2004 [14], [26]) shows that the intensity of commitment to change by the client and the first steps predict long-term change in behavior. Expressions of change-talk such as desire, ability, the reason and the need to change do not systematically initiate change but they announce the reinforcement of commitment to change. The effect of the intensity of client commitment talk on behavior change has been verified in a study on CBT for hospitalized cocaine addicts (Aharonovich et al., 2008 [27]). In conclusion, reflection allows the therapist to evoke the client's statements in the direction of the desired change, and to reinforce it, which should then lead to an effective change in behavior. However, it is still too early to make any conclusions about the efficiency of reflective listening. Despite its frequent use in psychotherapy, the specific therapeutic effectiveness of reflecting is still rarely assessed in empirical studies. It would thus be interesting to assess the role that reflective listening, a central technique in MI, plays in the production of the client's change-talk, in the building of the therapeutic alliance and in the effectiveness of MI and other empirically validated psychotherapies. Finally, it is important to expand its use to different types of psychotherapy and to assess its impact.La reformulation, marque d’une écoute empathique initialement développée par Rogers, trouve aujourd’hui de nouvelles orientations et applications dans le champ de la psychothérapie. L’objet de cet article est d’expliquer plus avant cette technique et d’examiner son rôle et ses principales formes dans la thérapie centrée sur la personne de Rogers et l’entretien motivationnel (EM), et de faire le point sur les études empiriques portant sur l’influence de la reformulation et de l’empathie dans l’efficacité des psychothérapies validées scientifiquement, et notamment de l’entretien motivationnel. Les changements et enrichissements apportés par l’entretien motivationnel à la reformulation sont mis en évidence à travers les nouveaux objectifs visés et techniques employées, et notamment en lien avec la production de discours-changement. Les effets du discours-changement sont étudiés à travers une revue de la littérature et notamment des études psycholinguistiques. Enfin, de nouvelles pistes de recherche sont proposées. Ainsi, il est intéressant de vérifier quel rôle joue l’écoute réflective, technique centrale de l’EM, dans la production du discours-changement du client et dans l’efficacité de l’EM et des psychothérapies. Enfin, il semble important d’élargir son utilisation aux différents types de psychothérapie et d’en évaluer ses effets

Essai de définition et de validation d'une méthode d'intervention cognitive et motivationnelle destinée à l'amélioration de l'adhésion des patients schizophrènes au traitement pharmacologique

La plupart des patients schizophrènes présentent des problèmes d'adhésion à leur traitement pharmacologique. Seul un tiers d'entre eux suivrait leur traitement à la lettre et les ruptures de traitement sont fréquentes. L'absence d'observance a de lourdes conséquences sur l'évolution de la maladie de telle sorte que l'amélioration de l'adhésion au traitement est un véritable enjeu pour les cliniciens comme pour les chercheurs. Objectif : évaluer une psychothérapie cognitive et motivationnelle destinée à améliorer l'observance médicamenteuse des patients atteints de schizophrénie. Méthode : l'observance de 54 patients schizophrènes a été évaluée lors de leur hospitalisation en service de psychiatrie adulte puis en ambulatoire sur une période de six mois. Les patients ont été répartis au hasard en deux groupes : le groupe contrôle recevait une psychothérapie de soutien, le groupe traité la psychothérapie cognitive et motivationnelle. Tous les patients étaient traités par neuroleptique injectable. L'observance médicamenteuse est fondée sur l'enregistrement des injections de neuroleptiques reçues, refusées ou manquées par le patient. Les résultats indiquent que la thérapie cognitive et motivationnelle a une influence sur le stade de changement de l'observance médicamenteuse, l'insight, et les croyances relatives aux médicaments comparativement à la thérapie de soutien.Most patients with schizophrenia exhibit full or partial non-adherence to pharmacological treatment. Only about one-third reliably take antipsychotic medication as prescribed. Poor adherence (i.e., both complete and partial non adherence) has been found to be associated with serious negative outcomes and as such, interventions aimed at improving and maintaining adherence are of great interest to clinicians, researchers, and policy makers. Objective: To assess the efficacy of a psychotherapy based on motivational enhancement and cognitive therapies designed to improve patient's adherence to treatment and motivation to change. Method: 54 patients diagnosed with schizophrenia about to be discharged following inpatient treatment were included in a six month repeated measures study. Patients were randomly assigned to either the experimental or control therapies and were blind to group assignment. All patients received long acting injectable antipsychotic medications and were rated as compliant when the injection was confirmed and non compliant if the injection was refused or the appointment was missed. Results show that compared to the control psychotherapy the cognitive and motivational therapy improved motivation for change, insight and attitudes toward treatment.NANTERRE-BU PARIS10 (920502102) / SudocSudocFranceF

La purification du foin a-t-elle une influence sur les signes cliniques et la réponse immune des chevaux atteints d’asthme sévère

International audienc

La purification du foin a-t-elle une influence sur les signes cliniques et la réponse immune des chevaux atteints d’asthme sévère

National audienc

La purification du foin a-t-elle une influence sur les signes cliniques et la réponse immune des chevaux atteints d’asthme sévère

National audienc

La purification du foin a-t-elle une influence sur les signes cliniques et la réponse immune des chevaux atteints d’asthme sévère

International audienc

In vitro stimulation of alveolar macrophages from severe asthmatic horses

International audiencePurpose of the study: The immune response in asthmatic horses is based on innate immunity with an important role of alveolar macrophages (AM) which are the first line of defense of immune response with phagocytosis and macropinocytosis mechanisms. In fact, AMs are present on the surface of lung cells and are thus directly exposed to inhaled particles. Multiple agents may be implicated in either initiation or maintenance of equine asthma syndrome like dust stables, season, bacteria or beeding. The composition of the administered hay had a greater influence than bedding on breathable dust concentrations and on endotoxin in the inhaled air. The objectives of this study were 1/ characterize alveolar macrophages population from control (CTL) and severe equine asthmatic (sEA) horses; 2/ study the alveolar macrophages phagocytosis and macropinocytosis activities from CTL and sEA horses, in vitro stimulated by different antigens whose hay dust solution; 3/ study the cell behavior and cytokinique response of AMs from CTL and sEA horses, preliminary in vivo hay challenged (Orard et al., 2018) and in vitro stimulated.Methods used: The in vivo hay challenge was previously described in Orard et al. (2018). The AMs were isolated on D-2 (pre-challenge) and D+5 (post-challenge) from the BALF. Hay dust suspensions (HDS) were realized by shaking 1kg of dry or steamed hay with Haygain HG-600, dusts were sieved and suspended at 10 ml of saline per gram of dust. The HDS were characterised for bacteria, mould, endotoxin and β-D-glucan content, inhalable and respirable particles. After 3h of adhesion, the AMs were stimulated with GFP-conjuagted E.coli bioparticles (10 by cells), FITC-conjugated BSA (1 mg/ml), LPS (500 ng/ml), Fumagilline (4 µg/ml), dry HDS (5 µl/ml) or steamed HDS (5 µl/ml). The real-time cellular activities of AMs were analysed by live cell imaging (IncuCyte® S3, Sartorius) and tested for impedance measurement (xCELLigence®, ACEA Biosciences). Immunophenotyping, macropinocytosis and phagocytosis capacities were analysed by flow cytometry (CytoFlex S, Beckman coulter). Griess test was realised at 6h and 24h post-stimulation. Summary of results: Bacteria, mould, endotoxins and beta D glucan decrease in HDS after steaming. Moreover steam treatment decreases significantly and sustainably both inhalable and respirable dust generated by hay shaking. The immunophenotyping of AMs showed that CD14+ cell proportion was more important in sEA horses compared to CTL horse with better phagocytosis and macropinocytosis capacities in CD14+ AMs in sEA horses. No significant difference of phagocytosis and macropinocytosis capacities were observed in CD206+ cells between sEA and CTL horses. When naive AMs (D-2) were only in vitro simulated, we can observe more important cell grouping with LPS and HDS in AMs from CTL horses. We can observe that the size of AMs stimulated with D-HDS is higher compared to the other stimuli. When AMs were preliminary in vivo challenged with steamed hay and in vitro stimulated with HDS, we also observed some grouping cells. This grouping are less important when AMs were preliminary challenged with dry hay. Moreover, the AMs from sEA are smaller size after dry hay challenge and HDS stimulation. Conclusions: The expression of markers of macrophages as CD14 seems to vary according to the status of the horse with better phagocytosis and macropinocytosis capacities in CD14+ AMs frome sEA horses. No difference in phagocytosis and macropinocytosis activity was observed for CD206+ cells regardless of the status of the horse. The behavior of AMs from sEA horses seem to be more affected by a previous in vivo dry hay challenge compared to AMs from CTL horses. In addition, steamed hay challenge in vivo seems appears to have less impact on the behavior of AMs compared dry hay for sEA and CTL horses

In vitro stimulation of alveolar macrophages from severe asthmatic horses

International audiencePurpose of the study: The immune response in asthmatic horses is based on innate immunity with an important role of alveolar macrophages (AM) which are the first line of defense of immune response with phagocytosis and macropinocytosis mechanisms. In fact, AMs are present on the surface of lung cells and are thus directly exposed to inhaled particles. Multiple agents may be implicated in either initiation or maintenance of equine asthma syndrome like dust stables, season, bacteria or beeding. The composition of the administered hay had a greater influence than bedding on breathable dust concentrations and on endotoxin in the inhaled air. The objectives of this study were 1/ characterize alveolar macrophages population from control (CTL) and severe equine asthmatic (sEA) horses; 2/ study the alveolar macrophages phagocytosis and macropinocytosis activities from CTL and sEA horses, in vitro stimulated by different antigens whose hay dust solution; 3/ study the cell behavior and cytokinique response of AMs from CTL and sEA horses, preliminary in vivo hay challenged (Orard et al., 2018) and in vitro stimulated.Methods used: The in vivo hay challenge was previously described in Orard et al. (2018). The AMs were isolated on D-2 (pre-challenge) and D+5 (post-challenge) from the BALF. Hay dust suspensions (HDS) were realized by shaking 1kg of dry or steamed hay with Haygain HG-600, dusts were sieved and suspended at 10 ml of saline per gram of dust. The HDS were characterised for bacteria, mould, endotoxin and β-D-glucan content, inhalable and respirable particles. After 3h of adhesion, the AMs were stimulated with GFP-conjuagted E.coli bioparticles (10 by cells), FITC-conjugated BSA (1 mg/ml), LPS (500 ng/ml), Fumagilline (4 µg/ml), dry HDS (5 µl/ml) or steamed HDS (5 µl/ml). The real-time cellular activities of AMs were analysed by live cell imaging (IncuCyte® S3, Sartorius) and tested for impedance measurement (xCELLigence®, ACEA Biosciences). Immunophenotyping, macropinocytosis and phagocytosis capacities were analysed by flow cytometry (CytoFlex S, Beckman coulter). Griess test was realised at 6h and 24h post-stimulation. Summary of results: Bacteria, mould, endotoxins and beta D glucan decrease in HDS after steaming. Moreover steam treatment decreases significantly and sustainably both inhalable and respirable dust generated by hay shaking. The immunophenotyping of AMs showed that CD14+ cell proportion was more important in sEA horses compared to CTL horse with better phagocytosis and macropinocytosis capacities in CD14+ AMs in sEA horses. No significant difference of phagocytosis and macropinocytosis capacities were observed in CD206+ cells between sEA and CTL horses. When naive AMs (D-2) were only in vitro simulated, we can observe more important cell grouping with LPS and HDS in AMs from CTL horses. We can observe that the size of AMs stimulated with D-HDS is higher compared to the other stimuli. When AMs were preliminary in vivo challenged with steamed hay and in vitro stimulated with HDS, we also observed some grouping cells. This grouping are less important when AMs were preliminary challenged with dry hay. Moreover, the AMs from sEA are smaller size after dry hay challenge and HDS stimulation. Conclusions: The expression of markers of macrophages as CD14 seems to vary according to the status of the horse with better phagocytosis and macropinocytosis capacities in CD14+ AMs frome sEA horses. No difference in phagocytosis and macropinocytosis activity was observed for CD206+ cells regardless of the status of the horse. The behavior of AMs from sEA horses seem to be more affected by a previous in vivo dry hay challenge compared to AMs from CTL horses. In addition, steamed hay challenge in vivo seems appears to have less impact on the behavior of AMs compared dry hay for sEA and CTL horses