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/)

Baldine Saint Girons. Esthétiques du XVIIIe siècle. Le modèle français. Philippe Sers éditeur, Paris, 1990, 740 p., 50 ill. n. et bl.

Pommier Edouard. Baldine Saint Girons. Esthétiques du XVIIIe siècle. Le modèle français. Philippe Sers éditeur, Paris, 1990, 740 p., 50 ill. n. et bl.. In: Revue de l'Art, 1991, n°92. pp. 95-96

Les Italiens et la découverte de la Moscovie

Pommier Édouard. Les Italiens et la découverte de la Moscovie. In: Mélanges d'archéologie et d'histoire, tome 65, 1953. pp. 247-283

Winckelman et la vision de l'Antiquité classique dans la France des Lumières et de la Révolution

Pommier Edouard. Winckelman et la vision de l'Antiquité classique dans la France des Lumières et de la Révolution. In: Revue de l'Art, 1989, n°83. pp. 9-20

Le problème des biens artistiques dans le contexte des rapports de force entre les nations : aux origines, 1750- 1815

Le problème de la circulation des biens artistiques entre les États commence à se poser à la Renaissance, avec la nouvelle relation qui s''établit entre la société italienne et la culture gréco-latine et qui amène le Souverain à affirmer un droit éminent sur les oeuvres d''art léguées par !'' Antiquité. Les mesures prises à Rome dès le XVI'' siècle, puis à Naples au XVIII'', introduisent le principe d''un contrôle à leur passage aux frontières. Étendue par la Toscane, au début du XVII'' siècle, à la sortie des tableaux «modernes » , l''application de cette politique est mise en échec, au XVIII'' siècle, par la puissance économique de certains États allemands, mais surtout de l''Angleterre. À la menace de !'' Or, la Révolution fait succéder celle du Fer, c''est-à-dire celle de l''appropriation des trésors patrimoniaux par la force des armes. Les restitutions de 1815 posent les termes d''un débat insoluble.Pommier Edouard. Le problème des biens artistiques dans le contexte des rapports de force entre les nations : aux origines, 1750- 1815. In: Mélanges de l'École française de Rome. Italie et Méditerranée, tome 114, n°1. 2002. La culture dans les relations internationales. Actes des colloques «La diplomazia culturale e le nazioni» (Bologne, 30 novembre-2 décembre 2000) et «La culture dans le champ multilatéral» (Lyon, 10-12 mai 2001) organisés par l'École française de Rome, la Facoltà di scienze politiche dell'Università degli studi di Bologna, l'Institut d'études politiques de Lyon, l'Institut français de Florence et le Collège européen de coopération culturelle (Luxembourg) pp. 59-73

L'itinéraire religieux d'un moine vagabond italien au XVIe siècle

Pommier Édouard. L'itinéraire religieux d'un moine vagabond italien au XVIe siècle. In: Mélanges d'archéologie et d'histoire, tome 66, 1954. pp. 293-322

Conservative versus Surgical Treatment for Odontoid Fracture: Is the Surgical Treatment Harmful? Systematic Review and Meta-Analysis

International audienceBackground: Odontoid fracture is a common injury especially in elderly people. Despite some recent studies arguing in favor of surgery, the best treatment is still being debated.Objective: We systematically review and analyze the comparative literature between surgical and conservative treatments of odontoid fractures.Methods: We systematically searched Medline and the Cochrane Library for studies reported from January 1990 to May 2019 in English. Comparative studies evaluating the results of surgical and conservative treatments for odontoid fractures were eligible for inclusion. Combined relative risks (RRs) for mortality at last follow-up, union or nonunion rates, and complications were calculated. Methodological quality was assessed using the Newcastle-Ottawa Scale. Influence of age and year of publication on treatment effect was explored using a meta-regression analysis.Results: A total of 1438 articles were identified, of which 30 articles with 2463 patients were eligible for inclusion. There was a trend toward lower mortality in the surgical group (RR, 0.80; 95% confidence interval [CI], 0.63-1.02). Nonunion rates (RR, 0.41; 95% CI, 0.28-0.6) were lower in the surgical group. Union rates were higher in the surgical group (RR, 1.26; 95% CI, 1.11-1.45). No significant influence of age or year of publication on treatment effect was found.Conclusions: Based on this meta-analysis of nonrandomized comparative studies, surgical treatment seems not to be inferior to conservative treatments. The conclusions of this study remain limited by the low quality of the evidence available. Randomized controlled studies are required

Three-Toed Sloth as Putative Reservoir of Coxiella burnetii, Cayenne, French Guiana

International audienceTo the Editor: Q fever is an emerging zoonosis and a major public health concern in French Guiana, a French overseas region located on the northeastern coast of South America (1,2). Most cases occur in the city of Cayenne (3), specifically in the suburbs , where houses are near wooded hills (4). Genotyping performed by using multispacer sequence typing showed that MST17, a unique genotype of C. burnetii, circulates in Cay-enne and is responsible for epidemics of Q fever (5). C. burnetii transmission peaks during the rainy season, and the incidence of Q fever usually increases 1–3 months later (6). The animal reservoir of C. burnetii in French Guiana is unknown; previous studies have excluded domestic ruminants, which are known to be C. burnetii reservoirs elsewhere in the world (6). Four sero-logic surveys showed few C. burnetii– positive opossums, dogs, rodents (Proechimys spp.), bovines, or birds in French Guiana (7). In 2013, using real-time PCR (qPCR) analysis of vaginal swab samples, we showed that 6/158 (3.8%) dogs from Cayenne and 0/206 bats from the coastal area of French Guiana were positive for C. burnetii (Cycle threshhold [C t ]<35). One of the positive samples was identified as genotype MST17 (5). A case–control study among humans identified several risk factors for Q fever, including living near a forest and the presence of wild animals near the house (6). During January–April 2013, a Q fever outbreak occurred in Tiger Camp, a military residential area located at the top of a wooded hill in Cay-enne. Vaginal swab samples were collected from animals living in the area (13 goats, 8 sheep, 7 bats, 34 birds, 2 opossums, 4 iguanas, and 17 geckos); all samples were negative for C. bur-netii by qPCR. In addition, serologic tests for C. burnetii were negative for samples from all 37 small ruminants maintained near the outbreak area. In January 2014, a dead (accidental death) female 3-toed sloth (Brad-ypus tridactylus) (Figure, panel A) was found on the road near the residence of a Q fever patient. We retrieved the sloth and collected feces, spleen, liver, kidney, lung, and uterus samples and a vaginal swab sample. A total of 16 ticks were removed from the sloth and stored in 70% alcohol. DNA was extracted from the fe-ces, organs, and ticks by using the BioRobot EZ1 Workstation (QIA-GEN, Courtaboeuf, France). qPCR targeting the repeated insertion sequence IS1111 was performed by using a CFX96 Touch Real-Time PCR Detection System (Bio-Rad, Marne la Coquette, France) as described (8). We confirmed all positive results by performing a second qPCR targeting the IS30a repeated sequence. DNA samples with C t values <35 in both assays were considered positive for C. burnetii. A standard calibration curve quantifying the target IS1111 was generated by using 10-fold serial dilutions of C. burnetii Nine Mile strain. The number of IS1111 intergenic sequences found in the genome of strain C. burnetii MST17 was identical to that for the Nine Mile strain (F. D'Amato, unpub. data); thus, the qPCR that we used was valid for quantifying the number of C. burnetii MST17 IS1111 copies/mL in samples we collected (5). qPCR analysis showed that the feces were highly positive for C. bur-netii; the sample had a low C t value of 23, corresponding to 7 log 10 DNA copies/mL (9). The spleen was also positive for C. burnetii; the C t value was 34, corresponding to 3.6 log 10 DNA copies/mL. Results for the other samples were negative. Using morphologic criteria, we identified all 16 ticks collected from the sloth as Amblyomma geayi (Figure,LETTERSpanelB).WeperformedC.burnetii–specificqPCRontheticks;14(88%)werepositive.WegenotypedC.burnetii–positiveDNAfromthefecesandfrom6ofthe16ticksbyusingmultispacersequencetypingasdescribed(5).AllsampleswereidentifiedasMST17,theuniquegenotypecirculatinginCayenne(5).Afterobtainingthelaboratoryre-sults,weconfirmedthatalocalgroupinchargeofthecollectionandtreatmentofinjuredanimalsusuallyreleasedrehabilitated3-toedslothsintoTigerCamp.ResidentsofTigerCampregu-larlyobservedandcameintocontactwiththesloths,andtickswerefrequent-lyobservedonthefuroftheanimals.Furthermore,3QfeverpatientsfromCayennereportedcontactwithsloths.FecesfromtheslothinthisstudywerehighlyinfectiousforC.burnetii.Becauseslothsliveintalltreesandcanshedthisbacteriumintheirfeces,humancontaminationmightoccurthroughin-halationofinfectiousaerosolsfromfe-ces.ThehighprevalenceofC.burnetiiinfectioninticksalsosuggestspossibletransmissionthroughtickbitesorfromaerosolsoftickfecesthathavebeende-positedontheskinofanimalhosts;suchfecescanbeextremelyrichinbacteriaandhighlyinfectious(10).Inthis2013outbreakofQfever,epidemiologicstudiesledtotheiden-tificationof3-toedslothsasaputativesourceofC.burnetiiinfection.FurtherinvestigationsareneededtoconfirmtheroleofslothsasareservoirforC.burnetiiinFrenchGuianaandtoim-plementefficientmeasurestopreventtransmissiontohumans

Epidemiology of respiratory pathogen carriage in the homeless population within two shelters in Marseille, France, 2015–2017: cross sectional 1-day surveys

International audienc