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/)

High pressure intrusion of water and LiCl aqueous solutions in hydrophobic KIT-6 mesoporous silica: Influence of the grafted group nature

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PrPSc accumulation and stability in ovine PrP transgenic mice infected with biologically distinct scrapie strains

International audienceWhile multiple conformations of the abnormal prion protein (PrPSc) are thought to encipher prion strain diversity, how they feature in the variable incubation periods observed upon experimental transmission into mice is currently unknown. In order to investigate the natural diversity of sheep scrapie agent, our laboratory has developed a new experimental model consisting of transgenic mice overexpressing the VRQ allele of sheep prion protein (tg338 line). Among 6 potential groups of natural scrapie strains, we have presently stabilised 4 strains that have been biologically cloned and shown to produce stable and distinct phenotypes, based on the incubation time (from 60 to ∼200 days), the molecular profile of PrPSc and its regional distribution in the brain. Moreover these scrapie strains differ in their capacity to replicate in peripheral tissues, such as spleen. For each of these strains, we have examined i) the kinetics of PrPSc accumulation in both brain and spleen, ii) the sensitivity of PrPSc to degradation by either digesting the protein with proteinase K or pepsin in an vitro assay or in vivo by exposing brain homogenates containing PrPP Sc to primary cultures of macrophages, iii) the resistance to denaturation with increasing concentration of guanidine-HCl. These data will be presented and their possible significance in term of strain biology will be discussed

Secretory IgA directed to the inner core rotavirus VP6 protein contributes to protection via intracellular neutralization but not via immune exclusion

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Recombinant rotavirus inner core proteins produced in the milk of transgenic rabbits confer a high level of protection after intrarectal delivery

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Gammastic: Towards a pseudo-gamma spectrometry in plastic scintillators

Conference of 2013 3rd International Conference on Advancements in Nuclear Instrumentation, Measurement Methods and Their Applications, ANIMMA 2013 ; Conference Code:102802International audienceWar against CBRN-E threats needs to continuously develop sensors with improved detection efficiency. More particularly, this topic concerns the NR controls for homeland security. A first analysis requires indeed a fast gamma spectrometry so as to detect potential special nuclear materials (SNM). To this aim, plastic scintillators could represent the best alternative for the production of large-scale, low-cost radiation portal monitors to be deployed on boarders, tolls, etc. Although they are known to be highly sensitive to gamma rays, due to their poor resolution, information relative to the nature of the SNM is tricky. Thus, only the Compton edge is obtained after interaction, and no information of the photoelectric peak is observed. This project concerns new developments on a possible pseudo-gamma spectrometry performed with plastic scintillators. This project is articulated on a combination of two developments: The design of new materials most suitable for recovering the photoelectric peak after gamma interaction with the scintillator. This work concerns mainly plastic scintillators loading with heavy elements, such as lead or bismuth. The analysis of the resulting signal with smart algorithms. This work is thus a pluridisciplinary work performed at CEA LIST and embeds 4 main disciplines: MCNPX simulations (simulated spectra), chemistry of materials (preparation of various plastic scintillators with different properties), instrumentation (lab experiments) and smart algorithms. Really impressive results were obtained with the unfolding of simulated spectra at various energies (from 241Am to 60Co) and an innovative approach was proposed to counter-balance the quenching effect of luminescence by heavy elements in plastic scintillators

VLP administered via the rectal route are immunogenic and induce protection against rotavirus

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Where Brain, Body and World Collide

The production cross section of electrons from semileptonic decays of beauty hadrons was measured at mid-rapidity (|y| &lt; 0.8) in the transverse momentum range 1 &lt; pt &lt; 8 Gev/c with the ALICE experiment at the CERN LHC in pp collisions at a center of mass energy sqrt{s} = 7 TeV using an integrated luminosity of 2.2 nb^{-1}. Electrons from beauty hadron decays were selected based on the displacement of the decay vertex from the collision vertex. A perturbative QCD calculation agrees with the measurement within uncertainties. The data were extrapolated to the full phase space to determine the total cross section for the production of beauty quark-antiquark pairs