CSF/serum quotient graphs for the evaluation of intrathecal C4 synthesis

<p>Abstract</p> <p>Background</p> <p>Cerebrospinal fluid (CSF)/serum quotient graphs have been used previously to determine local synthesis in brain of immunoglobulins and C₃complement component. The aim of this study was to use the same technique to construct quotient graphs, or Reibergrams, for the beta globulin C₄and to evaluate the method for assessing intrathecal synthesis in neurological disease.</p> <p>Methods</p> <p>The constants in the previously-defined Reibergram for immunoglobulin IgA were used to calculate the CSF/serum quotient for C₄. CSF and serum were analyzed for C₄, IgA and albumin from a total of 12 patients with meningoencephalitis caused by encapsulated microorganisms and 10 subjects without infections or inflammatory neurological disease, some of which had dysfunction of the blood-CSF barrier,</p> <p>Results</p> <p>The formula and C₄Reibergram with the constants previously found for IgA, determined the intrathecal C₄synthesis in CSF. The intrathecal C₄fraction in CSF (C₄loc in mg/l) was compared to the C₄-Index (fraction of CSF: serum for C ₄/fraction of CSF: serum for albumin). There was a significant correlation between the two formulae. The CSF/Serum quotient graph was superior for detecting intrathecal synthesis of C₄under variable conditions of blood-CSF barrier permeability.</p> <p>Conclusion</p> <p>The C₄Reibergram can be used to quantify the intrathecal synthesis of this component of the complement system in different infectious diseases of the central nervous system and is especially useful for patients with blood-brain barrier dysfunction.</p

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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/)

Swim now in orbit: a new horizon for wave observation

International audienceThe CFOSAT (China France Oceanography SATellite) mission is a CNES-CNSA space mission for ocean surface wind and wave observation. The satellite has been successfully launched on October, 29th, 2018 from China. The satellite behaves perfectly well until now with nice scientific acquisitions. For the very first time, wind and waves are observed at the same time and place. These simultaneous observations open new research fields on climate monitoring, sea-air interactions understanding and sea state forecasting.CFOSAT embarks two payloads: a wave scatterometer, SWIM (French contribution) and a wind scatterometer, SCAT (Chinese contribution). Both are Ku-band real aperture radar taking advantage of different backscattering properties. At high incidence angles (SCAT), the radar signal is sensitive to Bragg scattering, i.e. small surface roughness induced by the wind. At low incidence angles (SWIM), the radar backscattering depends only on large slopes, i.e. the waves.In this paper, we will present the status on the SWIM instrument and the SWIM products produced by the French ground segment. This status will be provided after 7 months in orbit, at the end of the commissioning phase. At the time of the writing of the abstract (few days after the launch), we are just checking the health of the satellite and the instruments as well as the generation of the first products. We are not thus able to provide quantitative results to the reviewers at this stage. During the commissioning phase, the internal calibration modes of SWIM are tested (internal impulse response, antenna calibration law, reception noise level). The different acquisition modes are also tested (sequence of the six beams and on-board processing options).The CFOSAT system is composed of the satellite with SWIM and SCAT on-board and two ground segments, one in China (CHOGS) and one in France (FROGS). Both mission centers process all the SWIM and the SCAT data. This paper is relative to the processing performed at FROGS for SWIM only. The CFOSAT data are processed in near real time in the French mission center up to level 2 (CNES) and in differed time from level 2 to level 4 (IFREMER). The products are available on-line on the AVISO+ website.The main scientific products of SWIM are the 2D wave spectrum at a spatial scale of 70x90 km², the backscattering coefficient profiles per 0.5° step in incidence and 15° step in azimuth and the significant wave height and wind speed from the nadir beam.The paper will detail the performance of the instrument relative to SNR and backscattering coefficient accuracy, pointing knowledge accuracy. The overall availability of the data will also be discussed (coverage over ocean, distance to coasts, coverage of the continents and ice sheets).We will also present the results on level 2 products

A methodological pipeline for serial-section imaging and tissue realignment for whole-brain functional and connectivity assessment

BackgroundUnderstanding the neurobiological basis of cognition and behavior, and disruptions to these processes following injury and disease, requires a large-scale assessment of neural populations, and knowledge of their patterns of connectivity.New methodWe present an analysis platform for large-scale investigation of functional and neuroanatomical connectivity in rodents. Retrograde tracers were injected and in a subset of animals behavioral tests to drive immediate-early gene expression were administered. This approach allows users to perform whole-brain assessment of function and connection in a semi-automated quantitative manner. Brains were cut in the coronal plane, and an image of the block face was acquired. Wide-field fluorescent scans of whole sections were acquired and analyzed using Matlab software.ResultsThe toolkit utilized open-source and custom platforms to accommodate a largely automated analysis pipeline in which neuronal boundaries are automatically segmented, the position of segmented neurons are co-registered with a corresponding image acquired during sectioning, and a 3-D representation of neural tracer (and other products) throughout the entire brain is generated.Comparison with existing methodsCurrent whole brain connectivity measures primarily target mice and use anterograde tracers. Our focus on segmented units of interest (e.g., NeuN labeled neurons) and restricting measures to these units produces a flexible platform for a variety of whole brain analyses (measuring activation, connectivity, markers of disease, etc.).ConclusionsThis open-source toolkit allows an investigator to visualize and quantify whole brain data in 3-D, and additionally provides a framework that can be rapidly integrated with user-specific analyses and methodologies