Response to Recruitment Maneuver Influences Net Alveolar Fluid Clearance in Acute Respiratory Distress Syndrome

Background: Alveolar fluid clearance is impaired in the majority of patients with acute respiratory distress syndrome (ARDS). Experimental studies have shown that a reduction of tidal volume increases alveolar fluid clearance. This study was aimed at assessing the impact of the response to a recruitment maneuver (RM) on net alveolar fluid clearance. Methods: In 15 patients with ARDS, pulmonary edema fluid and plasma protein concentrations were measured before and after an RM, consisting of a positive end-expiratory pressure maintained 10 cm H 2 O above the lower inflection point of the pressure-volume curve during 15 min. Cardiorespiratory parameters were measured at baseline (before RM) and 1 and 4 h later. RM-induced lung recruitment was measured using the pressure-volume curve method. Net alveolar fluid clearance was measured by measuring changes in bronchoalveolar protein concentrations before and after RM. Results: In responders, defined as patients showing an RMinduced increase in arterial oxygen tension of 20% of baseline value or greater, net alveolar fluid clearance (19 ؎ 13%/h) and significant alveolar recruitment (113 ؎ 101 ml) were observed. In nonresponders, neither net alveolar fluid clearance (؊24 ؎ 11%/h) nor alveolar recruitment was measured. Responders and nonresponders differed only in terms of lung morphology: Responders had a diffuse loss of aeration, whereas nonresponders had a focal loss of aeration, predominating in the lower lobes. Conclusion: In the absence of alveolar recruitment and improvement in arterial oxygenation, RM decreases the rate of alveolar fluid clearance, suggesting that lung overinflation may be associated with epithelial dysfunction

Dynamique des populations d'espèces élusives : le cas du dauphin commun dans l'océan Atlantique Nord-Est

Les espèces élusives sont difficiles à suivre individuellement et il est difficile d'estimer leur mortalité ce qui freine la mise en place de politiques de gestion. En tant qu’espèce élusive, le dauphin commun, Delphinus delphis présente des enjeux de conservation importants. La population Atlantique Nord-Est est affectée par les captures accidentelles qui menacent sa viabilité. Les informations démographiques sur cette population sont insuffisantes et notre compréhension de la structure spatio-temporelle des captures ne permet pas de fixer des objectifs de gestion appropriés. Ce projet vise à déterminer le statut actuel de la population au regard des objectifs de conservation européens. Premièrement, une approche flexible d'estimation des taux vitaux a été développée afin de mettre en évidence les variations temporelles et les effets de covariables en tenant compte de l'hétérogénéité individuelle. Ensuite, l'utilisation de cette méthode, combinée à un suivi transversal, nous a permis de mettre en évidence les variations temporelles des taux vitaux de la population et l'impact des captures sur sa démographie. La population n'est pas viable et son taux de croissance semble s'être détérioré depuis le milieu des années 2000. Troisièmement, en utilisant les données biaisées d’observateurs embarqués, le nombre de captures accidentelles a été quantifié sur une base hebdomadaire pour dix divisions CIEM sur seize ans. Quatrièmement, les taux vitaux obtenus combinés aux estimations de captures permettent de produire des seuils de captures soutenables. Cette évaluation a été effectué par une approche d'évaluation de stratégies de gestion en accord avec l'objectif de conservation européen.Elusive species are notoriously difficult to monitor individually and therefore it is difficult to estimate their anthropogenic mortality and to implement management policies. As an elusive species, the common dolphin, Delphinus delphis is a good example of these conservation challenges. The North-East Atlantic population is affected by bycatch that threatens its viability. However, demographic information on this population is very limited and our understanding of the spatio-temporal structure and dynamics of bycatch is insufficient to set appropriate management objectives. This project aims to determine the current status of this common dolphin population with regard to conservation objectives in European waters with a focus on the Bay of Biscay. First a flexible vital rates estimation approach has been developed in order to highlight variations in vital rates over time and the effects of covariates while taking into account individual heterogeneity. Second, using such a methodological approach through a cross-sectional monitoring, allowed us to highlight both the temporal variations of the population vital rates and the impact of bycatch on the common dolphin population demography. The population is not viable and the population growth rate seems to have deteriorated since the mid 2000's. Third, using biased data from on-board observers, the number of incidental catches on a weekly basis was quantified for ten ICES sub-area over sixteen years. Fourth, the resulting vital rates combined with by catch estimates finally allowed the production of sustainable bycatch thresholds through a Management Strategy Evaluation approach in line with the European conservation objective

Dynamique des populations d'espèces élusives : le cas du dauphin commun dans l'océan Atlantique Nord-Est

Elusive species are notoriously difficult to monitor individually and therefore it is difficult to estimate their anthropogenic mortality and to implement management policies. As an elusive species, the common dolphin, Delphinus delphis is a good example of these conservation challenges. The North-East Atlantic population is affected by bycatch that threatens its viability. However, demographic information on this population is very limited and our understanding of the spatio-temporal structure and dynamics of bycatch is insufficient to set appropriate management objectives. This project aims to determine the current status of this common dolphin population with regard to conservation objectives in European waters with a focus on the Bay of Biscay. First a flexible vital rates estimation approach has been developed in order to highlight variations in vital rates over time and the effects of covariates while taking into account individual heterogeneity. Second, using such a methodological approach through a cross-sectional monitoring, allowed us to highlight both the temporal variations of the population vital rates and the impact of bycatch on the common dolphin population demography. The population is not viable and the population growth rate seems to have deteriorated since the mid 2000's. Third, using biased data from on-board observers, the number of incidental catches on a weekly basis was quantified for ten ICES sub-area over sixteen years. Fourth, the resulting vital rates combined with by catch estimates finally allowed the production of sustainable bycatch thresholds through a Management Strategy Evaluation approach in line with the European conservation objective.Les espèces élusives sont difficiles à suivre individuellement et il est difficile d'estimer leur mortalité ce qui freine la mise en place de politiques de gestion. En tant qu’espèce élusive, le dauphin commun, Delphinus delphis présente des enjeux de conservation importants. La population Atlantique Nord-Est est affectée par les captures accidentelles qui menacent sa viabilité. Les informations démographiques sur cette population sont insuffisantes et notre compréhension de la structure spatio-temporelle des captures ne permet pas de fixer des objectifs de gestion appropriés. Ce projet vise à déterminer le statut actuel de la population au regard des objectifs de conservation européens. Premièrement, une approche flexible d'estimation des taux vitaux a été développée afin de mettre en évidence les variations temporelles et les effets de covariables en tenant compte de l'hétérogénéité individuelle. Ensuite, l'utilisation de cette méthode, combinée à un suivi transversal, nous a permis de mettre en évidence les variations temporelles des taux vitaux de la population et l'impact des captures sur sa démographie. La population n'est pas viable et son taux de croissance semble s'être détérioré depuis le milieu des années 2000. Troisièmement, en utilisant les données biaisées d’observateurs embarqués, le nombre de captures accidentelles a été quantifié sur une base hebdomadaire pour dix divisions CIEM sur seize ans. Quatrièmement, les taux vitaux obtenus combinés aux estimations de captures permettent de produire des seuils de captures soutenables. Cette évaluation a été effectué par une approche d'évaluation de stratégies de gestion en accord avec l'objectif de conservation européen

Dynamique des populations d'espèces élusives: Le cas du dauphin commun dans l'océan Atlantique Nord-Est

Elusive species are notoriously difficult to monitor individually and therefore it is difficult to estimate their anthropogenic mortality and to implement management policies. As an elusive species, the common dolphin, Delphinus delphis is a good example of these conservation challenges. The North-East Atlantic population is affected by bycatch that threatens its viability. However, demographic information on this population is very limited and our understanding of the spatio-temporal structure and dynamics of bycatch is insufficient to set appropriate management objectives. This project aims to determine the current status of this common dolphin population with regard to conservation objectives in European waters with a focus on the Bay of Biscay. First a flexible vital rates estimation approach has been developed in order to highlight variations in vital rates over time and the effects of covariates while taking into account individual heterogeneity. Second, using such a methodological approach through a cross-sectional monitoring, allowed us to highlight both the temporal variations of the population vital rates and the impact of bycatch on the common dolphin population demography. The population is not viable and the population growth rate seems to have deteriorated since the mid 2000's. Third, using biased data from on-board observers, the number of incidental catches on a weekly basis was quantified for ten ICES sub-area over sixteen years. Fourth, the resulting vital rates combined with bycatch estimates finally allowed the production of sustainable bycatch thresholds through a Management Strategy Evaluation approach in line with the European conservation objective.Les espèces élusives sont difficiles à suivre individuellement et il est difficile d'estimer leur mortalité ce qui freine la mise en place de politiques de gestion. En tant qu’espèce élusive, le dauphin commun, Delphinus delphis présente des enjeux de conservation importants. La population Atlantique Nord-Est est affectée par les captures accidentelles qui menacent sa viabilité. Les informations démographiques sur cette population sont insuffisantes et notre compréhension de la structure spatio-temporelle des captures ne permet pas de fixer des objectifs de gestion appropriés. Ce projet vise à déterminer le statut actuel de la population au regard des objectifs de conservation Européens. Premièrement, une approche flexible d'estimation des taux vitaux a été développée afin de mettre en évidence les variations temporelles et les effets de covariables en tenant compte de l'hétérogénéité individuelle. Ensuite, l'utilisation de cette méthode, combinée à un suivi transversal, nous a permis de mettre en évidence les variations temporelles des taux vitaux de la population et l'impact des captures sur sa démographie. La population n'est pas viable et son taux de croissance semble s'être détérioré depuis le milieu des années 2000. Troisièmement, en utilisant les données biaisées d’observateurs embarqués, le nombre de captures accidentelles a été quantifié sur une base hebdomadaire pour dix divisions CIEM sur seize ans. Quatrièmement, les taux vitaux obtenus combinés aux estimations de captures permettent de produire des seuils de captures soutenables. Cette évaluation a été effectué par une approche d'évaluation de stratégies de gestion en accord avec l'objectif de conservation européen

DELMOGES. Campagne de collecte de biopsies : DELphis golfe de Gascogne Océanique STructure

Depuis les années 1990, la France connaît régulièrement des épisodes de mortalités importantes de dauphins, qui entraînent des pics d’échouages sur le littoral Atlantique en hiver. Depuis 2016, les échouages de petits cétacés dans le golfe de Gascogne présentant des traces de capture, atteignent des niveaux inédits. Si les données scientifiques actuelles permettent d’évaluer globalement le risque induit par ces captures accidentelles pour la conservation de la population de dauphins communs, elles sont toutefois trop lacunaires pour comprendre les déterminants écosystémiques et halieutiques à l’origine de ces captures. En concertation avec l’Office français de la biodiversité, les professionnels de la pêche et l’Etat, l’Université la Rochelle-CNRS et l’Institut français de recherche pour l’exploitation de la mer (Ifremer) ont construit le projet Delmoges (Delphinus Mouvements Gestion). Il vise, dans un premier temps, à combler ces lacunes en allant chercher des nouvelles données sur les habitats des dauphins, sur leurs interactions trophiques dans l’écosystème et leurs interactions techniques avec les engins de pêche. Ensuite, le projet propose d’intégrer les connaissances sur l’ensemble du socioécosystème pour envisager une diversité de scénarios de diminution des captures accidentelles incluant des solutions technologiques et, enfin, d’en évaluer les conséquences biologiques et socioéconomiques. Ce livrable présente les résultats de la première campagne en mer du projet qui avait pour objectif de prélever des biopsies de peau et lard des dauphins communs océaniques (c.a.d. au-delà du talus continental) pour répondre à un enjeu clé qui est l’identification de la structuration de la (des) population(s), la définition d’unité(s) de gestion adapté(es) et le développement d’outils non-invasifs basés sur la collecte d’ADN environnemental

Estimating Bycatch From Non-representative Samples (II): A Case Study of Pair Trawlers and Common Dolphins in the Bay of Biscay

Marine megafauna plays an important functional role in marine ecosystems as top predators but are threatened by a wide range of anthropogenic activities. Bycatch, the incidental capture of non-targeted species in commercial and recreational fisheries, is of particular concern for small cetacean species, such as dolphins and porpoises. In the North-East Atlantic, common dolphin (Delphinus delphis, Linné 1758) bycatch has been increasing and associated with large numbers of animals stranding during winter on the French Atlantic seashore since at least 2017. However, uncertainties around the true magnitude of common dolphin bycatch and the fisheries involved have led to delays in the implementation of mitigation measures. Current data collection on dolphin bycatch in France is with non-dedicated observers deployed on vessels for the purpose of national fisheries sampling programmes. These data cannot be assumed representative of the whole fisheries' bycatch events. This feature makes it difficult to use classic ratio estimators since they require a truly randomised sample of the fishery by dedicated observers. We applied a newly developed approach, regularised multilevel regression with post-stratification, to estimate total bycatch from unrepresentative samples and total fishing effort. The latter is needed for post-stratification and the former is analysed in a Bayesian framework with multilevel regression to regularise and better predict bycatch risk. We estimated the number of bycaught dolphins for each week and 10 International Council for the Exploration of the Sea (ICES) divisions from 2004 to 2020 by estimating jointly bycatch risk, haul duration, and the number of hauls per days at sea (DaS). Bycatch risk in pair trawlers flying the French flag was the highest in winter 2017 and 2019 and was associated with the longest haul durations. ICES divisions 8.a and 8.b (shelf part of the Bay of Biscay) were estimated to have the highest common dolphin bycatch. Our results were consistent with independent estimates of common dolphin bycatch from strandings. Our method show cases how non-representative observer data can nevertheless be analysed to estimate fishing duration, bycatch risk and, ultimately, the number of bycaught dolphins. These weekly-estimates improve upon current knowledge of the nature of common dolphin bycatch and can be used to inform management and policy decisions at a finer spatio-temporal scale than has been possible to date. Our results suggest that limiting haul duration, especially in winter, could serve as an effective mitigation strategy. Data is available here to reproduce the method described in this paper : https://gitlab.univ-lr.fr/mauthier/cdptmbycatch

Plasma levels of sRAGE, loss of aeration and weaning failure in ICU patients: a prospective observational multicenter study.

Postextubation distress after a successful spontaneous breathing trial (SBT) is associated with increased morbidity and mortality. Lung ultrasound determination of changes in lung aeration predicts weaning failure. It remains unknown whether this derecruitment is related to alveolar epithelial dysfunction or not.To verify whether lung alveolar type I epithelial cell injury marker sRAGE (soluble form of the receptor for advanced glycation end-products) is predictive of postextubation distress and weaning failure or not, and to verify whether plasma sRAGE levels can be related to lung derecruitment during the process of weaning from mechanical ventilation or not. INTERVENTIONS MEASUREMENTS: 88 patients from 2 intensive care units were included in this observational prospective study. Plasma sRAGE levels were measured in duplicate by ELISA before, at the end of a 60-minute SBT, and 4 hours after extubation. To quantify lung aeration, a lung ultrasound score was calculated.34% of extubated patients experienced postextubation distress. Patients with or without postextubation distress had comparable sRAGE levels before SBT, after SBT, and 4 hours after extubation. In patients with postextubation distress, sRAGE levels were not predictive of the need for mechanical ventilation. sRAGE levels were not associated with lung aeration as assessed by echography. Patients who succeeded SBT (86%) and those who failed (14%) had no differences in sRAGE levels, before (median 1111 vs 1021 pg/mL, p = 0,87) and at the end of SBT (1165 vs 1038 pg/mL, p = 0.74).Plasma levels of sRAGE do not predict postextubation distress or SBT failure/success in patients weaning from mechanical ventilation. Lung aeration loss during a successful weaning trial predicts postextubation distress, but may not be evaluable by plasma levels of sRAGE, a marker of alveolar type I epithelial cell injury.ClinicalTrials.gov NCT01098773

The safety and efficacy of palbociclib in older patients with advanced breast cancer in a real-world setting

Aims: Palbociclib has been approved in combination with endocrine therapy (ET) for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC), regardless of age. Even though ABC is one of the most prevalent cancers in older patients, very few patients ≥ 65 years old were included in pivotal trials. Therefore, the current study evaluated the safety and efficacy of palbociclib in “real-world” routine treatment of unselected older patients with HR+/HER2- ABC. Methods: Data were collected on patients > 70 years old who were treated with palbociclib plus ET for HR+/HER2- ABC in our institution. We analyzed safety data (CTCAE v4.0 criteria) and outcomes, such as progression-free survival (PFS) and overall survival (OS), as well as any associations between main geriatric characteristics and our results. Furthermore, we assessed safety at a national level by analyzing all palbociclib-related adverse events (AEs) reported in the French Pharmacovigilance Database (FPVD) during the same period. Results: From February 2016 to July 2019, 52 patients were identified with a median age of 80.9 years, of whom 88% presented an AE. The most common grade 3-4 AE was neutropenia (64%). Median PFS and OS were nine months and not reached, respectively. The FPVD reports 227 cases of palbociclib-related AEs, with older and younger patients sharing similar characteristics. Conclusion: Palbociclib is well tolerated in older patients with efficacy comparable to that in younger patients. However, the addition of palbociclib to ET should be evaluated individually in this older and frailer subgroup