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/)

Le travail social en bref -- /

2e éd.Bibliogr.: p. 49-50Notes (part. bibliogr.) au bas des p

An Experimental Analysis of Investor Sentiment

International audienc

Chronic Aichi virus infection as a cause of long-lasting multi-organ involvement in patients with primary immune deficiencies

International audienceBackgroundMetagenomic Next Generation Sequencing (mNGS) was used to assess patients with primary or secondary Immune Deficiencies (PIDs and SIDs) presenting with immunopathological conditions related to immunodysregulation.Methods30 patients with PIDs and SIDs presenting symptoms related to immunodysregulation and 59 asymptomatic patients with similar PIDs and SIDs were enrolled. mNGS was performed on organ biopsy. Specific AiV RT-PCR was used to confirm Aichi virus (AiV) infection and screen the other subjects. In situ hybridization assay (ISH) was done on AiV infected organs to identify infected cells. Virus genotype was determined by phylogenetic analysis.ResultsAiV sequences were detected by mNGS in tissue samples of 5 patients and by RT-PCR in peripheral samples of another patient who all presented with PID and long-lasting multi-organ involvement, including hepatitis, splenomegaly and nephritis in 4. CD8+ T cell infiltration was a hallmark of the disease.RT-PCR detected intermittent low viral loads in urine and plasma from infected patients but in none of the other subjects. Viral detection stopped after immune reconstitution obtained by hematopoietic stem cell transplantation. ISH demonstrated the presence of the AiV RNA in hepatocytes (n = 1) and spleen tissue (n = 2). AiV belonged to genotype A (n = 2) or B (n = 3).ConclusionsThe similarity of the clinical presentation, the detection of AiV in a sub-group of patients suffering from immunodysregulation, its absence in asymptomatic patients, the detection of viral genome in infected organs by ISH, and the reversibility of symptoms after treatment argue for AiV causality

L’Art dans l’art

L’art autarcique existe-t-il ? Tout art n’est-il pas un art dans l’art ? À partir d’études sur la littérature anglophone des XIXe et XXe siècles, les auteurs de ce volume s’interrogent sur les différents modes de présence d’un art dans un autre : citation, montage, appropriation, greffes, etc. Parmi les formes d’interaction examinées : le tableau dans le tableau, la photographie et la musique dans l’écriture, l’architecture et la sculpture dans le roman, le poétique travaillé par le pictural, les résonances littéraires, picturales ou théâtrales de l’art cinématographique

Elicited and pre-existing anti-Neu5Gc antibodies differentially affect human endothelial cells transcriptome

none25siHumans cannot synthesize N-glycolylneuraminic acid (Neu5Gc) but dietary Neu5Gc can be absorbed and deposited on endothelial cells (ECs) and diet-induced anti-Neu5Gc antibodies (Abs) develop early in human life. While the interaction of Neu5Gc and diet-induced anti-Neu5Gc Abs occurs in all normal individuals, endothelium activation by elicited anti-Neu5Gc Abs following a challenge with animal-derived materials, such as following xenotransplantation, had been postulated. Ten primary human EC preparations were cultured with affinity-purified anti-Neu5Gc Abs from human sera obtained before or after exposure to Neu5Gc-glycosylated rabbit IgGs (elicited Abs). RNAs of each EC preparation stimulated in various conditions by purified Abs were exhaustively sequenced. EC transcriptomic patterns induced by elicited anti-Neu5Gc Abs, compared with pre-existing ones, were analyzed. qPCR, cytokines/chemokines release, and apoptosis were tested on some EC preparations. The data showed that anti-Neu5Gc Abs induced 967 differentially expressed (DE) genes. Most DE genes are shared following EC activation by pre-existing or anti-human T-cell globulin (ATG)-elicited anti-Neu5Gc Abs. Compared with pre-existing anti-Neu5Gc Abs, which are normal component of ECs environment, elicited anti-Neu5Gc Abs down-regulated 66 genes, including master genes of EC function. Furthermore, elicited anti-Neu5Gc Abs combined with complement-containing serum down-regulated most transcripts mobilized by serum alone. Both types of anti-Neu5Gc Abs-induced a dose- and complement-dependent release of selected cytokines and chemokines. Altogether, these data show that, compared with pre-existing anti-Neu5Gc Abs, ATG-elicited anti-Neu5Gc Abs specifically modulate genes related to cytokine responses, MAPkinase cascades, chemotaxis, and integrins and do not skew the EC transcriptome toward a pro-inflammatory profile in vitro.openLe Berre, Ludmilla; Danger, Richard; Mai, Hoa L; Amon, Ron; Leviatan Ben-Arye, Shani; Bruneau, Sarah; Senage, Thomas; Perreault, Helene; Teraiya, Milan; Nguyen, Thi Van Ha; Le Tourneau, Thierry; Yu, Hai; Chen, Xi; Galli, Cesare; Roussel, Jean-Christian; Manez, Rafael; Costa, Cristina; Brouard, Sophie; Galinanes, Manuel; Harris, Kristina M; Gitelman, Stephen; Cozzi, Emanuele; Charreau, Beatrice; Padler-Karavani, Vered; Soulillou, Jean-PaulLe Berre, Ludmilla; Danger, Richard; Mai, Hoa L; Amon, Ron; Leviatan Ben-Arye, Shani; Bruneau, Sarah; Senage, Thomas; Perreault, Helene; Teraiya, Milan; Nguyen, Thi Van Ha; Le Tourneau, Thierry; Yu, Hai; Chen, Xi; Galli, Cesare; Roussel, Jean-Christian; Manez, Rafael; Costa, Cristina; Brouard, Sophie; Galinanes, Manuel; Harris, Kristina M; Gitelman, Stephen; Cozzi, Emanuele; Charreau, Beatrice; Padler-Karavani, Vered; Soulillou, Jean-Pau

Comparing the Cologne Sonderbund of 1912 and the Second Post-Impressionist Exhibition in London

The article examines the agendas of the International Art Exhibition of the West German Sonderbund held in Cologne in 1912 and the Second Post-Impressionist Exhibition organised in London the same year, by contrasting their historical contexts and comparing their theoretical backgrounds. While the shows varied slightly in approach, both sought to give a systematic overview of the latest trends in art, which was then marketed mainly by private dealers. They addressed similar issues, such as defining the inherited tradition and topical dilemmas about the autonomy of painting and its decorative potential. The paper will discuss the emphasis on the progressive timeline and international outlook on modern art they formulated. It will also revisit the role of these exhibitions in light of the currently expanding discussion of the mechanisms that shaped the canon of European modernism

Effective Anti–SARS-CoV-2 Immune Response in Patients With Clonal Mast Cell Disorders

International audienceBackgroundMast cells are key players in innate immunity and the TH2 adaptive immune response. The latter counterbalances the TH1 response, which is critical for antiviral immunity. Clonal mast cell activation disorders (cMCADs, such as mastocytosis and clonal mast cell activation syndrome) are characterized by abnormal mast cell accumulation and/or activation. No data on the antiviral immune response in patients with MCADs have been published.ObjectiveTo study a comprehensive range of outcomes in patients with cMCAD with PCR- or serologically confirmed coronavirus disease 2019 and to characterize the specific anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune response in this setting.MethodsClinical follow-up and outcome data were collected prospectively over a 12-month period by members of the French Centre de Référence des Mastocytoses rare disease network. Anti–SARS-CoV-2–specific T-cell activity was measured with an ELISA, and humoral responses were evaluated by assaying circulating levels of specific IgG, IgA, and neutralizing antibodies.ResultsOverall, 32 patients with cMCAD were evaluated. None required noninvasive or mechanical ventilation. Two patients were admitted to hospital for oxygen and steroid therapy. The SARS-CoV-2–specific immune response was characterized in 21 of the 32 patients. Most had high counts of circulating SARS-CoV-2–specific, IFN-γ–producing T cells and high titers of neutralizing antispike IgGs. The patients frequently showed spontaneous T-cell IFN-γ production in the absence of stimulation; this production was correlated with basal circulating tryptase levels (a marker of the mast cell burden).ConclusionsPatients with cMCADs might not be at risk of severe coronavirus disease 2019, perhaps due to their spontaneous production of IFN-γ