Association of Gender with Clinical Expression, Quality of Life, Disability, and Depression and Anxiety in Patients with Systemic Sclerosis

OBJECTIVES: To assess the association of gender with clinical expression, health-related quality of life (HRQoL), disability, and self-reported symptoms of depression and anxiety in patients with systemic sclerosis (SSc). METHODS: SSc patients fulfilling the American College of Rheumatology and/or the Leroy and Medsger criteria were assessed for clinical symptoms, disability, HRQoL, self-reported symptoms of depression and anxiety by specific measurement scales. RESULTS: Overall, 381 SSc patients (62 males) were included. Mean age and disease duration at the time of evaluation were 55.9 (13.3) and 9.5 (7.8) years, respectively. One-hundred-and-forty-nine (40.4%) patients had diffuse cutaneous SSc (dcSSc). On bivariate analysis, differences were observed between males and females for clinical symptoms and self-reported symptoms of depression and anxiety, however without reaching statistical significance. Indeed, a trend was found for higher body mass index (BMI) (25.0 [4.1] vs 23.0 [4.5], p = 0.013), more frequent dcSSc, echocardiography systolic pulmonary artery pressure >35 mmHg and interstitial lung disease in males than females (54.8% vs 37.2%, p = 0.010; 24.2% vs 10.5%, p = 0.003; and 54.8% vs 41.2%, p = 0.048, respectively), whereas calcinosis and self-reported anxiety symptoms tended to be more frequent in females than males (36.0% vs 21.4%, p = 0.036, and 62.3% vs 43.5%, p = 0.006, respectively). On multivariate analysis, BMI, echocardiography PAP>35 mmHg, and anxiety were the variables most closely associated with gender. CONCLUSIONS: In SSc patients, male gender tends to be associated with diffuse disease and female gender with calcinosis and self-reported symptoms of anxiety. Disease-associated disability and HRQoL were similar in both groups

Validation of the Body Concealment Scale for Scleroderma (BCSS): Replication in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort

© 2016 Elsevier Ltd Body concealment is an important component of appearance distress for individuals with disfiguring conditions, including scleroderma. The objective was to replicate the validation study of the Body Concealment Scale for Scleroderma (BCSS) among 897 scleroderma patients. The factor structure of the BCSS was evaluated using confirmatory factor analysis and the Multiple-Indicator Multiple-Cause model examined differential item functioning of SWAP items for sex and age. Internal consistency reliability was assessed via Cronbach's alpha. Construct validity was assessed by comparing the BCSS with a measure of body image distress and measures of mental health and pain intensity. Results replicated the original validation study, where a bifactor model provided the best fit. The BCSS demonstrated strong internal consistency reliability and construct validity. Findings further support the BCSS as a valid measure of body concealment in scleroderma and provide new evidence that scores can be compared and combined across sexes and ages

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/)

Prise en charge de l arrêt cardiaque réfractaire extra-hospitalier à l aide d une assistance circulatoire de type ECMO (oxygénation par membrane extra-corporelle)

Introduction : Des résultats encourageants ont été obtenus dans la réanimation des arrêts cardiaques (ACR) intra-hospitaliers à l aide de techniques d assistance circulatoire.L objectif de cette étude était d évaluer la faisabilité d un algorithme de prise en charge de l ACR réfractaire extra-hospitalier incluant une assistance circulatoire de type ECMO. Matériels et méthodes : Etude prospective, observationnelle, monocentrique conduite au sein de la Salle de soins post-interventionnelle (SSPI) du Groupe hospitalier Pitié-Salpêtrière (GHPS). Tous les patients victimes d un ACR extra-hospitalier (non hypothermique) survenu devant témoin et ayant été pris en charge à l aide d un dispositif de massage cardiaque automatisé puis d une assistance circulatoire de type ECMO ont été inclus. Résultats : Cinquante et un patients successifs (âge moyen, 42+-15 ans) ont été inclus. Le délai médian entre l effondrement et le massage cardiaque (MCE) était de 3 [25-75e interquartile : 1-6] min et la durée médiane de MCE était de 120 [102-149] min.Le rythme cardiaque initial était respectivement une fibrillation ventriculaire (63%), une asystolie (29%) ou une dissociation électro-mécanique (8%). Au 28e jour de suivi, 2 (4%) patients étaient vivants. Au 6e mois de suivi, ces patients ne présentaient pas de séquelle neurologique grave (Glasgow outcome scale >= 4). Les causes observées de décès sous assistance circulatoire étaient une défaillance multiviscérale (47%), une mort encéphalique (20%) ou un choc hémorragique (14%). La majorité des patients (90%) est décédée en moins de 48 heures.Conclusion : Compte tenu du faible taux de survie observé, les indications d assistance circulatoire devraient se restreindre à une population rigoureusement sélectionnée.Encouraging results were obtained in the resuscitation of cardiac arrest (ACR) in-hospital with circulatory support techniques.The objective of this study was to evaluate the feasibility of an algorithm for management of refractory ACR non-hospital circulatory support including ECMO type.Materials and methods:Prospective, observational, single center pipe in the room post-interventional care (SSPI) of the Groupe Hospitalier Pitié-Salpêtrière (GHPS). All victims of cardiac arrest patients outside the hospital (not hypothermic) occurred before a witness and having been supported with an automated CPR device and a type of ECMO circulatory support were included.results:Fifty-one consecutive patients (mean age, 42 +- 15 years) were included. The median time between collapse and cardiac massage (ECM) was 3 [25-75th interquartile range: 1-6] min, and the median was 120 MCE [102-149] min.The initial cardiac rhythm was ventricular fibrillation,respectively (63%), asystole (29%) or electromechanical dissociation (8%).Day 28 follow-up, 2 (4%) patients were alive. In the sixth month follow-up, these patients showed no serious neurological sequelae (Glasgow Outcome Scale >= 4).The observed causes of death were circulatory support in multiple organ failure (47%), brain death (20%) or hemorrhagic shock (14%).The majority of patients (90%) died within 48 hours.conclusion:Given the low survival rate observed indications of circulatory support should be limited to a carefully selected population.PARIS12-CRETEIL BU Médecine (940282101) / SudocSudocFranceF

Effects of Acute Respiratory and Metabolic Acidosis on Diaphragm Muscle Obtained from Rats

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Impact of earplugs and eye mask on sleep in critically ill patients: a prospective randomized study

International audienceBackgroundPoor sleep is common in intensive care unit (ICU) patients, where environmental factors contribute to reduce and fragment sleep. The objective of this study was to evaluate the impact of earplugs and eye mask on sleep architecture in ICU patients.MethodsA single-center randomized controlled trial of 64 ICU patients was conducted from July 2012 to December 2013. Patients were randomly assigned to sleep with or without earplugs and an eye mask from inclusion until ICU discharge. Polysomnography was performed on the first day and night following inclusion. The primary outcome was the proportion of stage N3 sleep over total sleep time. Secondary outcomes were other descriptors of sleep and major outcome variables.ResultsIn the intervention group, nine (30%) patients did not wear earplugs all night long. The proportion of N3 sleep was 21 [7–28]% in the intervention group and 11 [3–23]% in the control group (p = 0.09). The duration of N3 sleep was higher among the patients in the intervention group who wore earplugs all night long than in the control group (74 [32–106] vs. 31 [7–76] minutes, p = 0.039). The number of prolonged awakenings was smaller in the intervention group (21 [19–26] vs. 31 [21–47] in the control group, p = 0.02). No significant difference was observed between the two groups in terms of clinical outcome variables.ConclusionsEarplugs and eye mask reduce long awakenings and increase N3 duration when they are well tolerated

Diaphragmatic Function Is Preserved during Severe Hemorrhagic Shock in the Rat

International audienceBackground: Acute diaphragmatic dysfunction has been reported in septic and cardiogenic shock, but few data are available concerning the effect of hemorrhagic shock on dia-phragmatic function. The authors examined the impact of a hemorrhagic shock on the diaphragm. Methods: Four parallel groups of adult rats were submitted to hemorrhagic shock induced by controlled exsanguinatio