Successful high flow nasal cannula therapy for severe COVID-19 pneumonia is associated with tocilizumab use.

INTRODUCTION: Our aim was to determine the rate of success of HFNO and its relationship with current treatments for severe COVID-19. METHOD: This was a cohort study including patients admitted for HFNO because of respiratory failure despite oxygen therapy through a facial mask. Care was standardized, with systematic use of steroids and prevention or treatment of thromboembolic complications, and tocilizumab when deemed useful. HFNO failure was defined by the requirement for mechanical ventilation and/or death. RESULTS: In August 2021, among 1397 patients with COVID-19 admitted in the emergency department, 110 (7.8%) received HFNO (mean age 55 years, sex-ratio M/F 1.4). Thirteen patients (12%) had received a steroid treatment before hospital admission. At least one comorbid condition was observed in 57% of the patients. Mean duration of the disease at admission was 8.8 days and mean respiratory rate was 34/min. A CT scan was performed for 101 patients (92%), among whom 13 had a pulmonary embolism. All patients received a steroid treatment, and tocilizumab was prescribed in 79 cases (72%). Failure of HFNO was observed in 54 cases (49%); the only risk factor was the absence of tocilizumab administration: AOR [IC95%] 3.50 [1.40-8.69]. We observed a trend toward failure with steroid use before hospital admission: AOR 3.83 [0.96-16.66]. CONCLUSION: Success of HFNO, when all therapeutic means of treatment for severe COVID-19 pneumonia were applied, was associated with tocilizumab administration. Our data suggest the interest of a randomized study to determine whether HFNO is the right signal for prescription of anti-IL6 drugs.

The Regenerative Effect of Trans-spinal Magnetic Stimulation After Spinal Cord Injury: Mechanisms and Pathways Underlying the Effect.

Spinal cord injury (SCI) leads to a loss of sensitive and motor functions. Currently, there is no therapeutic intervention offering a complete recovery. Here, we report that repetitive trans-spinal magnetic stimulation (rTSMS) can be a noninvasive SCI treatment that enhances tissue repair and functional recovery. Several techniques including immunohistochemical, behavioral, cells cultures, and proteomics have been performed. Moreover, different lesion paradigms, such as acute and chronic phase following SCI in wild-type and transgenic animals at different ages (juvenile, adult, and aged), have been used. We demonstrate that rTSMS modulates the lesion scar by decreasing fibrosis and inflammation and increases proliferation of spinal cord stem cells. Our results demonstrate also that rTSMS decreases demyelination, which contributes to axonal regrowth, neuronal survival, and locomotor recovery after SCI. This research provides evidence that rTSMS induces therapeutic effects in a preclinical rodent model and suggests possible translation to clinical application in humans.

[Cognitive decline in geriatric oncology: Trends, evaluation and treatment]. / Cancer de la personne âgée : rechercher, évaluer et prendre en charge le déclin cognitif.

Cancer prevalence increases with aging. Prevalent or incident neurocognitive disorders are frequent in geriatric oncology. Cognitive decline associated with cancer increases the risk of under or over-cancer treatment and makes therapeutic decisions complex. In this context, we present tools to optimize cognitive impairment screening, identification of underlying mechanisms and specific treatments. Geriatric specialists intervention can help global care, social services utilization and patient's orientation when ambulatory cares become difficult.

[Oxytocin administration during spontaneous labour: Guidelines for clinical practice. Guidelines short text]. / Recommandations pour l'administration d'oxytocine au cours du travail spontané. Texte court des recommandations.

OBJECTIVES: To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. METHOD: A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. RESULTS: The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1cm per 4hour during the first part of the active phase, and below 1cm per 2hours above 7cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrated. However, in the case of an extension of the second stage beyond 2hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2mUI/min, to respect at least 30min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2mUI/min intervals without surpassing a maximum IV flow rate of 20mUI/min. The reported maternal adverse effects concern uterine hyperstimulation, uterine rupture and post-partum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyperstimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. CONCLUSION: The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file.

Information fusion for diagnosis coding support.

All patient-related medical information during a hospital stay in France, has to be collected and coded in the compilation of medical units discharge documents, according to a standardized approach. The process of describing a patient disease in terms of appropriate diagnostic codes is nevertheless, a non-intuitive operation for the physician. As a consequence, coding errors, inaccuracies and missing data are frequent, leading to potentially severe economical upshots. A coding support system developed to improve medical coding results, integrates three information processing methodologies, using the outputs from various Hospital Information System applications. Each methodology generates partial heterogeneous information, with considerable semantic variety. In order to properly synthesize these outputs, information fusion is required to produce enriched contextualized information, presented to the physician as an ordered list of suggested codes. This paper explores two information fusion approaches: voting system and possibilistic. Both methods are tested on a database of 1,000 discharge summaries, to show the interest of information fusion in this context. Results show that fusion methods perform better in most of the cases than partial information extraction methods.

ANTEROCOD: actuarial survival curves applied to medical coding support for chronic diseases.

For the practitioner, choosing diagnosis codes is a non-intuitive operation. Mistakes are frequent, causing severe consequences on healthcare performance evaluation and funding. French physicians have to assign a code to all their activities and are frequently prone to these errors. Given that most of the time and particularly for chronic diseases indexed information is already available, we propose a tool named AnterOcod, in order to support the medical coding task. It suggests the list of most relevant plausible codes, predicted from the patient's earlier hospital stays, according to a set of previously utilized diagnosis codes. Our method applies the estimation of code reappearance rates, based on an equivalent approach to actuarial survival curves. Around 33% of the expected correct diagnosis codes were retrieved in this manner, after evaluating 998 discharge abstracts, significantly improving the coding task.

[Hypothyroidism as the result of drug interaction between ferrous sulfate and levothyroxine]. / Hypothyroïdie secondaire à une interaction médicamenteuse entre lévothyroxine et sels de fer.

We report a case of drug-drug interaction between ferrous sulfate and l-thyroxin. A 95-year-old woman treated successfully with l-thyroxin for many years received ferrous sulfate for anemia. This association led rapidly to recurrence of hypothyroidism with elevated serum than TSH level which completely resolved after withdrawal of iron therapy. Interaction was confirmed after both drugs were daily administrated separately without recurrence of hypothyroidism.

REFEROCOD: a probabilistic method to medical coding support.

Choosing diagnosis codes is a non-intuitive operation for the practitioner. Mistakes are frequent with severe consequences on healthcare evaluation and funding. French physicians have to assign a code for everything they do and they are not spared with these kinds of errors. We propose a tool named REFEROCOD to support the medical coding task in order to minimize errors without losing time, by suggesting a list of codes in accordance with the physician activities and of the patient medical context. The proposed method uses probabilistic knowledge and indicates the probability to have a proper diagnosis code considering the realized procedure, age, sex and other information available in the discharge abstract.

Stable isotope ratio analysis as a tool to discriminate between rainbow trout (O. mykiss) fed diets based on plant or fish-meal proteins.

The use of stable isotope ratio analysis (SIRA) as a rapid analytical tool to characterize and discriminate farmed fish on the basis of the feedstuffs included in the diet formulation is discussed. Two isoproteic (44.8%) and isolipidic (19.6%) extruded diets were formulated: a fish-meal-based diet (FM diet), containing fish meal as the sole protein source; a plant-protein-based diet (PP diet), where pea protein concentrate and wheat gluten meal replaced 80% of fish meal protein. The diets were fed to eight groups of rainbow trout (initial body weight: 106.6g) for 103 days in two daily meals under controlled rearing conditions. Growth performance (final body weight: 318.5 g; specific growth rate: 1.06%) and feed-to-gain ratio (0.79) were not affected by the dietary treatment. The differences in isotopic values of the two diets were clearly reflected in the different carbon and nitrogen isotopic values in rainbow trout fillets. The delta(13)C and delta(15)N values of muscle of farmed rainbow trout showed differences between farmed fish fed a fish-protein-based diet (-20.47 +/- 0.34 and 12.38 +/- 0.57 for delta(13)C and delta(15)N, respectively) and those fed a plant-protein-based diet (-23.96 +/- 0.38 and 7.15 +/- 0.51 for delta(13)C and delta(15)N, respectively). The results suggest that SIRA provides a robust and verifiable analytical tool to discriminate between fish fed on a plant or a fish protein diet.

[Lymphomatoid papulosis in childhood: six case reports and a literature review]. / Papulose lymphomatoïde de l'enfant : six cas et revue de la littérature.

BACKGROUND: Lymphomatoid papulosis (LyP) is a rare lymphoproliferative disorder. It is now included in the World Health Organisation (WHO) classification of cutaneous lymphomas. Although frequently described in adults, there have been only a few reported cases of LyP in children; diagnosis is often difficult in this population and no clear guidelines have been established regarding management or monitoring. In this article we report six new cases of LyP in children. PATIENTS AND METHODS: This is a retrospective study of six children, aged between two and 11 years, seen at the Hôtel-Dieu Hospital in Lyon and at the Grenoble Hospital Centre between 2005 and 2008. Each child underwent skin biopsy for histological and immunohistochemical analysis. RESULTS: All six children presented papulonodular lesions on the limbs and trunk, in some cases necrotic, present for different times and developing in episodes. Histology and immunolabelling announces in all six cases militated in favour of LyP type A, with large CD30+ and CD15- cells dispersed in an inflammatory dermal infiltrate made up for the most part of lymphocytes, polynuclear neutrophils, eosinophils and a small number of histiocytes. DISCUSSION: Only around 60 cases of LyP have so far been reported in children, principally type A. Association with malignant lymphoma occurs, with high risk in relation to the general population of the same age. Clinical diagnosis is confirmed histopathology and immunolabelling. There is currently no consensus regarding therapeutic management. First-line treatment generally comprises therapeutic abstention or dermal corticosteroids. Methotrexate and phototherapy constitute possible alternatives but should be used only in very disseminate or debilitating forms of the disease. CONCLUSION: The presentation and course of LyP of childhood differs very little from the adult form. Cases of associated lymphoma have been reported. Although regular clinical monitoring is recommended, there is no call for routine laboratory testing.

[Elective single embryo transfer - the Scandinavian experiment]. / Transfert électif d'un embryon - le modèle scandinave.

Limiting the number of embryos transferred from three to two does not reduce the high risk of twin pregnancy (between 21 and 40%). Scandinavian centers have proposed in the 2000s the elective single embryo transfer (eSET) as the only means to reduce maternal, neonatal and psychological consequences related to multiple births. Pooled results from prospective randomized controlled trials and prospective cohort studies comparing eSET and transfer of two embryos (DET) in a selected population have confirmed the almost complete disappearance of twins when eSET was effective but the compromising effect of eSET upon live birth rates was discussed. Optimizing the eSET overall pregnancy rate need to associate a freezing policy and to define risk factors for increased chance of multiple birth (patient age, diagnosis, number of top-embryos or unsuccessful attempts). The extension of eSET practice to an unselected population irrespective of embryo quality is still controversial. The choice between offering one cycle of SET or DET in an unselected patient population depends on the society's willingness to optimize the in vitro fertilization results according to a defined health care policy: the first one is the twins disappearance with reduced overall pregnancy rate and the second one is a reduced twin birth rate with maintain of the total pregnancy percentage. The real question is to define what percentage of twin pregnancy could be considered as acceptable.

[Dermatologic follow-up and evaluation of skin tumours in renal transplant patients]. / Evaluation du suivi dermatologique et des tumeurs cutanées chez les greffés rénaux.

BACKGROUND: Renal transplant patients are at increased risk for warts, actinic keratoses and carcinomas. A descriptive study was conducted to investigate the number and frequency of dermatologic examinations in renal transplant patients with a functional graft. The incidence and clinical factors for skin tumours were also assessed. PATIENTS AND METHODS: We sent an initial questionnaire to 686 renal transplant patients asking whether they had consulted a dermatologist since the time of transplantation. A second questionnaire was then sent to private dermatologists in order to evaluate dermatologic follow-up and the frequency and anatomic distribution of warts and cancerous skin lesions. At the same time, the patients' medical records at the hospital were studied. RESULTS: About two thirds of the 436 patients included in the study have seen a dermatologist at least once since the time of transplantation. Only 31.2% are being followed up regularly by a dermatologist. The incidence of warts and actinic keratoses is 48.8% and 20.6% respectively, and increases with the duration of immunosuppressive therapy. The incidence of carcinomas is 20.2%, with basal cell carcinomas being seen more frequently than other carcinomas. Risk factors identified for carcinomas are older age at transplantation, duration of immunosuppressive therapy, fair skin, presence of warts and actinic keratoses. All these skin lesions arise predominantly on highly sun-exposed surfaces. Nevertheless, squamous cell carcinomas are more often confined to sun-exposed skin than Bowen's diseases and basal cell carcinomas. DISCUSSION: Dermatologic follow-up of transplant recipients has rarely been investigated and our study shows that monitoring of skin cancer is probably inadequate. It also confirms the high incidence of carcinomas among renal-transplant recipients in a temperate climate, although basal cell carcinomas are more frequent than squamous cell carcinomas.

Inter-laboratory comparison of elemental analysis and gas chromatography combustion isotope ratio mass spectrometry (GC-C-IRMS). Part I: delta13C measurements of selected compounds for the development of an isotopic Grob-test.

This study was directed towards investigating suitable compounds to be used as stable isotope reference materials for gas chromatography combustion isotope ratio mass spectrometry (GC-C-IRMS) calibration. Several compounds were selected from those used in the 'Grob-test' mixture. Oxygen- and nitrogen-containing substances were added to these compounds to allow the mixture to be used as a possible multi-isotopic calibration tool for 2H/1H, 13C/12C, 15N/14N and 18O/16O ratio determinations. In this paper we present the results of delta13C measurements performed by the consortium of the five laboratories taking part in this inter-calibration exercise. All the compounds were individually assessed for homogeneity, short-term stability and long-term stability by means of EA-IRMS, as required by the bureau communitaire de reference (BCR) Guide for Production of Certified Reference Materials. The results were compared then with the GC-C-IRMS measurements using both polar and non-polar columns, and the final mixture of selected compounds underwent a further certification exercise assessing limits of accuracy and reproducibility under specified GC-C-IRMS conditions.

13C and 18O isotopic analysis to determine the origin of L-tartaric acid.

Due to the ever-increasing amount of attention paid to the 'naturalness' of ingredients in food and beverages by both consumers and controlling authorities, the search for suitable methods for the characterisation of origin is of primary importance. Within the European Community the wine production industry is often faced with the problem of origin control of tartaric acid. This has led to the decision that only L-tartaric acid extracted from grapes (therefore natural) should be used. In order to implement these regulations, a screening of different techniques has been carried out to assess the methodology that best identifies the origin of the tartaric acid. It has already been indicated in previous scientific literature that isotope ratio mass spectrometry is an ideal technique for this type of identification. In this paper we present the results obtained for the measurement of the isotope ratios of carbon-13 and oxygen-18 of natural and synthetic samples of L-tartaric acid considering also natural samples of different geographical origin and years of production.

Differentiation of the geographical origin of durum wheat semolina samples on the basis of isotopic composition.

The identification of the geographical origin of foods is attracting great interest from consumers and producers since it may be used as a criterion for guaranteeing quality and authenticity. Stable isotope techniques can provide useful information on the origin of food products. The natural abundance isotopic ratios of carbon, oxygen and nitrogen were determined and a comparison made between the isotopic content of samples originating from Italy and those of samples originating from other countries (Canada, Turkey, Australia). A correlation was found between the isotopic composition and geographical origin of the samples. The relationship between isotopic content and the latitude has been confirmed.

delta(13)C- and delta(18)O-values of glycerol of food fats.

The average values of carbon and oxygen isotopic contents (delta(13)C and delta(18)O) of 36 glycerol samples from fats have been determined. The examined samples arise from many fats of animal and plant origin, as well as from the three Italian hard cheeses Parmigiano-Reggiano, Grana Padano and Trentingrana. The total (13)C content allows one to distinguish between glycerol from plants with the C-4 carbon fixation pathway (maize, mean delta(13)C = -14.4 per thousand) and that from plants with the C-3 pathway (mean delta(13)C = -30.7 per thousand). The delta(13)C-values of glycerols of animal origin seem to depend on the diet of the animal, as suggested by the mean values -29.6, -29.0 and -25.1 per thousand, respectively, observed for Parmigiano-Reggiano, Trentingrana and Grana Padano. Additionally, the mean total (18)O content of glycerol samples of vegetable origin is approximately 23.8 per thousand, while that from animal fat is 15.1 per thousand. However, the delta(18)O mean values relative to Parmigiano-Reggiano, Grana Padano and Trentingrana are 11.8, 16.0 and 13.8 per thousand, respectively. The combination of the (13)C and (18)O measurements relative to the fat glycerol of the three cheeses might be considered a potential criterion of authentication.

The global methane cycle: isotopes and mixing ratios, sources and sinks.

A review of the global cycle of methane is presented with emphasis on its isotopic composition. The history of methane mixing ratios, reconstructed from measurements of air trapped in ice-cores is described. The methane record now extends back to 420 kyr ago in the case of the Vostok ice cores from Antarctica. The trends in mixing ratios and in delta13C values are reported for the two Hemispheres. The increase of the atmospheric methane concentration over the past 200 years, and by 1% per year since 1978, reaching 1.7 ppmv in 1990 is underlined. The various methane sources are presented. Indeed the authors describe the methane emissions by bacterial activity under anaerobic conditions in wet environments (wetlands, bogs, tundra, rice paddies), in ruminant stomachs and termite guts, and that originating from fossil carbon sources, such as biomass burning, coal mining, industrial losses, automobile exhaust, sea floor vent, and volcanic emissions. Furthermore, the main sinks of methane in the troposphere, soils or waters via oxidation are also reported, and the corresponding kinetic isotope effects.

Potent acetylcholinesterase inhibitors: design, synthesis and structure-activity relationships of alkylene linked bis-galanthamine and galanthamine-galanthaminium salts.

The syntheses, the anticholinesterase activities and structure-activity relationships of homodimeric (3a-c) and heterodimeric (6a-c) alkylene linked bis-galanthamine are reported. Compounds 6b-c were found to be more potent than galanthamine and tacrine in inhibiting AChE.