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Avoiding the use of nasogastric tubes (NGTs) is recommended after colorectal surgery but there is no consensus on intraoperative gastric decompression using NGTs during colorectal surgery. The objective was to assess the effect of avoiding insertion of NGTs during colorectal surgery for the recovery of gastrointestinal (GI) functions. 1561 patients undergoing colorectal surgery, for whom information on NGT use was available, were included in this retrospective analysis and propensity score analysis of the prospective GRACE Audit database. Patients who did and did not have an NGT during surgery were compared. Among the study population of 1561 patients, 696 patients were matched to correct baseline differences between groups. The no-NGT group significantly improved GI motility impairment (e.g., less postoperative nausea [OR = 0.59; CI 95%: 0.42–0.84] and a better tolerance of early feeding [OR = 2.07; CI 95%: 1.33–3.22]). Such an association was also highlighted for reduced postoperative morbidity [OR = 0.60; CI 95%: 0.43–0.83], and especially pulmonary complications [OR = 0.08; CI 95%: 0.01–0.59], or parietal complications [OR = 0.29; CI 95%: 0.09–0.87]. The risk of postoperative ileus was not significantly reduced in the no-NGT group [OR = 0.67; CI 95%: 0.43–1.06]. No NGT insertion during colorectal surgery is safe and could improve postoperative GI function recovery.

International audience; Objective To assess the relationship between anal incontinence (AI) 8 years after childbirth and the occurrence of obstetrical anal sphincter injuries (OASIS) and/or performance of an episiotomy during childbirth. Methods This is a nationwide database analysis performed on two national medico-administrative databases, including all the women aged 18 years or older who delivered infants in France in 2012. The main outcome measure was AI in the 8 years after delivery. Results Of the 163 443 perineal tears reported, 0.47% were grade 3 (n = 3173) and 0.08% were grade 4 (n = 579); 8938 women experienced AI (1.33%) and 261 women experienced severe AI (0.04%). Episiotomies performed in the absence of risk factors for OASIS were significantly associated with an increased risk of AI (odds ratio [OR] 1.59, 95% confidence interval [CI]1.49-1.69; P < 0.001). Grade 3 and 4 OASIS also significantly increased the risk of AI and severe AI. Mediolateral episiotomy was preventive of OASIS when performed in women at risk (OR 0.26, 95% CI 0.23-0.30; P < 0.001) but contributed to OASIS in the absence of risk (OR 2.18, 95% CI 1.98-2.40; P < 0.001). Conclusion OASIS present a risk factor for AI. Episiotomies could reduce the occurrence of OASIS, but they could also increase the risk of long-term AI in the absence of risk factors for OASIS.

To assess severe short-term maternal and neonatal morbidity and pelvic floor disorders at 6 months postpartum after attempted operative vaginal delivery according to the instrument used.We conducted a prospective study of women with live, singleton, term fetuses in vertex presentation. Patients attempted operative vaginal delivery in a French tertiary care university hospital from December 2008 through October 2013. We used multivariable logistic regression and propensity score methods to control for indication bias and compare outcomes associated with vacuum-assisted or forceps- or spatula-assisted delivery. Severe maternal and neonatal morbidity were composite primary endpoints. Symptoms of urinary incontinence (UI) and anal incontinence (AI) were assessed 6 months after delivery by validated self-administered questionnaires.Among 2,128 attempted operative vaginal deliveries, 30.7% (n=654) used vacuum and 69.3% (n=1,474) used forceps or spatulas. Severe maternal morbidity occurred in 5.4% (n=35; 95% CI 3.8-7.4) of vacuum attempts and 10.5% (n=154; 95% CI 8.3-12.1) of forceps or spatula attempts (P.001); severe neonatal morbidity occurred in 8.4% (n=55; 95% CI 6.4-10.8) and 10.2% (n=155; 95% CI 8.7-11.8), respectively (P=.2). Although attempted operative vaginal deliveries with forceps or spatula were significantly associated with more frequent severe maternal morbidity (adjusted odds ratio [aOR] 1.99 95% CI 1.27-3.10) in the multivariable logistic regression analysis, this association was no longer significant after propensity score matching (aOR 1.46 95% CI 0.72-2.95). Attempted operative vaginal deliveries with forceps or spatula were not significantly associated with more frequent severe neonatal morbidity after multivariable logistic regression or propensity score matching. Among the 934 women (43.9%) who responded to questionnaires at 6 months, the prevalence of symptoms of UI and AI were 22.7% and 22.0%, respectively, with no significant differences between the groups.In singleton term pregnancies, neither severe short-term maternal or neonatal morbidity nor UI or AI were more frequent after attempted operative vaginal delivery by forceps or spatulas than by vacuum after controlling for indication bias with a propensity score analysis.

The innate immunity of echinoderms has been a research focus since the early twentieth century, consistently providing ever deeper knowledge of its complexity and evolutionary aspects. At its core are coelomocytes, which are diverse cells collectively known to respond in a variety of ways, including via movement, phagocytosis, and aggregation. However, features of cellular immunity have never been compared in echinoderms from phylogenetic and distributional perspectives, to provide insight into ecological and evolutionary patterns. The present study catalyzed and characterized the formation of coelomocyte aggregates in members of all five extant classes of echinoderms. The morphological characteristics of these aggregates (including their colour, shape, texture, size) were assessed, as well as the major cells composing them. Coelomocyte diversity (both as free and aggregated forms) was determined to be maximum in class Holothuroidea, followed by Echinoidea, with the other classes showing similar levels of diversity. The colours of coelomocyte aggregates appeared to be more closely linked to phylogeny (classes, orders) rather than geographic range, or external colour of the species themselves. Asteroids and ophiuroids displayed primarily light-coloured aggregates, from transparent to green; while holothuroids, echinoids and crinoids demonstrated more vivid variants, from red to deep purple. The kinetics of aggregate formation and expulsion were monitored in selected species, showing immediate cellular response to foreign particulate matter in the form of encapsulation and various methods of expulsion, including through the dermal papillae of asteroids and the anus (cloaca) of holothuroids. The findings support that coelomocyte aggregate formation is a conserved immune response across all five extant classes of echinoderms with variations in their cell catalysts, complexity, shape, colour, and size.

Velvet shell, Velutina velutina (Müller, 1776), is a specialist predator of ascidians, like other members of the gastropod family Velutinidae. Globally, invasive ascidians have become problematic, ecologically and economically, yet ecological knowledge of velutinids remains limited. This study outlines the life history and feeding ecology of V. velutina in eastern Canada based on laboratory work complemented by field observations. The life history of V. velutina is closely linked with ascidians, which serve as prey and protection for their egg capsules. Egg capsules were embedded within tunics of Aplidium glabrum (Verrill, 1871) and Ascidia callosa Stimpson, 1852, with a preference for the latter. Seasonal behavioural shifts were consistent annually and corresponded with seawater temperature cycles. Feeding dominated during the coldest months (January–May), growth occurred as water temperature increased to the annual maximum (June and July), transitioning to mating during the warmest period (July–August), and egg capsule deposition dominated as water temperature declined (November–January). Larvae hatched between January and July after 2–4 months of development. Velutina velutina preyed on all ascidian species presented during this study, including golden star tunicate, Botryllus schlosseri (Pallas, 1766), and vase tunicate, Ciona intestinalis (Linnaeus, 1767), two non-indigenous species, although solitary species were preferred.

Biochemical markers developed initially for food-web studies of terrestrial and shallow-water environments have only recently been applied to deep-sea ecosystems (i.e., in the early 2000s). For the first time since their implementation, this review took a close look at the existing literature in the field of deep-sea trophic ecology to synthesize current knowledge. Furthermore, it provided an opportunity for a preliminary analysis of global geographic (i.e., latitudinal, along a depth gradient) trends in the isotopic (δ15N, δ13C) and fatty acid composition of deep-sea macro- and megafauna from heterotrophic systems. Results revealed significant relationships along the latitudinal and bathymetric gradients. Deep-sea animals sampled at temperate and polar latitudes displayed lower isotopic ratios and greater proportions of essential ω3 long-chain polyunsaturated fatty acids (LC-PUFAs) than did tropical counterparts. Furthermore, δ15N and δ13C ratios as well as proportions of arachidonic acid increased with increasing depth. Since similar latitudinal trends in the isotopic and fatty acid composition were found in surface water phytoplankton and particulate organic matter, these results highlight the link across latitudes between surface primary production and deep-water communities. Because global climate change may affect quantity and quality (e.g., levels of essential ω3 PUFAs) of surface primary productivity, and by extension those of its downward flux, the dietary intake of deep-sea organisms may likely be altered. In addition, because essential ω3 PUFAs play a major role in the response to temperature variations, climate change may interfere with the ability of deep-sea species to cope with potential temperature shifts. Importantly, methodological disparities were highlighted that prevented in-depth analyses, indicating that further studies should be conducted using standardized methods in order to generate more reliable global predictions.

Purpose/background Quetiapine is a relatively new atypical antipsychotic with fewer adverse effects. It is increasingly prescribed to patients. The purpose of this study was to describe the cases of poisoning observed at the western France Poison Control Centre and identify potential risk factors that increase the severity of the cases. Methods This was a retrospective study of self-poisoning with quetiapine as reported by the western France Poison Control Centre between 2007 and 2017. Results There were 372 cases of quetiapine poisoning. Circumstances are known in 367 of 372 cases. There were 75 cases of null severity (grade 0), 133 cases of mild severity (grade 1), 85 cases of moderate severity (grade 2), and 79 cases of high severity (grade 3). Five deaths were listed in this series. The most commonly observed symptoms were neurological and cardiovascular in nature (drowsiness, coma, tachycardia, hypotension). Of these cases, 79.8% included voluntary ingestions. Among 302 cases with coagents, the most common coagents were benzodiazepines (56%), other psychotropic drugs (41%), and antidepressants (37%). An evaluated ingested dose 1500 mg or greater and 2 or more coagents increase the risk of severe poisoning. In particular, concomitant ingestion of benzodiazepines and antidepressants with quetiapine was associated with high severity (odds ratio, 2.478 [confidence interval, 1.3-4.723]; odds ratio, 1.820 [confidence interval, 1.010-3.316]). Conclusions Quetiapine may lead to severe poisoning for which there is currently no specific treatment. Patients and practitioners should be aware of this when quetiapine is prescribed, particularly when used in combination with other medications, and in order to deal with cases of poisoning.

The environmental control of reproductive processes is central to both fundamental and applied aspects of animal ecology. The present study experimentally assessed how environmental factors modulate gametogenesis and spawning and impact embryo development and survival in the holothuroid Cucumaria frondosa, a cold-water echinoderm with lecithotrophic development. Adults were exposed to three seawater temperatures, four photoperiod regimes, and two food concentrations during 120 days overlapping the natural gametogenic and spawning periods. Among all the treatments tested, exposure to ambient conditions of water temperature (−1 to 3 °C), photoperiod (8 to 13 h of light) and food concentration (3 × 103 ± 896 rotifers g−1 of sea cucumbers d−1) yielded the greatest reproductive output and embryo survival. At pre-spawning, males and females had the highest gonad index (~33%) and where filled with mature gametes. At spawning, females in ambient conditions released the highest number of oocytes (1.2 × 103 oocytes female−1) and yielded the highest embryo survival rates (21% at 20 days post fertilization). Individuals exposed to warmer water temperatures (6 and 12 °C) experienced delayed gametogenesis and did not spawn. Individuals under 24-h light, 24-h dark, and advanced (4 months) photoperiods showed delayed gametogenesis and low numbers of oocytes released; moreover, embryos died within 10 days post fertilization. Individuals fed with high food concentration (6 × 103 ± 982 rotifers g−1 of sea cucumbers d−1) showed similar results to ambient conditions, suggesting that increased food supply neither decreased nor enhanced reproductive output over the experimental period. This study sheds new light on the environmental drivers of reproductive success in C. frondosa, which is of value for developing conservation strategies and mariculture protocols in cold-water holothuroids with lecithotrophic development.

While the study of dispersal and connectivity in the ocean typically centres on pelagic species and planktonic larval stages of benthic species, the present work explores an overlooked locomotor means in post‐settlement benthic stages that redefines their dispersal potential.Members of the echinoderm class Holothuroidea colonize a diversity of marine environments world‐wide, where they play key ecological and economical roles, making their conservation a priority. Holothuroids are commonly called sea cucumbers or sea slugs to reflect their slow movements and are assumed to disperse chiefly through pelagic larvae.The present study documents and explores their unexpected ability to actively modify their buoyancy, leading them to tumble or float at speeds orders of magnitudes faster than through benthic crawling. Two focal species representing different taxonomic orders, geographic distributions and reproductive strategies were studied over several years.Active buoyancy adjustment (ABA) was achieved through a rapid increase in water‐to‐flesh ratio by up to 740%, leading to bloating, and simultaneously detachment from the substrate. It occurred as early as 6 months post settlement in juveniles and was recorded in wild adult populations. In experimental trials, ABA was triggered by high conspecific density, decreasing salinity and increasing water turbidity. Based on field video footage, ABA‐assisted movements generated speeds of up to 90 km/day.These findings imply that displacement during planktonic larval stages may not supersede the locomotor capacity of benthic stages, challenging the notion of sedentarity. Combining the present results and anecdotal reports, ABA emerges as a generalized means of dispersal among benthic animals, with critical implications for world‐wide management and conservation of commercially and ecologically significant species., This study documents the unexpected ability of so‐called sessile or sedentary benthic marine animals (e.g. sea cucumbers) to actively modify their buoyancy to tumble or float at speeds orders of magnitudes faster than anticipated. These findings redefine the locomotor capacity of benthic animals, challenging the notion of sedentarity, with critical implications for worldwide management and conservation of commercially and ecologically significant species.

The present study investigated methods to trigger spawning and artificially induce oocyte maturation in the commercial cold-water suspension-feeding sea cucumber Cucumaria frondosa. Spawning occurred after exposure to live phytoplankton, commercial phytoplankton paste, and conspecific sperm. Live phytoplankton at 1 × 105 cells ml−1 induced the highest proportion of females to spawn (mean of 56%); promoted the greatest oocyte release (mean of 19,200 oocytes female−1), best quality of eggs and highest survival of embryos (65%; 20 d post fertilization). More concentrated live phytoplankton (1 × 106 cells ml−1) triggered 43% of the females to release ~16,100 oocytes female−1 and survival rates 20 d post fertilization were lower (50%). Both phytoplankton paste treatments (1 × 105 and 1 × 106 cells ml−1) yielded intermediate results in terms of percent spawning females (26%), abundance of oocytes released (11,000 and 7300 oocytes female−1, respectively), quality of eggs, and survival of embryos (44 and 50%, respectively). Sperm from conspecific (2 and 10 × 106 spermatozoa ml−1) induced the lowest proportion of females to spawn (16%) with release of 3000 and 1700 oocytes female−1, respectively; furthermore, all embryos died within 10 d post fertilization. Results for males were slightly different: spawning was more frequent (63%) in the sperm treatment at 2 × 106 spermatozoa ml−1 followed by live phytoplankton at 1 × 106 and 1 × 105 cells ml−1 (43%), and phytoplankton paste at 1 × 105 cells ml−1 (46%); the lowest spawning success was observed for phytoplankton paste at 1 × 106 cells ml−1 and conspecific sperm at 10 × 106 spermatozoa ml−1 (26%). Thermal shock, desiccation, potassium chloride (injection or bath), and serotonin (injection) did not induce spawning in C. frondosa. When oocytes isolated from mature ovaries were exposed to three different concentrations of 1-Methyladenine (1-MA), Dithiothreitol (DTT), 2,3-Dimercapto-1-propanol (BAL), and L-cysteine (L-cyst), DTT at 10−1 M induced the highest proportion of oocytes (48%) to shed follicle cells (i.e. ovulate); whereas other treatments induced only 2–6% of ovulation, similar to the control (seawater). All oocytes that shed follicle cells remained unfertilizable. Overall, live phytoplankton emerged as the most suitable spawning trigger for C. frondosa, a Dendrochirotida that produces maternally-provisioned oocytes. In the context of expanding sea cucumber aquaculture, this finding provides a tool to maximize the availability of gametes in this cold-water species, with possible applicability to similar commercial dendrochitotids.

International audience; Mostly studied at the individual level, the analysis of immigrants’ health status at a populational level may provide a different perspective to investigate, including social determinants as part of the explanation of the relationship between them and health status in France. We analyzed freely accessible databases curated by French public bodies. The dependent variables were death rate and mean age at death. Immigrant rate and covariates associated with either of the outcomes were explored in univariate and multivariate models. Linear models were used to explain the mean age at death, whereas tobit models were used to explain the death rate. The immigrant rate varied markedly from one department to another, as did healthcare accessibility, population’s age profile, and economic covariates. Considering univariate models, almost all the studied covariates were significantly associated with comes. The immigrant rate was associated with a lower death rate and a lower age at death. In multivariate models, the immigrant rate was no longer associated with age at death but was still negatively associated with the death rate. In France, the departments with a higher proportion of immigrants were those with a lower death rate, possibly because immigrants are attracted to economically thriving areas.

International audience; Objectives: The impact of conventional treatment for acute myeloid leukemia (AML) on the nutritional, cognitive, and functional status of elderly patients is seldom studied. This assessment was performed in the context of the LAMSA 2007 trial.Methods: The trial enrolled 424 patients with de novo AML. Among them, 316 benefited from geriatric assessment (GA) including nutritional, cognitive, and functional status and were scored according to Eastern Cooperative Oncology Group (ECOG) and sorror for the prediction of treatment toxicity, morbidity, and mortality. Patients were investigated at diagnosis for three times during follow-up.Results: This study showed that AML and its treatment have no impact on cognitive (P = .554) nor functional status (P = .842 for Activity of Daily Living and P = .087 for Instrumental Activities of Daily Living). The nutritional status improved over time (P = .041). None of these three parameters at baseline, associated or not with ECOG and sorror scores, impacted survivals or toxicities.Conclusions: The cognitive, functional, and nutritional status had no impact in this cohort of fit elderly AML patients without unfavorable cytogenetics. The GA tools used provided no additional information compared with ECOG and sorror scores, to predict toxicity, morbidity, or mortality due to intensive chemotherapy.

International audience; In this randomized phase 3 study, the FILO group tested whether the addition of 6 mg/m(2) of gemtuzumab ozogamycin (GO) to standard chemotherapy could improve outcome of younger patients with de novo acute myeloid leukemia (AML) and intermediate-risk cytogenetics. GO arm was prematurely closed after 254 inclusions because of toxicity. A similar complete remission rate was observed in both arms. Neither event-free survival nor overall survival were improved by GO in younger AML patients (

IntroductionIn the context of the COVID-19 pandemic, early identification of patients who are likely to get worse is a major concern. Severity mainly depends on the development of acute respiratory distress syndrome (ARDS) with a predominance of subpleural lesions. Lung point-of-care ultrasonography (L-POCUS) is highly effective in detecting pulmonary peripheral patterns and may be appropriate for examining patients with COVID-19. We suggest that L-POCUS performed during the initial examination may identify patients with COVID-19 who are at a high risk of complicated treatment or unfavourable evolution.Methods and analysisPoint-of-care ultrasonography for risk stratification of non-critical COVID-19 patients on admission is a prospective, multicentre study. Adult patients visiting the emergency department (ED) of participating centres for suspected or confirmed COVID-19 are assessed for inclusion. Included patients have L-POCUS performed within 48 hours following ED admission. The severity of lung damage is assessed using the L-POCUS score based on 36 points for ARDS. Apart from the L-POCUS score assessment, patients are treated as recommended by the WHO. For hospitalised patients, a second L-POCUS is performed at day 5±3. A follow-up is carried out on day 14, and the patient’s status according to the Ordinal Scale for Clinical Improvement for COVID-19 from the WHO is recorded.The primary outcome is the rate of patients requiring intubation or who are dead from any cause during the 14 days following inclusion. We will determine the area under the ROC curve of L-POCUS.Ethics and disseminationThe protocol has been approved by the French and Belgian Ethics Committees and is carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The study is funding by a grant from the French Health Ministry, and its findings will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration numberNCT04338100.

The objective was to develop a radiological score obtained from multi-detector computed tomography (MDCT) to differentiate between single band adhesion (SBA) and matted adhesions (MA) as the etiology of small bowel obstruction (SBO). All consecutive patients who underwent surgery from January 2013 to June 2018 for adhesion-induced SBO were retrospectively included. Among the 193 patients having surgery for SBO, 119 (61.6%) had SBA and 74 (38.4%) had MA surgically proven. In multivariate analysis, the presence of a beak sign (OR = 3.47, CI [1.26; 9.53], p = 0.02), a closed loop (OR = 11.37, CI [1.84; 70.39], p = 0.009), focal mesenteric haziness (OR = 3.71, CI [1.33; 10.34], p = 0.01) and focal and diffuse peritoneal fluid (OR = 4.30, CI [1.45; 12.73], p = 0.009 and OR = 6.34, CI [1.77; 22.59], p = 0.004, respectively) were significantly associated with SBA. Conversely, the presence of diffuse mesenteric fluid without focal fluid (OR = 0.23, CI [0.06; 0.92], p = 0.04) and an increase of the diameter of the most dilated loop (OR = 0.94, CI [0.90; 0.99], p = 0.02) were inversely associated with SBA. Using the significant predictive factors of SBA, we built a composite score to radiologically predict the etiology of SBO. The area under the receiver operating characteristic (ROC) curve of the score was 0.8274. For a cut-off score of -0.523, sensitivity, specificity and the percentage of patients correctly classified were 78.4%, 84.6% and 80%, respectively. If the score is ≥ 7, the probability that the mechanism of SBO is not SBA was 100%. The present score, validated in a different population, could be a significant tool in the decision for surgical management.

Additional file 1. Proxy’s questionnaire for patient’s initial assessment at ICU admission.

International audience

Background Students’ choice of medical specialties has evolved throughout year, with a growing interest in quality of life and in technological specialties. We investigated the repartition of such choices in the world and its influencing factors with a focus on the gender's influence, for helping policy-makers to deal with medical shortage and territorial to specialty disconnect. Methods A systematic search was conducted on MEDLINE and Scopus from January 2010 to January 2020. Data extraction and analysis followed JBI and PRISMA recommendations. The selected articles had to focus on medical students, detail their choice of specialty, and look for factors influencing their choice. Articles were excluded if they only assessed the attractiveness of a specialty, or evaluated a public policy. This review was registered on PROSPERO, CRD 42020169227. Findings 751 studies were screened, and fifty-four were included. Surgery and internal medicine were the most wanted specialties, both in occidental and non-occidental countries. The main factors influencing the choice of specialty were lifestyle, work-life balance and discipline interest, with variation across different countries. Gender clearly affected this choice with 63.7% of men willing radiology and 14.7% of men in obstetrics and gynecology. Interpretation Influential factors vary with specialty and are affected by the country of residence. Gender has a great impact in students’ willingness to work in specific specialties. Policymakers should adapt their appealing strategies according to the country and the medical discipline concerned. Funding The authors have no support or funding to report.

While so-called brown bodies were first defined in the 1950s as colorful aggregates of cells in the general cavity of echinoderms and other marine benthic taxa, their distribution and role have not yet been fully clarified. This work characterized free coelomocytes and corresponding aggregates ("bodies") in the hydrovascular system and perivisceral coelom, as well as those attached on the membranes of the viscera, in the holothuroid

International audience; Background: Arterial pressure lability is common during the process of replacing syringes used for norepinephrine infusions in critically ill patients. It is unclear if there is an optimal approach to minimise arterial pressure instability during this procedures. We investigated whether 'double pumping' changeover (DPC) or automated changeover (AC) reduced blood pressure lability in critically ill adults compared with quick syringe changeover (QC).Methods: Patients requiring a norepinephrine infusion syringe change were randomised in a non-blinded trial undertaken in six ICUs. Randomisation was minimised by norepinephrine flow rate at inclusion and centre. The primary outcome was the frequency of increased/decreased mean arterial pressure (defined by 15 mm Hg from baseline measurements) within 15 min of switching the syringe compared with QC.Results: Patients (mean age: 64 (range:18-88)) yr were randomly assigned to QC (n=95), DPC (n=95), or AC (n=96). Increased MAP was the commonest consequence of syringe changeovers. MAP variability was most frequent after DPC (89/224 changeovers; 39.7%) compared with 57/223 (25.6%) changeovers after quick syringe switch and 46/181 (25.4%) in patients randomised to receive automated changeover (P=0.001). Fewer events occurred with QC compared with DPC (P=0.002). Sensitivity analysis based on mixed models showed that performing several changeovers on a single patient had no impact. Both type of changeover and norepinephrine dose before syringe changeover were independently associated with MAP variations >15 mm Hg.Conclusions: Quick changeover of norepinephrine syringes was associated with less blood pressure lability compared with DPC. The prevalence of MAP variations was the same between AC and QC.Clinical trial registration: NCT02304939.

Background Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population. Methods We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit. Results 501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients’ place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors. Conclusions The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171

International audience; PURPOSE: While patient’s reported autonomy (PRA) may help the physician to adapt the day of discharge, the link between postoperative ileus and length of stay and PRA is not known. The aim of this study was to evaluate the evolution of the PRA score during the postoperative period and to determine the factors possibly influencing such an evolution. METHODS: This retrospective study on a prospective database took place in a single centre over 14 months. PRA was defined by the by using part I of the Groningen Activity Restriction Scale known as activity of daily life [from 9 (best) to 45 (worst)]. RESULTS: Among the 101 patients operated on for elective or emergent colorectal surgery, 80% of the patients had recovered their preoperative PRA (±5 points) before discharge and maintained their PRA during the 2 days preceding discharge. While PRA was significantly decreased by surgery (P2 increased PRA (P=0.03). Age, emergency surgery and the occurrence of postoperative morbidity did not affect postoperative autonomy. Finally, enhanced recovery programs (ERP) tended to improve postoperative autonomy recovery (P=0.09). CONCLUSION: PRA may be used as a means of optimising a patient’s day of discharge following colorectal surgery.

The association between elevated plasma vitamin B12 (B12) level and solid cancers has been documented by two national registries. However, their design did not allow for the adjustment for other conditions associated with elevated B12. The objectives of this study were to confirm this association after the adjustment for all causes of elevated B12, and to study the variations according to the increasing B12 level, the type of cancers, and the presence of metastases. We compared 785 patients with B12 &ge, 1000 ng/L with 785 controls matched for sex and age with B12 &lt, 1000 ng/L. Analyses were adjusted for the causes of elevated B12: myeloid blood malignancies, acute or chronic liver diseases, chronic kidney failure, autoimmune or inflammatory diseases, and excessive B12 supplementation. A B12 &ge, 1000 ng/L was associated with the presence of solid cancer without metastases (OR 1.96 [95%CI: 1.18 to 3.25]) and with metastases (OR 4.21 [95%CI: 2.67 to 6.64]) after adjustment for all elevated B12-related causes. The strength of the association rose with the increasing B12 level, in particular in cases of metastases. No association between liver cancers and elevated B12 level was found after adjustment for chronic liver diseases. In conclusion, unexplained elevated B12 levels should be examined as a possible marker of solid cancer.

Background No recommendation exists about the timing and setting for tracheal intubation and mechanical ventilation in septic shock. Patients and methods This prospective multicenter observational study was conducted in 30 ICUs in France and Spain. All consecutive patients presenting with septic shock were eligible. The use of tracheal intubation was described across the participating ICUs. A multivariate analysis was performed to identify parameters associated with early intubation (before H8 following vasopressor onset). Results Eight hundred and fifty-nine patients were enrolled. Two hundred and nine patients were intubated early (24%, range 4.5–47%), across the 18 centers with at least 20 patients included. The cumulative intubation rate during the ICU stay was 324/859 (38%, range 14–65%). In the multivariate analysis, seven parameters were significantly associated with early intubation and ranked as follows by decreasing weight: Glasgow score, center effect, use of accessory respiratory muscles, lactate level, vasopressor dose, pH and inability to clear tracheal secretions. Global R-square of the model was only 60% indicating that 40% of the variability of the intubation process was related to other parameters than those entered in this analysis. Conclusion Neurological, respiratory and hemodynamic parameters only partially explained the use of tracheal intubation in septic shock patients. Center effect was important. Finally, a vast part of the variability of intubation remained unexplained by patient characteristics. Trial registration Clinical trials NCT02780466, registered on May 23, 2016. https://clinicaltrials.gov/ct2/show/NCT02780466?term=intubatic&draw=2&rank=1.

Sea anemones are often presented as a major component of benthic communities and described as ecologically important in benthic food webs. However, studies on the trophic ecology of deep-sea species are rare. Here, the feeding habits and dietary sources of three species of bathyal sea anemones (Actinostola callosa, Actinauge cristata, Urticina sp.) from the Northwest Atlantic were studied in a multi-faceted approach including stable isotopes, gastrovascular contents, lipid and fatty acids analysis and observations in a mesocosm. Stable isotope analysis showed that A. callosa sits at a slightly lower trophic level than A. cristata and Urticina sp. and that the two latter species rely on different carbon sources at roughly the same trophic level. The gastrovascular cavity contents and mesocosm study revealed that all three species ingest a variety of food items, from inorganic materials to a diversity of metazoans, including whole large prey. Total lipid content varied across species and was highest in Urticina sp. Phospholipids constituted the main lipid class in all three species, with consistently high levels of wax ester storage lipids. All sea anemones were also characterized by high proportions of mono and polyunsaturated fatty acids (MUFA and PUFA) as well as ω3 and ω9 FAs, and strikingly low proportions of 20:4ω6 (ARA). High values of 20:5ω3 (EPA), 20:1ω9 and 22:1ω11(13) evoke a diet centered on zooplankton, with notable particularities. For instance, Urticina sp. had the highest PUFA to saturated FAs ratio, indicative of carnivory. Overall, results suggest that the three sea anemone species occupy different niches in the spectrum of opportunistic polyphagous predation/feeding, with Urticina sp. relying chiefly on more energetic and larger prey and A. cristata targeting smaller zooplankton, foraminifera and particulate food, highlighting that large actinians play diverse roles in benthic food webs.

The advantages of enhanced recovery programs (ERP) after colorectal surgery for morbidity and length of stay are well known. On a longer term, evidence is much more limited. The aim of this study is to determine the impact of ERP on survival after 3 years of follow-up, following colorectal cancer surgery.All the patients undergoing resection for colorectal cancer between the years 2010 and 2014 were included. Patients were classified according to their compliance with the ERP ( 70 or ≥ 70%).Among the 206 patients included during the period, 129 were male (62.6%). The 3-year overall survival rate was 70.4% (145 patients) and relapse-free survival was 59.2% (122 patients). The survival after 3 years was influenced by the initial metastatic status (p 0.0001), operative morbidity (p 0.001), and the presence of peritumoral emboli (p = 0.006). However, the compliance with the ERP ≥ 70% did not influence overall survival (p = 0.63), nor relapse-free survival (p = 0.93). The same observations were found among the "at-risk" population (synchronous metastasis and postoperative complication).The ERP does not seem to influence the 3-year relapse-free survival after colorectal resection for cancer.

As deep-sea benthic ecosystems of continental margins provide numerous functions and services to humans, a better understanding of these key habitats and their communities is needed to help predict climate-driven shifts and support conservation efforts. Here stable isotope (δ13C and δ15N), elemental (%C, %N, and molar C:N), and fatty acid (FA) composition of 50 different deep-sea species, belonging to 7 major taxa, were analyzed in order to characterize their diet and trophic position, and to study the fate of energy and essential nutrients in the food web. In addition, relationships between depth and biochemical signatures (δ13C, δ15N, %C, %N, C:Nmol, and FAs) were also investigated. In this regard, %C, oleic acid (18:1ω9), and arachidonic acid (ARA, 20:4ω6) increased with depth. While the increase of %C was likely due to the preferential assimilation of the more nutritious N along the gradient, that of 18:1ω9 was presumed to reflect the need for longer-term energy reserves in deeper organisms, and that of ARA to indicate a higher reliance on the benthic trophic pathway at greater depth. Analyses also revealed that the focal deep-sea invertebrates occupied three trophic levels, whereas the weak correlation between δ13C and δ15N indicated that two or more trophic pathways were represented. Several feeding modes were also recognized within the assemblage. The lowest trophic positions were occupied by sponges most likely feeding on bacteria. Intermediate positions were mainly occupied by suspension feeders (e.g. sea anemones, corals), detritivores (e.g. the sea urchin Phormosoma placenta), and predators on small infaunal animals (e.g. the sea star Leptychaster arcticus). Conversely, predator/scavengers (e.g. various sea stars, gastropods, polychaete worms) occupied the highest trophic positions, together with sponges that were determined to be either carnivorous (e.g. Iophon piceum), or to feed on 15N- and 13C-enriched organic matter. Energetic compounds (i.e. 20:1ω11(13), 20:1ω9, and 22:1ω7) and essential nutrients (i.e. ARA) increased in proportion across the trophic levels of this food web, emphasizing the importance of certain dietary FAs for optimal organism health, and the key role of benthic communities in carbon cycling.

This study presents new records for 4 eulimid species (Gastropoda, Eulimidae) including Melanella eburnea (Megerle von Mühlfeld, 1824), Melanella hypsela (Verrill & Bush, 1900), Melanella sp., and Eulimostraca encalada Espinosa, Ortea & Magaña, 2006 found on the body wall of the sea cucumber Holothuria mexicana in Belize. Three of these records (M. hypsela, M. eburnea, and E. encalada) represent a first for the Western Caribbean ecoregion and close a distributional gap for these species in the Caribbean. The geographic distribution of M. eburnea is thereby expanded by ~800 km; M. hypsela by ~1,200 km and E. encalada by ~970 km in the Tropical Northwestern Atlantic province. This article presents for the first time H. mexicana as a new host record for E. encalada.

International audience; PURPOSE: The quantification of mtDNA in cumulus granulosa cells (CGCs) surrounding an oocyte has been positively linked with morphological embryonic quality. In the present study, we evaluated the link between the amount of mtDNA in CGCs surrounding an oocyte and the chances for the corresponding embryo of implanting and leading to an ongoing pregnancy.METHODS: This is an observational study, performed on 84 oocyte-cumulus-complexes (OCCs) having led to the replacement of an embryo in the maternal uterus, retrieved from 71 patients undergoing IVF with intracytoplasmic sperm. The OCCs were classified in two groups, one including 26 OCCs having led to an implanted embryo and the other including 58 OCCs having led to a non-implanted embryo. The average mtDNA content of CGCs was assessed by using a quantitative real-time PCR technique.RESULTS: Significantly higher mtDNA copy numbers in CGCs were associated with implanted embryos than with non-implanted embryos (mean 215 [sd 375] and 59 [sd 72], respectively; p CONCLUSION: During in vitro fertilization (IVF) procedures, the probability of the implantation of the embryo appears to be closely correlated to the mtDNA copy numbers in the CGCs. Our results highlight the interest of mtDNA quantification in GCGs as a biomarker of the potential of embryo implantation.

While sea cucumbers have been fished in Belizean waters for ∼ 20 years for trade through Guatemala and the local Asian market in Belize, harvesting for export to international markets only started with the establishment of the sea cucumber fishery regulations in 2009. The fishery included two main species, Holothuria mexicana and Isostichopus badionotus but only the former was legally managed by the Belize Fisheries Department through a closed season and catch reporting. By 2016, H. mexicana was considered overfished and in 2017, the entire fishery was closed. Here we provide a comprehensive analysis of this fishery in Belize from 2009–2016 with the goal to make recommendations for policy development. This study combined key informant interviews with secondary data collection and observation of sea cucumber fishing, landing and processing. Fishers hand-picked sea cucumbers using mask and snorkel and sold their catch to exporters or middlemen. Sea cucumber harvesting increased fishers’ income to 154 times the minimum wage in 2010 and 5 times the minimum wage in 2016, concurrent with a drastic decline of stocks. Some fishers rated sea cucumber harvesting as their primary fishing activity but knew very little about their biology or ecology. They were concerned about the decrease in catch that forced them to fish in deeper waters and about the illegal fishing by Guatemalan and Honduran fishers in Belizean waters. Sea cucumbers sold locally since 2009 were neither reflected in the market economy nor used to adjust the Total Allowable Catch by the Belize Fisheries Department. Maintaining the long-term sustainability of this fishery will rely on greater investments in enforcing fisheries regulations, in scientific research to determine the viability of sea cucumber fishing, and in the education of fishers. A closer collaboration with fishers is necessary to adequately inform future management decisions on the socioeconomic consequence of overfishing.

Aim: Accidental inoculation of humans with veterinary vaccines can lead to early and late complications. The aim of our study is to describe these complications and their risk factors.Methods: Pros...

The present study examined morphological and behavioural development in post-settled juveniles of the commercial sea cucumber Cucumaria frondosa, in an effort to assist captive breeding and conservation initiatives. Juveniles developed all 10 tentacles within 16 months; they had 9 podia and measured 4.6 mm in length after 21 months. Scaling between body length and number of podia was isometric, whereas dorsal tentacle metrics showed negative allometric scaling, indicating that growth was accompanied by a decreasing tentacle to body size ratio. Dorsally-oriented tentacles developed and ramified faster, showing 6 ramifications after 21 months, when ventrally-oriented tentacles only displayed one. This asynchrony underlines the distinctive roles of dorsal vs. ventral tentacles during the early months. The former were strictly used to capture plankton from the water column; whereas the latter were used for anchorage and feeding on deposited material. Ossicles of the body wall increased in length and thickness, and became slightly curved and rounded in older juveniles. Light intensity and water flow tolerance increased with age; from 25 lx and 5 cm s−1 in 1-month-old individuals, to >50 lx and 10 cm s−1 in 6, 12, and 21-month-old individuals, consistent with migration from sheltered to more exposed locations. Moreover, 1 and 6-month-old juveniles preferred rock substrates and black or red background colours; whereas 12 and 21-monthd-old individuals favoured substrates of coralline algae and a red background, also indicative of increasing affinity with sunlit environments and a shift from benthic to planktonic feeding. Juveniles of all age classes were feeding (i.e. had deployed tentacles) 24 h a day and commonly sought vertical surfaces. Together, the findings shed light on the early juvenile ecology of this cold-water suspension-feeding sea cucumber. Considering the expansion of sea cucumber fisheries and growing interest in the aquaculture of C. frondosa, this work also provides a framework for improved stock management and culture protocols.

Background Electromagnetic pulses that precede earthquakes, and the ensuing crust deformations and vibrations, have been associated with unusual animal behavior (UAB), most commonly in terrestrial species but also in certain marine species, chiefly in the Chordata phylum (eg fish, cetaceans). Goals . The present study explored the occurrence of earthquake-related UAB in an entirely new marine phylum, the Echinodermata. Methods. Formal and informal surveys conducted by fishing vessels and pre- and post-earthquake along the southern coast of Belize (Central America) were collated. Results The first cases of post-earthquake UAB in echinoderms were documented. They involved thousands of individuals of the holothuroidsIsostichopus badionotus and Holothuria mexicana spawning on May 29 2009 and January 10 2018, respectively. These rare accounts represent the first direct correlation between an earthquake and spawning activity, which occurred outside the normal spawning season and at an unusual time of day. Conclusion. While a growing number of reports indicate that many terrestrial and a smaller number of marine species can change their behavior before and during an earthquake, post-earthquake effects related to reproduction have apparently never been reported before in the animal kingdom. While underlying mechanisms remain unclear, holothuroid echinoderms may be reacted directly or indirectly to seismic activity, or the pressure change generated by it.

Among arthropods, pycnogonids are generally considered of minor ecological significance in marine ecosystems. However, the fact that they can host a wide diversity and high abundance of epibiotic organisms suggests that their role in benthic communities may be underestimated. The present study characterized the diversity, dynamics and role of the epibiotic community associated with deep-sea pycnogonids (Nymphon hirtipes). Despite their small size, they hosted a mean of 62 macro-organisms belonging to at least 26 species from 11 different phyla. Foraminifera was the dominant phylum while other phyla, such as Bryozoa, Cnidaria (Hydrozoa), Porifera and Brachiopoda were common. The macro-epibiont burden varied from 1 to 235 organisms per pycnogonid; it was consistent across depths and locations but fluctuated as a function of sex and of the reproductive state in males. Specifically, most colonized individuals were females, which are larger and thus offer more surface for epibionts. Among males, burdens peaked in those carrying larvae. Maximum epibiont burden and coverage was correlated with the cessation of grooming at the beginning of the breeding period. Micro-epibionts consisted of bacterial mats covering most body parts. Several epibionts were estimated to have negative effects on their host (e.g. increasing drag, preventing mating, decreasing limb mobility and impeding feeding). However, because this species dies after reproducing, epibiosis may be considered as a positive trade-off since it may provide food to the mobile juveniles living on the male for several months. Furthermore, epibionts could be used as camouflage during this period. N. hirtipes has been identified as a common component of the benthofauna in the deep sea of the North Atlantic and Arctic Oceans, and the present study indicates that it displays the greatest diversity and burden of associates ever reported among pycnogonids.

13 pages, 8 figures, 1 tables, aupplementary data https://doi.org/10.1016/j.jembe.2021.151607, The feeding behaviour of deep-sea animals is largely understudied despite being of relevance to assess changes in ecosystems functioning in the face of anthropogenic impacts and climate regime shifts. Here, time-lapse videography in dark, cold-water, flow-through laboratory settings was used to study the behaviours of a gastropod (Buccinum scalariforme) and three sea stars (Ceramaster granularis, Hippasteria phrygiana, Henricia lisa) from the bathyal Northwest Atlantic, to build knowledge on their foraging strategies (i.e. food search, assessment and handling). In all species tested, the presence/absence of a palatable food source modulated the speed and directionality of movements. Approach paths were erratic in the absence of palatable food and targeted in its presence: B. scalariforme, C. granularis and H. phrygiana, moved in straight line to the food, while H. lisa moved either in straight line or counterclockwise loop. The four species traveled at mean speeds of 2.9, 0.2, 0.7, and 0.6 cm min−1, respectively. At the finer scale, unprecedented pulses in displacement speed were detected, varying in amplitude and frequency depending on the food item. The results also support more generalist diets and broader scavenging habits in deep-sea sea gastropods and sea stars than assumed from previous studies and knowledge of shallower-water counterparts. Depth-related food limitation may drive greater flexibility in foraging strategies and acceptable food items, This work was supported in part by the Natural Sciences and Engineering Research Council of Canada (NSERC) via grants awarded to A.M., J.A. is a member of the Tecnoterra Associated Research Unit (ICM-CSIC/UPC) and supported by the Spanish Government through the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S)

Aims Over the last decades, Health-related Quality of Life (HRQoL) end-points have become an important outcome of the randomised controlled trials (RCTs). HRQoL methodology in RCTs has improved following international consensus recommendations. However, no international recommendations exist concerning the statistical analysis of such data. The aim of our study was to identify and characterise the quality of the statistical methods commonly used for analysing HRQoL data in cancer RCTs. Methods Building on our recently published systematic review, we analysed a total of 33 published RCTs studying the HRQoL methods reported in RCTs since 1991. We focussed on the ability of the methods to deal with the three major problems commonly encountered when analysing HRQoL data: their multidimensional and longitudinal structure and the commonly high rate of missing data. Results All studies reported HRQoL being assessed repeatedly over time for a period ranging from 2 to 36 months. Missing data were common, with compliance rates ranging from 45% to 90%. From the 33 studies considered, 12 different statistical methods were identified. Twenty-nine studies analysed each of the questionnaire sub-dimensions without type I error adjustment. Thirteen studies repeated the HRQoL analysis at each assessment time again without type I error adjustment. Only 8 studies used methods suitable for repeated measurements. Conclusion Our findings show a lack of consistency in statistical methods for analysing HRQoL data. Problems related to multiple comparisons were rarely considered leading to a high risk of false positive results. It is therefore critical that international recommendations for improving such statistical practices are developed.

In shallow benthic communities, sponges are widely recognized for their ability to contribute to food webs by cycling nutrients and mediating carbon fluxes through filter feeding. In comparison, little is known about filter feeding in deep-sea species and how it may be modulated by environmental conditions. Here, a rare opportunity to maintain live healthy deep-sea sponges for an extended period led to a preliminary experimental study of their feeding metrics. This work focused on demosponges collected from the continental slope of eastern Canada at ~ 1000 m depth. Filtration rates (as clearance of phytoplankton cells) at holding temperature (6 °C) were positively correlated with food particle concentration, ranging on average from 18.8 to 160.6 cells ml −1 h −1 at nominal concentrations of 10,000–40,000 cells ml −1 . Cell clearance was not significantly affected by decreasing seawater temperature, from 6 °C to 3 °C or 0 °C, although two of the sponges showed decreased filtration rates. Low pH (~ 7.5) and the presence of a predatory sea star markedly depressed or inhibited feeding activity in all sponges tested. While performed under laboratory conditions on a limited number of specimens, this work highlights the possible sensitivity of deep-sea demosponges to various types and levels of biotic and abiotic factors, inferring a consequent vulnerability to natural and anthropogenic disturbances.