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As increasing anthropogenic CO2 emissions are absorbed by the oceans, a decrease in seawater pH is expected to occur, causing what is now termed ocean acidification (OA). Deep-sea species have been greatly understudied with respect to OA, even though their response may differ from those evidenced so far in shallow-water taxa. The polychaete worm Ophryotrocha sp. collected at bathyal depth was held and reproduced for several years, offering a rare opportunity to study environmental effects in a member of a deep-sea community. This hermaphroditic species exhibits well defined seasonality in feeding and reproduction and its development and growth have been characterized. The purpose of the present study was to explore the effects of OA on gametogenesis following exposure to a 0.4 unit pH decrease under realistic conditions over 26 weeks. Opportunistic assessments of spawning and development were also conducted. A flow-through design allowing for natural fluctuations in pH, temperature and salinity was used. Individuals exposed to low pH/high ρCO2 produced larger and more abundant oocytes but fewer spermatozoa, compared to individuals in ambient conditions. However, lower effective fecundity (number of eggs laid) was ultimately recorded under low pH conditions, together with slower development of the embryos and larvae. Microstructure of the body wall, and appearance and elemental composition of chaeta were not affected. Despite its ability to live and reproduce normally for years in the laboratory, a realistic decrease of pH in the environment of Ophryotrocha sp. led to reproductive disruption, highlighting its potential vulnerability to OA.

International audience; Background. Admission of allogeneic stem cell transplantation (SCT) recipients to the intensive care unit (ICU) remains controversial , especially when graft-versus-host disease (GVHD) is present. Methods. We performed a retrospective study to assess prognostic factors of survival in all allogeneic SCT recipients admitted to the ICU between 2002 and 2013 in our center which has flexible admission criteria, especially regarding GVHD. Results. Of 349 patients who underwent allogeneic SCT during the study period, 92 patients (26%) were admitted to the ICU. Intensive care unit and hospital discharge rates were 66% and 46%, respectively , whereas 1 year survival was 24%. Acute GVHD, either grade III to IV (30 patients, 33%) or refractory (12 patients, 13%) had a nonsignificant impact on hospital mortality (odds ratio [OR], 2.1; P = 0.1; OR, 5, P = 0.05, respectively). Fifty percent of patients required invasive mechanical ventilation, 30% required vasopressors, 17% required renal replacement therapy, and 28% had liver impairment (bilirubin >34 μmol/L), each of these parameters defining organ failure. Mortality was closely associated with the number of organ failures as hospital discharge rates were 69%, 50%, 42%, and 0% among patients with 0 (26 patients), 1 (26 patients), 2 (26 patients), and 3 to 4 (14 patients) organ failures, respectively (OR, 2.7; 95% confidence interval, 1.6-4.6; P < 0.001 according to the number of organ failures). Conclusions. Early mortality of allogeneic SCT recipients admitted to the ICU is especially influenced by the number of organ failures and therefore patients with 0 to 2 organ failures should be considered if required. Refractory GVHD affects survival but not within the confined ICU admission.

Specimens of the neogastropod Buccinum scalariforme (60–70 mm shell height) collected between 700 and 1450 m depth along the continental slope of eastern Canada were kept for 4 years in mesocosm settings. Their mating, spawning and development were assessed, thereby generating the first complete life cycle account of a deep-sea gastropod. Egg laying occurred in March and September, with a total of 9 egg masses laid in 2013 and 2015, coinciding with periods of maximum deposition of particulate organic matter (phytodetritus). Oviposition lasted 2–3 days and the female protected the egg mass for ~3 more days until it had hardened. Typically, egg masses contained 50–75 egg capsules, each measuring 5–8 mm in diameter. A capsule contained between 100 and 150 spherical eggs (300–500 µm) of which ≤50 developed into embryos. Potential fecundity calculated from the entire egg mass at spawning was between 1500 and 2250 propagules; it drastically decreased over ~4–5 months of development to an effective fecundity of 30–50 juveniles emerging from the mass (0–2 juveniles per capsule). Development went through early embryonic stages in ~15 days and reached the trocophore in 15–21 days, followed by intracapsular veliger larva (480 µm) and intracapsular pediveliger (~1000 µm) after ~90 days. Completion of development relied on oophagy and adelphophagy. The juveniles hatched at a shell height of 1–2 mm and consumed the capsule membrane. Over 2.5 years, they reached a maximum size of ~8–10 mm shell height at an average of 9.8 µm day −1 . Estimations indicate that B. scalariforme could require between 20 and 50 years to reach maximum adult size. Large gastropods like B. scalariforme are among the most abundant motile benthic invertebrates of the bathyal zone of eastern Canada. Knowledge of their reproductive biology constitutes a first step in assessing their vulnerability and resilience to ever growing anthropogenic pressures, including fisheries, and oil/gas exploration and exploitation.

To assess both severe maternal and neonatal mortality and morbidity after attempted operative vaginal deliveries by residents under supervision and by attending obstetricians.Secondary analysis of a 5-year prospective study with cross-sectional analysis including 2192 women with live singleton term fetuses in vertex presentation who underwent an attempted operative vaginal delivery in a tertiary care university hospital. Obstetricians who attempted or performed an operative vaginal delivery were classified into 2 groups according to their level of experience: attending obstetricians (who had 5 years or more of experience) and obstetric residents (who had less than 5 years of experience) under the supervision of an attending obstetrician. We used multivariate logistic regression and propensity score methods to compare outcomes associated with attending obstetricians and obstetric residents. Severe maternal morbidity was defined as third- or fourth-degree perineal laceration, perineal hematoma, cervical laceration, extended uterine incision for cesareans, postpartum hemorrhage1500 mL, surgical hemostatic procedures, uterine artery embolization, blood transfusion, infection, thromboembolic events, admission to the intensive care unit, or maternal death; severe neonatal morbidity was defined as a 5-minute Apgar score7, umbilical artery pH7.00, need for resuscitation or intubation, neonatal trauma, intraventricular hemorrhage greater than grade 2, neonatal intensive care unit admission for more than 24 hours, convulsions, sepsis, or neonatal death.High prepregnancy body mass index, high dose of oxytocin, manual rotation, persistent occiput posterior or transverse positions, operating room delivery, midpelvic delivery, forceps, and spatulas were significantly more frequent in deliveries managed by attending obstetricians than residents whereas a second-stage pushing phase longer than 30 minutes was significantly more frequent in deliveries managed by residents. The rate of severe maternal morbidity was 7.8% (115/1475) for residents vs 9.9% (48/484) for attending obstetricians; for severe neonatal morbidity, the rates were 8.3% (123/1475) vs 15.1% (73/484), respectively. In the univariate, multivariable, and sensitivity analyses, attempted operative vaginal delivery managed by a resident was significantly and inversely associated with severe neonatal but not maternal morbidity. After propensity score matching, delivery managed by a resident was not significantly associated with severe maternal morbidity (adjusted odds ratio, 0.74; 95% confidence interval, 0.39-1.38) and was no longer associated with neonatal morbidity (adjusted odds ratio, 0.51; 95% confidence interval, 0.25-1.04).Management of attempted operative vaginal deliveries by residents under the supervision of attending obstetricians, compared with by the attending obstetricians themselves, does not appear to be associated with either maternal or neonatal morbidity. These reassuring results support the continued use of residency programs for training in operative vaginal deliveries under the supervision of attending obstetricians.

Defining severe postoperative ileus in terms of consequences could help physicians standardize the management of this condition. The recently described classification based on consequences requires further investigation. The aim of this study was to obtain a snapshot of postoperative ileus in patients undergoing colorectal surgery within enhanced recovery programs and to identify factors associated with non-severe and severe postoperative ileus.This prospective registry data analysis was conducted in 40 centers in five different countries. A total of 786 patients scheduled for colorectal surgery within enhanced recovery programs were included. The primary endpoint was the incidence rate of postoperative ileus as defined by Vather et al. RESULTS: A total of 121 patients experienced postoperative ileus (15.4%). Non-severe POI occurred in 48 patients (6.1%), and severe postoperative ileus occurred in 73 patients (9.3%). In multivariate analysis, the male gender and intra-abdominal complications were associated with severe postoperative ileus: odd ratio (OR) = 2.03 [95% confidence interval (CI) 1.14-3.59], p = 0.01 and OR = 3.60 [95% CI 1.75-7.40], p 0.0001, respectively. Conversely, open laparotomy and urinary retention were associated with non-severe POI: OR = 3.03 [95% CI 1.37-6.72], p = 0.006 and OR = 2.70 [95% CI 0.89-8.23], p = 0.08, respectively.Postoperative ileus occurred in 15% of patients after colorectal surgery within enhanced recovery programs. For 60% of patients, this was considered severe. The physiopathology of these two entities could be different, severe POI being linked to intraabdominal complication, while non-severe POI being linked with risk factors for "primary" POI. The physician should pay attention to male patients having POI after colorectal surgery and look for features evocating intraabdominal complications.

Objectives Pasteurella bacteraemia is rare, but has been associated with a high mortality rate. The aim of this study was to estimate the impact of comorbidities on patients with Pasteurella bacteraemia. Methods All cases of Pasteurella bacteraemia in adults treated in our centre between January 2008 and December 2017 were included retrospectively and compared with cases identified in a systematic review of the literature via MEDLINE covering the years 1951–2017. The epidemiological, bacteriological, and clinical data were collected, as well as the instances of death after 30 days. Results Twenty cases of Pasteurella bacteraemia identified in our centre and 99 cases from the literature review were included. A major comorbidity was found in 80/119 (67.2%) patients. The death rate at 30 days was 31.1%. The most common comorbidities were cirrhosis, immunosuppressive therapy, and malignant diseases. Age was not associated with mortality. On multivariate analysis, the only factor associated with mortality was a major comorbidity (odds ratio 2.78, 95% confidence interval 1.01–7.70; p = 0.04). Conclusions This study confirms the high mortality rate and highlights the importance of the host background, independent of age, in Pasteurella bacteraemia. Clinicians should be aware of the comorbidities in cases of Pasteurella infection, due to the poor prognosis of bacteraemia.

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 taxa. 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-PUFA) 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 PUFA) 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 PUFA 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.

Echinoderms are favored study organisms not only in cell and developmental biology, but also physiology, larval biology, benthic ecology, population biology and paleontology, among other fields. However, many echinoderm embryology labs are not well-equipped to continue to rear the post-embryonic stages that result. This is unfortunate, as such labs are thus unable to address many intriguing biological phenomena, related to their own cell and developmental biology studies, that emerge during larval and juvenile stages. To facilitate broader studies of post-embryonic echinoderms, we provide here our collective experience rearing these organisms, with suggestions to try and pitfalls to avoid. Furthermore, we present information on rearing larvae from small laboratory to large aquaculture scales. Finally, we review taxon-specific approaches to larval rearing through metamorphosis in each of the four most commonly-studied echinoderm classes-asteroids, echinoids, holothuroids and ophiuroids.

Introduction The prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin is still considered the "gold standard" and is, therefore, increasingly prescribed. Monitoring of metformin continues to be debated because of its association with lactic acidosis (MALA), a rare but life-threatening complication. The aim of this study was to identify the main individual characteristics associated with severe poisoning in self-poisonings and therapeutic accidents reported at the Western France Poison Control Centre (PCC). Methods Retrospective study of metformin poisoning from September 1999 to September 2016 at the Western France PCC recorded in the French PCC's database (SICAP). The end-point was clinically high severity (mortality and/or cardiovascular shock and/or GCS ≤ 7/15). Results Of the 382 cases included, 197 concerned acute accidental exposures, 127 self-poisonings and 58 therapeutic accidents. MALA concerned 63 patients: 44 therapeutic accidents and 19 self-poisonings. High severity concerned 59 patients: 47 therapeutic accidents and 12 self-poisonings. T2D and age > 60 significantly increase the risk of high severity (OR 7.7, CI [1.54-38.41]; P = 0.013; OR 3.5, CI [1.60-7.84]; P = 0.002, respectively). Conclusions Metformin may lead to MALA and severe poisoning in therapeutic accidents but also in self-poisoning circumstances. Among reported cases, T2D history and age >60 increase the risk of serious poisoning. Monitoring of their treatment should be taken seriously especially in the event of digestive symptoms such as diarrhoea.

International audience; BACKGROUND: Increased renal resistive index (RI) measured by Doppler ultrasonography has been shown to be associated with acute kidney injury (AKI) in septic patients. However, its clinical use is limited by poor sensitivity and specificity which may be explained by its numerous determinants [in particular mean arterial pressure (MAP)]. We measured, in patients with septic shock, RI at different MAP levels over a short period of time on the admission day to ICU (D1) and every 3days until day 10 (D10) to define the determinants of RI and study specifically the relationship between RI and MAP.RESULTS: Consecutive patients with septic shock without preexisting chronic renal dysfunction were included in this prospective cohort study in two ICUs. Sixty-five patients were included in the study. Thirty-three (50.8%) and 15 (23.1%) patients had a history of chronic hypertension or diabetes, respectively. At D3, 35 patients presented AKI with AKIN 2 or 3 criteria (severe AKI, AKIN2-3 group) and 30 presented no AKIN or AKIN 1 criteria (AKIN0-1 group). As previously described, RI at D1 was higher in the AKIN2-3 group than in the AKIN0-1 group (0.73 interquartile range [0.67; 0.78] vs. 0.67 [0.59; 0.72], p = 0.001). A linear mixed model for predicting RI from D1 to D10 showed that an increase in pulse pressure, presence of severe AKI and additional day of ICU hospitalization were associated with an increase in RI. An increase in MAP and recovery from severe AKI were associated with a decrease in RI. In the presence of chronic hypertension or diabetes, an increase in MAP resulted in a lower decrease in RI, than in the absence of such factors. Presence of AKI at D3 did not impact the relationship between MAP and RI.CONCLUSIONS: Severe AKI was associated with a reversible increase in RI without significant interaction with the relationship between MAP and RI. Conversely, the presence of chronic hypertension and/or diabetes interacted with this relationship.

STUDY QUESTIONDoes ageing affect the kinetics of the mitochondrial pool during oogenesis and early embryogenesis?SUMMARY ANSWERWhile we found no age-related change during oogenesis, the kinetics of mitochondrial DNA content and the expression of the factors involved in mitochondrial biogenesis appeared to be significantly altered during embryogenesis.WHAT IS KNOWN ALREADYOocyte mitochondria are necessary for embryonic development. The morphological and functional alterations of mitochondria, as well as the qualitative and quantitative mtDNA anomalies, observed during ovarian ageing may be responsible for the alteration of oocyte competence and embryonic development.STUDY DESIGN, SIZE, DURATIONThe study, conducted from November 2016 to November 2017, used 40 mice aged 5–8 weeks and 45 mice aged 9–11 months (C57Bl6/CBA F(1)). A total of 488 immature oocytes, with a diameter ranging from 20 μm to more than 80 μm, were collected from ovaries, and 1088 mature oocytes or embryos at different developmental stages (two PN, one-cell, i.e. syngamy, two-cell, four-cell, eight-cell, morula and blastocyst) were obtained after ovarian stimulation and, for embryos, mating.PARTICIPANTS/MATERIALS, SETTING, METHODSMitochondrial DNA was quantified by quantitative PCR. We used quantitative reverse transcriptase PCR (RT-PCR) (microfluidic method) to study the relative expression of three genes involved in the key steps of embryogenesis, i.e. embryonic genome activation (HSPA1) and differentiation (CDX2 and NANOG), two mtDNA genes (CYB and ND2) and five genes essential for mitochondrial biogenesis (PPARGC1A, NRF1, POLG, TFAM and PRKAA). The statistical analysis was based on mixed linear regression models applying a logistic link function (STATA v13.1 software), with values of P MAIN RESULTS AND THE ROLE OF CHANCEDuring oogenesis, there was a significant increase in oocyte mtDNA content (P LARGE SCALE DATAN/A.LIMITATIONS, REASONS FOR CAUTIONBecause of the ethical impossibility of working on a human, this study was conducted only on a murine model. As superovulation was used, we cannot totally exclude that the differences observed were, at least partially, influenced by differences in ovarian response between young and old mice.WIDER IMPLICATIONS OF THE FINDINGSOur findings suggest a pathophysiological explanation for the link observed between mitochondria and the deterioration of oocyte quality and early embryonic development with age.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by the University of Angers, France, by the French national research centres INSERM and the CNRS and, in part, by PHASE Division, INRA. There are no competing interests.

Echinoderms are favored study organisms not only in cell and developmental biology, but also physiology, larval biology, benthic ecology, population biology and paleontology, among other fields. However, many echinoderm embryology labs are not well-equipped to continue to rear the post-embryonic stages that result. This is unfortunate, as such labs are thus unable to address many intriguing biological phenomena, related to their own cell and developmental biology studies, that emerge during larval and juvenile stages. To facilitate broader studies of post-embryonic echinoderms, we provide here our collective experience rearing these organisms, with suggestions to try and pitfalls to avoid. Furthermore, we present information on rearing larvae from small laboratory to large aquaculture scales. Finally, we review taxon-specific approaches to larval rearing through metamorphosis in each of the four most commonly-studied echinoderm classes—asteroids, echinoids, holothuroids and ophiuroids.

The suspension-feeding sea cucumber Cucumaria frondosa is widely distributed in cold waters and is commercially exploited in the North Atlantic. While the species is considered to have potential for aquaculture, its feeding and reproductive biology differs markedly from that of currently cultivated sea cucumbers. Here, for the first time, the influence of food sources on the condition of C. frondosa was experimentally tested. Individuals were fed with either diatoms or fish eggs for 3 months. Specific growth rate (SGR), organ indices, fecundity, gonad maturity and profiles of lipids and fatty acids (FA) in tissues were compared among treatments and with sea cucumbers collected from the field. Individuals fed with fish eggs showed higher SGR and organ indices than all other treatments. The highest proportion of large oocytes was also found in gonad tubules of females from the fish egg treatment, although individuals fed with diatoms were the only ones in which spontaneous spawning occurred. Moreover, gonad and muscle tissues of sea cucumbers from the fish egg treatment presented the highest levels of lipids and essential FA. In contrast, non-fed sea cucumbers showed negative SGR, relatively low female fecundity and low concentrations of lipids and FA in tissues. While the fish egg diet presented several obvious benefits, phytoplankton remains an important source of carotenoids, which are vital for vitellogenesis in echinoderms. This indicates that mixed diets rich in lipids, essential FA and carotenoids can be further investigated to optimize growth and reproductive output of this species in captivity.

The partial credit and rating scale models are classical models from item response theory; they belong to the generalized linear latent and mixed model family and allow one to analyze questionnaires such as patient-reported outcomes. Few goodness-of-fit testing procedures have been proposed for such models, and few computer programs implement such tests. Here we describe two tests: the R1m test (which tests the overall adequacy of the model to the data) and the Si test (which evaluates the contribution of each item to a possible lack of fit). We also propose two commands: pcmodel, which implements partial credit or rating scale models, and pcmtest, which tests the adequacy of such models to the data.

Sea cucumber is one of the top five luxury seafoods in Asia and its commercialization primarily revolves around the processed body wall. Hence, live transport and storage of sea cucumbers prior to processing must preserve the condition of the body wall and underlying muscles. Unlike most commercial shellfish on which industry standards are chiefly based, sea cucumbers lack a protective exoskeleton and have the ability to autolyze. Here, we tested the efficacy of different live storage methods on Cucumaria frondosa , a commercial species that is widely distributed in the North Atlantic and the Arctic. Current technologies and low-cost variants were experimentally tested under conditions prescribed for the transport of seafood in Canada. Markers of post-storage health, body wall condition and muscle integrity were compared among treatments. The most common method currently in use (icing and salting) yielded the highest rates of mortality and skin necrosis, whereas iced seawater emerged as the best storage condition. These findings should help stakeholders adapt their methodologies to optimize the exploitation of temperate and cold-water sea cucumber resources.

While the suspension-feeding sea cucumber Cucumaria frondosa is commercially exploited in the North Atlantic and is considered to have potential for integrated aquaculture, the impact of environmental conditions on its behaviour and population structure remains incompletely understood. The present study showed that adults are not photosensitive; they do not exhibit any preference for either illuminated or shaded areas. Within each photoperiod treatment, analyses of the daily activity cycle revealed that the proportion of individuals with feeding tentacles deployed did not change over time; however, the proportion of moving individuals increased in the dark phase under the 12 h light/12 dark regime, but remained constant under continuous light or darkness. Hence, from an aquaculture perspective, long days (i.e. summer photoperiod) might decrease the time spent moving in favour of feeding, potentially shifting the energy budget toward faster growth. Variations in phytoplankton concentration modulated the deployment of tentacles but did not trigger any displacement toward the food source, indicating that feeding responds directly to the presence of food. Moreover, C. frondosa exhibited a clear preference for substrates composed of bare rocks and rocks with coralline algae and displayed a weak preference for darker substrate backgrounds. Together, these findings highlight how some key environmental factors can govern the feeding, locomotor activities, and eventual distribution of cold-water suspension-feeding sea cucumbers.

While reproduction in deep-sea corals remains incompletely understood, there is a particularly crucial shortage of information related to corals living in deep waters of the Arctic Ocean. In the present study, colonies of the deep-sea pennatulacean coral Umbellula encrinus were collected in Baffin Bay (High Canadian Arctic) at bathyal depths between 2006 and 2010. From examination of gamete sizes, maturity levels and densities at several time points, U. encrinus was determined to be a gonochoric species with an equal sex ratio and a broadcast-spawning strategy. Fully mature oocytes measured between 800-950 μm in diameter, consistent with lecithotrophic larval development. Potential fecundity was ∼4200 mature oocytes colony−1 and ∼5300 mature spermatocysts colony−1. Gametogenesis was synchronous between sexes; a single main cohort of oocytes and spermatocysts was seen to increase in size throughout the year. Gametogenetically mature colonies were detected in late June during the earliest possible spring samplings. Spent colonies were detected in July and August. Early stages of gametogenesis appeared in early September shortly after the spawning months and more advanced growth stages occurred in late September and early November, after which time sampling was prevented by ice cover. The spawning season in U. encrinus appears to occur once a year, closely following the disappearance of the ice cover in early spring, when chlorophyll-a in Baffin Bay increases. The initiation of gametogenesis coincides with a period of sustained phytoplankton production and continues until the entire bay freezes over in fall. Since mature gametes were found in both male and female colonies just after the spring melt, gamete maturation likely continues under the ice. Both depth and latitude were shown to impact gamete development and fecundity in U. encrinus, with more advanced and fertile colonies occurring in deeper water and at higher latitudes.

In the list of participating investigators that appears in Acknowledgements, one of the investigators names appears incorrectly.

The population and reproductive biology of the commercial sea cucumber Holothuria mexicana (Ludwig, 1875) was studied in Southern Belize (Caribbean Sea), including the sex ratio, size at sexual maturity and reproductive cycle, as well as the size structure among habitats located inside and outside protected areas. Individuals found inside marine protected areas were consistently larger than individuals found outside these boundaries. The male:female sex ratio was 1.1:1.0 with a unimodal size distribution composed mainly of sexually mature individuals (87 %). Size at sexual maturity was established to be ~10 cm based on measures of gamogenetically mature individuals during the peak of the gametogenic maturity period. Juveniles and small adults measuring ≤ 15 cm (13 %), were collected exclusively in sandy and muddy areas of seagrass habitats associated with mangroves. Larger adults were commonly found on hard substrates in both seagrass-associated and coral-reef-associated habitats. Based on histology and gonad indices, the first sign of early gametogenesis was detected in August in both sexes. Gametes developed and matured throughout the colder months between November and February. Decreases in gonad index in both years suggest annual spawning, starting in March-April 2014 (single major event) and March-April and July-August 2015 (two smaller events) for both males and females. The spawning periods were correlated with warmer or increasing temperatures, low rainfall and increasing or high chlorophyll-a concentrations. These data will hopefully guide management and protection of the natural populations of H. mexicana, which are already suffering from overfishing in Belize and neighboring countries.

Postoperative ileus (POI) occurrence within enhanced recovery programs (ERPs) has decreased. Also, intra-abdominal complications (IAC) such as anastomotic leakage (AL) generally present late. The aim was to characterize the link between POI and the other complications occurring after surgery.This retrospective analysis of a prospective database was conducted by the Francophone Group for Enhanced Recovery after Surgery. POI was considered to be present if gastrointestinal functions had not been recovered within 3 days following surgery or if a nasogastric tube replacement was required.Of the 2773 patients who took part in the study, 2335 underwent colorectal resections (83.8%) for cancer, benign tumors, inflammatory bowel disease, and diverticulosis. Among the 2335 patients, 309 (13.2%) experienced POI, including 185 (59.9%) cases of secondary POI. Adjusted for well-known risk factors (male gender, need for stoma, right hemicolectomy, surgery duration, laparotomy, and conversion to open surgery), POI was associated with abdominal complications (OR = 4.55; 95% confidence interval (CI): 3.30-6.28), urinary retention (OR = 1.75; 95% CI: 1.05-2.92), pulmonary complications (OR = 4.55; 95% CI: 2.04-9.97), and cardiological complications (OR = 3.01; 95% CI: 1.15-8.02). Among the abdominal complications, AL and IAC were most strongly associated with POI (respectively, OR = 5.97; 95% CI: 3.74-8.88 and OR = 5.76; 95% CI: 3.56-10.62).Within ERPs, POI should not be considered as usual. There is a significant link between POI and IAC. Since POI is an early-onset clinical sign, its occurrence should alert the physician and prompt them to consider performing CT scans in order to investigate other potential morbidities.

Although hydrostatic pressure is one of the most prominent abiotic drivers of faunal bathymetric ranges, it is one of the least understood. To better understand hyperbaric constraints on depth distributions, we explored responses to high pressure of adult echinoderms from eastern Canada. The sea urchin Strongylocentrotus droebachiensis, the sea star Leptasterias polaris and the sea cucumber Cucumaria frondosa were exposed to various pressures within and beyond their known bathymetric distribution (i.e. surface pressure; pressure at the midpoint in bathymetric distribution; pressure at twice the maximum depth in the species bathymetric distribution) for different durations (24 h, 72 h, 9 days). Survival was compromised by exposure to the highest pressure levels, with the sea urchin exhibiting the highest mortality. After 72-h exposure, mortality was observed for sea urchin and sea cucumber individuals while all sea star individuals survived. Following 9-day exposure of sea star individuals to high pressure, 100% mortality occurred. Exposure to pressures typical of natural distributions had little effect on the selected health and motor metrics. Pressures atypical of natural ranges negatively affected the motor functions of all species, irrespective of exposure duration. During and after 24-h exposure, feeding was reduced in sea urchin and sea cucumber individuals, but was unchanged in sea star individuals. Overall, there were no clear signs of acclimation to high pressure following sustained periods of exposure in any species. These results highlight constraints applied by hydrostatic pressure beyond current bathymetric ranges on life-sustaining behaviours in echinoderms. The potential of long-lived echinoderms to survive downward migration to greater depths is species-specific, suggesting there may be winners and losers in the face of near-future climate-driven migration patterns.

Although movement in response to environmental conditions represents a fundamental link between animal behaviour and population ecology, it is rarely investigated in suspension feeders because they are generally perceived as sessile. Here, the interplay between water flow and fine locomotor and feeding behaviours was experimentally investigated for the first time in a free-moving suspension-feeding sea cucumber ( Cucumaria frondosa ; Echinodermata, Holothuroidea) using time-lapse videography in a mesocosm setting. Individuals moved away from static conditions in the weakest flow treatment and fled the strongest flows (>40 cm s −1 ) in the more dynamic treatments. The tentacles of individuals located in areas with flows of ≥40 cm s −1 was aligned with the direction of the current, whereas in flows −1 , they were typically perpendicular to the direction of flow. Tentacle deployment and insertion rates (i.e. feeding rate) increased with flow, from 0.95 min −1 at 10 cm s −1 to 1.13 min −1 at 40 cm s −1 . Three modes of locomotion were detected. Forward crawling was most frequent at flows ≤40 cm s −1 , passive rolling dominated at flows >40 cm s −1 and active rolling occurred randomly at flows between 0 and 120 cm s −1 . Overall, the flow regime favoured by C . frondosa was determined to be between 21 and 40 cm s −1 , under which an optimal balance between efficient food capture and energy expenditure for attachment to the bottom was presumably found. These findings provide insight into the distribution and population dynamics of suspension-feeding holothuroids, and may also assist the fisheries management and aquaculture development of commercial species.

Lipids are key compounds in marine ecosystems being involved in organism growth, reproduction, and survival. Despite their biological significance and ease of measurement, the use of lipids in deep-sea studies is limited, as is our understanding of energy and nutrient flows in the deep ocean. Here, a comprehensive analysis of total lipid content, and lipid class and fatty acid composition, was used to explore functional diversity and nutritional content within a deep-sea faunal assemblage comprising 139 species from 8 phyla, including the Chordata, Arthropoda, and Cnidaria. A wide range of total lipid content and lipid class composition suggested a diversified set of energy allocation strategies across taxa. Overall, phospholipid was the dominant lipid class. While triacylglycerol was present in most taxa as the main form of energy storage, a few crustaceans, fish, jellyfishes, and corals had higher levels of wax esters/steryl esters instead. Type and amount of energy reserves may reflect dietary sources and environmental conditions for certain deep-sea taxa. Conversely, the composition of fatty acids was less diverse than that of lipid class composition, and large proportions of unsaturated fatty acids were detected, consistent with the growing literature on cold-water species. In addition, levels of unsaturation increased with depth, likely suggesting an adaptive strategy to maintain normal membrane structure and function in species found in deeper waters. Although proportions of n-3 fatty acids were high across all phyla, representatives of the Chordata and Arthropoda were the main reservoirs of these essential nutrients, thus suggesting health benefits to their consumers.

International audience; BACKGROUND: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions.METHODS: We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before.RESULTS: Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1-Q3], 14 [10.5-15] vs 11 [10-12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54-96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51-0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0-1] vs 3 [1-4] times/session; P < .0001). The 2 factors associated with UI in multilevel mixed-effects logistic regression were Sequential Organ Failure Assessment score (odds ratio [95% CI], 0.81 [0.65-99]; P = .047) and the intervention group (odds ratio, 0.19 [0.05-0.73]; P = .015).CONCLUSIONS: High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover.

Primary central nervous system lymphomas (PCNSL) are non-Hodgkin lymphomas strictly localized to the CNS, occurring mainly in elderly patients with comorbidities. Current treatment in fit patients relies on high-dose methotrexate and high-dose cytarabine. The aim of this study was to evaluate the efficacy and feasibility of this treatment in elderly patients and to assess potential prognostic factors associated with survival. We conducted a retrospective study in two centers between January 2008 and September 2015 including 35 elderly immunocompetent patients who received first-line treatment with high-dose methotrexate. With a median follow-up of 19.8 months (range: 1.7–73.4 months), median overall survival (OS) was 39.5 months (95% confidence interval (95% CI): 18.3–60.7) and median progression-free survival (PFS) was 25.8 months (95% CI: 5.2–46.4). In univariate analysis, administration of high-dose cytarabine and achieving a relative dose intensity for methotrexate > 75% were associated with increased OS (p = 0.006 and p = 0.003, respectively) and PFS (p = 0.003 and p = 0.04, respectively) whereas comorbidities, defined by a CIRS-G score ≥ 8, were associated with decreased OS and PFS (p = 0.02 and p = 0.04, respectively). A high MSKCC score was associated with decreased OS (p = 0.02). In multivariate analysis, administration of high-dose cytarabine was associated with increased OS and PFS (p = 0.02 and p = 0.007, respectively). Comorbidities and relative dose intensity for methotrexate are important for the prognosis of elderly patients with PCNSL. These results must be confirmed in prospective trials.

Background Endothelial dysfunction, a pathophysiologic determinant of atherogenesis, has been found to occur in obstructive sleep apnea syndrome (OSA) and is improved by continuous positive airway pressure (CPAP). However, the efficacy of CPAP therapy is limited by variable adherence. Alternative treatment strategies are needed. The impact of polyphenols on endothelial function has never been evaluated in OSA. Objective We evaluated the impact of 1-mo supplementation with grape juice polyphenols (GJPs) on the reactive hyperemia index (RHI), a validated measure of endothelial function in patients with severe OSA. Methods Forty participants [75% men, median (IQR) age: 61 y (34, 64 y), BMI (in kg/m2): 30.6 (20.9, 33.7)] with severe OSA [median apnea-hypopnea index 43/h (33/h, 56/h)] were randomly assigned to receive GJPs (300 mg/d; n = 20) or placebo (n = 20) for 1 mo. The primary outcome was the change in RHI between baseline and after 1 mo of GJPs or placebo. Secondary outcome measures included changes in blood pressure (BP), heart rate (HR), and polysomnographic indexes. Results No significant differences in RHI and BP outcomes were observed between the GJPs and placebo groups. A significant between-group difference was observed for HR changes [-1 bpm (-5, +5 bpm) in the GJPs group compared with +6 bpm (+3, +10 bpm) in the placebo group; P = 0.001]. A significant decrease in total sleep time was observed in the GJPs group compared with the placebo group [-10 min (-33, 6 min) compared with +15 min (-12, 40 min), respectively; P = 0.02], with no between-group differences in the distribution of sleep stages. Conclusions In participants with severe OSA and no overt cardiovascular disease, 1-mo GJP supplementation had no effect on endothelial function. This trial was registered at clinicaltrials.gov as NCT01977924.

Whole-body chimaeras (organisms composed of genetically distinct cells) have been directly observed in modular/colonial organisms (e.g. corals, sponges, ascidians); whereas in unitary deuterostosmes (including mammals) they have only been detected indirectly through molecular analysis. Here, we document for the first time the step-by-step development of whole-body chimaeras in the holothuroid Cucumaria frondosa , a unitary deuterostome belonging to the phylum Echinodermata. To the best of our knowledge, this is the most derived unitary metazoan in which direct investigation of zygote fusibility has been undertaken. Fusion occurred among hatched blastulae, never during earlier (unhatched) or later (larval) stages. The fully fused chimaeric propagules were two to five times larger than non-chimaeric embryos. Fusion was positively correlated with propagule density and facilitated by the natural tendency of early embryos to agglomerate. The discovery of natural chimaerism in a unitary deuterostome that possesses large externally fertilized eggs provides a framework to explore key aspects of evolutionary biology, histocompatibility and cell transplantation in biomedical research.

International audience; Background and aimsThe first cause of low-dose acetylsalicylic-acid (ASA) inefficacy is poor adherence to treatment. No non-invasive technique is available to assess ASA intake. Current-induced vasodilation (CIV) was found abolished in healthy volunteers after low-dose ASA intake. We tested clinical characteristics, treatments, and comorbid conditions influencing CIV amplitude in vascular patients.MethodsCIV was tested in 400 patients (277 males and 123 females, aged 65.4 ± 13.4 years). We focused on clinical characteristics, treatments, and comorbid conditions as covariates of CIV amplitude. We studied the CIV amplitude to covariate relationships with multivariate linear regression and receiver operating characteristics (ROC).ResultsThe multivariate linear model determined that ASA intake within the last 48 h and the interaction between ASA intake and body mass index (BMI) were the sole covariates associated with CIV amplitude. For the whole population, the area under the ROC curve (AUC) for CIV to predict ASA intake was 0.853 [95% confidence interval (CI): 0.814–0.892]. Considering separately the areas observed for non-obese (BMI ≤30, n = 303) and obese (BMI>30, n = 93) patients, the AUC [95% CI] was 0.873 [0.832–0.915] and 0.776 [0.675–0.878], respectively (p = 0.083).ConclusionsASA is the only drug that affects the amplitude of CIV response observed after galvanic current application to the skin of vascular patients. CIV depends on BMI but not age or gender. As such, CIV appears to be a potential objective marker of ASA intake and could facilitate future non-invasive assessments of adherence to ASA treatment.

Whole-body chimaeras (organisms composed of genetically distinct cells) have been directly observed in modular/colonial organisms (e.g. corals, sponges, ascidians); whereas in unitary deuterostosmes (including mammals) they have only been detected indirectly through molecular analysis. Here, we documented for the first time the step-by-step development of whole-body chimaeras in the holothuroid Cucumaria frondosa, a unitary deuterostome belonging to the phylum Echinodermata. To the best of our knowledge, this is the most derived unitary metazoan in which direct investigation of zygote fusibility has been undertaken. Fusion occurred among hatched blastulae, never during earlier (unhatched) or later (larval) stages. The fully fused chimaeric propagules were two to five times larger than non-chimaeric embryos. Fusion was positively correlated with propagule density and facilitated by the natural tendency of early embryos to agglomerate. The discovery of natural chimaerism in a unitary deuterostome that possesses large externally fertilized eggs provides a framework to explore key aspects of evolutionary biology, histocompatibility and cell transplantation in biomedical research.

International audience; The benefit of early admission of allogeneic stem cell transplantation (SCT) recipients to the intensive care unit (ICU) as soon as they develop organ injury is unknown. We performed a retrospective study on 92 patients admitted to the ICU to determine the impact of time from organ injury to ICU admission on outcome. The number of organ injuries prior to ICU admission was associated with an increased in-hospital mortality (OR 1.7, 95% CI 1–2.7, p = 0.04). Time between first organ injury and ICU admission was also associated with an increased in-hospital survival (OR 1.4, 95% CI 1.1–1.8, p = 0.02). A score combining these two covariates—the number of organ injuries/day (sum of days spent with each individual organ injury)—further improved the prediction of hospital survival. Patients with more organ injuries/day had significantly higher in-hospital mortality rate even after adjustment for refractory acute GVHD and the SOFA (OR 1.3, 95% CI 1–1.7, p = 0.02). Early ICU admission of allogeneic SCT recipients to the ICU as soon as they develop organ injury is associated with decreased in-hospital mortality.

IntroductionAs patient assessment of health-related quality of life (HRQOL) in cancer clinical trials has increased over the years, so has the need to attach meaningful interpretations to differences in HRQOL scores between groups and changes within groups. Determining what represents a minimally important difference (MID) in HRQOL scores is useful to clinicians, patients and researchers, and can be used as a benchmark for assessing the success of a healthcare intervention. Our objective is to provide an evidence-based protocol to determine MIDs for the European Organisation for Research and Treatment for Cancer Quality of life Questionnaire core 30 (EORTC QLQ-C30). We will mainly focus on MID estimation for group-level comparisons. Responder thresholds for individual-level change will also be estimated.Methods and analysisData will be derived from published phase II and III EORTC trials that used the QLQ-C30 instrument, covering several cancer sites. We will use individual patient data to estimate MIDs for different cancer sites separately. Focus is on anchor-based methods. Anchors will be selected per disease site from available data. A disease-oriented and methodological panel will provide independent guidance on anchor selection. We aim to construct multiple clinical anchors per QLQ-C30 scale and also to compare with several anchor-based methods. The effects of covariates, for example, gender, age, disease stage and so on, will also be investigated. We will examine how our estimated MIDs compare with previously published guidelines, hence further contributing to robust MID guidelines for the EORTC QLQ-C30.Ethics and disseminationAll patient data originate from completed clinical trials with mandatory written informed consent, approved by local ethical committees. Our findings will be presented at scientific conferences, disseminated via peer-reviewed publications and also compiled in a MID ‘blue book’ which will be made available online on the EORTC Quality of Life Group website as a free guideline document.

Cardiac rehabilitation (CR) combines therapeutic education with physical training and is recognized to reduce mortality rates by approximately 22% following myocardial infarction (MI) [(1)][1]. Despite its broad acceptance, some studies have reported that CR may be harmful, in terms of left

Introduction The objective of the study to is to determine the characteristics associated with endotracheal intubation in septic shock patients. Methods This is a post hoc analysis of the database of the SEPSISPAM study, including patients with septic shock. Results Among the 776 patients, 633 (82%) were intubated within 12 hours of study inclusion (early intubation), 113 (15%) were never intubated, and 30 (4%) had delayed intubation. Intensive care units (ICUs) were classified according to frequency of early intubation: early intubation less than 80% of patients (lowest frequency: 7 ICUs, 254 patients), 80% to 90% (middle frequency: 5 ICUs, 170 patients), and greater than 90% (highest frequency: 6 ICUs, 297 patients). Type of ICU, pulmonary infection, lactate greater than 2 mmol/L, lower Pao 2 /fraction of inspired oxygen ratio, lower Glasgow score, and absence of immunosuppression were independently associated with early intubation. Patients never intubated had a lower initial severity and a low mortality rate. In comparison to patients intubated early, patients with delayed intubation had had fewer days alive without organ support by day 28. Intensive care units with the highest frequency of early intubation had a higher mortality rate in comparison to ICUs with middle frequency of early intubation. A nonsignificant increased mortality was observed in ICU with lowest frequency of early intubation. Conclusions Practices regarding the place of endotracheal intubation in septic shock may impact outcome.

Pycnogonids (sea spiders) are commonly collected at bathyal and abyssal depths all around the world; however, little is known about species from deep-water habitats. The present study explores the life history of Nymphon hirtipes collected in northeastern Newfoundland between 700 and 1450 m depth and monitored in mesocosms for over 2 years. The pycnogonids were found in association with octocorals, hydrozoans and sea anemones. Adult females developed mature oocytes between June and August. Paired mating followed by oviposition occurred between early July and mid-October. Up to three egg masses were brooded by each male. It took a maximum of 4 months for the propagules to hatch from the egg mass. Offspring developed from walking leg-bearing larvae to early juveniles over the next ~5 months before leaving the male’s protection. Mating and oviposition coincided with the highest water temperatures of the annual cycle and dispersal of juveniles occurred in spring, when phytodetritus deposition was high and as ocean temperature rose markedly. All the females died after oviposition and the males ~9 months later, after juvenile dispersal. The sex ratio of mature individuals (~55–60 mm leg span) was 2 males for 3 females. Fecundity was estimated to be 184–288 eggs per adult female. Adults of N. hirtipes were seen feeding on hydrozoan polyps, small sea anemones (Stephanauge nexilis) and nudibranchs. Larvae and early juveniles did not feed while brooded by the male. Upon dispersal, their feeding apparatus became functional and they began feeding on hydrozoan polyps. After 13 months of growth post hatching, the juveniles reached ~21 mm leg span. Curve fitting estimated that ~7 years are required to reach the adult size of 55 mm leg span.

OBJECTIVE Splanchnic vein thrombosis (SVT) is a potentially severe complication of pancreatitis. The aim of this single-center, retrospective cohort study was to investigate the incidence of SVT and to determine the connected risk factors. METHODS All consecutive patients with acute pancreatitis (AP) managed in our hospital were included. The primary outcome was the occurrence of SVT and data was collected in accordance with Ranson's criteria. RESULTS A total of 318 patients were included, of whom 124 (39.0%) were women. Biliary lithiasis was the main cause of pancreatitis (n = 156, 49.1%). A total of 19 (6.0%) SVT were identified. In univariate analysis, alcohol intake, smoking and male gender were associated with SVT (P = 0.005, 0.003 and 0.007, respectively). Biological parameters significantly associated with thrombosis were lactate dehydrogenase (LDH) 75% was a protective factor against thrombosis (OR 0.148, P = 0.019). Leukocytes >10 × 10(9)/L (OR 6.397, P = 0.034), hyperglycemia (≥ 10 mmol/L) (OR 6.845, P = 0.023), LDH

Spatial and temporal shifts in biometric features were examined in three common deep-water pennatulacean corals (sea pens) from the Northwest Atlantic: Anthoptilum grandiflorum, Halipteris finmarchica and Pennatula aculeata. These three species show different morphological characters and adaptations to their environment. Analyses of colony length, ratio of peduncle to colony length, weight/length ratio, polyp size and density as well as sclerite shape, location and abundance indicate that their phenotype is modulated by environmental factors (e.g. food availability, currents and sediment type) and antipredator strategies. Moreover, the three species had different carbon and nitrogen stable isotope signatures that could be explain primarily by their different polyp diameters and colony shapes, suggesting that they rely on slightly different food sources (varying proportions of phytodetritus and zooplankton). Finally, sclerites were found only in H. finmarchica and P. aculeata and are not known to occur in A. grandiflorum, except for minute oval bodies inside the peduncle. The Mg/Ca ratio of sclerites differed between the two species and, for P. aculeata, among types of sclerites, evoking different biomineralization pathways related to their functional roles (structural support or defence). Overall, this study provides new information on the ecology of poorly known species, which are ubiquitous and suspected to play an important ecological role in deep-water ecosystems.

Our study focused on the precise reproductive behavior of the starfish Leptasterias polaris (Muller and Troschel) before and during spawning--a subject of much speculation and evident ecological importance. Between the third week of December 1992 and mid-January 1993, we observed spawning in the laboratory that roughly corresponded to field observations in the Lower St. Lawrence Estuary. In experimental tanks provided with natural environmental conditions, the spawning was preceded by 7 to 8 weeks of complex aggregative interactions among the starfish. The individuals, which usually avoid each other, began to make discreet arm contact, which intensified with time and eventually led to the superposition of two or more starfish, independently of sex. The interactions seem to be associated with decreasing temperature, because aggregative and spawning behaviors were not observed under stable temperature conditions. Male spawning is first initiated when the temperature falls to about 2{deg}C during minimum daylength (9 h.d-1). In seawater, the spermatozoa are negatively buoyant and tend to deposit as a sticky film on the substrate, where they enter a state of low activity. Stimulated by male spawning, females spawn on the layer of sperm, which is reactivated by contact with the oocytes, ensuring fertilization. In the laboratory, the fertilized eggs undergo first cleavage in 45 h, become brachiolaria in 40 days, and form fully developed young starfish within 5.5 to 6 months, synchronously with populations in the field. The embryos develop at the same rate even when not brooded, suggesting that the brooding behavior in L. polaris serves mainly to keep the eggs clean, healthy, and protected against predation.