Search

Abstract While the efficacy of GpIIb–IIIa-inhibitors during primary PCI (pPCI) for ST-elevated myocardial infarction (STEMI) has previously been demonstrated, its ongoing role and safety in combination with newer P2Y12-inhibitors is unclear. We therefore sought to compare outcomes between two centers with divergent approaches to the use of GpIIbIIIa antagonists in pPCI. We performed a retrospective chart review of all-comer STEMI patients treated with pPCI at two high-volume Montreal academic tertiary care centers. One center tended to use GpIIb–IIIa-inhibitors up-front in a large proportion of patients (liberal strategy) and the other preferring a bail-out approach (conservative strategy). Baseline patient characteristics and procedural data were compared between the two groups. The main efficacy outcome was rate of no-reflow/slow-reflow and the main safety outcome was BARC ≥ 2 bleeding events. A total of 459 patients were included, of whom 167 (36.5%) were exposed to a GpIIb–IIIa-antagonist. There was a significant overall difference in use of GpIIb–IIIa-antagonist between the two centers (60.5% vs. 16.1%, p

BackgroundSevere COVID-19 is associated with neutrophilic inflammation and immunothrombosis. Several members of the IL-17 cytokine family have been associated with neutrophilic inflammation and activation of the endothelium. Therefore, we investigated whether these cytokines were associated with COVID-19.MethodsWe investigated the association between COVID-19 and circulating plasma levels of IL-17 cytokine family members in participants to the Biobanque québécoise de la COVID-19 (BQC19), a prospective observational cohort and an independent cohort from Western University (London, Ontario). We measured the in vitro impact of IL-17F on intercellular adhesion molecule 1 (ICAM-1) cell surface expression and neutrophil adhesion on endothelial cells in culture. The contribution of two Mitogen Activated Protein Kinase (MAPK) pathways was determined using small molecule inhibitors PD184352 (a MKK1/MKK2 inhibitor) and BIRB0796 (a p38 MAPK inhibitor).ResultsWe found increased IL-17D and IL-17F plasma levels when comparing SARS-CoV-2-positive vs negative hospitalized participants. Moreover, increased plasma levels of IL-17D, IL-17E and IL-17F were noted when comparing severe versus mild COVID-19. IL-17F, but not IL-17A, was significantly elevated in people with COVID-19 compared to healthy controls and with more severe disease. In vitro work on endothelial cells treated with IL-17F for 24h showed an increase cell surface expression of ICAM-1 accompanied by neutrophil adhesion. The introduction of two MAPK inhibitors significantly reduced the binding of neutrophils while also reducing ICAM-1 expression at the surface level of endothelial cells, but not its intracellular expression.DiscussionOverall, these results have identified an association between two cytokines of the IL-17 family (IL-17D and IL-17F) with COVID-19 and disease severity. Considering that IL-17F stimulation promotes neutrophil adhesion to the endothelium in a MAPK-dependent manner, it is attractive to speculate that this pathway may contribute to pathogenic immunothrombosis in concert with other molecular effectors.

ABSTRACT Microorganisms with simplified genomes represent interesting cell chassis for systems and synthetic biology. However, genome reduction can lead to undesired traits, such as decreased growth rate and metabolic imbalances. To investigate the impact of genome reduction on Escherichia coli strain DGF-298, a strain in which ~ 36% of the genome has been removed, we reconstructed a strain-specific metabolic model (iAC1061), investigated the regulation of gene expression using iModulon-based transcriptome analysis, and performed adaptive laboratory evolution to let the strain correct potential imbalances that arose during its simplification. The model notably predicted that the removal of all three key pathways for glycolaldehyde disposal in this microorganism would lead to a metabolic bottleneck through folate starvation. Glycolaldehyde is also known to cause self-generation of reactive oxygen species, as evidenced by the increased expression of oxidative stress resistance genes in the SoxS iModulon. The reintroduction of the aldA gene, responsible for one native glycolaldehyde disposal route, alleviated the constitutive oxidative stress response. Our results suggest that systems-level approaches and adaptive laboratory evolution have additive benefits when trying to repair and optimize genome-engineered strains.IMPORTANCEGenomic streamlining can be employed in model organisms to reduce complexity and enhance strain predictability. One of the most striking examples is the bacterial strain Escherichia coli DGF-298, notable for having over one-third of its genome deleted. However, such extensive genome modifications raise the question of how similar this simplified cell remains when compared with its parent, and what are the possible unintended consequences of this simplification. In this study, we used metabolic modeling along with iModulon-based transcriptomic analysis in different growth conditions to assess the impact of genome reduction on metabolism and gene regulation. We observed little impact of genomic reduction on the regulatory network of E. coli DGF-298 and identified a potential metabolic bottleneck leading to the constitutive activity of the SoxS iModulon. We then leveraged the model's predictions to successfully restore SoxS activity to the basal level.

Jason Robert Guertin,1– 3 Mahée Gilbert-Ouimet,1,4 Michèle Dugas,5 Valérie Carnovale,5 Laura Jalbert,5 Olha Svyntozelska,2,5 Juliette Demers,5 Léonie Matteau,2,4 Frédéric Bergeron,6 Annie LeBlanc2,5 1Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada; 2Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; 3Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada; 4Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada; 5VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada; 6Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, CanadaCorrespondence: Jason Robert Guertin, Centre de recherche du CHU de Québec – Université Laval, Axe Santé des Populations et Pratiques Optimales en Santé, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, local J1-11, Quebec City, Québec, G1S 4L8, Canada, Tel +1 418-682-7511, ext 82516, Email jason.guertin@fmed.ulaval.caBackground: Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden.Purpose: We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies.Data Sources: Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases.Study Selection: Manuscript selection was performed by pairs of reviewers.Data Extraction: Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach.Data Synthesis: We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers’ financial burden. Less than half (n = 93, 47%) of studies reported on caregivers’ sex and none reported on their gender.Conclusion: We conducted an unrestricted review of published studies examining caregiver’s financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.Keywords: scoping review, caregivers, financial burden, sex and gender considerations, methods

Mesoplasma florum is an emerging model organism for systems and synthetic biology due to its small genome (∼800 kb) and fast growth rate. While M. florum was isolated and first described almost 40 years ago, many important aspects of its biology have long remained uncharacterized due to technological limitations, the absence of dedicated molecular tools, and since this bacterial species has not been associated with any disease. However, the publication of the first M. florum genome in 2004 paved the way for a new era of research fueled by the rise of systems and synthetic biology. Some of the most important studies included the characterization and heterologous use of M. florum regulatory elements, the development of the first replicable plasmids, comparative genomics and transposon mutagenesis, whole-genome cloning in yeast, genome transplantation, in-depth characterization of the M. florum cell, as well as the development of a high-quality genome-scale metabolic model. The acquired data, knowledge, and tools will greatly facilitate future genome engineering efforts in M. florum, which could next be exploited to rationally design and create synthetic cells to advance fundamental knowledge or for specific applications.

Mesoplasma florum, a fast-growing near-minimal organism, is a compelling model to explore rational genome designs. Using sequence and structural homology, the set of metabolic functions its genome encodes was identified, allowing the reconstruction of a metabolic network representing ˜ 30% of its protein-coding genes. Growth medium simplification enabled substrate uptake and product secretion rate quantification which, along with experimental biomass composition, were integrated as species-specific constraints to produce the functional iJL208 genome-scale model (GEM) of metabolism. Genome-wide expression and essentiality datasets as well as growth data on various carbohydrates were used to validate and refine iJL208. Discrepancies between model predictions and observations were mechanistically explained using protein structures and network analysis. iJL208 was also used to propose an in silico reduced genome. Comparing this prediction to the minimal cell JCVI-syn3.0 and its parent JCVI-syn1.0 revealed key features of a minimal gene set. iJL208 is a stepping-stone toward model-driven whole-genome engineering.

Abstract Helicobacter pylori (H. pylori) screening and treatment is recommended for patients on chronic aspirin (ASA) therapy to reduce the risk of gastrointestinal bleeding. Coronary artery disease patients requiring combination antithrombotic therapy (dual antiplatelet therapy; DAPT, or dual pathway inhibition; DPI) are at an even higher risk of GI bleeding. Therefore, we aimed to evaluate the prevalence of H. pylori among patients referred for angiography and likely to receive DAPT or DPI. This single-center prospective observational study recruited patients undergoing coronary angiography and with the possibility of requiring DAPT or DPI. All included patients underwent H. pylori serology testing. Multivariable logistic regression was performed to determine predictors of seropositivity. 195 patients were included in the analysis. Mean age was 67 years, 50% had known prior CAD, and 49% underwent coronary intervention. H. pylori serology was positive in 36%. Chronic kidney disease (odds ratio [OR] 2.76; 95% confidence interval [CI] 1.24 to 6.15; p = 0.01) and chronic obstructive pulmonary disease (OR 2.52; 95% CI 1.14 to 5.55; p = 0.02) history were independent predictors of H. pylori seropositivity. Given the clinically significant prevalence of H. pylori seropositivity among patients referred for angiography, systematic screening strategies and eradication of H. pylori could significantly reduce the incidence of GI bleeding in patients requiring DAPT or DPI.

Background: Prehospital electrocardiographic ST-elevation myocardial infarction (STEMI) diagnosis and prehospital cardiac catheterization laboratory activation have been shown to significantly reduce average treatment delay, and further standardization of such systems may help reduce sex-related treatment and outcome gaps. However, what types of prehospital STEMI activation systems are in place across Canada, and to what extent sex-based STEMI treatment disparities are tracked, is unknown. Methods: We conducted a national survey of catheterization laboratory directors between October 11 and December 25, 2021. Seventeen catheterization laboratory directors representing 6 community and 11 academic centres completed the survey (40% response rate). Results: : All responding centres use a prehospital STEMI diagnosis and cardiac catheterization laboratory activation system, and the majority (59%) rely on real-time physician oversight. Slightly less than half (47%) of percutaneous coronary intervention centres reported prospectively tracking sex-related differences in STEMI care, and only one respondent believed that a significant systemic sex-related bias was present in their prehospital STEMI referral system. Patient factors (symptom description or time to presentation; 23.5%) and limitations of electrocardiogram diagnosis of STEMI in women (23.5%) were cited most frequently as contributing to sex-related bias in STEMI referral systems. In contrast, implicit bias in the referral algorithm, prehospital provider bias, and physician bias were not considered important contributing factors. Conclusions: Although all responding centres employ prehospital activation systems, less than half tracked sex-related differences, and most respondents believed that no sex-related bias existed in their prehospital STEMI system. Résumé: Contexte: Il a été démontré que le diagnostic préhospitalier par électrocardiogramme de l’infarctus du myocarde avec élévation du segment ST (STEMI) et l’activation du laboratoire de cathétérisme cardiaque préhospitalier permettent de réduire significativement le délai moyen de traitement, et un usage plus standardisé de ces systèmes pourrait contribuer à la réduction des écarts liés au sexe dans les traitements et les résultats de santé. Toutefois, on ignore quels types de systèmes d’activation préhospitaliers pour la prise en charge du STEMI sont en place à travers le Canada, ni dans quelle mesure les disparités de traitement liées au sexe font l’objet d’un suivi. Méthodologie: Nous avons mené un sondage national auprès des directeurs de laboratoires de cathétérisme entre le 11 octobre et le 25 décembre 2021. Notre questionnaire a été rempli par les directeurs de 17 laboratoires de cathétérisme, dont six centres communautaires et 11 centres universitaires (taux de réponse de 40 %). Résultats: Pour tous les centres répondants, un système de diagnostic préhospitalier du STEMI et d’activation de laboratoire de cathétérisme cardiaque était en place, dont la surveillance était assurée majoritairement par un médecin en temps réel (59 %). Un peu moins de la moitié des centres d’intervention coronarienne percutanée (47 %) ont rapporté faire un suivi prospectif des différences liées au sexe dans la prise en charge du STEMI, et un seul répondant a dit croire qu’un biais systématique lié au sexe était présent dans le système d’orientation préhospitalier pour les STEMI. Les facteurs liés aux patients (la description des symptômes ou le temps écoulé depuis leur apparition; 23,5 %) et les limites inhérentes au diagnostic du STEMI par électrocardiogramme chez les femmes (23,5 %) étaient les facteurs les plus fréquemment mentionnés comme sources de biais liés au sexe dans les systèmes d’orientation pour les STEMI. Par ailleurs, les biais implicites dans l’algorithme d’orientation et les biais des prestataires de soins préhospitaliers et des médecins n’étaient pas des facteurs contributifs jugés importants. Conclusions: Bien que des systèmes d’activation préhospitaliers soient en place dans tous les centres répondants, moins de la moitié d’entre eux ont rapporté faire le suivi des différences liées au sexe, et la plupart des répondants étaient d’avis que leur système préhospitalier de prise en charge des STEMI ne comportait pas de biais liés au sexe.

Background: Severe COVID-19 is associated with neutrophilic inflammation and immunothrombosis. Several members of the IL-17 cytokine family have been associated with neutrophilic inflammation and activation of the endothelium. Therefore, we investigated whether these cytokines were associated with COVID-19. Methods: We investigated the association between COVID-19 and circulating plasma levels of IL-17 cytokine family members in participants to the Biobanque québécoise de la COVID-19 (BQC19), a prospective observational cohort and an independent cohort from Western University (London, Ontario). We measured the in vitro impact of IL-17F on intercellular adhesion molecule 1 (ICAM-1) cell surface expression and neutrophil adhesion on endothelial cells in culture. The contribution of two Mitogen Activated Protein Kinase (MAPK) pathways was determined using small molecule inhibitors PD184352 (a MKK1/MKK2 inhibitor) and BIRB0796 (a p38 MAPK inhibitor). Results: We found increased IL-17D and IL-17F plasma levels when comparing SARS-CoV-2-positive vs negative hospitalized participants. Moreover, increased plasma levels of IL-17D, IL-17E and IL-17F were noted when comparing severe versus mild COVID-19. IL-17F, but not IL-17A, was significantly elevated in people with COVID-19 compared to healthy controls and with more severe disease. In vitro work on endothelial cells treated with IL-17F for 24h showed an increase cell surface expression of ICAM-1 accompanied by neutrophil adhesion. The introduction of two MAPK inhibitors significantly reduced the binding of neutrophils while also reducing ICAM-1 expression at the surface level of endothelial cells, but not its intracellular expression. Discussion: Overall, these results have identified an association between two cytokines of the IL-17 family (IL-17D and IL-17F) with COVID-19 and disease severity. Considering that IL-17F stimulation promotes neutrophil adhesion to the endothelium in a MAPK-dependent manner, it is attractive to speculate that this pathway may contribute to pathogenic immunothrombosis in concert with other molecular effectors. [ABSTRACT FROM AUTHOR]

Background: Boys use cannabis at a younger age and more frequently than girls. It has been suggested these sex differences might vary according to students' relationship to school. We explored whether the association between sex and adolescents' cannabis use varies among schools and according to students' school connectedness. Methods: The study population consisted of all students from 11 secondary schools in the greater Québec City area. The sample included 6185 respondents in years 1 to 5 at the secondary level (equivalent to grades 7-11). Study outcomes were monthly cannabis use and early cannabis use. Results: The association between sex and monthly cannabis use varied significantly among schools after controlling for students' main characteristics and school socioeconomic environment. We found a statistically significant modifying effect of school connectedness on the association between sex and monthly cannabis use. For early cannabis use, we found no modifying effect of school connectedness nor any association with sex. Conclusions: Measures to reduce adolescents' cannabis use could be better adapted to local context and more tailored to specific higher-risk groups. School connectedness is a protective factor for cannabis use, although this effect appears stronger for girls than boys.

Introduction : La détresse psychologique est fréquente chez la population étudiante universitaire. Sa prévalence s’élève entre 26,6% et 65,3% chez des étudiant·es du domaine infirmier de divers pays pendant la pandémie de COVID-19. Les stresseurs psychosociaux académiques, parmi lesquels figurent la surcharge de travail et le manque de soutien social, semblent nuire à la santé mentale. Davantage d’études sont requises pour comprendre cette association, notamment en contexte de pandémie. Objectifs : Cette étude a été menée auprès d’étudiant·es du domaine infirmier du Québec durant la pandémie de COVID-19. Elle visait à 1) examiner la prévalence d’exposition aux stresseurs psychosociaux académiques et de détresse psychologique; 2) évaluer les associations entre les stresseurs psychosociaux académiques et la détresse psychologique. Méthode : Cette étude s’appuyait sur un devis corrélationnel transversal. Les données ont été collectées au moyen d’un questionnaire en ligne auto-administré auprès de 230 étudiant·es du domaine infirmier. Des modèles de régression Poisson robustes ont permis d’évaluer si les stresseurs (demandes psychologiques élevées, latitude décisionnelle faible, soutien social faible, reconnaissance faible, surinvestissement) accroissent la prévalence de la détresse psychologique (Kessler-6, où un résultat ≥7/24 correspond à une détresse psychologique élevée ou très élevée). Résultats : La détresse psychologique touchait 77% des étudiant·es. L’exposition était plus importante pour les demandes psychologiques élevées (75,65%) et le surinvestissement (53,91%). Après ajustement, seul le surinvestissement augmentait la prévalence de la détresse psychologique (RP : 1,91; IC95% 1,05-3,47). Discussion et conclusion : Les résultats s’alignent à ceux de recherches précédentes. Le surinvestissement est une caractéristique personnelle, mais il est possible qu’il soit encouragé par une surcharge de travail. Les résultats suggèrent que le surinvestissement ait un impact néfaste sur la santé mentale étudiante.

Background: The management of atrial fibrillation and/or flutter (AF) patients requiring percutaneous coronary intervention (PCI) has evolved significantly. The Canadian Cardiovascular Society AF guidelines, last updated in 2020, seek to aid physicians in balancing both bleeding and thrombotic risks. Methods: A tertiary academic centre registry of patients with AF who had PCI was examined for the antithrombotic therapy at discharge in 4 time periods (cohort 2010–2011; cohort 2014–2015; cohort 2017; cohort 2019). Discharge prescription patterns were compared among the cohorts, using the χ2 test. In addition, antithrombotic management in cohorts 2017 and 2019 were compared to guideline-expected therapy, using the χ2 test. Results: A total of 576 AF patients undergoing PCI were included. Clinical and procedural characteristics were similar among cohorts, except for an increase in drug-eluting stent use in the most recent cohort (94% vs 99%; P = 0.04). The rate of oral anticoagulation increased over time (75% vs 89%; P < 0.01), driven primarily by an increase in direct oral anticoagulants prescription (63% vs 84%; P < 0.01). In contrast to previous cohorts, there was no significant difference between the observed and the guideline-expected anticoagulation rate in cohort 2019 (89% vs 94%; P = 0.23). Conclusions: A combination of expert guidance and educational initiatives in the past decade contributed to dramatic changes in the management of patients with AF undergoing PCI. Résumé: Introduction: La prise en charge des patients atteints de fibrillation auriculaire et/ou de flutter (FA) qui ont besoin d'une intervention coronarienne percutanée (ICP) a considérablement évolué. La dernière révision, en 2020, des lignes directrices sur la FA de la Société canadienne de cardiologie vise à aider les médecins à établir l’équilibre entre les risques d'hémorragie et de thrombose. Méthodes: Nous avons fouillé le registre d'un centre universitaire en soins tertiaires portant sur des patients atteints de FA qui avaient subi une ICP pour nous pencher sur le traitement antithrombotique offert à la sortie de l'hôpital de quatre périodes (cohorte 2010–2011; cohorte 2014–2015; cohorte 2017; cohorte 2019). Nous avons comparé les pratiques en matière d'ordonnances à la sortie de l'hôpital entre les cohortes à l'aide du test du χ2. De plus, nous avons comparé la prise en charge des cohortes de 2017 et de 2019 qui avaient reçu le traitement antithrombotique à celles qui avaient reçu le traitement prévu dans les lignes directrices à l'aide du test du χ2. Résultats: Nous avons sélectionné un total de 576 patients atteints de FA qui avaient subi une ICP. Les caractéristiques cliniques et interventionnelles étaient similaires entre les cohortes, à l'exception d'une augmentation de l'utilisation d'une endoprothèse médicamentée dans la plus récente cohorte (94 % vs 99 %; P = 0,04). Le taux d'anticoagulation par voie orale qui avait augmenté au fil du temps (75 % vs 89 %; P

Abstract Mesoplasma florum, a fast‐growing near‐minimal organism, is a compelling model to explore rational genome designs. Using sequence and structural homology, the set of metabolic functions its genome encodes was identified, allowing the reconstruction of a metabolic network representing ˜ 30% of its protein‐coding genes. Growth medium simplification enabled substrate uptake and product secretion rate quantification which, along with experimental biomass composition, were integrated as species‐specific constraints to produce the functional iJL208 genome‐scale model (GEM) of metabolism. Genome‐wide expression and essentiality datasets as well as growth data on various carbohydrates were used to validate and refine iJL208. Discrepancies between model predictions and observations were mechanistically explained using protein structures and network analysis. iJL208 was also used to propose an in silico reduced genome. Comparing this prediction to the minimal cell JCVI‐syn3.0 and its parent JCVI‐syn1.0 revealed key features of a minimal gene set. iJL208 is a stepping‐stone toward model‐driven whole‐genome engineering.

Soil disturbance resulting from tuber crop harvesting is a major threat to soil health. The depth of soil intervention is a critical factor that further strengthens the effects of such disturbance and makes harvest one of the most harmful cropping operations. In the case of potato, soil moisture is a determining factor for root and stolon development, hence, a deeper soil intervention may be required at harvest. While potato ranks as the fourth most cultivated crop worldwide, the impact of soil moisture on potato tuber vertical and horizontal distribution has received very little attention. The objective of this study was to evaluate the effects of four soil matric potential thresholds (SMPTs; –10, –20, –30, and –45 kPa) on the spatial (vertical and horizontal) distribution of potato tubers grown in plastic containers filled with sandy soil using an X-ray computed tomography scanner. The results of the experiments conducted in a greenhouse environment suggest that the horizontal distribution of the tubers did not differ significantly across the irrigation treatments. However, a linear relationship between SMPT, and therefore irrigation threshold, and potato tuber depth was observed. In addition, the deepest tuber position was observed under the –10 kPa SMPT, while the tubers were closer to the soil surface under the –45 kPa SMPT, which could lead to a greater preponderance of tuber diseases such as late blight or greening. Thus, potato irrigation events implementing a SMPT between –20 and –30 kPa could reduce the harvest depth, hence, decreasing the negative impacts of soil disturbance on soil structural stability and soil organic carbon degradation while mitigating the impacts of disease as well as reducing fuel costs, greenhouse gas emissions, soil loss and erosion.

Background: ST-elevation myocardial infarction diagnosis at first medical contact (FMC) and prehospital cardiac catheterization laboratory (CCL) activation are associated with reduced total ischemic time and therefore have become the dominant ST-elevation myocardial infarction referral method in primary percutaneous coronary intervention systems. We sought to determine whether physician oversight was associated with improved diagnostic performance in a prehospital CCL activation system and what effect the additional interpretation has on treatment delay. Methods: Between 2012 and 2015, all patients in 2 greater Montreal catchment areas with a chief symptom of chest paint or dyspnea had an in-the-field electrocardiogram (ECG). A machine diagnosis of “acute myocardial infarction” resulted either in automatic CCL (automated cohort without oversight) or transmission of the ECG to the receiving centre emergency physician for reinterpretation before CCL activation. System performance was assessed in terms of the proportion of false positive and inappropriate activations (IA), as well as the proportion of patients with FMC-to-device times ≤ 90 minutes. Results: Four hundred twenty-eight (428) activations were analyzed (311 automated; 117 with physician oversight). Physician oversight tended to decrease IAs (7% vs 3%; P = 0.062), but was also associated with a smaller proportion of patients achieving target FMC-to-device (76% vs 60%; P < 0.001). There was no significant effect on the proportion of false positive activation. Conclusions: Real-time physician oversight might be associated with fewer IAs, but also appears to have a deleterious effect on FMC-to-device performance. Identifying predictors of IA could improve overall performance by selecting ECGs that merit physician oversight and streamlining others. Larger clinical studies are warranted. Résumé: Contexte: Un diagnostic d’infarctus du myocarde avec élévation du segment ST au moment du premier contact avec un professionnel de la santé et l’activation du processus de cathétérisme cardiaque avant l’arrivée à l’hôpital sont associés à une réduction de la durée totale de l’épisode ischémique, et sont donc désormais la méthode de préférence en cas d’infarctus du myocarde avec élévation du segment ST dans les établissements où l’intervention coronarienne percutanée primaire est possible. Nous avons voulu déterminer si la supervision par un médecin était associée à une amélioration de la justesse du diagnostic dans un tel contexte et les répercussions d’une interprétation additionnelle sur les délais de traitement. Méthodologie: De 2012 à 2015, tous les patients de deux zones desservies du Grand Montréal qui présentaient comme principal symptôme une douleur à la poitrine ou une dyspnée ont subi un électrocardiogramme (ECG) sur le terrain. Un diagnostic d’infarctus aigu du myocarde posé par l’appareil a automatiquement donné lieu à l’activation du processus de cathétérisme cardiaque (cohorte automatisée sans supervision) ou à la transmission de l’ECG à l’urgentologue de l’établissement où le patient était conduit pour la réinterprétation des résultats avant l’activation du processus de cathétérisme cardiaque. La performance du système a été évaluée en fonction de la proportion de faux positifs et d’activations inappropriées, ainsi que de la proportion de patients chez qui le délai entre le premier contact avec un professionnel de la santé et l’intervention était ≤ 90 minutes. Résultats: Quatre cent vingt-huit (428) activations du processus ont été analysées (311 automatisées; 117 après la supervision par un médecin). La supervision par un médecin était associée à une baisse non significative des activations inappropriées du processus (7 % vs 3 %; p = 0,062), mais était aussi associée à une plus faible proportion de patients chez qui le délai visé entre le premier contact avec un professionnel de la santé et l’intervention était respecté (76 % vs 60 %; p < 0,001). Aucun effet significatif quant à la proportion de faux positifs n’a été observé. Conclusions: La supervision en temps réel par un médecin pourrait être associée à une réduction des activations inappropriées du processus de cathétérisme cardiaque urgent, mais pourrait également nuire aux résultats quant au délai entre le premier contact avec un professionnel de la santé et l’intervention. L’identification des facteurs prédictifs d’une activation inappropriée du processus pourrait améliorer les résultats globaux en permettant de choisir les résultats d’ECG qui mériteraient d’être passés en revue par le médecin, et en déclenchant le processus habituel pour les autres. Des études cliniques de plus grande envergure sont de mise.

Abstract Soil organic carbon (SOC) has a significant effect on the carbon cycle, playing a vital role in environmental services and crop production. Increasing SOC stock is identified as an effective way to improve carbon dioxide sequestration, soil health, and plant productivity. Knowing soil water is one of the primary SOC decomposition driver, periods in the crops growth stages with increased water movement might influence the SOC dynamics. Here, we evaluate the temporal effect of four precision irrigation thresholds ( $$-15$$ - 15 , $$-30$$ - 30 , $$-45$$ - 45 , and $$-60$$ - 60 kPa) in potato crop on SOC dynamics using the Partial Least Square algorithm and the Tea Bag Index in a sandy soil under potato production. The difference of SOC decomposition rate between the precision irrigation thresholds is developed in the second quarter of the growing season, between 38 and 53 days after planting. This critical period occurred in a stage of strong vegetative growth and rapid irrigation cycles. The precision irrigation threshold affected the decomposition rate of SOC. A faster decomposition of labile organic carbon was promoted by water excess ( $$-15$$ - 15 kPa). The dryer ( $$-30$$ - 30 , $$-45$$ - 45 , and $$-60$$ - 60 kPa) precision irrigation thresholds did not show any differences. The advancement of this knowledge may promote soil health conservation and carbon sequestration in agricultural soil.

Abstract Bacterial infections are commonly treated with antimicrobials, but the rise of multi‐drug resistance and the presence of biofilms can compromise treatment efficacy. Recently, new approaches using live bacteria or engineered microorganisms have gained attention in the fight against several diseases. In their recent work, Lluch‐Senar and colleagues (Garrido et al, 2021) genetically modified the lung pathogen Mycoplasma pneumoniae to attenuate its virulence and secrete antibiofilm and bactericidal enzymes. Their strategy successfully altered a Staphylococcus aureus biofilm on catheters implanted in mice, providing an additional demonstration of the potential of genetically engineered microorganisms as therapeutic agents.

Abstract The near‐minimal bacterium Mesoplasma florum is an interesting model for synthetic genomics and systems biology due to its small genome (~ 800 kb), fast growth rate, and lack of pathogenic potential. However, fundamental aspects of its biology remain largely unexplored. Here, we report a broad yet remarkably detailed characterization of M. florum by combining a wide variety of experimental approaches. We investigated several physical and physiological parameters of this bacterium, including cell size, growth kinetics, and biomass composition of the cell. We also performed the first genome‐wide analysis of its transcriptome and proteome, notably revealing a conserved promoter motif, the organization of transcription units, and the transcription and protein expression levels of all protein‐coding sequences. We converted gene transcription and expression levels into absolute molecular abundances using biomass quantification results, generating an unprecedented view of the M. florum cellular composition and functions. These characterization efforts provide a strong experimental foundation for the development of a genome‐scale model for M. florum and will guide future genome engineering endeavors in this simple organism.

Background: Antithrombotic management following acute coronary syndromes (ACSs) has evolved significantly. However, given lingering uncertainty as to when an ACS may be considered stable, there is the possibility of practice divergence beyond the first year. Methods: An online adaptive survey describing patients with varying cardiac and extracardiac ischemic risk was developed in order to asses self-reported physician practice intentions pertaining to the antithrombotic management of ACS patients who lack a formal indication for therapeutic anticoagulation. Provincial “champions” (Prince Edward Island not represented) were identified to ensure dissemination of the survey within their jurisdictions via 3 coordinated e-mailings; the survey was made available in French and English from November 2018 through January 2019. Results: A total of 135 practitioners responded to the survey (response rate 15%). Surveys were fully completed in all cases. Nearly all respondents (97%) were cardiologists; 76% worked at an academic center, and 54% had been in practice ≥ 10 years. Most respondents (81%-90%, depending on the scenario) preferred ticagrelor-based dual antiplatelet therapy as the initial ACS treatment. However, beyond 12 months, management decisions differed significantly according to the balance of cardiac and extracardiac risk. Conclusions: This study provides a first look at how the introduction of rivaroxaban 2.5 mg might be integrated into the clinical management of ACS patients beyond the first year in Canada. Whether to pursue dual antiplatelet therapy or transition early to low-dose rivaroxaban plus acetylsalicylic acid will likely be driven by patient clinical characteristics and perceived cardiac vs extra-cardiac ischemic risk. Résumé: Contexte: La prise en charge antithrombotique des patients ayant subi un syndrome coronarien aigu (SCA) a sensiblement évolué au fil du temps. Toutefois, compte tenu de l’incertitude qui persiste quant aux critères définissant un SCA stable, il est possible que les pratiques divergent après la première année. Méthodologie: Nous avons mis au point un questionnaire adaptatif en ligne décrivant les cas de patients présentant divers degrés de risque d’ischémie cardiaque ou extracardiaque, afin d’évaluer les objectifs autodéclarés des médecins quant à la prise en charge antithrombotique des patients ayant subi un SCA chez qui une anticoagulothérapie n’est pas formellement indiquée. Des « champions » provinciaux (l’Île-du-Prince-Édouard n’étant pas représentée) ont été désignés pour assurer la diffusion du questionnaire dans leur province respective en trois envois par courriel coordonnés; le questionnaire était offert en français et en anglais, et l’enquête s’est déroulée de novembre 2018 à janvier 2019. Résultats: Au total, 135 praticiens ont répondu au sondage (taux de réponse : 15 %). Tous les participants ont répondu à toutes les questions. Presque tous les participants (97 %) étaient cardiologues; 76 % des participants travaillaient dans un centre universitaire, et 54 % exerçaient depuis 10 ans ou plus. La plupart des participants (de 81 à 90 %, selon le scénario) préféraient une bithérapie antiplaquettaire à base de ticagrélor comme premier traitement après un SCA. Toutefois, les décisions quant au traitement au-delà des 12 premiers mois suivant le SCA variaient considérablement selon le risque cardiaque et extracardiaque résiduel évalué. Conclusions: L’étude constitue une première évaluation de la façon dont le rivaroxaban à 2,5 mg pourrait être intégré à la stratégie canadienne de prise en charge des patients au-delà de la première année suivant le SCA. Le choix de poursuivre la bithérapie antiplaquettaire ou de faire promptement la transition vers un traitement associant rivaroxaban à faible dose et acide acétylsalicylique dépendra vraisemblablement des caractéristiques cliniques du patient et du risque d’ischémie cardiaque et extracardiaque perçu.

This joint Canadian Heart Failure Society and the CCS Heart Failure guidelines report has been developed to provide a pan-Canadian snapshot of the current state of clinic-based ambulatory heart failure (HF) care in Canada with specific reference to elements and processes of care associated with quality and high performing health systems. It includes the viewpoints of persons with lived experience, patient care providers, and administrators. It is imperative to build on the themes identified in this survey, through engaging all health care professionals, to develop integrated and shared care models that will allow better patient outcomes. Several patient and organizational barriers to care were identified in this survey, which must inform the development of regional care models and pragmatic solutions to improve transitions for this patient population. Unfortunately, we were unsuccessful in incorporating the perspectives of primary care providers and internal medicine specialists who provide the majority of HF care in Canada, which in turn limits our ability to comment on strategies for capacity building outside the HF clinic setting. These considerations must be taken into account when interpreting our findings. Engaging all HF care providers, to build on the themes identified in this survey, will be an important next step in developing integrated and shared care models known to improve patient outcomes. Résumé: Ce rapport conjoint des lignes directrices de la Société canadienne d'insuffisance cardiaque et de la Société canadienne de cardiologie (SCC) sur l'insuffisance cardiaque a été élaboré pour fournir un aperçu pancanadien de l'état actuel des soins ambulatoires de l'insuffisance cardiaque (IC) en clinique au Canada, en se référant spécifiquement aux éléments et aux processus de soins associés à des systèmes de santé très performants et de qualité. Il comprend les points de vue de personnes ayant une expérience vécue de l'IC, de prestataires de soins aux patients et d'administrateurs. Il est impératif de s'appuyer sur les thématiques identifiées dans cette enquête, en y engageant tous les professionnels de la santé, pour développer des modèles de soins intégrés et partagés qui permettront de meilleurs pronostics pour les patients. Plusieurs obstacles relatifs aux patients et organisationnels dont il faudra se soucier ont été identifiés dans cette enquête, qui doit servir de base à l'élaboration de modèles de soins régionaux et de solutions pragmatiques pour améliorer les transitions pour cette population de patients. Malheureusement, nous n'avons pas réussi à intégrer les points de vue des prestataires de soins primaires et des spécialistes en médecine interne qui fournissent la majorité des soins en IC au Canada, ce qui limite notre capacité à commenter les stratégies de renforcement des capacités en dehors du cadre des cliniques d’IC. Ces considérations doivent être prises en compte lors de l'interprétation de nos conclusions. L'engagement de tous les prestataires de soins de santé en IC à s'appuyer sur les thématiques identifiées dans cette enquête constituera une prochaine étape importante dans le développement de modèles de soins intégrés et partagés connus pour améliorer le pronostic des patients.