A multi-faceted framework of diversity for prioritizing the conservation of fish assemblages

Floodplain waterbodies and their biodiversity are increasingly threatened by human activities. Given the limited resources available to protect them, methods to identify the most valuable areas for biodiversity conservation are urgently needed. In this study, we used freshwater fish assemblages in floodplainwaterbodies to propose an innovative method for selecting priority areas based on four aspects of their diversity: taxonomic (i.e. according to species classification), functional (i.e. relationship between speciesand ecosystem processes), natural heritage (i.e. species threat level), and socio-economic (i.e. species interest to anglers and fishermen) diversity. To quantitatively evaluate those aspects, we selected nine indices derived either from metrics computed at the species level and then combined for each assemblage (species rarity, origin, biodiversity conservation concern, functional uniqueness, functional originality, fishing interest), or from metrics directly computed at the assemblage level (species richness, assemblage rarity, diversity of biological traits). Each of these indices belongs to one of the four aspects of diversity. A synthetic index defined as the sum of the standardized aspects of diversity was used to assess the multifaceted diversity of fish assemblages. We also investigated whether the two main environmental gradients at the catchment (distance from the sea) and at the floodplain (lateral connectivity of the waterbodies) scales influenced the diversity of fish assemblages, and consequently their potential conservation value. Finally, we propose that the floodplain waterbodies that should be conserved as a priority are those located in the downstream part of the catchment and which have a substantial lateral connectivity with the main channel

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Evolution of Endoscopic Lesions in Steroid-Refractory Acute Severe Ulcerative Colitis Responding to Infliximab or Cyclosporine

BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS: Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS: Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS >= 6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p CONCLUSION: In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.Peer reviewe

Adherent-invasive Escherichia coli in Crohn’s disease: the 25th anniversary

In 1998, Arlette Darfeuille-Michaud, Christel Neut and Jean-Frederic Colombel discovered a novel pathovar of Escherichia coli, adherent and invasive Escherichia coli (AIEC), in the ileum of patients with Crohn's disease (CD), that was genetically distinct from diarrheagenic E. coli, could adhere to and invade intestinal epithelial cells and survive in macrophages. The consistent association between AIEC and CD (approximately 30% across the world), their ability to exploit CD-associated genetic traits, and virulence in preclinical colitis models but not healthy hosts spurred global research to elucidate their pathogenicity. Research focused on integrating AIEC with the microbiome, metabolome, metagenome, host response and the impact of diet and antimicrobials has linked the luminal microenvironment and AIEC metabolism to health and disease. This deeper understanding has led to therapeutic trials and precision medicine targeting AIEC-colonised patients. In November 2023, prominent members of the AIEC research community met to present and discuss the many facets of basic, translational and clinical AIEC fields at 'AIEC: past, present and future' in NYC. This review is a summary of this international meeting highlighting the history of AIEC, knowledge accumulated over the past 25 years about its pathogenic properties and proposes a standardised approach for screening patients for AIEC

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P &lt; 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Dépistage endoscopique de la dysplasie colique au cours des MICI : pour qui, quand et comment ?

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Study of the behavior of macrophages against adherent and invasive Escherichia coli isolated from patients with Crohn's disease according to susceptibility factors of the host.

La maladie de Crohn (MC) est une maladie inflammatoire chronique de l’intestin (MICI), dont la physiopathologie résulterait d’une interaction anormale entre le microbiote intestinal et le système immunitaire de l’hôte sous l’influence de facteurs génétiques et environnementaux. Au sein de ce microbiote, les E. coli adhérents et invasifs (AIEC) colonisent la muqueuse iléale des patients atteints de la MC et sont capables de survivre et se multiplier à l’intérieur des macrophages. Par ailleurs, les objectifs thérapeutiques de la MC et notamment la cicatrisation muqueuse endoscopique nécessitent des endoscopies répétées, peu acceptables du point de vue des patients. Parmi les moyens alternatifs, la calprotectine fécale est le marqueur fécal de référence même si ses performances semblent diminuées dans certaines situations comme la maladie iléale pure. Le premier objectif de ces travaux étaient de comparer la capacité des macrophages dérivés de monocytes (MDM) issus de patients atteints de MC, de rectocolite hémorragique (RCH) ou de sujets sains à contrôler l’infection par les AIEC et d’identifier les facteurs associés à cette multiplication des AIEC et notamment le rôle des polymorphismes génétiques associés à la MC en lien avec l’autophagie. Les AIEC se multipliaient de manière plus importante que la souche non pathogène K12 dans les macrophages quel que soit leur origine. L’entrée des AIEC (1h post- infection) ne variait pas en fonction de la provenance des macrophages. La survie des AIEC était augmentée dans les MDM issus de patients MC comparés à ceux issus de RCH ou de sujets contrôles. En analyse multivariée, cette survie était positivement corrélée à la sécrétion d’IL1β mais était diminuée en présence des variants à risque pour ULK1 (p=0,046) et XBP1 (p=0,014). Les MDM issus de patients MC étaient incapable de contrôler la multiplication des AIEC contrairement à ceux issus de RCH ou de sujets contrôles d’autant plus en présence du variant à risque pour IRGM (p=0,045). L’infection des MDM de patients MC par les bactéries AIEC induit un profil de sécrétion cytokinique pro-inflammatoire. La deuxième partie de ces travaux avait pour but de comparer les performances de la chitinase 3-like 1 fécale (CHI3L1), une protéine de l’hôte interagissant avec un facteur de virulence des AIEC, et la métalloprotéase matricielle 9 (MMP-9) pour détecter l’activité inflammatoire endoscopique de la MC en comparaison du marqueur fécal de référence, la calprotectine. Les taux de CHI3L1, de MMP-9 et de calprotectine fécales étaient corrélés au ‘Crohn’s Disease Endoscopic Index of Severity’ (CDEIS) et étaient significativement augmentés en présence d’ulcérations endoscopiques. En cas d’atteinte iléale pure, la CHI3L1 fécale semblait mieux corrélée au CDEIS que la calprotectine fécale. Le seuil de CHI3L1 fécale de 15 ng/g présentait de meilleures performances que la calprotectine fécale pour détecter la présence d’ulcérations endoscopiques. La MMP-9 étaient un marqueur performant pour détecter la présence de lésions endoscopiques dans les MICI. En conclusion, nous avons montré qu’il existe un défaut des macrophages à contrôler l’infection par les bactéries AIEC chez les patients atteints de MC en rapport avec les variants à risque impliqués dans l’autophagie conduisant à un phénotype de macrophages pro-inflammatoires. La CHI3L1 fécale, connue comme une protéine de l’hôte interagissant avec un facteur de virulence des AIEC, tout comme la MMP-9 semblent être de bons marqueurs d’activité endoscopique dans les MICI.Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) whose pathophysiology results from an abnormal interaction between the gut microbiota and the host's immune system under the influence of genetic and environmental factors. . Within this microbiota, adherent and invasive E. coli (AIEC) colonize the ileal mucosa of patients with CD and are able to survive and multiply within macrophages. Moreover, the therapeutic objectives of CD, and especially endoscopic mucosal healing, require repeated endoscopies, which are not acceptable from the patients' point of view. Among alternative means, fecal calprotectin is the fecal marker of reference even if its performance seems to be diminished in certain situations like pure ileal disease. The primary objective of this work was to compare the ability of monocyte-derived macrophages (MDM) from patients with CD, ulcerative colitis (UC) or healthy subjects to control AIEC infection and to identify associated with this multiplication of AIEC and in particular the role of genetic polymorphisms associated with CD in connection with autophagy. AIEC multiplied more than non-pathogenic strain K12 in macrophages irrespective of their origin. The entry of the AIEC (1h post-infection) did not vary according to the origin of the macrophages. The survival of AIEC was increased in MDM from MC patients compared to those from HCR or control subjects. In multivariate analysis, this survival was positively correlated with the secretion of IL1β but was decreased in the presence of the variants at risk for ULK1 (p = 0.046) and XBP1 (p = 0.014). MDM from MC patients were unable to control the multiplication of AIEC, unlike those from HCR or control subjects, especially in the presence of the variant at risk for IRGM (p = 0.045). Infection of MDM from MC patients by AIEC bacteria induces a pro-inflammatory cytokine secretion pattern. The second part of this work aimed to compare the performance of faecal chitinase 3-like 1 (CHI3L1), a host protein interacting with AIEC virulence factor, and matrix metalloprotease 9 (MMP-9). to detect the endoscopic inflammatory activity of MC in comparison with the standard fecal marker, calprotectin. Fecal CHI3L1, MMP-9 and calprotectin levels were correlated with Crohn's Disease Endoscopic Index of Severity (CDEIS) and were significantly increased in the presence of endoscopic ulcerations. In case of pure ileal involvement, fecal CHI3L1 seemed better correlated with CDEIS than fecal calprotectin. The fecal CHI3L1 threshold of 15 ng / g showed better performance than faecal calprotectin in detecting the presence of endoscopic ulcerations. MMP-9 was a powerful marker for detecting the presence of endoscopic lesions in IBD. In conclusion, we have shown that there is a macrophage defect to control infection by AIEC bacteria in patients with CD related to atopic risk variants involved in autophagy leading to a pro-inflammatory macrophage phenotype . Fecal CHI3L1, known as a host protein interacting with AIEC virulence factor, as well as MMP-9 appear to be good markers of endoscopic activity in IBD

Editorial: real‐world evidence of tofacitinib and vedolizumab in ulcerative colitis—are we one step closer to better positioning therapies after anti‐TNF failure? Authors' reply

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