Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak.

BACKGROUND: The outbreak of chilblain-like lesions (CLL) during the COVID-19 pandemic has been reported extensively, potentially related to SARS-CoV-2 infection, yet its underlying pathophysiology is unclear. OBJECTIVES: To study skin and blood endothelial and immune system activation in CLL in comparison with healthy controls and seasonal chilblains (SC), defined as cold-induced sporadic chilblains occurring during 2015 and 2019 with exclusion of chilblain lupus. METHODS: This observational study was conducted during 9-16 April 2020 at Saint-Louis Hospital, Paris, France. All patients referred with CLL seen during this period of the COVID-19 pandemic were included in this study. We excluded patients with a history of chilblains or chilblain lupus. Fifty patients were included. RESULTS: Histological patterns were similar and transcriptomic signatures overlapped in both the CLL and SC groups, with type I interferon polarization and a cytotoxic-natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL. CONCLUSIONS: Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN-polarized cells leading to clinical manifestations.

The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage (PPH) is a major source of maternal morbidity. OBJECTIVES: This study's objective was to determine whether changes in hemostasis markers during the course of PPH are predictive of its severity. PATIENTS AND METHODS: We enrolled 128 women with PPH requiring uterotonic prostaglandin E2 (sulprostone) infusion. Two groups were defined (severe and non-severe PPH) according to the outcome during the first 24 hours. According to our criteria, 50 of the 128 women had severe PPH. Serial coagulation tests were performed at enrollment (H0), and 1, 2, 4 and 24 hours thereafter. RESULTS: At H0, and through H4, women with severe PPH had significantly lower fibrinogen, factor V, antithrombin activity, protein C antigen, prolonged prothrombin time, and higher D-dimer and TAT complexes than women with non-severe PPH. In multivariate analysis, from H0 to H4, fibrinogen was the only marker associated with the occurrence of severe PPH. At H0, the risk for severe PPH was 2.63-fold higher for each 1 gL(-1) decrease of fibrinogen. The negative predictive value of a fibrinogen concentration >4 gL(-1) was 79% and the positive predictive value of a concentration

[Interference between a dual-chamber pacemaker and argon electrocautery device during hepatectomy]. / Interférence entre un stimulateur cardiaque double-chambre et un bistouri à argon au cours d'une hépatectomie.

We report an unusual electromagnetic interference induced by an argon electrocautery device during a left hepatectomy on a dual chamber pacemaker, implanted for sinus node dysfunction in 87-year-old patient. Argon electrocautery induced inhibition of atrial stimulation and occurrence of irregular ventricular triggered activity. Normal pacemaker function resumed after electrocautery interruption. This case illustrates the need to focus on cardiac rhythm when a new electrical device is used in a pacemaker patient.

[Prognostic factors of pregnancy in intra-uterine insemination with sperm of donor: a review of 535 cycles over 7 years]. / Facteurs pronostiques de grossesse en insémination intra-utérine avec sperme de donneur: analyse sur 535 cycles.

AIM: To determine the pronostic factors of pregnancy in intra-uterine insemination using sperm of donor (IIU-D) by analysing female factors, data from the ovarian stimulation and even the characteristics of the donor selected for the recipient couple. MATERIAL AND METHODS: Retrospective study between January 2002 and December 2009. It took place at the University and Hospital of Amiens over 149 couples performing a total of 535 IIU-D cycles. Factors related to the pregnancy were defined thanks to uni and multivariate analysis. RESULTS: Female age was 30.6 ± 4.3 years old (6% of the cycles with women>38). The initiated pregnancy rate per cycle was 27.9%; the birth rate per cycle was 20.4% and the cumulative live birth rate over 63.4% for six cycles. In multivariate analysis prognostic factors of success were: day 3 of estradiol level less than 80 pg/mL (P<0.05), no tube defects (P=0.022), cured and benign womb pathology (P=0.005), a higher number of follicles greater than 16 mm the day of the ovulation triggering (P=0.0018) and a higher number of pregnancies already obtained by the donor in ART in the CECOS (P<0.001). Neither the female age nor the donor age was associated with a probability of success. DISCUSSION AND CONCLUSION: Classical pronostic factors concerning the female profile and the ovarian stimulation quality have been found. But the most interesting and original part is that the most significant factor concerns the donor and his history of pregnancy in Assisted Reproductive Technology (ART) in the center. This may be very useful to guide the choice of the donor for the recipients.

Effects of HIV protease inhibitors on cardiac conduction velocity in unselected HIV-infected patients.

We examined the prevalence and the extent of prolongation of the PR and QRS intervals and their relation to anti-HIV treatments and other clinical characteristics in 970 HIV-infected patients, 749 treated with antiretroviral therapy and 221 untreated. Age, body mass index, heart rate, and treatment with ß-blockers and HIV protease inhibitors (PIs) were independent predictors of increase in the duration of the PR interval. Male gender, Caucasian ethnicity, heart rate, duration of antiretroviral therapy, and use of PIs were independent predictors of an increase in the duration of the QRS interval. Users of HIV PIs had an adjusted QRS-interval duration that was 2.6 ms (95% confidence interval (CI) 1.4-3.9) longer than the interval in nonusers (P = 0.0004). The adjusted odds ratios of first-degree atrioventricular block (n = 54) and complete bundle branch block (n = 23) were 1.62 (95% CI 0.90-2.89; P = 0.10) and 2.71 (95% CI 1.10-7.13; P = 0.03), respectively, in patients taking PIs. These findings may have important clinical implications, particularly with respect to QRS prolongation in patients with myocardial ischemia or heart failure.

Factors influencing indoor concentrations of nitric oxide in a Parisian intensive care unit.

In low concentrations, inhaled nitric oxide (NO) increases arterial oxygenation in patients with severe acute respiratory distress syndrome. When present in the ambient atmosphere, NO and its oxidative derivate, nitrogen dioxide (NO2), are considered pollutants. The aim of this study was to assess whether the administration of inhaled NO to mechanically ventilated patients was associated with an increased risk of exposure to NO and NO2 for medical and paramedical staff. During a 1-yr period, indoor and outdoor NO and NO2 concentrations were measured using chemiluminescence in a 14-bed intensive care unit (ICU) to assess the possible influence of therapeutic NO administration on indoor pollution. Ambient concentrations of NO within the ICU were 237 +/- 147 parts per billion (ppb) during periods of NO administration and 289 +/- 147 ppb during periods without NO administration (mean +/- SD, NS). Indoor concentrations of NO and NO2 were entirely dependent on outdoor concentrations and were mainly influenced by climatic conditions such as atmospheric pressure, mass of clouds, and speed of the wind. Therapeutic administration of concentrations of inhaled NO < or = 5 ppm to critically ill patients did not affect the ambient concentration of NO and NO2 within the ICU, which was mainly dependent on the outdoor air pollution. As a consequence, scavenging of exhaust NO from the breathing circuit in the ventilator does not appear mandatory in ICUs located in areas with significant urban pollution when NO concentrations < or = 5 ppm are administered.