Association between benzodiazepine receptor agonist use and mortality in patients hospitalised for COVID-19: a multicentre observational study.

AIMS: To examine the association between benzodiazepine receptor agonist (BZRA) use and mortality in patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS: A multicentre observational study was performed at Greater Paris University hospitals. The sample involved 14 381 patients hospitalised for COVID-19. A total of 686 (4.8%) inpatients received a BZRA at hospital admission at a mean daily diazepam-equivalent dose of 19.7 mg (standard deviation (s.d.) = 25.4). The study baseline was the date of admission, and the primary endpoint was death. We compared this endpoint between patients who received BZRAs and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, medical comorbidities and other medications. The primary analysis was a Cox regression model with inverse probability weighting (IPW). RESULTS: Over a mean follow-up of 14.5 days (s.d. = 18.1), the primary endpoint occurred in 186 patients (27.1%) who received BZRAs and in 1134 patients (8.3%) who did not. There was a significant association between BZRA use and increased mortality both in the crude analysis (hazard ratio (HR) = 3.20; 95% confidence interval (CI) = 2.74-3.74; p < 0.01) and in the IPW analysis (HR = 1.61; 95% CI = 1.31-1.98, p < 0.01), with a significant dose-dependent relationship (HR = 1.55; 95% CI = 1.08-2.22; p = 0.02). This association remained significant in sensitivity analyses. Exploratory analyses indicate that most BZRAs may be associated with an increased mortality among patients hospitalised for COVID-19, except for diazepam, which may be associated with a reduced mortality compared with any other BZRA treatment. CONCLUSIONS: BZRA use may be associated with an increased mortality among patients hospitalised for COVID-19, suggesting the potential benefit of decreasing dose or tapering off gradually these medications when possible.

A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study.

AIM: The oncological risk/benefit trade-off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic vs open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain). METHODS: This was a multicentre retrospective cohort study of all patients who had surgery with curative intent for primary rectal cancer at Catalonian public hospitals from 2011 to 2012. We obtained follow-up data for up to 5 years. To minimize the differences between the two groups, we performed propensity score matching on baseline patient characteristics. We used multivariate Cox proportional hazards regression analyses to assess locoregional relapse at 2 years and death at 2 and 5 years. RESULTS: Of 1513 patients with Stage I-III rectal cancer, 933 (61.7%) had laparoscopy (conversion rate 13.2%). After applying our propensity score matching strategy (2:1), 842 laparoscopy patients were matched to 517 open surgery patients. Multivariate Cox analysis of death at 2 years [hazard ratio (HR) 0.65, 95% CI 0.48, 0.87; P = 0.004] and 5 years (HR 0.61, 95% CI 0.5, 0.75; P < 0.001) and of local relapse at 2 years (HR 0.44, 95% CI 0.27, 0.72; P = 0.001) showed laparoscopy to be an independent protective factor compared with open surgery. CONCLUSIONS: Laparoscopy results in lower locoregional relapse and long-term mortality in rectal cancer in unselected patients with all-risk groups included. Studies using long-term follow-up of cohorts and unselected data can provide information on clinically relevant outcomes to supplement randomized controlled trials.

Influence of age on variation in patterns of care in patients with rectal cancer in Catalonia (Spain)

Background: Population ageing is a relevant concern in people diagnosed with rectal cancer. This study evaluates the adherence to clinical practice guidelines (CPGs) and patient outcomes in rectal cancer, with a particular focus on variation according to age. Methods: This is a multicentre retrospective cohort study of all patients surgically treated for the first time for primary rectal cancer with curative intent in public hospitals in Catalonia during two study periods: first, with data from 2005 to 2007, and then with data from 2011 to 2012. We obtained the study data through a comprehensive review of patients’ clinical records. Information on diagnosis, treatment and follow-up was collected and then compared with the relevant CPGs. We then performed a descriptive analysis of the categorical variables followed by a univariate and multivariate logistic regression analysis to calculate the odds ratio. Finally, we calculated the recurrence and death rates per person-year at 2 years’ follow-up. Results: In total, 3770 people were included in this study. The participants aged 70 and under were more likely to receive neoadjuvant therapy than those aged over 80 (2005/2007, 63 vs 17.4% p < 0.001; 2011/2012, 72 vs 41.1% p < 0.001); however, in the second study period there was less imbalance between the two groups in this regard, showing improved administration of neoadjuvant therapy in the elderly. The quality of surgery was suboptimal in a larger proportion of the elderly population, and the choice of surgical technique was dependent to some extent on the age of the participant. Recurrence and survival rates were significantly better in the second study period. Conclusions: Compared to younger patients, the most elderly were less likely to receive the recommended adjuvant treatment, laparoscopy and total mesorectal excision. However, we observed improved adherence to the recommended treatment regimen in the most elderly participants, resulting in decreased recurrence and increased survival rates in this population

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Influence of age on variation in patterns of care in patients with rectal cancer in Catalonia (Spain).

BACKGROUND: Population ageing is a relevant concern in people diagnosed with rectal cancer. This study evaluates the adherence to clinical practice guidelines (CPGs) and patient outcomes in rectal cancer, with a particular focus on variation according to age. METHODS: This is a multicentre retrospective cohort study of all patients surgically treated for the first time for primary rectal cancer with curative intent in public hospitals in Catalonia during two study periods: first, with data from 2005 to 2007, and then with data from 2011 to 2012. We obtained the study data through a comprehensive review of patients' clinical records. Information on diagnosis, treatment and follow-up was collected and then compared with the relevant CPGs. We then performed a descriptive analysis of the categorical variables followed by a univariate and multivariate logistic regression analysis to calculate the odds ratio. Finally, we calculated the recurrence and death rates per person-year at 2 years' follow-up. RESULTS: In total, 3770 people were included in this study. The participants aged 70 and under were more likely to receive neoadjuvant therapy than those aged over 80 (2005/2007, 63 vs 17.4% p < 0.001; 2011/2012, 72 vs 41.1% p < 0.001); however, in the second study period there was less imbalance between the two groups in this regard, showing improved administration of neoadjuvant therapy in the elderly. The quality of surgery was suboptimal in a larger proportion of the elderly population, and the choice of surgical technique was dependent to some extent on the age of the participant. Recurrence and survival rates were significantly better in the second study period. CONCLUSIONS: Compared to younger patients, the most elderly were less likely to receive the recommended adjuvant treatment, laparoscopy and total mesorectal excision. However, we observed improved adherence to the recommended treatment regimen in the most elderly participants, resulting in decreased recurrence and increased survival rates in this population.

African humid periods triggered the reactivation of a large river system in Western Sahara.

The Sahara experienced several humid episodes during the late Quaternary, associated with the development of vast fluvial networks and enhanced freshwater delivery to the surrounding ocean margins. In particular, marine sediment records off Western Sahara indicate deposition of river-borne material at those times, implying sustained fluvial discharges along the West African margin. Today, however, no major river exists in this area; therefore, the origin of these sediments remains unclear. Here, using orbital radar satellite imagery, we present geomorphological data that reveal the existence of a large buried paleodrainage network on the Mauritanian coast. On the basis of evidence from the literature, we propose that reactivation of this major paleoriver during past humid periods contributed to the delivery of sediments to the Tropical Atlantic margin. This finding provides new insights for the interpretation of terrigenous sediment records off Western Africa, with important implications for our understanding of the paleohydrological history of the Sahara.

Aldosterone and the control of secretion by the nasal salt gland of the north African desert lizard, Uromastix acanthinurus.

The secretory response of the nasal salt gland of the north African agamid lizard Uromastix acanthinurus to injections of 1 M KCl and NaCl is correlated with changes in circulating levels of the corticosteroids aldosterone and corticosterone. KCl loading led to a progressive rise in plasma aldosterone levels, and NaCl loading was associated with a fall. Neither treatment significantly altered plasma corticosterone concentrations which remained at levels characteristic of unstressed animals. Rates of potassium excretion were positively correlated with circulating levels of aldosterone whereas sodium excretion showed a negative correlation. As in previous studies, injections of exogenous aldosterone or dexamethasone into KCl-loaded animals failed to further stimulate potassium excretion, but did depress sodium excretion by the gland. Spironolactone, an aldosterone antagonist in mammals, was without effect on the rate of potassium excretion in KCl-injected animals. These data suggest that aldosterone functions as a mineralocorticoid on the nasal gland of U. acanthinurus (i.e., natriferic and kaliuretic) but direct evidence of this will require the use of adrenalectomized animals.

[Changes in the internal temperature and the cardiac rhythm of the Saharian lizard, Varanus griseus Daud., using radiotelemetry]. / Etude de l'évolution de la température interne et du rythme cardiaque chez le lézard saharien: Varanus griseus Daud. par radiotélémétrie

The evolution of the internal temperature and of the heart rate, recorded by telemetry, has been studied on Varanus griseus, by using transmitters of reduced size, in the natural conditions of Sahara. A parallelism between these two parameters exists. However, an anticipation of the heart rate increase during sun basking has been established. The hearing and cooling dynamics have been specified; a hypothesis on the mechanism of winter dormancy entrance has been proposed.

[Biological cycle of the nematode Rictulariidae: Pterygodermatites (Multipectines) affinis (Jägerskiold, 1904) (author's transl)]. / Cycle biologique du Nématode rictulaire Pterygodermatites (Multipectines) affinis (Jagerskiold, 1904)

Infestant larva of the Nematode Rictulariidae: Pterygodermatities affinis (Jägerskiold, 1904) are localized in Pimelia: Tachyderma hispida Forskael of Algeria. Through the infestation of a young cat, embryonated eggs are collected after 38 days of development altogether with a female parasite. The experimental cycle of this rictulariid nematode in Locusta migratoria is characterized by the shortness of its development and the similarity in growth during the first and second larval stages. The cellular reaction of the Insect to the larva P. affinis is weaker in the Pimelia than in the Grasshopper, used as experimental host.

Nuclear magnetic resonance spectroscopy. Ring-current effects on carbon-13 chemical shifts.

A comparison of the (13)C nuclear magnetic resonance chemical shifts of some 15,16-dialkyl-15,16-dihydropyrenes with the corresponding 15,16-dialkyl-2,7,15,16-tetrahydropyrenes provides a measure of the effect of ring current on carbon-13 chemical shifts in which other effects may be expected to be negligibly small. The general conclusion is that the absolute magnitude of the ring-current effect is the same for carbon-13 as for protons when they occupy the same position in space relative to the aromatic pi-electron cloud.