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1. Do Surgeons Anticipate Women’s Hopes and Fears Associated with Prolapse Repair? A Qualitative Analysis in the PROSPERE Trial

Author: Fritel, Xavier, Ravit, Marion, Pizzoferrato, Anne-Cécile, Campagne-Loiseau, Sandrine, Bader, Georges, Capmas, Perrine, Cosson, Michel, Debodinance, Philippe, Deffieux, Xavier, Fernandez, Hervé, Ferry, Philippe, Garbin, Olivier, Jacquetin, Bernard, Legendre, Guillaume, Saussine, Christian, Tayrac, Renaud de, Wagner, Laurent, Lucot, Jean-Philippe, Fauconnier, Arnaud, team, the PROSPERE team the PROSPERE, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Liverpool School of Tropical Medicine (LSTM), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, CMC Ambroise Paré [Neuilly-sur-Seine], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Université de Lille, Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CH Dunkerque, AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris-Sud - Paris 11 (UP11), Groupe hospitalier de La Rochelle, CHU Strasbourg, Université de Strasbourg (UNISTRA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), Hôpital Saint Vincent de Paul de Lille, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), Université Paris-Saclay, and CHI Poissy-Saint-Germain
Subjects: surgery, [SDV]Life Sciences [q-bio], hope, fear, General Medicine, pelvic organ prolapse, expectations
Abstract: Women’s preoperative perceptions of pelvic-floor disorders may differ from those of their physicians. Our objective was to specify women’s hopes and fears before cystocele repair, and to compare them to those that surgeons anticipate. We performed a secondary qualitative analysis of data from the PROSPERE trial. Among the 265 women included, 98% reported at least one hope and 86% one fear before surgery. Sixteen surgeons also completed the free expectations-questionnaire as a typical patient would. Women’s hopes covered seven themes, and women’s fears eleven. Women’s hopes were concerning prolapse repair (60%), improvement of urinary function (39%), capacity for physical activities (28%), sexual function (27%), well-being (25%), and end of pain or heaviness (19%). Women’s fears were concerning prolapse relapse (38%), perioperative concerns (28%), urinary disorders (26%), pain (19%), sexual problems (10%), and physical impairment (6%). Surgeons anticipated typical hopes and fears which were very similar to those the majority of women reported. However, only 60% of the women reported prolapse repair as an expectation. Women’s expectations appear reasonable and consistent with the scientific literature on the improvement and the risk of relapse or complication related to cystocele repair. Our analysis encourages surgeons to consider individual woman’s expectations before pelvic-floor repair.
Published: 2023
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2. Point-of-care ultrasonography for risk stratification of non-critical suspected COVID-19 patients on admission (POCUSCO): A prospective binational study

Author: François Morin, Delphine Douillet, Jean François Hamel, Dominique Savary, Christophe Aubé, Karim Tazarourte, Kamélia Marouf, Florence Dupriez, Phillipe Le Conte, Thomas Flament, Thomas Delomas, Mehdi Taalba, Nicolas Marjanovic, Francis Couturaud, Nicolas Peschanski, Thomas Boishardy, Jérémie Riou, Vincent Dubée, Pierre-Marie Roy, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), École des Hautes Études en Santé Publique [EHESP] (EHESP), Research on Healthcare Performance (RESHAPE - Inserm U1290 - UCBL1), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Cliniques Universitaires Saint-Luc [Bruxelles], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Mémorial France États-Unis de Saint-Lô (CH Saint-Lô), CHU Rouen, Normandie Université (NU), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), CHU Pontchaillou [Rennes], Micro et Nanomédecines Translationnelles (MINT), and Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)
Subjects: [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Multidisciplinary, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract
Abstract: Background Lung point-of-care ultrasonography (L-POCUS) is highly effective in detecting pulmonary peripheral patterns and may allow early identification of patients who are likely to develop an acute respiratory distress syndrome (ARDS). We hypothesized that L-POCUS performed within the first 48 hours of non-critical patients with suspected COVID-19 would identify those with a high-risk of worsening. Methods POCUSCO was a prospective, multicenter study. Non-critical adult patients who presented to the emergency department (ED) for suspected or confirmed COVID-19 were included and had L-POCUS performed within 48 hours following ED presentation. The lung damage severity was assessed using a previously developed score reflecting both the extension and the intensity of lung damage. The primary outcome was the rate of patients requiring intubation or who died within 14 days following inclusion. Results Among 296 patients, 8 (2.7%) met the primary outcome. The area under the curve (AUC) of L-POCUS was 0.80 [95%CI:0.60–0.94]. The score values which achieved a sensibility >95% in defining low-risk patients and a specificity >95% in defining high-risk patients were Conclusion L-POCUS performed within the first 48 hours following ED presentation allows risk-stratification of patients with non-severe COVID-19.
Published: 2023

3. Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis

Author: Samir Jaber, Shannon M. Fernando, Robert A. Fowler, Daniel Brodie, Pierre Cardinal, Laveena Munshi, Margaret S. Herridge, Laurent Brochard, Eddy Fan, Deborah J. Cook, Andrew J.E. Seely, Behnam Sadeghirad, Alexandre Tran, Arthur S. Slutsky, Niall D. Ferguson, Morten Hylander Møller, Karen E. A. Burns, Arnaud W. Thille, Ewan C. Goligher, Bram Rochwerg, University of Ottawa [Ottawa], McMaster University [Hamilton, Ontario], University of Toronto, St. Michael's Hospital, Mount Sinai Health System, University Health Network, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, Sunnybrook Health Sciences Centre, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), University of Copenhagen = Københavns Universitet (KU), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ottawa Hospital Research Institute [Ottawa] (OHRI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), University of Copenhagen = Københavns Universitet (UCPH), and MORNET, Dominique
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine.disease_cause, law.invention, 03 medical and health sciences, Mechanical ventilation, 0302 clinical medicine, Randomized controlled trial, law, Oxygen therapy, Anesthesiology, medicine, Critical care medicine, 030212 general & internal medicine, Extubation failure, Critically ill, business.industry, Incidence (epidemiology), 3. Good health, [SDV] Life Sciences [q-bio], 030228 respiratory system, Meta-analysis, High-flow nasal cannula, Emergency medicine, business, Nasal cannula
Abstract: International audience; Purpose: Systematic review and network meta-analysis to investigate the efficacy of noninvasive respiratory strategies, including noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC), in reducing extubation failure among critically ill adults.Methods: We searched databases from inception through October 2021 for randomized controlled trials (RCTs) evaluating noninvasive respiratory support therapies (NIPPV, HFNC, conventional oxygen therapy, or a combination of these) following extubation in critically ill adults. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was reintubation. We used GRADE to rate the certainty of our findings.Results: We included 36 RCTs (6806 patients). Compared to conventional oxygen therapy, NIPPV (OR 0.65 [95% CI 0.52-0.82]) and HFNC (OR 0.63 [95% CI 0.45-0.87]) reduced reintubation (both moderate certainty). Sensitivity analyses showed that the magnitude of the effect was highest in patients with increased baseline risk of reintubation. As compared to HFNC, no difference in incidence of reintubation was seen with NIPPV (OR 1.04 [95% CI 0.78-1.38], low certainty). Compared to conventional oxygen therapy, neither NIPPV (OR 0.8 [95% CI 0.61-1.04], moderate certainty) or HFNC (OR 0.9 [95% CI 0.66-1.24], low certainty) reduced short-term mortality. Consistent findings were demonstrated across multiple subgroups, including high- and low-risk patients. These results were replicated when evaluating noninvasive strategies for prevention (prophylaxis), but not in rescue (application only after evidence of deterioration) situations.Conclusions: Our findings suggest that both NIPPV and HFNC reduced reintubation in critically ill adults, compared to conventional oxygen therapy. NIPPV did not reduce incidence of reintubation when compared to HFNC. These findings support the preventative application of noninvasive respiratory support strategies to mitigate extubation failure in critically ill adults, but not in rescue conditions.
Published: 2021

4. Late Onset of Chronic Granulomatous Disease Revealed by Paecilomyces lilacinus Cutaneous Infection

Author: Felipe Suarez, Cindy Barbarin, Jean-Claude Chomel, Blandine Rammaert, Kévin Brunet, Jose Torregrosa-Diaz, Ewa Hainaut, Clément Lemaigre, Jean-Philippe Martellosio, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Genetics in Ophthalmology (Equipe Inserm U1163), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Pharmacologie des anti-infectieux et antibiorésistance (PHAR2), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Chauzy, Alexia
Subjects: medicine.medical_specialty, business.industry, [SDV]Life Sciences [q-bio], Immunology, Inflammation, Late onset, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Skin infection, medicine.disease, Asymptomatic, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Chronic granulomatous disease, Medical microbiology, antifungal prophylaxis, clonal hematopoiesis, Immunology and Allergy, Medicine, invasive fungal disease, medicine.symptom, business, Asymptomatic carrier, Immunodeficiency
Abstract: Chronic granulomatous disease (CGD) is an inherited immunodeficiency due to defective leukocyte NADPH responsible for recurrent infections and aberrant inflammation. Mutations in the CYBB gene are responsible for the X-linked CGD and account for approximately 70% of the cases. CGD is diagnosed during childhood in males. Female carriers may have biased X-inactivation and may present with clinical manifestations depending on the level of residual NADPH oxidase activity. We report the case of a previously asymptomatic female carrier who was diagnosed at age 67 with a skin infection with the rare fungus Paecilomyces lilacinus as the first manifestation of CGD. Dihydrorhodamine 123 (DHR) activity was below 10%. Next-generation sequencing (NGS) revealed mutations in DNMT3A, ASXL1, and STAG2 suggesting that clonal hematopoiesis could be responsible for a progressive loss of NADPH oxidase activity and the late onset of X-linked CGD in this patient. Long-term follow-up of asymptomatic carrier women seems to be essential after 50 years old.
Published: 2021

5. Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece

Author: Arnaud W, Thille, Arnaud, Gacouin, Rémi, Coudroy, Stephan, Ehrmann, Jean-Pierre, Quenot, Mai-Anh, Nay, Christophe, Guitton, Damien, Contou, Guylaine, Labro, Jean, Reignier, Gael, Pradel, Gaëtan, Beduneau, Laurence, Dangers, Clement, Saccheri, Gwénaël, Prat, Guillaume, Lacave, Nicholas, Sedillot, Nicolas, Terzi, Béatrice, La Combe, Jean-Paul, Mira, Antoine, Romen, Marie-Ange, Azais, Anahita, Rouzé, Jérôme, Devaquet, Agathe, Delbove, Martin, Dres, Jeremy, Bourenne, Alexandre, Lautrette, Joe, de Keizer, Stéphanie, Ragot, Jean-Pierre, Frat, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional d'Orléans (CHRO), Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier Victor Dupouy, Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Henri Mondor d'Aurillac, Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Groupe de Recherche sur le Handicap Ventilatoire et Neurologique (GRHVN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], Centre Hospitalier Universitaire de Nice (CHU Nice), Unité de Recherche Clinique de la Côte d’Azur (URRIS UR2CA), Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Fleyriat [Bourg en Bresse], CHU Grenoble, Hypoxie et PhysioPathologie (HP2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Groupe Hospitalier Bretagne Sud (GHBS), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier de Pau, Centre Hospitalier Loire Vendée Océan, CHU Lille, Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Hôpital Foch [Suresnes], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Supported by a grant (18-007) from the Programme Hospitalier de Recherche Clinique National 2018 of the French Ministry of Health., REVA Research Network: Anne Veinstein, Delphine Chatellier, Florence Boissier, Maeva Rodriguez, Céline Deletage, Céline Abonneau, Adel Maamar, Florian Reizine, Jean-Marc Tadie, Charlotte Salmon-Gandonniere, Emmanuelle Mercier, Stefan Mankikian, Pascal Andreu, Marine Jacquier, Marie Labruyère, Dalila Benzekri-Lefevre, Grégoire Muller, Armelle Mathonnet, Nicolas Chudeau, Mickaël Landais, Cédric Darreau, Gaëtan Plantefève, Paul Desaint, Radj Cally, Pierre Oudeville, Valentin Pointurier, Yannick Rabouel, Gauthier Blonz, Maité Agbakou, Thi My-Hue Nguyen, Marie-Hélène Hausermann, Christophe Girault, Dorothée Carpentier, Chloé Combe, Amélie Renou, Jean Dellamonica, Lucas Morand, Pierre Bailly, Christelle Teiten, Marine Paul, Hugo Bellut, Clio Torres, Camille Bouisse, Guillaume Rigault, Louis-Marie Galerneau, Pierre Bouju, Roland Smoning, Driss Laghlam, Morgane Bertrix, Alexandre Massri, Ugo Gouedard, Saad Nseir, Benjamin Zuber, Yannick Fedun, Côme Bureau, Julien Carvelli, Guillaume Gayraud, Quentin Levrat, Emmanuel Vivier, Christophe Leroy, Laurent Argaud, Alexandre Demoule, Gaetan Beduneau, Jean Dellamonica, Claude Guerin, Samir Jaber, Armand Mekontso-Dessap, Alain Mercat, Saad Nseir, Jean Roeseler, Matthieu Schmidt, Nicolas Terzi, Arnaud W Thille, Unité de Recherche Clinique de la Côte d’Azur [Nice] (URRIS UR2CA), Université Côte d'Azur (UCA), and MORNET, Dominique
Subjects: Positive-Pressure Respiration, [SDV] Life Sciences [q-bio], Recurrence, Respiration, [SDV]Life Sciences [q-bio], Airway Extubation, Humans, General Medicine, Respiratory Insufficiency, Respiration, Artificial, Ventilator Weaning
Abstract: International audience; Background: Spontaneous-breathing trials can be performed with the use of either pressure-support ventilation (PSV) or a T-piece. Whether PSV trials may result in a shorter time to tracheal extubation than T-piece trials, without resulting in a higher risk of reintubation, among patients who have a high risk of extubation failure is unknown.Methods: In this multicenter, open-label trial, we randomly assigned patients who had a high risk of extubation failure (i.e., were >65 years of age or had an underlying chronic cardiac or respiratory disease) to undergo spontaneous-breathing trials performed with the use of either PSV (with a pressure-support level of 8 cm of water and no positive end-expiratory pressure) or a T-piece. The primary outcome was the total time without exposure to invasive ventilation (reported as the number of ventilator-free days) at day 28 after the initial spontaneous-breathing trial. Secondary outcomes included extubation within 24 hours and extubation within 7 days after the initial spontaneous-breathing trial, as well as reintubation within 7 days after extubation.Results: A total of 969 patients (484 in the PSV group and 485 in the T-piece group) were included in the analysis. At day 28, the median number of ventilator-free days was 27 (interquartile range, 24 to 27) in the PSV group and 27 (interquartile range, 23 to 27) in the T-piece group (difference, 0 days; 95% confidence interval [CI], -0.5 to 1; P = 0.31). Extubation was performed within 24 hours in 376 patients (77.7%) in the PSV group and in 350 patients (72.2%) in the T-piece group (difference, 5.5 percentage points; 95% CI, 0.01 to 10.9), and extubation was performed within 7 days in 473 patients (97.7%) and 458 patients (94.4%), respectively (difference, 3.3 percentage points; 95% CI, 0.8 to 5.9). Reintubation was performed in 72 of 481 patients (14.9%) in the PSV group and in 65 of 477 patients (13.6%) in the T-piece group (difference, 1.3 percentage points; 95% CI, -3.1 to 5.8). Cardiac or respiratory arrest was a reason for reintubation in 9 patients (3 in the PSV group and 6 in the T-piece group).Conclusions: Among patients who had a high risk of extubation failure, spontaneous-breathing trials performed with PSV did not result in significantly more ventilator-free days at day 28 than spontaneous-breathing trials performed with a T-piece. (Supported by the French Ministry of Health; TIP-EX ClinicalTrials.gov number, NCT04227639.).
Published: 2022

6. Isolated intraocular relapses of primary cerebral lymphomas: An loc network study

Author: Nadia Younan, Carole Soussain, Sylvain Choquet, Nathalie Cassoux, Valérie Touitou, Anna Schmitt, Olivier Chinot, Lucie Oberic, Gandhi Damaj, Roch Houot, Hervé Ghesquières, Kamel Laribi, Guido Ahle, Luc Taillandier, Jérôme Paillassa, Emmanuel Gyan, Fabrice Jardin, Vincent Delwail, Jean‐Pierre Marolleau, Adrian Tempescul, Philippe Agapé, Marie Bourniquel, Fabienne Vacheret, Ibrahim Jdid, Magali Le Garff‐Tavernier, Denis Malaise, Agusti Alentorn, Khê Hoang Xuan, Caroline Houillier, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Curie - Saint Cloud (ICSC), Immunité et cancer (U932), Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche de l'Institut Curie [Paris], Institut Curie [Paris], Institut Bergonié [Bordeaux], UNICANCER, Institut de neurophysiopathologie (INP), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Timone [CHU - APHM] (TIMONE), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Microenvironment and B-cells: Immunopathology,Cell Differentiation, and Cancer (MOBIDIC), Université de Rennes (UR)-Etablissement français du sang [Rennes] (EFS Bretagne)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre Hospitalier Le Mans (CH Le Mans), Service de Neurologie [Hôpitaux Civils de Colmar], Hôpitaux Civils Colmar, Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques (GPMCND), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Amiens-Picardie, HEMATIM - Hématopoïèse et immunologie - UR UPJV 4666 (HEMATIM), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), Hopital d'instruction des armées Sainte-Anne [Toulon] (HIA), Service d'Hématologie [CH Perpignan], CH Perpignan, CHU Orléans, Département d'Oncologie Chirurgicale [Institut Curie], Laboratoire d'Imagerie Translationnelle en Oncologie (LITO ), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), DESSAIVRE, Louise, Service d'Onco-neurologie = Département de neurologie 2 [CHU Pitié Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Ophtalmologie [CHU Pitié-Salpêtrière], Service de Biochimie Métabolique [CHU Pitié-Salpêtrière], and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: relapse, Cancer Research, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, primary CNS lymphoma, Oncology, [SDV.CAN] Life Sciences [q-bio]/Cancer, ocular lymphoma, hemic and lymphatic diseases, [SDV.CAN]Life Sciences [q-bio]/Cancer, Hematology, General Medicine, prognosis, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Most relapses of primary central nervous system lymphoma (PCNSL) occur in the brain and are associated with a poor prognosis. Isolated intraocular relapses (IIORs) are rare and poorly described. We retrospectively selected from the French Lymphome Oculo-Cérébral database PCNSL patients who initially presented with cerebral localization and who experienced IIOR during the course of the disease. Of the 1472 patients included in the database, 55 patients presented an IIOR. Their median age was 68 years, and median Karnofsky Performance Status 80. IL-10 levels in the aqueous humor and/or in the vitreous were increased in 42/46 patients. 45/55 patients received systemic chemotherapy, and 11/55 received high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) as consolidation treatment. After a median follow-up of 69 months, 42/55 patients had relapsed, including 90% of the patients who did not receive HCT-ASCT at IIOR and 40% of the patients who received HCT-ASCT at IIOR (p 0.001). The first relapse after the initial IIOR was exclusively in the eye in 23/42 patients, and 29/42 patients had a subsequent brain relapse during the course of the disease. The median progression-free survival, brain-free survival and overall survival from IIOR were 12.2, 48.6 and 57.1 months, respectively. Isolated intraocular relapse is not exceptional in the course of PCNSL and deserves systematic ophthalmological follow-up. Its prognosis is much better than the prognosis of brain relapse, with an evolution close to that of primary vitreoretinal lymphoma. With the exception of patients who received HCT-ASCT at IIOR, almost all patients subsequently relapsed, often with other IIORs.
Published: 2022

7. Duration of the effectiveness of nicotine electronic cigarettes on smoking cessation and reduction: Systematic review and meta-analysis

Author: Paul Vanderkam, Audrey Bonneau, Shérazade Kinouani, Palina Dzeraviashka, Philippe Castera, Marc Besnier, Philippe Binder, Nicolas Doux, Nematollah Jaafari, Claire Lafay-Chebassier, Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Henri Laborit (CHL), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bordeaux (UB), Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Admin, Oskar
Subjects: Serious adverse effects, Psychiatry and Mental health, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Electronic cigarettes (E-cigarettes), Electronic Nicotine Delivery Systems (ENDS), [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Smoking cessation, Smoking reduction
Abstract: BackgroundThe success of pharmacotherapies for smoking cessation in real-life remains limited, with a significant number of long-term relapses. Despite first promising results, the duration of the effectiveness of electronic cigarettes is still unknown. Our objective was to assess the duration of the effectiveness of electronic cigarettes on smoking cessation and reduction in daily smokers.MethodsThe databases EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and PUBMED were consulted until March 23, 2022. We selected only randomized controlled trials with daily adult smokers. The intervention was the nicotinic electronic cigarette vs. non-nicotine electronic cigarette or other validated pharmacotherapies (varenicline, bupropion and nicotine replacement therapy). The minimum duration of the intervention was 3 months, with a follow-up of at least 6 months. Two independent reviewers used the PRISMA guidelines. The primary endpoint was smoking cessation at the end of the intervention and follow-up periods confirmed by a reduction in expired CO < 10 ppm. The reduction was defined as at least 50% of the initial consumption or by a decrease of daily mean cigarette consumption at the end of the intervention and follow-up periods.ResultsAbstinence at the end of the intervention and follow-up periods was significantly higher in the nicotine electronic cigarette group, compared to nicotine replacement therapy (NRT) [respectively: RR: 1.37 (CI 95%: 1.32–2.93) and RR: 1.49 (CI 95%: 1.14–1.95)] and to the non-nicotine electronic cigarette condition [respectively: RR: 1.97 (CI 95%: 1.18–2.68) and RR: 1.66 (CI 95%: 1.01–2.73)]. With regard to smoking reduction, the electronic cigarette with nicotine is significantly more effective than NRT at the end of the intervention and follow-up periods [respectively RR: 1.48 (CI 95%: 1.04–2.10) and RR: 1.47 (CI 95%: 1.18–1.82)] and non-nicotine electronic cigarette in the long term [RR: 1.31 (CI 95%: 1.02–1.68)].ConclusionsThis meta-analysis shows the duration of the effectiveness of the nicotine electronic cigarette vs. non-nicotine electronic cigarette and NRT on smoking cessation and reduction. There are still uncertainties about the risks of its long-term use and its potential role as a gateway into smoking, particularly among young people.
Published: 2022
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8. Obinutuzumab and idelalisib in symptomatic patients with relapsed/refractory Waldenström macroglobulinemia

Author: Veronique Leblond, Charles Herbaux, Olivier Casasnovas, Sylvie Chevret, Aurore Perrot, Stéphanie Poulain, Bruno Villemagne, Beatrice Mahe, Olivier Tournilhac, Souad Assaad, Stéphane Leprêtre, Damien Roos-Weil, Thérèse Aurran, Delphine Nollet, Pierre Morel, Cécile Tomowiak, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Hématologie [IUCT Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Amiens-Picardie, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel), Centre Léon Bérard [Lyon], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, UFR des Sciences de Santé (Université de Bourgogne), Université de Bourgogne (UB), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service d'Hématologie Biologique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Service Hématologie - IUCT-Oncopole [CHU Toulouse], Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle IUCT [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Gestionnaire, HAL Sorbonne Université 5
Subjects: [SDV.MHEP.HEM] Life Sciences [q-bio]/Human health and pathology/Hematology, medicine.medical_specialty, Clinical Trials and Observations, Phases of clinical research, 030204 cardiovascular system & hematology, Neutropenia, Antibodies, Monoclonal, Humanized, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Interquartile range, Obinutuzumab, Internal medicine, medicine, Humans, Quinazolinones, Univariate analysis, business.industry, Waldenstrom macroglobulinemia, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, medicine.disease, Chemotherapy regimen, 3. Good health, chemistry, Purines, 030220 oncology & carcinogenesis, Neoplasm Recurrence, Local, Waldenstrom Macroglobulinemia, business, Idelalisib
Abstract: We present the results of a phase 2 study evaluating the combination of obinutuzumab + idelalisib in relapsed/refractory (R/R) Waldenström macroglobulinemia (WM). The goal was to determine the safety and efficacy of a fixed-duration chemotherapy-free treatment. During the induction phase, patients received idelalisib + obinutuzumab for 6 cycles, followed by a maintenance phase with idelalisib alone for ≤2 years. Forty-eight patients with R/R WM were treated with the induction combination, and 27 patients participated in the maintenance phase. The best responses, reached after a median of 6.5 months (interquartile range, 3.4-7.1; range, 2.6-22.1 months), were very good partial response in 5 patients, partial response in 27 patients, and minor response in 3 patients, leading to overall response rate and major response rate estimates of 71.4% (95% confidence interval [CI], 56.7-83.4) and 65.3% (95% CI, 50.4-78.3), respectively. With a median follow-up of 25.9 months, median progression-free survival was 25.4 months (95% CI, 15.7-29.0). Univariate analysis focusing on molecular screening found no significant impact of CXCR4 genotypes on responses and survivals but a deleterious impact of TP53 mutations on survival. Although there was no grade 5 toxicity, 26 patients were removed from the study because of side effects; the most frequent were neutropenia (9.4%), diarrhea (8.6%), and liver toxicity (9.3%). The combination of idelalisib + obinutuzumab is effective in R/R WM. Nonetheless, the apparent lack of impact of genotype on outcome could give new meaning to targeting of the phosphatidylinositol 3-kinase pathway in WM. This trial was registered at www.clinicaltrials.gov as #NCT02962401.
Published: 2021

9. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

Author: Nseir, Saad, Martin-Loeches, Ignacio, Povoa, Pedro, Metzelard, Matthieu, Du Cheyron, Damien, Lambiotte, Fabien, Tamion, Fabienne, Labruyere, Marie, Makris, Demosthenes, Boulle Geronimi, Claire, Pinetonde Chambrun, Marc, Nyunga, Martine, Pouly, Olivier, Mégarbane, Bruno, Saade, Anastasia, Gomà, Gemma, Magira, Eleni, Llitjos, Jean-François, Torres, Antoni, Ioannidou, Iliana, Pierre, Alexandre, Coelho, Luis, Reignier, Jean, Garot, Denis, Kreitmann, Louis, Baudel, Jean-Luc, Voiriot, Guillaume, Contou, Damien, Beurton, Alexandra, Asfar, Pierre, Boyer, Alexandre, Thille, Arnaud, Mekontso-Dessap, Armand, Tsolaki, Vassiliki, Vinsonneau, Christophe, Floch, Pierre-Edouard, Le Guennec, Loïc, Ceccato, Adrian, Artigas, Antonio, Bouchereau, Mathilde, Labreuche, Julien, Duhamel, Alain, Rouzé, Anahita, Favory, Raphaël, Préau, Sébastien, Jourdain, Mercé, Poissy, Julien, Leger, Piehr Saint, van der Linden, Thierry, Veinstein, Anne, Azoulay, Elie, Pene, Frédéric, Martin, Maelle, Razazi, Keyvan, Plantefeve, Gaëtan, Fartoukh, Muriel, Thevenin, Didier, Guidet, Bertrand, Weiss, Nicolas, Kouatchet, Achille, Salmon, Charlotte, Brunin, Guillaume, Nemlaghi, Safaa, Meguerditchian, David, Argaud, Laurent, Voicu, Sebastian, Luyt, Charles-Edouard, Kowalski, Benjamin, Moglia, Edgar, Morales, Luis, Koutsoukou, Antonia, Mentzelopoulos, Spyros, Nora, David, Boyd, Sean, Maizel, Julien, Cuchet, Pierre, Delforge, Quentin, Quenot, Jean-Pierre, Boyer, Déborah, Cilloniz, Catia, CHU Lille, Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), CHU Amiens-Picardie, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre hospitalier [Valenciennes, Nord], CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier [Douai, Nord], Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier de Roubaix, Hôpital Saint Philibert [Lomme], Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Cochin [AP-HP], Centre Hospitalier de Lens, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Tenon [AP-HP], Centre Hospitalier Victor Dupouy, CHU Charles Foix [AP-HP], Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Bordeaux [Bordeaux], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Hôpital Duchenne, CH Boulogne sur Mer, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), coVAPid study group, Mégarbane, Bruno, and Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Henri Mondor [Créteil]
Subjects: Male, medicine.medical_treatment, Pneumònia, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Pneumonia, Ventilator-Associated/epidemiology, Medicine, Hospital Mortality, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, education.field_of_study, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, COVID-19/mortality, Mortality rate, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Europe, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Intensive Care Units, Length of Stay/statistics & numerical data, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, medicine.medical_specialty, Respiration, Artificial/statistics & numerical data, Coronavirus disease 2019 (COVID-19), Population, Europe/epidemiology, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Mortalitat, Humans, Mortality, education, Aged, Retrospective Studies, Mechanical ventilation, business.industry, RC86-88.9, Research, COVID-19, 030208 emergency & critical care medicine, Retrospective cohort study, Pneumonia, Length of Stay, bacterial infections and mycoses, medicine.disease, Respiration, Artificial, respiratory tract diseases, 030228 respiratory system, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, business
Abstract: Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46), p = 0.013), but not in influenza (1.74 (0.99–3.06), p = 0.052), or no viral infection groups (1.13 (0.68–1.86), p = 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.
Published: 2021

10. A core outcome set development for a French national prospective study about the effect of mediolateral episiotomy on obstetric anal sphincter injury during operative vaginal delivery (INSTRUMODA)

Author: Bertrand Gachon, Thomas Schmitz, France Artzner, Olivier Parant, Renaud De Tayrac, Guillaume Ducarme, Camille Le Ray, Anne Cécile Pizzoferrato, Charles Garabedian, Didier Riethmuller, Fabrice Pierre, Stephanie Ragot, Xavier Fritel, the GROG (Groupe de Recherche en Gynécologie Obstétrique), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Le Mans Université (UM), Hôpital Robert Debré, Collectif Inter-Associatif autour de la Naissance - CIANE [Paris] (Patients representative), Hôpital Paule de Viguier, CHU Toulouse [Toulouse], Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Maternité Port-Royal [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire [Grenoble] (CHU), Malbec, Odile, Le Mans Université (UM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Episiotomy, Male, medicine.medical_specialty, Consensus, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Reproductive medicine, Delphi method, Anal Canal, lcsh:Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Stakeholder Participation, Surveys and Questionnaires, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, education, lcsh:RG1-991, education.field_of_study, 030219 obstetrics & reproductive medicine, Vaginal delivery, Obstetrics, business.industry, Obstetric anal sphincter injury, Obstetrics and Gynecology, Core outcome set, medicine.disease, Delivery, Obstetric, 3. Good health, Obstetric Labor Complications, [SDV] Life Sciences [q-bio], Observational Studies as Topic, Research Design, Operative delivery, Observational study, Female, business, Research Article
Abstract: Background We aimed at developing a core outcome and variables of interest set to investigate the effects of mediolateral episiotomy on Obstetric Anal Sphincter Injury (OASI) during and after operative delivery in nulliparous women in a large-scale one-year observational French study including 15,000 women (INSTRUMODA). Methods A list of outcomes and variables of interest was suggested to obstetricians participating in the INSTRUMODA study using online questionnaires divided into 7 categories: the woman’s history and course of pregnancy, course of labor, modalities of operative delivery, episiotomy characteristics, immediate maternal morbidity, one-year maternal morbidity, immediate neonatal morbidity. We used a three-round DELPHI method to reach a consensus. In the first round, outcomes and variables considered as essential by 70% or more of obstetricians were included in the corpus whereas they were excluded when 70% rated them as “not important”. In the second round, non-consensual outcomes and variables were reassessed and excluded or definitively included if considered as “not important” or essential by 50% or more of the obstetricians. During the first round, obstetricians were invited to suggest new outcomes and/or variables that were then assessed in the second and third round. We used the same method to develop a core outcome and variables of interest set in a population of women in the community recruited via an association of patients. At the end of the procedure the core outcome and variables of interest sets were merged to provide the final core outcome set for the INSTRUMODA study. Results Fifty-three obstetricians and 16 women filled out questionnaires. After the 3 rounds of Delphi procedure in each population, 74 outcomes and variables were consensually reported by obstetricians and 92 by women in the community. By mixing these two consensual corpora we reported a final consensual list of 114 variables of interest and outcomes for both obstetricians and women. Conclusion We established a core outcome and variables of interest set among obstetricians and women in the community to investigate the association between mediolateral episiotomy and OASI during operative delivery. Trial registration The INSTRUMODA study was registered on https://clinicaltrials.gov on June 25, 2020 (NCT04446780).
Published: 2021

11. Efficacy of Chest CT for COVID-19 Pneumonia Diagnosis in France

Author: Herpe, Guillaume, Lederlin, Mathieu, Naudin, Mathieu, Ohana, Mickaël, Chaumoitre, Kathia, Gregory, Jules, Vilgrain, Valérie, Freitag, Cornelia Anna, De Margerie-Mellon, Constance, Flory, Violaine, Ludwig, Marie, Mondot, Lydiane, Fitton, Isabelle, Jacquier, Alexis, Raymond, Robert, Ardilouze, Paul, Petit, Isabelle, Gervaise, Alban, Bayle, Olivier, Crombe, Arielle, Mekuko sokeng, Magloire, Thomas, Clément, Henry, Geraldine, Bliah, Virginie, Le Tat, Thomas, Guillot, Marc-Samir, Gendrin, Paul, Garetier, Marc, Bertolle, Estelle, Montagne, Catherine, Langlet, Benjamin, Kalaaji, Abdulrazak, Kayayan, Hampar, Desmots, Florian, Dhaene, Benjamin, Saulnier, Pierre-Jean, Guillevin, Remy, Bartoli, Jean-Michel, Beregi, Jean-Paul, Tasu, Jean Pierre, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Data Analysis and Computations Through Imaging Modeling-Mathématiques, Imagerie, Santé (DACTIM-MIS), Laboratoire de Mathématiques et Applications (LMA-Poitiers), Université de Poitiers-Centre National de la Recherche Scientifique (CNRS)-Université de Poitiers-Centre National de la Recherche Scientifique (CNRS), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Nouvel Hôpital Civil de Strasbourg, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille Université - École de médecine (AMU SMPM MED), Aix-Marseille Université - Faculté des sciences médicales et paramédicales (AMU SMPM), Aix Marseille Université (AMU)-Aix Marseille Université (AMU), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hopital Saint-Louis [AP-HP] (AP-HP), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Hôpital Pasteur [Nice] (CHU), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier de la Côte Basque (CHCB), Département de Radiologie adultes [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Lorraine (UL), Hôpital d'Instruction des Armées Legouest, Service de Santé des Armées, Imagerie Guilloz [CHRU Nancy] (Service d'imagerie Guilloz), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Saint-Joseph [Marseille], Clinique Emilie de Vialar, Centre Hospitalier [Douai, Nord], Centre Hospitalier Rives De Seine (CHRDS), Hôpital d'Instruction des Armées Begin, Hôpital d'instruction des Armées Percy, Service de Radiologie et Imagerie Médicale [CHU Limoges], CHU Limoges, Hôpital Dupuytren [CHU Limoges], Hôpital d'Instruction des Armées Clermont Tonnerre, Hôpital d’Argenteuil, Centre hospitalier Pierre Le Damany - Lannion, Centre hospitalier de Lannion, Institut Bergonié [Bordeaux], UNICANCER, Centre hospitalier Lucien Hussel, Hôpital d'Instruction des Armées Laveran, CHU Tivoli, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Hôpital de la Timone [CHU - APHM] (TIMONE)
Subjects: Adult, Male, 2019-20 coronavirus outbreak, medicine.medical_specialty, Adolescent, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Chest ct, Sensitivity and Specificity, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 030218 nuclear medicine & medical imaging, Thoracic Imaging, Young Adult, MESH: SARS-CoV-2, Tomography, X-Ray Computed / methods, 03 medical and health sciences, 0302 clinical medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Prospective Studies, Child, Letters to the Editor, Prospective cohort study, Aged, Original Research, Aged, 80 and over, SARS-CoV-2, business.industry, COVID-19, MESH: Female, France / epidemiology, Middle Aged, Radiography, Thoracic / methods, Thorax, medicine.disease, Communications, MESH: Adolescent, COVID-19 / diagnostic imaging, COVID-19 / epidemiology, Child, Preschool, Reverse transcription polymerase chain reaction, Pneumonia, Tomography x ray computed, 030220 oncology & carcinogenesis, Female, Radiography, Thoracic, France, Radiology, Tomography, X-Ray Computed, business
Abstract: International audience; The role and performance of chest CT in the diagnosis of the coronavirus disease 2019 (COVID-19) pandemic remains under active investigation. Purpose To evaluate the French national experience using chest CT for COVID-19, results of chest CT and reverse transcription polymerase chain reaction (RT-PCR) assays were compared together and with the final discharge diagnosis used as the reference standard. Materials and Methods A structured CT scan survey (NCT04339686) was sent to 26 hospital radiology departments in France between March 2, 2020, and April 24, 2020. These dates correspond to the peak of the national COVID-19 epidemic. Radiology departments were selected to reflect the estimated geographic prevalence heterogeneities of the epidemic. All symptomatic patients suspected of having COVID-19 pneumonia who underwent both initial chest CT and at least one RT-PCR test within 48 hours were included. The final discharge diagnosis, based on multiparametric items, was recorded. Data for each center were prospectively collected and gathered each week. Test efficacy was determined by using the Mann-Whitney test, Student t test, χ2 test, and Pearson correlation coefficient. P < .05 indicated a significant difference. Results Twenty-six of 26 hospital radiology departments responded to the survey, with 7500 patients entered; 2652 did not have RT-PCR test results or had unknown or excess delay between the RT-PCR test and CT. After exclusions, 4824 patients (mean age, 64 years ± 19 [standard deviation], 2669 male) were included. With final diagnosis as the reference, 2564 of the 4824 patients had COVID-19 (53%). Sensitivity, specificity, negative predictive value, and positive predictive value of chest CT in the diagnosis of COVID-19 were 2319 of 2564 (90%; 95% CI: 89, 91), 2056 of 2260 (91%; 95% CI: 91, 92), 2056 of 2300 (89%; 95% CI: 87, 90), and 2319 of 2524 (92%; 95% CI: 91, 93), respectively. There was no significant difference for chest CT efficacy among the 26 geographically separate sites, each with varying amounts of disease prevalence. Conclusion Use of chest CT for the initial diagnosis and triage of patients suspected of having coronavirus disease 2019 was successful.
Published: 2021

12. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study

Author: Martine Nyunga, Matthieu Turpin, Alexandre Pierre, Anahita Rouzé, Jean-Luc Baudel, Saad Nseir, Pierre Cuchet, Antonio Artigas, Alain Duhamel, Justine Bardin, Gaëtan Plantefève, Mathilde Bouchereau, Iliana Ioannidou, Matthieu Metzelard, Pedro Póvoa, Claire Boulle Geronimi, Antoni Torres, Jean-François Llitjos, Olivier Pouly, Fabienne Tamion, Fabien Lambiotte, Denis Garot, Adrian Ceccato, Nicolas Weiss, Pierre-Edouard Floch, Ignacio Martin-Loeches, Pierre Asfar, Alexandra Beurton, Julien Labreuche, Marie Labruyere, Christophe Vinsonneau, Anastasia Saade, Eleni Magira, Charles-Edouard Luyt, Demosthenes Makris, Jean Reignier, Louis Kreitmann, Edgar Moglia, David Meguerditchian, Armand Mekontso-Dessap, Bruno Mégarbane, Gestionnaire, Hal Sorbonne Université, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lille Inflammation Research International Center - U 995 (LIRIC), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), University of Thessaly [Volos] (UTH), Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Centre hospitalier [Valenciennes, Nord], CHU Amiens-Picardie, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier [Douai, Nord], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Saint Philibert [Lomme], Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Saint-Antoine [AP-HP], Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), National and Kapodistrian University of Athens (NKUA), Hospices Civils de Lyon (HCL), Unité de Soins Intensifs [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], University of Athens Medical School [Athens], Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], CHU de Bordeaux Pellegrin [Bordeaux], Hôpital Henri Mondor, Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon], CHU Tenon [AP-HP], Centre Hospitalier Victor Dupouy, Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Hôpital Lariboisière-Fernand-Widal [APHP], Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, medicine.medical_specialty, Original, [SDV]Life Sciences [q-bio], Respiratory Tract Infections/epidemiology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Influenza, Human/epidemiology, Pneumonia, Ventilator-Associated/epidemiology, Internal medicine, Influenza, Human, medicine, Humans, Ventilator-associated pneumonia, Cumulative incidence, Respiratory Tract Infections, COVID-19/epidemiology, Aged, Retrospective Studies, Ventilators, Mechanical, Respiratory tract infections, SARS-CoV-2, business.industry, Incidence, Incidence (epidemiology), Hazard ratio, Pneumonia, Ventilator-Associated, Correction, COVID-19, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, Ventilator-associated tracheobronchitis, medicine.disease, respiratory tract diseases, 3. Good health, Europe, [SDV] Life Sciences [q-bio], Pneumonia, 030228 respiratory system, Female, Critical illness, business, Cohort study
Abstract: Purpose Although patients with SARS-CoV-2 infection have several risk factors for ventilator-associated lower respiratory tract infections (VA-LRTI), the reported incidence of hospital-acquired infections is low. We aimed to determine the relationship between SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, and the incidence of VA-LRTI. Methods Multicenter retrospective European cohort performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation > 48 h were eligible if they had: SARS-CoV-2 pneumonia, influenza pneumonia, or no viral infection at ICU admission. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. All VA-LRTI were prospectively identified, and chest-X rays were analyzed by at least two physicians. Cumulative incidence of first episodes of VA-LRTI was estimated using the Kalbfleisch and Prentice method, and compared using Fine-and Gray models. Results 1576 patients were included (568 in SARS-CoV-2, 482 in influenza, and 526 in no viral infection groups). VA-LRTI incidence was significantly higher in SARS-CoV-2 patients (287, 50.5%), as compared to influenza patients (146, 30.3%, adjusted sub hazard ratio (sHR) 1.60 (95% confidence interval (CI) 1.26 to 2.04)) or patients with no viral infection (133, 25.3%, adjusted sHR 1.7 (95% CI 1.2 to 2.39)). Gram-negative bacilli were responsible for a large proportion (82% to 89.7%) of VA-LRTI, mainly Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp. Conclusions The incidence of VA-LRTI is significantly higher in patients with SARS-CoV-2 infection, as compared to patients with influenza pneumonia, or no viral infection after statistical adjustment, but residual confounding may still play a role in the effect estimates. Electronic supplementary material The online version of this article (10.1007/s00134-020-06323-9) contains supplementary material, which is available to authorized users.
Published: 2021

13. Differential prognostic burden of cardiovascular disease and lower-limb amputation on the risk of all-cause death in people with long-standing type 1 diabetes

Author: Marion, Camoin, Gilberto, Velho, Pierre-Jean, Saulnier, Louis, Potier, Yawa, Abouleka, Charlyne, Carpentier, Severine, Dubois, Alice, Larroumet, Vincent, Rigalleau, Elise, Gand, Olivier, Bourron, Lyse, Bordier, André, Scheen, Samy, Hadjadj, Ronan, Roussel, Michel, Marre, Kamel, Mohammedi, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Necker Enfants-Malades (INEM - UM 111 (UMR 8253 / U1151)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Hôpital d'Instruction des Armées Begin, Service de Santé des Armées, Centre Hospitalier Universitaire de Liège (CHU-Liège), Université de Liège, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Ambroise Paré [Centres Médico-Chirurgicaux Ambroise Pré, Pierre Cherest, Hartmann], Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Admin, Oskar
Subjects: Adult, Male, Endocrinology, Diabetes and Metabolism, Type 1 diabetes mellitus, Lower-limb amputation, Middle Aged, Prognosis, Cardiovascular disease, Amputation, Surgical, Stroke, Myocardial infarction, Diabetes Mellitus, Type 1, Lower Extremity, Cardiovascular Diseases, Risk Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Prospective Studies, Mortality, Cardiology and Cardiovascular Medicine
Abstract: Background Cardiovascular disease (CVD) and nontraumatic lower-limb amputation (LLA) each results in reduced life expectancy in patients with type 1 diabetes, but the differential burden between these conditions is unknown. We compared the effects of CVD and LLA on the risk of mortality in people with type 1 diabetes. Methods We used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data were divided into: 1/absence of CVD (myocardial infarction and/or stroke) nor LLA, 2/history of CVD alone without LLA, 3/LLA alone without CVD or 4/both conditions at baseline. Participants with baseline history of peripheral artery disease were excluded from groups 1 and 2. The study endpoint was any death occurring during follow-up, regardless of the causes. Results Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA or both were present at baseline in 49 (4.2%), 62 (5.3%) and 20 (1.7%) subjects, respectively. All-cause death occurred in 304 (26%) participants during 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 (95%CI, 15–18) per 1000 person-years. The risk of death increased in individuals with baseline history of CVD (adjusted HR 2.00 [95% CI 1.34–3.01], p = 0.0008) or LLA (2.26 [1.56–3.28], p versus no condition, with an additive effect in people with both conditions (5.32 [3.14–9.00], p versus LLA (0.87 [0.54–1.41]). Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 (95% CI 1.26–4.32) and 3.38 (1.87–4.88) years, respectively. Combined conditions expose to 7.04 (4.76–9.31) less years of life expectancy (all p Conclusions CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes population. Our findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments and prevention.
Published: 2022

14. Comparison of standard prophylactic, intermediate prophylactic and therapeutic anticoagulation in patients with severe COVID-19: protocol for the ANTICOVID multicentre, parallel-group, open-label, randomised controlled trial

Author: Vincent Labbe, Damien Contou, Nicholas Heming, Bruno Megarbane, Hafid Ait-Oufella, Florence Boissier, Serge Carreira, Alexandre Robert, Emmanuel Vivier, Mohamed Fejjal, Denis Doyen, Mehran Monchi, Sebastien Preau, Elise Noel-Savina, Bertrand Souweine, Noémie Zucman, Santiago Alberto Picos, Martin Dres, William Juguet, Eric Mariotte, Jean-François Timsit, Matthieu Turpin, Keyvan Razazi, Ségolène Gendreau, Samia Baloul, Guillaume Voiriot, Muriel Fartoukh, Etienne Audureau, Armand Mekontso Dessap, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Henri Mondor [Créteil], Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Victor Dupouy, Hôpital Raymond Poincaré [Garches], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection et inflammation (2I), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Lariboisière-Fernand-Widal [APHP], Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), CHU Saint-Antoine [AP-HP], Sorbonne Université (SU), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Saint-Camille [Bry sur Marne], Centre Hospitalier Simone Veil (CH Simone Veil), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Centre hospitalier Saint Joseph - Saint Luc [Lyon], Centre Hospitalier Léon Binet, Hôpital l'Archet, Unité de Recherche Clinique de la Côte d’Azur (URRIS UR2CA), Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), Centre Hospitalier de Melun (CHM), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Lille, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Louis Mourier - AP-HP [Colombes], Centre Hospitalier de la Dracénie [Draguignan], CHU Pitié-Salpêtrière [AP-HP], Hôpital Avicenne [AP-HP], Université Sorbonne Paris Nord, Hopital Saint-Louis [AP-HP] (AP-HP), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Groupe Henri Mondor-Albert Chenevier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Hôpital Albert Chenevier, Département Médico-Universitaire APPROCHES, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor [Créteil], Unité de Recherche Clinique de la Côte d’Azur [Nice] (URRIS UR2CA), Université Côte d'Azur (UCA), CHU Larrey, Site Simone Veil [CHPC], CH Centre Hospitalier Public du Cotentin (CHPC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Henri Mondor, Hôpital Raymond Poincaré [AP-HP], Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC), Centre Hospitalier de Cannes, Centre Hospitalier Universitaire de Nice (CHU Nice), Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, Département Médico-Universitaire Épidémiologie et biostatistique, Santé publique, Pharmacie, Pharmacologie, Recherche, Information médicale, Thérapeutique et médicaments) (DMU Esprit), CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Université Paris Cité - UFR Médecine Paris Nord [Santé] (UPC Médecine Paris Nord), Université Paris Cité (UPC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), Université Paris Cité (UPCité), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, Balse, Elise, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], and Université Paris Cité - UFR Médecine [Santé] (UPCité UFR Médecine)
Subjects: Microcirculation, [SDV]Life Sciences [q-bio], Anticoagulants, COVID-19, Respiratory infections, General Medicine, [SDV] Life Sciences [q-bio], Anticoagulation, Thromboembolism, Quality of Life, Humans, Multicenter Studies as Topic, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Blood Coagulation, Randomized Controlled Trials as Topic
Abstract: IntroductionCOVID-19 induces venous, arterial and microvascular thrombosis, involving several pathophysiological processes. In patients with severe COVID-19 without macrovascular thrombosis, escalating into high-dose prophylactic anticoagulation (HD-PA) or therapeutic anticoagulation (TA) could be beneficial in limiting the extension of microvascular thrombosis and forestalling the evolution of lung and multiorgan microcirculatory dysfunction. In the absence of data from randomised trials, clinical practice varies widely.Methods and analysisThis is a French multicentre, parallel-group, open-label, randomised controlled superiority trial to compare the efficacy and safety of three anticoagulation strategies in patients with COVID-19. Patients with oxygen-treated COVID-19 showing no pulmonary artery thrombosis on computed tomography with pulmonary angiogram will be randomised to receive either low-dose PA, HD-PA or TA for 14 days. Patients attaining the extremes of weight and those with severe renal failure will not be included. We will recruit 353 patients. Patients will be randomised on a 1:1:1 basis, and stratified by centre, use of invasive mechanical ventilation, D-dimer levels and body mass index. The primary endpoint is a hierarchical criterion at day 28 including all-cause mortality, followed by the time to clinical improvement defined as the time from randomisation to an improvement of at least two points on the ordinal clinical scale. Secondary outcomes include thrombotic and major bleeding events at day 28, individual components of the primary endpoint, number of oxygen-free, ventilator-free and vasopressor-free days at day 28, D-dimer and sepsis-induced coagulopathy score at day 7, intensive care unit and hospital stay at day 28 and day 90, and all-cause death and quality of life at day 90.Ethics and disseminationThe study has been approved by an ethical committee (Ethics Committee, Ile de France VII, Paris, France; reference 2020-A03531-38). Patients will be included after obtaining their signed informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT04808882.
Published: 2022

15. French guidelines for restrictive episiotomy during instrumental delivery were not followed by an increase in obstetric anal sphincter injury

Author: Bertrand Gachon, Xavier Fritel, Olivier Rivière, Bruno Pereira, Françoise Vendittelli, Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Nantes Université - UFR des Sciences et Techniques des Activités Physiques et Sportives (Nantes Univ - UFR STAPS), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie et obstétrique [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), CHU Clermont-Ferrand, Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), and Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA)
Subjects: Multidisciplinary, Episiotomy, Pregnancy, Risk Factors, Anal Canal, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Delivery, Obstetric, Obstetric Labor Complications, Retrospective Studies
Abstract: The objective was to assess the influence of the French guidelines in favor of a restrictive use of episiotomy on both episiotomy and obstetric anal sphincter injury (OASI) rates during instrumental delivery. It was aulticenter study involving 193 maternities between 2000 and 2016. We included women with a singleton pregnancy, with cephalic presentation at 34 weeks of gestation or more who underwent an instrumental delivery. The study period was divided into three phases: 2000–2005 (reference) 2006–2011, and 2012–2016. We calculated the adjusted relative risk (aRR) of episiotomy and OASI and investigated for changes in episiotomy and OASI rates over time by using Prais–Winsten regression. We considered 96,035 deliveries. The episiotomy’s risk was lower in 2006–2011 (69.4%) and 2012–2016 (59.1%) compared to 2000–2005 (81.2%), respectively: aRR 0.93 [0.92–0.95] and 0.89 [0.87–0.90]. The OASI’s risk was higher in 2006–2011 (2.5%) and 2012–2016 (3.1%) compared to 2000–2005, respectively: aRR 1.30 [1.10–1.53]) and 1.57 [1.33–1.85]. However, Prais–Winsten regression showed no difference in the OASI rate during the study period. We observed a massive decrease in episiotomy use and a moderate increase in crude OASI’s rate but multivariate analysis failed to report an association between these outcomes.
Published: 2022

16. Cellules humaines à usage thérapeutique : état de la question

Author: Guilhot, F., CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CCSD, Accord Elsevier
Subjects: 0301 basic medicine, [SDV]Life Sciences [q-bio], Genetic enhancement, Stem cells, Disease, Article, 03 medical and health sciences, 0302 clinical medicine, hemic and lymphatic diseases, Medicine, 030212 general & internal medicine, Cardiac disorders, Induced pluripotent stem cell, CAR T cells, business.industry, cellules CAR T, personalized medicine, General Medicine, gene therapy, Embryonic stem cell, 3. Good health, [SDV] Life Sciences [q-bio], Transplantation, thérapie génique, 030104 developmental biology, médecine personnalisée, Cellules souches, Cancer research, Personalized medicine, Stem cell, business
Abstract: Résumé Les cellules souches humaines pluripotentes induites et les cellules souches embryonnaires humaines ont des caractéristiques de pluripotence et de dérivation permettant aussi l’étude des maladies. Ces cellules sont utilisées actuellement pour le traitement de maladies neurologiques comme la maladie de Parkinson ou dans les pathologies cardiaques. La thérapie génique a été un succès pour le traitement des hémophilies A et B, les hémoglobinopathies et les déficits immunitaires. La greffe de cellules souches hématopoïétiques est un traitement standard des leucémies, cependant que les CAR T représentent un nouveau traitement prometteur y compris dans les lymphomes et le myélome.
Published: 2020

17. Lymphoblastic predominance of blastic phase in children with chronic myeloid leukaemia treated with imatinib: A report from the I-CML-Ped Study

Author: Petr Sedlacek, Krzysztof Kałwak, Arnaud Petit, Chi Kong Li, Joelle Guilhot, Frédéric Millot, Eveline S. J. M. de Bont, Barbara De Moerloose, Meinolf Suttorp, Andrea Biondi, Deborah Meyran, Srdjana Culic, Birgitte Lausen, Université de Paris (UP), AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'hématologie-immunologie-oncologie pédiatrique [CHU Trousseau], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Meyran, D, Petit, A, Guilhot, J, Suttorp, M, Sedlacek, P, De Bont, E, Li, C, Kalwak, K, Lausen, B, Culic, S, de Moerloose, B, Biondi, A, and Millot, F
Subjects: Male, 0301 basic medicine, Cancer Research, [SDV]Life Sciences [q-bio], RECOMMENDATIONS, Tyrosine-kinase inhibitor, Chronic myeloid leukaemia, Children, Accelerated phase, Blastic phase, Tyrosine kinase inhibitors, Haematopoietic stem cell transplantation, 0302 clinical medicine, hemic and lymphatic diseases, Cumulative incidence, Lymphocytes, Child, Incidence (epidemiology), CHRONIC MYELOGENOUS LEUKEMIA, 3. Good health, Oncology, Child, Preschool, 030220 oncology & carcinogenesis, Imatinib Mesylate, Female, PROGNOSTIC DISCRIMINATION, medicine.drug, medicine.medical_specialty, Adolescent, medicine.drug_class, Accelerated phase, Blastic phase, Children, Chronic myeloid leukaemia, Haematopoietic stem cell transplantation, Tyrosine kinase inhibitors, Blastic Phase, DIAGNOSIS, 03 medical and health sciences, ADHERENCE, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Internal medicine, MANAGEMENT, medicine, Humans, neoplasms, business.industry, Infant, Imatinib, KINASE INHIBITOR ERA, YOUNGER PATIENTS, medicine.disease, RANDOMIZED CML, Transplantation, 030104 developmental biology, Blast Crisis, FOLLOW-UP, business, Chronic myelogenous leukemia, Rare disease
Abstract: Background: Chronic myeloid leukaemia (CML) is a rare disease in children. The frequency and outcome of children evolving to accelerated phase (AP) or blastic phase (BP) under treatment with imatinib is unknown. The aim of the current study is to assess the inci-dence of progression from CML in chronic phase with imatinib frontline in a paediatric setting and describe the management and outcome of these patients.Patients and methods: In the I-CML-Ped Study database (www.clinicaltrials.gov, #NCT01281735), 19 of 339 paediatric patients in chronic phase treated with imatinib in the frontline evolved to CML-AP or CML-BP.Results: With a median follow-up of 38 months (range: 2-190 months), the cumulative inci-dence of progression at 1 and 3 years was 3% (confidence interval [CI] 95%: 1-5%) and 7% (CI 95%: 4-11%), respectively. We observed a large predominance of lymphoid-BP (70%) over myeloid-BP (30%) with imatinib in frontline therapy. Sixteen patients underwent haemato-poietic stem cell transplantation, and eight were treated with a tyrosine kinase inhibitor after transplant. Only the transplanted patients are alive. The 5-year overall survival rate of children with CML-AP/BP is 44%, with no statistical difference between the lymphoid-BP and myeloid-BP outcome.Conclusion: Children evolving to AP or BP under treatment with imatinib have a very poor prognosis with an overall survival under 50%, much worse than children with advanced phase at diagnosis. (c) 2020 Elsevier Ltd. All rights reserved.
Published: 2020

18. High-flow nasal cannula oxygen therapy in acute respiratory failure at Emergency Departments: A systematic review

Author: Nicolas Marjanovic, Jean-Pierre Frat, Jérémy Guenezan, Olivier Mimoz, Arnaud W. Thille, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), and CCSD, Accord Elsevier
Subjects: Respiratory rate, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Respiratory failure, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Respiratory Rate, Oxygen therapy, medicine, Humans, Intubation, Hospital Mortality, 030212 general & internal medicine, Mechanical ventilation, Respiratory Distress Syndrome, Emergency department, business.industry, Oxygen Inhalation Therapy, General Medicine, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Length of Stay, Respiration, Artificial, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Dyspnea, 030228 respiratory system, Anesthesia, High-flow nasal cannula, Emergency Medicine, Breathing, Emergency Service, Hospital, Respiratory Insufficiency, business, Nasal cannula
Abstract: International audience; Objectives: The use of high-flow oxygen therapy (HFOT) through nasal cannula for the management of acute respiratory failure at the emergency department (ED) has been only sparsely studied. We conducted a systematic review of randomized-controlled and quasi-experimental studies comparing the early use of HFOT versus conventional oxygen therapy (COT) in patients with acute respiratory failure admitted to EDs.Methods: A systematic research of literature was carried out for all published control trials comparing HFOT with COT in adult patients admitted in EDs. Eligible data were extracted from Medline, Embase, Pascal, Web of Science and the Cochrane database. The primary outcome was the need for mechanical ventilation, i.e. intubation or non-invasive ventilation as rescue therapy. Secondary outcomes included respiratory rate, dyspnea level, ED length of stay, intubation and mortality.Results: Out of 1829 studies screened, five studies including 673 patients were retained in the analysis (350 patients treated with HFOT and 323 treated with COT). The need for mechanical ventilation was similar in both treatments (RR = 0.75; 95% CI 0.41 to 1.35; P = 0.31; I2 = 16%). Respiratory rate was lower with HFOT (Mean difference (MD) = -3.14 breaths/min; 95% CI = -4.9 to -1.4; P < 0.001; I2 = 39%), whereas sensation of dyspnea did not differ. (MD = -1.04; 95% CI = -2.29 to -0.22; P = 0.08; I2 = 67%). ED length of stay and mortality were similar between groups.Conclusion: The early use of HFOT in patients admitted to an ED for acute respiratory failure did not reduce the need for mechanical ventilation as compared to COT. However, HFOT decreased respiratory rate.Registration: PROSPERO ID CRD42019125696
Published: 2020

19. Glioma-grade diagnosis using in-phase and out-of-phase T1-weighted magnetic resonance imaging: A prospective study

Author: G. Herpe, J.-P. Tasu, S. Boucebci, C. Fauche, M. De Pardieu, Pierre Ingrand, S. Velasco, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Traitement de l'Information Medicale (LaTIM), Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)
Subjects: Male, Magnetic Resonance Spectroscopy, Adolescent, [SDV]Life Sciences [q-bio], Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Glioma, medicine, Grade II Glioma, T1 weighted, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, 10. No inequality, Prospective cohort study, Aged, Aged, 80 and over, Radiological and Ultrasound Technology, Receiver operating characteristic, medicine.diagnostic_test, Brain Neoplasms, business.industry, Magnetic resonance imaging, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Out of phase, 030220 oncology & carcinogenesis, Biomarker (medicine), Female, Neoplasm Grading, business, Nuclear medicine
Abstract: Purpose The purpose of this prospective study was to determine whether chemical shift gradient-echo magnetic resonance imaging (MRI) could predict glioma grade. Materials and methods A total of 69 patients with 69 gliomas were prospectively included. There were 41 men and 28 women with a mean age of 50 ± (SD) years (range: 16–82 years). All patients had MRI of the brain including chemical shift gradient-echo sequence, further referred to as in- and out-of phase sequence (IP/OP). Intravoxel fat content was estimated by signal loss ratio (SLR = [IP-OP]/2IP), between in- and out-of-phase images, using a region of interest placed on the viable portion of the gliomas. Association between SLR and glioma grade was searched for using Wilcoxon and Mann–Whitney U tests and diagnostic capabilities using area under the receiver operating characteristic (AUROC) curves. Results A significant association was found between SLR value and glioma grade (P 9‰ allowed complete discrimination between grade III and grade II glioma with 100% specificity (95% CI: 85–100%), 100% sensitivity (95% CI: 78–100%) and 100% accuracy (95% CI: 90–100%) (AUROC = 1). A SLR > 20‰ allowed discriminating between grade IV and grade III glioma with 75% specificity (95% CI: 57–89%), 73% sensitivity (95% CI: 45–92%) and 72% accuracy (95% CI: 57–84%) (AUC = 0.825, 95% CI: 0.702–0.948). The AUROC for the diagnosis of high-grade glioma (grade III and IV vs. grade II) was 1. Conclusion Chemical shift gradient echo MRI provides accurate grading of gliomas. This simple method should be used as a biomarker to predict glioma grade.
Published: 2020

20. Effect of 6-Benzoyl-benzothiazol-2-one scaffold on the pharmacological profile of α-alkoxyphenylpropionic acid derived PPAR agonists

Author: Nathalie Hennuyer, Nicolas Lebegue, Morgan Le Naour, Monique Beucher-Gaudin, Daniel-Henri Caignard, Pascal Carato, Catherine Dacquet, Bart Staels, Veronique Leclerc, Patricia Melnyk, Aurelie Hurtevent, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 [JPArc], CIC - Poitiers, Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 [RNMCD], Institut de Recherches Internationales Servier [Suresnes] [IRIS], Institut de Recherches SERVIER [IRS], Université de Lille, Inserm, CHU Lille, Université de Lille, LillOA, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires (RNMCD - U1011), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 (RNMCD), Institut de Recherches SERVIER (IRS), Lille Neurosciences & Cognition - U 1172 (LilNCog (ex-JPARC)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherches Internationales Servier [Suresnes] (IRIS), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, and Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD)
Subjects: Male, Agonist, Scaffold, body weight gain, medicine.drug_class, Stereochemistry, [SDV]Life Sciences [q-bio], [CHIM.THER] Chemical Sciences/Medicinal Chemistry, Mice, Obese, Peroxisome proliferator-activated receptor, RM1-950, [CHIM.THER]Chemical Sciences/Medicinal Chemistry, Ligands, PPAR, 01 natural sciences, Article, PPAR agonist, Mice, Structure-Activity Relationship, SPPARγM, Chlorocebus aethiops, Drug Discovery, medicine, Animals, Hypoglycemic Agents, PPAR alpha, Benzothiazoles, [SDV.MHEP.EM] Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Pharmacology, chemistry.chemical_classification, Dose-Response Relationship, Drug, Molecular Structure, Phenylpropionates, 010405 organic chemistry, Chemistry, Type 2 diabetes, General Medicine, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, 3. Good health, 0104 chemical sciences, Molecular Docking Simulation, PPAR gamma, 010404 medicinal & biomolecular chemistry, Diabetes Mellitus, Type 2, COS Cells, benzothiazol-2-one, Therapeutics. Pharmacology, SPPARM
Abstract: International audience; A series of nitrogen heterocycles containing α-ethoxyphenylpropionic acid derivatives were designed as dual PPARα/γ agonist ligands for the treatment of type 2 diabetes (T2D) and its complications. 6-Benzoyl-benzothiazol-2-one was the most tolerant of the tested heterocycles in which incorporation of O-methyl oxime ether and trifluoroethoxy group followed by enantiomeric resolution led to the (S)-stereoisomer 44 b displaying the best in vitro pharmacological profile. Compound 44 b acted as a very potent full PPARγ agonist and a weak partial agonist on the PPARα receptor subtype. Compound 44 b showed high efficacy in an ob/ob mice model with significant decreases in serum triglyceride, glucose and insulin levels but mostly with limited body-weight gain and could be considered as a selective PPARγ modulator (SPPARγM).
Published: 2020

21. Septal versus apical pacing sites in permanent right ventricular pacing: The multicentre prospective SEPTAL-PM study

Author: Galand, Vincent, Martins, Raphaël P, Donal, Erwan, Behar, Nathalie, Crocq, Christophe, Soulié, Gaelle Gresis, Degand, Bruno, Garcia, Rodrigue, Solnon, Aude, Lande, Gilles, Probst, Vincent, Marjaneh, Fatemi, Mansourati, Jacques, Dupuis, Jean-Marc, Laviolle, Bruno, Leclercq, Christophe, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), PHRC – Hospital Clinical Research Programme, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Pacemaker, Artificial, Left ventricular ejection fraction, Stimulation apicale droite, Heart Ventricles, Stimulation ventriculaire droit au long-cours, Ventricular Function, Left, Ventricular Dysfunction, Left, Long-term right ventricular pacing, Humans, Prospective Studies, cardiovascular diseases, Fraction d’éjection du ventricule gauche, Atrioventricular Block, Bloc auriculo-ventriculaire complet, Cardiac Pacing, Artificial, Right ventricular apical pacing, Stroke Volume, General Medicine, High-degree atrioventricular block, Treatment Outcome, Quality of Life, cardiovascular system, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Stimulation septale droite, Cardiology and Cardiovascular Medicine, Right ventricular septal pacing
Abstract: International audience; BACKGROUND: The optimal right ventricular pacing site for patients requiring pacemaker implantation for permanent atrioventricular block is a matter of debate. Long-term right ventricular apical pacing has been associated with left ventricular ejection fraction impairment and heart failure. Right ventricular septal pacing has been proposed as an alternative. AIM: The aim of this randomized prospective multicentre trial was to compare left ventricular remodelling and outcomes between right ventricular apical and septal pacing after mid-term follow-up. METHODS: Patients requiring pacemaker implantation for high-degree atrioventricular block were enrolled and randomized in a 1:1 fashion to receive a right ventricular apical or septal lead. RESULTS: A total of 141 patients were included, 69 in the septal group and 72 in the apical group. Both groups exhibited similar left ventricular ejection fractions after 18 months of follow-up (septal 57.1±11.9% vs. apical 57.4±13.4%), and left ventricular ejection fraction variation was similar in the two groups at the end of follow-up (septal -1.5±13.2% vs. apical 0.3±13.3%). Additionally, left ventricular volume, quality of life and 6-minute walk distance were similar in the two groups. However, patients in the septal group were more likely to be asymptomatic, with a significantly lower concentration of N-terminal prohormone of brain natriuretic peptide. Lastly, lead position did not impact 18-month survival. CONCLUSION: Pacing from the right ventricular apex does not have any detrimental effect on left ventricular systolic function compared with septal pacing over an 18-month period.
Published: 2022

22. Practical management of frailty in older patients with heart failure: Statement from a panel of multidisciplinary experts on behalf the Heart Failure Working Group of the French Society of Cardiology and on behalf French Society of Geriatrics and Gerontology

Author: Anne‐Sophie Boureau, Cédric Annweiler, Joël Belmin, Claire Bouleti, Mathieu Chacornac, Michel Chuzeville, Jean‐Philippe David, Patrick Jourdain, Pierre Krolak‐Salmon, Nicolas Lamblin, Marc Paccalin, Laurent Sebbag, Olivier Hanon, Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Laboratoire de Psychologie des Pays de la Loire (LPPL), Université d'Angers (UA)-Nantes Université - UFR Lettres et Langages (Nantes Univ - UFR LL), Nantes Université - pôle Humanités, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Humanités, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Gérontopôle autonomie longévité des Pays de la Loire, Robarts Research Institute [Canada], University of Western Ontario (UWO), CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Henri Mondor, IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique, Centre Chirurgical Marie Lannelongue (CCML)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Bicêtre, Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Coeur Poumon [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital de la Milétrie, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Louis Pradel [CHU - HCL], Dpt Gériatrie [CHU Broca], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Maladie d'Alzheimer : marqueurs génétiques et vasculaires, neuropsychologies (URP_4468), Groupe hospitalier Broca-Université Paris Cité (UPCité), CarMeN, laboratoire, and Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: [SDV] Life Sciences [q-bio], Practical management, Frailty, Geriatrics, [SDV]Life Sciences [q-bio], Cardiology, Older patients, Humans, Heart failure, Comorbidity, Cardiology and Cardiovascular Medicine, Aged
Abstract: International audience; AIMS: The heart failure (HF) prognosis in older patients remains poor with a high 5-years mortality rate more frequently attributed to noncardiovascular causes. The complex interplay between frailty and heart failure contribute to poor health outcomes of older adults with HF independently of ejection fraction. The aim of this position paper is to propose a practical management of frailty in older patients with heart failure. METHODS: A panel of multidisciplinary experts on behalf the Heart Failure Working Group of the French Society of Cardiology and on behalf French Society of Geriatrics and Gerontology conducted a systematic literature search on the interlink between frailty and HF, met to propose an early frailty screening by non-geriatricians and to propose ways to implement management plan of frailty. Statements were agreed by expert consensus. RESULTS: Clinically relevant aspects of interlink between frailty and HF have been reported to identify the population eligible for screening and the most suitable screening test(s). The frailty screening program proposed focuses on frailty model defined by an accumulation of deficits including geriatric syndromes, comorbidities, for older patients with HF in different settings of care. The management plan of frailty includes optimization of HF pharmacological treatments and non-surgical device treatment as well as optimization of a global patient-centred biopsychosocial blended collaborative care pathway. CONCLUSION: The current manuscript provides practical recommendations on how to screen and optimize frailty management in older patients with heart failure.
Published: 2022

23. Quantification of Head Tremors in Medical Conditions: A Comparison of Analyses Using a 2D Video Camera and a 3D Wireless Inertial Motion Unit

Author: David Amarantini, Isabelle Rieu, Giovanni Castelnovo, Frédérique Fluchère, Chloé Laurencin, Bertrand Degos, Aurélia Poujois, Alexandre Kreisler, Sophie Sangla, Mélissa Tir, Isabelle Benatru, Geneviève Blanchet-Fourcade, Dominique Guehl, Dominique Gayraud, Laurent Tatu, Christine Tranchant, Franck Durif, Marion Simonetta-Moreau, Toulouse Neuro Imaging Center (ToNIC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre interdisciplinaire de recherche en biologie (CIRB), Labex MemoLife, École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Collège de France (CdF (institution))-Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Rothschild [AP-HP], Département de Pharmacologie, PRES Université Lille Nord de France, Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Narbonne, CHU Bordeaux [Bordeaux], Service de neurologie, Hôpital Général, Laboratoire de Neurosciences Intégratives et Cliniques - UFC (UR 481) (NEURO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Département Neurologie [CHU Toulouse], Pôle Neurosciences [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), DESSAIVRE, Louise, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), CHU Clermont-Ferrand, Université Clermont Auvergne (UCA), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Aix Marseille Université (AMU), CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Lille, CHU Amiens-Picardie, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHI Aix Pertuis CHPA-CHIAP, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université Bourgogne Franche-Comté [COMUE] (UBFC), Hôpital de Hautepierre [Strasbourg], Centre d'investigation clinique de Toulouse (CIC 1436), and Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Pôle Santé publique et médecine publique [CHU Toulouse]
Subjects: head tremor amplitude, head tremor frequency, 2D video motion analysis, miniature wireless inertial magnetic motion unit, Fourier transform, wavelet transform, [SDV]Life Sciences [q-bio], Biochemistry, Atomic and Molecular Physics, and Optics, Analytical Chemistry, [SDV] Life Sciences [q-bio], Motion, Head Movements, Tremor, Humans, Electrical and Electronic Engineering, Instrumentation
Abstract: International audience; This study compares two methods to quantify the amplitude and frequency of head movements in patients with head tremor: one based on video-based motion analysis, and the other using a miniature wireless inertial magnetic motion unit (IMMU). Concomitant with the clinical assessment of head tremor severity, head linear displacements in the frontal plane and head angular displacements in three dimensions were obtained simultaneously in forty-nine patients using one video camera and an IMMU in three experimental conditions while sitting (at rest, counting backward, and with arms extended). Head tremor amplitude was quantified along/around each axis, and head tremor frequency was analyzed in the frequency and time-frequency domains. Correlation analysis investigated the association between the clinical severity of head tremor and head linear and angular displacements. Our results showed better sensitivity of the IMMU compared to a 2D video camera to detect changes of tremor amplitude according to examination conditions, and better agreement with clinical measures. The frequency of head tremor calculated from video data in the frequency domain was higher than that obtained using time-frequency analysis and those calculated from the IMMU data. This study provides strong experimental evidence in favor of using an IMMU to quantify the amplitude and time-frequency oscillatory features of head tremor, especially in medical conditions.
Published: 2022

24. COVID-19 in Patients with Pulmonary Hypertension A National Prospective Cohort Study

Author: Montani, David, Certain, Marie-Caroline, Weatherald, Jason, Jaïs, Xavier, Bulifon, Sophie, Noel-Savina, Elise, Nieves, Ana, Renard, Sébastien, Traclet, Julie, Bouvaist, Hélène, Riou, Marianne, de Groote, Pascal, Moceri, Pamela, Bertoletti, Laurent, Favrolt, Nicolas, Guillaumot, Anne, Jutant, Etienne-Marie, Beurnier, Antoine, Boucly, Athénaïs, Ebstein, Nathan, Jevnikar, Mitja, Pichon, Jérémie, Keddache, Sophia, Preda, Mariana, Roche, Anne, Solinas, Sabina, Seferian, Andrei, Reynaud-Gaubert, Martine, Cottin, Vincent, Savale, Laurent, Humbert, Marc, Sitbon, Olivier, Kais, Ahmad, Elise, Artaud-Macari, Céline, Chabanne, Ari, Chaouat, Surnameclaire, Dauphin, Frédéric, Gagnadoux, Anne, Gaudoin, Sébastien, Hascoet, Delphine, Horeau-Langlard, Jocelyn, Inamo, Bouchra, Lamia, Pascal, Magro, Jean-Claude, Meurice, Patrice, Poubeau, Grégoire, Prevot, Roger, Rosario, Servettaz, Amélie, Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay, Hospices Civils de Lyon (HCL), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique - Hôpitaux de Marseille (APHM), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Stress Oxydant et Pathologies Métaboliques (SOPAM), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de Recherche sur le Handicap Ventilatoire (GRHV), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Universitaire de Reims (CHU Reims)
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, COVID-19, pulmonary aterial hypertension, pulmonary hypertension, outcomes, SARS-CoV-2, Hypertension, Pulmonary, Critical Care and Intensive Care Medicine, COVID-19 Testing, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, pulmonary arterial hypertension, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Prospective Studies
Abstract: International audience; Rationale: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with pulmonary endothelial dysfunction. There are limited data available on the outcomes of coronavirus disease (COVID-19) in patients with pulmonary hypertension (PH), a disease characterized by pulmonary endothelial dysfunction. Objectives: To describe characteristics and outcomes of patients with precapillary PH and COVID-19. Methods: We prospectively collected characteristics, management, and outcomes of adult patients with precapillary PH in the French PH network who had COVID-19 between February 1, 2020, and April 30, 2021. Clinical, functional, and hemodynamic characteristics of PH before COVID-19 were collected from the French PH registry. Measurements and Main Results: A total of 211 patients with PH (including 123 with pulmonary arterial hypertension, 47 with chronic thromboembolic PH, and 41 with other types of PH) experienced COVID-19, and 40.3% of them were outpatients, 32.2% were hospitalized in a conventional ward, and 27.5% were in an ICU. Among hospitalized patients (n = 126), 54.0% received corticosteroids, 37.3% high-flow oxygen, and 11.1% invasive ventilation. Right ventricular and acute renal failure occurred in 30.2% and 19.8% of patients, respectively. Fifty-two patients (all hospitalized) died from COVID-19. Overall mortality was 24.6% (95% CI [confidence interval], 18.8-30.5) and in-hospital mortality 41.3% (95% CI, 32.7-49.9). Nonsurvivors were significantly older, more frequently male and suffering comorbidities (diabetes, chronic respiratory diseases, systemic hypertension, chronic cardiac diseases, and/or chronic renal failure), and had more severe PH at their most recent evaluation preceding COVID-19 diagnosis (in terms of functional class and 6-minute-walk distance; all P < 0.05). Use of pulmonary arterial hypertension therapy was similar between survivors and nonsurvivors. Conclusions: COVID-19 in patients with precapillary PH was associated with a high in-hospital mortality. The typical risk factors for severe COVID-19 and severity of PH were associated with mortality in this population.
Published: 2022

25. Nutritional biomarkers and heart failure requiring hospitalization in patients with type 2 diabetes: the SURDIAGENE cohort

Author: Matthieu, Wargny, Mikaël, Croyal, Stéphanie, Ragot, Elise, Gand, David, Jacobi, Jean-Noël, Trochu, Xavier, Prieur, Cédric, Le May, Thomas, Goronflot, Bertrand, Cariou, Pierre-Jean, Saulnier, Samy, Hadjadj, Barnabas, Gellen, Le May, Cedric, Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Santé publique - Clinique des données [CHU Nantes] (Pôle Hospitalo-Universitaire 11), Santé - François Bonamy, Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche en Santé de l'Université de Nantes (IRS-UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Mass Spectrometry Core Facility [Nantes] (CRNH-O ), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), and SURDIAGENE study group: Richard Marechaud, Vincent Javaugue, Charlotte Hulin-Delmotte, Pierre Llatty, Gregory Ducrocq, Ronan Roussel, Vincent Rigalleau, Yann Pucheu, David Montaigne, Jean-Michel Halimi, Philippe Gatault, Philippe Sosner, Barnabas Gellen
Subjects: Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Endocrinology, Diabetes and Metabolism, Heart failure, TMAO, Choline, Cohort Studies, Methionine, Diabetes mellitus, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Carnitine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Cysteine, Prospective Studies, Homocysteine, Aged, Nutritional biomarkers, [SDV.MHEP.EM] Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Middle Aged, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Betaine, Hospitalization, Diabetes Mellitus, Type 2, Female, Cardiology and Cardiovascular Medicine, Cohort study, Biomarkers
Abstract: Background Heart failure (HF) is a growing complication and one of the leading causes of mortality in people living with type 2 diabetes (T2D). Among the possible causes, the excess of red meat and the insufficiency of vegetables consumption are suspected. Such an alimentation is associated with nutritional biomarkers, including trimethylamine N-oxide (TMAO) and its precursors. Here, we aimed to study these biomarkers as potential prognostic factors for HF in patients with T2D. Methods We used the SURDIAGENE (SURvival DIAbetes and GENEtics) study, a large, prospective, monocentric cohort study including 1468 patients with T2D between 2001 and 2012. TMAO and its precursors (trimethylamine [TMA], betaine, choline, and carnitine) as well as thio-amino-acids (cysteine, homocysteine and methionine) were measured by liquid chromatography-tandem mass spectrometry. The main outcome was HF requiring Hospitalization (HFrH) defined as the first occurrence of acute HF leading to hospitalization and/or death, established by an adjudication committee, based on hospital records until 31st December 2015. The secondary outcomes were the composite event HFrH and/or cardiovascular death and all-cause death. The association between the biomarkers and the outcomes was studied using cause-specific hazard-models, adjusted for age, sex, history of coronary artery disease, NT-proBNP, CKD-EPI-derived eGFR and the urine albumin/creatinine ratio. Hazard-ratios (HR) are expressed for one standard deviation. Results The data of interest were available for 1349/1468 of SURDIAGENE participants (91.9%), including 569 (42.2%) women, with a mean age of 64.3 ± 10.7 years and a median follow-up of 7.3 years [25th–75th percentile, 4.7–10.8]. HFrH was reported in 209 patients (15.5%), HFrH and/or cardiovascular death in 341 (25.3%) and all-cause death in 447 (33.1%). In unadjusted hazard-models, carnitine (HR = 1.20, 95% CI [1.05; 1.37]), betaine (HR = 1.34, [1.20; 1.50]), choline (HR = 1.35, [1.20; 1.52]), TMAO (HR = 1.32, [1.16; 1.50]), cysteine (HR = 1.38, [1.21; 1.58]) and homocysteine (HR = 1.28, [1.17; 1.39]) were associated with HFrH, but not TMA and methionine. In the fully adjusted models, none of these associations was significant, neither for HFrH nor for HFrH and/or CV death, when homocysteine only was positively associated with all-cause death (HR = 1.16, [1.06; 1.27]). Conclusions TMAO and its precursors do not appear to be substantial prognosis factors for HFrH, beyond usual cardiac- and kidney-related risk factors, whereas homocysteine is an independent risk factor for all-cause death in patients with T2D.
Published: 2022

26. Transperineal ultrasound shear-wave elastography is a reliable tool for assessment of the elastic properties of the levator ani muscle in women

Author: Bertrand Gachon, Fabrice Pierre, Antoine Nordez, Xavier Fritel, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Le Mans Université (UM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Universitaire de France (IUF), Ministère de l'Education nationale, de l’Enseignement supérieur et de la Recherche (M.E.N.E.S.R.), Le Mans Université (UM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN), and NantesU ST, Dépôt
Subjects: Adult, Intraclass correlation, Science, medicine.medical_treatment, Coefficient of variation, Levator ani muscle, 030232 urology & nephrology, Urinary incontinence, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Article, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Valsalva maneuver, Humans, Medicine, Prospective Studies, Transperineal ultrasound, Reproducibility, Shear wave elastography, 030219 obstetrics & reproductive medicine, Multidisciplinary, business.industry, Transperineal approach, Muscles, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Elasticity Imaging Techniques, Muscle, Female, Shear Strength, business, Nuclear medicine
Abstract: Our main objective was to assess the intraoperator intersession reproducibility of transperineal ultrasound Shear Wave Elastography (SWE) to measure the levator ani muscle (LAM) elastic properties. Secondary objective was to compare reproducibility when considering the mean of three consecutives measurements versus one. In this prospective study involving non-pregnant nulliparous women, two visits were planned, with a measurement of the shear modulus (SM) on the right LAM at rest, during Valsalva maneuver and maximal contraction. Assessments were done with a transperineal approach, using an AIXPLORER device with a linear SL 18–5 (5-18 MHz) probe. For each condition, 3 consecutive measures were performed at each visit. The mean of the three measures, then the first one, were considered for the reproducibility by calculating intraclass correlation coefficient (ICC), and coefficient of variation (CV). Twenty women were included. Reproducibility was excellent when considering the mean of the 3 measures at rest (ICC = 0.90; CV = 15.7%) and Valsalva maneuver (ICC = 0.94; CV = 10.6%), or the first of the three measures at rest (ICC = 0.87; CV = 18.6%) and Valsalva maneuver (ICC = 0.84; CV = 19.9%). Reproducibility was fair for measurement during contraction. Transperineal ultrasound SWE is a reliable tool to investigate LAM elastic properties at rest and during Valsalva maneuver.
Published: 2021

27. Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients

Author: Jan O. Friedrich, Sebastian Dubo, Ewan C. Goligher, Leo M. A. Heunks, Michael C. Sklar, Fabiana Madotto, Michela Rauseo, Ibrahim Soliman, Ricard M. Artigas, Nuttapol Rittayamai, L. Felipe Damiani, Rémi Coudroy, Lu Chen, Irene Telias, Annemijn H. Jonkman, Guang-Qiang Chen, Laurent Brochard, Tài Pham, Martin Dres, Christer Sinderby, Intensive care medicine, ACS - Pulmonary hypertension & thrombosis, University of Toronto, St. Michael's Hospital, Università degli Studi di Milano, IRCCS Policlinico San Donato, VU University Medical Center [Amsterdam], Università degli Studi di Foggia - University of Foggia, Pontificia Universidad Católica de Chile (UC), Universidad de Concepción - University of Concepcion [Chile], Universidad de la frontera [Chile], Siriraj Hospital, Mahidol University, Mahidol University [Bangkok], Mount Sinai Health System, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Università degli Studi di Foggia = University of Foggia (Unifg), HAL-SU, Gestionnaire, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Male, Time Factors, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Sedation, medicine.medical_treatment, Critical Illness, Diaphragm, Diaphragmatic breathing, Critical Care and Intensive Care Medicine, Electrical activity of the diaphragm, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Interquartile range, Severity of illness, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Intubation, Intratracheal, Medicine, Intubation, Humans, Prospective Studies, Aged, Aged, 80 and over, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, Respiration, Artificial, 3. Good health, Diaphragm (structural system), Critical care, 030228 respiratory system, Anesthesia, Breathing, Female, medicine.symptom, Sedentary Behavior, business
Abstract: BackgroundIn patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weakness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity.MethodsProspective observational study in critically ill patients. Diaphragm electrical activity (EAdi) was continuously recorded after intubation looking for resumption of a minimal level of diaphragm activity (beginning of the first 24 h period with median EAdi > 7 µV, a threshold based on literature and correlations with diaphragm thickening fraction). Recordings were collected until full spontaneous breathing, extubation, death or 120 h. A 1 h waveform recording was collected daily to identify reverse triggering.ResultsSeventy-five patients were enrolled and 69 analyzed (mean age ± standard deviation 63 ± 16 years). Reasons for ventilation were respiratory (55%), hemodynamic (19%) and neurologic (20%). Eight catheter disconnections occurred. The median time for resumption of EAdi was 22 h (interquartile range 0–50 h); 35/69 (51%) of patients resumed activity within 24 h while 4 had no recovery after 5 days. Late recovery was associated with use of sedative agents, cumulative doses of propofol and fentanyl, controlled ventilation and age (older patients receiving less sedation). Severity of illness, oxygenation, renal and hepatic function, reason for intubation were not associated with EAdi resumption. At least 20% of patients initiated EAdi with reverse triggering.ConclusionLow levels of diaphragm electrical activity are common in the early course of mechanical ventilation: 50% of patients do not recover diaphragmatic activity within one day. Sedatives are the main factors accounting for this delay independently from lung or general severity.Trial RegistrationClinicalTrials.gov (NCT02434016). Registered on April 27, 2015. First patients enrolled June 2015.
Published: 2021

28. Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative

Author: Bertrand, Cariou, Matthieu, Wargny, Anne-Sophie, Boureau, Sarra, Smati, Blandine, Tramunt, Rachel, Desailloud, Maylis, Lebeault, Coralie, Amadou, Deborah, Ancelle, Beverley, Balkau, Lyse, Bordier, Sophie, Borot, Muriel, Bourgeon, Olivier, Bourron, Emmanuel, Cosson, Martin, Eisinger, Céline, Gonfroy-Leymarie, Jean-Baptiste, Julla, Lucien, Marchand, Laurent, Meyer, Dominique, Seret-Bégué, Dominique, Simon, Ariane, Sultan, Charles, Thivolet, Anne, Vambergue, Camille, Vatier, Patrice, Winiszewski, Pierre-Jean, Saulnier, Bernard, Bauduceau, Pierre, Gourdy, Samy, Hadjadj, Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Santé publique - Clinique des données [CHU Nantes] (Pôle Hospitalo-Universitaire 11), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut des Maladies Métaboliques et Casdiovasculaires (UPS/Inserm U1297 - I2MC), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Amiens-Picardie, Périnatalité et Risques Toxiques - UMR INERIS_I 1 (PERITOX), Institut National de l'Environnement Industriel et des Risques (INERIS)-Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Sud Francilien, Université Paris-Saclay, CH Le Havre, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital d'Instruction des Armées Begin, Service de Santé des Armées, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Avicenne [AP-HP], Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IDF), Institut de Veille Sanitaire (INVS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut National Agronomique Paris-Grignon (INA P-G)-CETAF-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Sorbonne Paris Nord, Centre Intégré Nord Francilien de l'Obésité (CINFO), Unité de Recherche en Epidémiologie Nutritionnelle (UREN), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Sorbonne Paris Nord, Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier René Dubos [Pontoise], Hôpital Lariboisière-Fernand-Widal [APHP], Centre hospitalier Saint Joseph - Saint Luc [Lyon], Les Hôpitaux Universitaires de Strasbourg (HUS), Centre Hospitalier de Gonesse, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Société Francophone du Diabète, Partenaires INRAE, CHU Lille, CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), École pratique des hautes études (EPHE), Centre National de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité [CHu Saint-Antoine] (PRISIS), and MORNET, Dominique
Subjects: Male, SARS-CoV-2, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Diabetes, Charlson index, COVID-19, Comorbidity, Prognosis, [SDV] Life Sciences [q-bio], Death, Cohort Studies, Internal Medicine, Diabetes Mellitus, Humans, Female, Invasive mechanical ventilation
Abstract: International audience; Aims/hypothesis: Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question.Methods: The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes.Results: A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p
Published: 2021

29. Radiotherapy (WBRT) or Autologous Stem-Cell Transplantation (ASCT) for Primary CNS Lymphoma in Patients 60 Years of Age and Younger: Long-Term Results of the Intergroup Anocef-Goelams Randomized Phase II Precis Study

Author: Pierre Morel, Vincent Delwail, Damien Ricard, Roch Houot, Gandhi Damaj, Alain Delmer, Anna Schmitt, Cécile Moluçon-Chabrot, Valérie Touitou, Anne-Sophie Plissonnier, Nathalie Cassoux, Adrien Chauchet, Frederic Peyrade, Carole Soussain, Reda Garidi, Mouna Laadhari, Laurence Sanhes, Khê Hoang-Xuan, Emmanuel Gyan, Luc Taillandier, Choquet Sylvain, Loïc Feuvret, Jérôme Cornillon, Sylvain Dureau, Marie-Laure Tanguy, Marie-Pierre Moles, Julie Abraham, Thomas Gastinne, Ahmad Al Jijakli, Olivier Chinot, Remy Gressin, Caroline Houillier, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pontchaillou [Rennes], Microenvironment and B-cells: Immunopathology,Cell Differentiation, and Cancer (MOBIDIC), Université de Rennes (UR)-Etablissement français du sang [Rennes] (EFS Bretagne)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de neurophysiopathologie (INP), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service d’Oncologie Médicale [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Louise Michel [Clermont-Ferrand], CHU Clermont-Ferrand, Institut Bergonié [Bordeaux], UNICANCER, Centre Hospitalier Universitaire [Grenoble] (CHU), Laboratoire d'Hématologie Biologique [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe innovation et ciblage cellulaire (GICC), EA 7501 [2018-...] (GICC EA 7501), Université de Tours (UT), ERL 7001 LNOx (Leukemic Niche & redOx metabolism / Niche leucémique et métabolisme redOx) (LNOx), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Centre National de la Recherche Scientifique (CNRS)-Microenvironnement des niches tumorales (CNRS GDR 3697 Micronit ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Groupe innovation et ciblage cellulaire (GICC), EA 7501 [2018-...] (GICC EA 7501), Université de Tours (UT)-Université de Tours (UT), Institut Curie [Paris], Université Paris sciences et lettres (PSL), Centre Hospitalier Saint Jean de Perpignan, Institut de Cancérologie Lucien Neuwirth, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Hôpital Saint-Quentin, Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Immunité et cancer (U932), and Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Oncology, medicine.medical_specialty, business.industry, medicine.medical_treatment, Immunology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Cell Biology, Hematology, Long term results, Biochemistry, Radiation therapy, Autologous stem-cell transplantation, Primary CNS Lymphoma, Internal medicine, Medicine, In patient, business
Abstract: Introduction: We previously reported the results of the PRECIS trial with a median follow-up of 33 months. Both whole brain radiotherapy (WBRT) and autologous stem cell transplantation (ACST) were effective according to the predetermined threshold. However, more relapses occurred in the WBRT arm. The 2-year event-free survival (EFS) from consolidation (relapse or death defined as event) were 69% (95% CI, 57% to 83%) and 87% (95% CI, 77% to 98%) after WBRT and ASCT, respectively (p = 0.03). Overall survival (OS) was similar in both arms. Cognitive impairment was observed after WBRT, whereas cognitive functions were preserved or improved after ASCT. A longer follow-up is required to better assess the impact of the treatment on relapse, survival and late complications. We report here the results of the PRECIS trial with a median follow-up of 98.3 months [min= 4,1 - max= 131.1], focusing on the per protocol population from time of consolidation. Methods: Immunocompetent patients (18 to 60 years of age) with untreated primary CNS lymphoma (PCNSL) were randomly assigned upfront to receive WBRT (Arm A) or ASCT (Arm B) as consolidation treatment after an induction chemotherapy consisting of two cycles of R-MBVP (rituximab, methotrexate, VP16, BCNU, prednisone) followed by two cycles of R-AraC (rituximab, cytarabine). Intensive chemotherapy consisted of thiotepa (250 mg/m2/d D9; D8; D7), busulfan (8 mg/kg D6 through D4), and cyclophosphamide (60 mg/kg/d D3; D2). WBRT delivered 40 Gy (2 Gy/ fraction). Cognitive functions were prospectively assessed until disease progression and focused on global cognitive function, episodic verbal memory, attention and mental flexibility, and psychoaffective status. Results: 140 patients were randomized (Arm A: N = 70; Arm B: N = 70). Fifty-three and 44 patients completed WBRT and ASCT respectively (per protocol population), including 3 and 5 patients who were in progressive disease (PD) at time of WBRT and ASCT, respectively. 8-y EFS from time of consolidation in the per protocol population was 75.9% [63.3-91.0] and 39.9% [26.8-59.3] after ASCT and WBRT, respectively (p = 0.007) (fig 1a). The risk of relapse was significantly decreased after ASCT compared to WBRT (8-y relapse-free interval 94.1% [86.4-100] vs 47.6% [34.2-66.3], (p Causes of deaths after WBRT (n = 17) were PD (n = 12), neurotoxicity (n = 3), second-line ASCT (n = 2). After ASCT, causes of deaths (n = 14) were treatment-related death (n = 5, including 2 occurring > 100 days post-ASCT, and 2 in patients in PD before ASCT), PD (n = 4), neurotoxicity following salvage WBRT (n = 1), second solid cancer (n = 3) and undetermined in one patient. In multivariate analysis, ECOG, disease status at the end of induction, and protein level in the CSF at diagnosis were independent prognostic factors for OS. Disease status at the end of induction and intraocular involvement at diagnosis were independent prognostic factors for EFS. Cognitive decline that could be fatal was only observed in patients who received WBRT. Imaging analysis of post consolidation leukoencephalopathy is ongoing. Conclusions: Consolidation with ASCT after HD-MTX based induction chemotherapy resulted in an excellent disease control but with a higher treatment-related mortality than WBRT. Severe Cognitive decline and late treatment-induced neurotoxic deaths were observed after WBRT. Intensity of the thiotepa-busulfan-cyclophosphamide regimen used before ASCT should be slightly reduced to improve the benefit/risk ratio of ASCT in first-line treatment of young patients with PCNSL. Figure 1 Figure 1. Disclosures Sylvain: Sanofi, Celegene, Roche, Abbvie, Sandoz, Janssen, Takeda: Consultancy. Damaj: takeda: Consultancy, Honoraria; roche: Consultancy, Honoraria. Sanhes: Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
Published: 2021

30. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI‐MESH registry

Author: X Fritel, R Tayrac, J Keizer, S Campagne‐Loiseau, M Cosson, P Ferry, X Deffieux, J‐P Lucot, L Wagner, P Debodinance, C Saussine, A‐C Pizzoferrato, C Carlier‐Guérin, T Thubert, L Panel, P‐O Bosset, E Nkounkou, R Ramanah, T Boisramé, T Charles, C Raiffort, A Charvériat, S Ragot, A Fauconnier, Adnan Aboukassem, Chérif Akladios, Emmanuelle Arsène, Jean‐Sébastien Aucouturier, Georges Bader, Emmanuel Bailly, Jean‐Jacques Baldauf, Stéphanie Bartolo, Marie‐Line Barussaud, Fanny Béchard, Simon Bernardeau, Clément Biscans, Deepak Boodhun, Revaz Botchorishvili, Michel Boukaram, Aude Brams, Laurent Bressler, Clément Bruhat, Michel Canis, Victor Cavillon, Olivier Celhay, Armand Chevrot, Pierre Collinet, Arnaud Cornille, Pierre Costa, Christophe Courtieu, Laurent Courtois, Sandra Curinier, Eric Darnis, Pierre‐Olivier Delpech, Véronique Delporte, Anne Dubois, Emilie Faller, Brigitte Fatton, Cécile Féyeux, Victor Gabriele, Pierre Gadonneix, Olivier Garbin, Florent Genty, Géraldine Giraudet, Pascale Gres, Pauline Gueudry, Jean‐François Haab, Audrey Hedde, Aline Host, Michel Hummel, Estelle Jean dit Gautier, Aminata Kane, Sophie Gouic, Isabelle Teuff, Gil Lebreton, Lise Lecointre, Grégoire Léon, Yolande Maisonnette, Lucile Martin, Aurore Marx, Pascal Mouracade, Corinne Palamara, Petit Nicolas, Caroline Pettenati, Laurence Peyrat, Pierre Pillot, Jean‐Luc Pouly, Clothilde Poupon, Michel Prudhomme, Benoît Rabishong, Hélène Ricard, Jérémie Ripoche, Géraldine Rivaux, Jennifer Salerno, Delphine Salet‐Lizée, Richard Sarfati, Maxence Sarradin, Elodie Schuller, An Segaert, François Stoll, Yannick Thirouard, Caroline Trichot, Mélusine Turck, David Vandendriessche, Edouard Vaucel, Sarah Vieillefosse, Anne Villot, Denis Vinatier, Etienne Vincens, Marie Vinchant, Béatrice Vinson‐Bonnet, Soraya Wapler, Sophie Warembourg, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, CHU Lille, Hôpital Saint-Louis de La Rochelle (CH La Rochelle), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Saint Vincent de Paul de Lille, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), CH Dunkerque, CHU Strasbourg, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CH de Châtellerault, Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Beau Soleil [Montpellier], Hôpital Foch [Suresnes], Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Fritel, Xavier, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), and centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
Subjects: Reoperation, medicine.medical_specialty, Multivariate analysis, [SDV]Life Sciences [q-bio], Population, registry, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Risk profile, 03 medical and health sciences, Gynecologic Surgical Procedures, Postoperative Complications, 0302 clinical medicine, surgical complication, Recurrence, Risk Factors, Humans, Medicine, Prospective Studies, Registries, 030212 general & internal medicine, education, Prospective cohort study, Aged, Pelvic organ, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Prolapse surgery, Incidence (epidemiology), Hazard ratio, Obstetrics and Gynecology, Middle Aged, Surgical Mesh, Vaginal repair, pelvic organ prolapse, Confidence interval, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, mesh, Vagina, Female, Laparoscopy, Longitudinal study, business
Abstract: Objective To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design Prospective cohort study using a registry. Setting Nineteen French surgical centres. Population A total of 2309 women participated between 2017 and 2019. Methods A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures Serious complications and subsequent reoperations for POP recurrence. Results The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. Conclusions Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Tweetable abstract Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.
Published: 2021

31. Early versus differed arterial catheterisation in critically ill patients with acute circulatory failure: a multicentre, open-label, pragmatic, randomised, non-inferiority controlled trial: the EVERDAC protocol

Author: Toufik Kamel, Damien Contou, Jean-Pierre Quenot, Alexandra Monnier, Thierry Boulain, Jean-Claude Lacherade, Maelle Martin, Sylvie Vimeux, Elsa Tavernier, Grégoire Muller, Solène Brunet Houdard, Florence Boissier, Stephan Ehrmann, Centre Hospitalier Régional d'Orléans (CHRO), Réseau CRICS-TRIGGERSEP [CHRU Tours] (F-CRIN research network), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre hospitalier Argenteuil (CH Argenteuil), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [Tours], Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Strasbourg, Centre hospitalier de Montauban (CH Montauban), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), and Malbec, Odile
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Informed consent, law, Medicine, health economics, 030212 general & internal medicine, adult intensive & critical care, Protocol (science), clinical trials, business.industry, 030208 emergency & critical care medicine, General Medicine, Arterial catheter, medicine.disease, Intensive care unit, Thrombosis, 3. Good health, Clinical trial, [SDV] Life Sciences [q-bio], Shock (circulatory), Emergency medicine, medicine.symptom, business
Abstract: IntroductionThe use of peripheral indwelling arterial catheter for haemodynamic monitoring is widespread in the intensive care unit and is recommended in patients with shock. However, there is no evidence that the arterial catheter could improve patient’s outcome, whereas the burden of morbidity generated is significant (pain, thrombosis, infections). We hypothesise that patients with shock may be managed without an arterial catheter.Methods and analysisThe EVERDAC study is an investigator-initiated, pragmatic, multicentre, randomised, controlled, open-label, non-inferiority clinical trial, comparing a less invasive intervention (ie, no arterial catheter insertion until felt absolutely needed, according to predefined safety criteria) or usual care (ie, systematic arterial catheter insertion in the early hours of shock). 1010 patients will be randomised with a 1:1 ratio in two groups according to the strategy. The primary outcome is all-cause mortality by 28 days after inclusion. A health economic analysis will be carried out.Ethics and disseminationThe study has been approved by the Ethics Committee (Comité de Protection des Personnes Île de France V, registration number 61606 CAT 2, 19 july 2018) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03680963.
Published: 2021

32. Early Bacterial Identification among Intubated Patients with COVID-19 or Influenza Pneumonia: A European Multicenter Comparative Clinical Trial

Author: Anahita Rouzé, Ignacio Martin-Loeches, Pedro Povoa, Matthieu Metzelard, Damien Du Cheyron, Fabien Lambiotte, Fabienne Tamion, Marie Labruyere, Claire Boulle Geronimi, Ania Nieszkowska, Martine Nyunga, Olivier Pouly, Arnaud W. Thille, Bruno Megarbane, Anastasia Saade, Emili Diaz, Eleni Magira, Jean-François Llitjos, Catia Cilloniz, Iliana Ioannidou, Alexandre Pierre, Jean Reignier, Denis Garot, Louis Kreitmann, Jean-Luc Baudel, Muriel Fartoukh, Gaëtan Plantefeve, Alexandra Beurton, Pierre Asfar, Alexandre Boyer, Armand Mekontso-Dessap, Demosthenes Makris, Christophe Vinsonneau, Pierre-Edouard Floch, Nicolas Weiss, Adrian Ceccato, Antonio Artigas, Mathilde Bouchereau, Alain Duhamel, Julien Labreuche, Saad Nseir, Julien Poissy, Raphaël Favory, Sébastien Preau, Mercè Jourdain, Sean Boyd, Luis Coelho, Pierre Cuchet, Wafa Zarrougui, Déborah Boyer, Jean-Pierre Quenot, Mehdi Imouloudene, Charles-Edouard Luyt, Thierry van der Linden, Justine Bardin, Sebastian Voicu, Elie Azoulay, Gemma Goma, Frédéric Pene, Antoni Torres, Didier Thevenin, Stéphan Ehrmann, Laurent Argaud, Bertrand Guidet, Guillaume Voiriot, Damien Contou, Julien Le Marec, Julien Demiselle, David Meguerditchian, Keyvan Razazi, Vassiliki Tsolaki, Caroline Sejourne, Guillaume Brunin, Loïc Le Guennec, Luis Morales, CHU Lille, Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Trinity College Dublin, University of Barcelona, New University of Lisbon, Odense University Hospital (OUH), CHU Amiens-Picardie, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre hospitalier [Valenciennes, Nord], Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier [Douai, Nord], Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier de Roubaix, Hôpital Saint Philibert [Lomme], Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hopital Saint-Louis [AP-HP] (AP-HP), Universitat Autònoma de Barcelona (UAB), National and Kapodistrian University of Athens (NKUA), Hôpital Cochin [AP-HP], Centre Hospitalier de Lens, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Tenon [AP-HP], Centre Hospitalier Victor Dupouy, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Bordeaux [Bordeaux], CHU Henri Mondor [Créteil], Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Henri Mondor [Créteil], Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), University of Thessaly [Larissa], Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Hôpital Duchenne, CH Boulogne sur Mer, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), coVAPid Study Group, CHU Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, and Mégarbane, Bruno
Subjects: Surviving Sepsis Campaign, medicine.medical_treatment, Disease, Critical Care and Intensive Care Medicine, medicine.disease_cause, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Mechanical ventilation, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, 030212 general & internal medicine, intensive care, Coronavirus, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Coinfection, Bacterial, virus diseases, Antimicrobial, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, [SDV.TOX]Life Sciences [q-bio]/Toxicology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, influenza, Cohort study, Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), mechanical ventilation, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Intensive care, Internal medicine, Influenza, Human, Humans, bacterial, COVID-19/Pulmonary Infections, Retrospective Studies, business.industry, SARS-CoV-2, COVID-19, Original Articles, Pneumonia, Influenza, respiratory tract diseases, 030228 respiratory system, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, business
Abstract: International audience; Rationale: Early empirical antimicrobial treatment is frequently prescribed to critically ill patients with coronavirus disease (COVID-19) based on Surviving Sepsis Campaign guidelines.Objectives: We aimed to determine the prevalence of early bacterial identification in intubated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, as compared with influenza pneumonia, and to characterize its microbiology and impact on outcomes.Methods: A multicenter retrospective European cohort was performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation >48 hours were eligible if they had SARS-CoV-2 or influenza pneumonia at ICU admission. Bacterial identification was defined by a positive bacterial culture within 48 hours after intubation in endotracheal aspirates, BAL, blood cultures, or a positive pneumococcal or legionella urinary antigen test.Measurements and Main Results: A total of 1,050 patients were included (568 in SARS-CoV-2 and 482 in influenza groups). The prevalence of bacterial identification was significantly lower in patients with SARS-CoV-2 pneumonia compared with patients with influenza pneumonia (9.7 vs. 33.6%; unadjusted odds ratio, 0.21; 95% confidence interval [CI], 0.15-0.30; adjusted odds ratio, 0.23; 95% CI, 0.16-0.33; P < 0.0001). Gram-positive cocci were responsible for 58% and 72% of coinfection in patients with SARS-CoV-2 and influenza pneumonia, respectively. Bacterial identification was associated with increased adjusted hazard ratio for 28-day mortality in patients with SARS-CoV-2 pneumonia (1.57; 95% CI, 1.01-2.44; P = 0.043). However, no significant difference was found in the heterogeneity of outcomes related to bacterial identification between the two study groups, suggesting that the impact of coinfection on mortality was not different between patients with SARS-CoV-2 and influenza.Conclusions: Bacterial identification within 48 hours after intubation is significantly less frequent in patients with SARS-CoV-2 pneumonia than patients with influenza pneumonia.Clinical trial registered with www.clinicaltrials.gov (NCT04359693).
Published: 2021

33. Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process

Author: Blandine Courbiere, Enora Le Roux, Emmanuelle Mathieu d’Argent, Antoine Torre, Catherine Patrat, Christophe Poncelet, Jacques Montagut, Anne-Sophie Gremeau, Hélène Creux, Maëliss Peigné, Isabella Chanavaz-Lacheray, Lara Dirian, Xavier Fritel, Jean-Luc Pouly, Arnaud Fauconnier, on behalf of the PreFerBe Expert Panel, Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, 13005 Marseille, France, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Unité d’Epidémiologie Clinique, Hôpital Universitaire Robert Debré, AP-HP Nord-Université de Paris, Inserm, CIC 1426, 75019 Paris, France, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Groupe de recherche clinique Centre Expert en Endométriose (GRC 6 - C3E), Sorbonne Université (SU), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Department of Gynecology-Obstetric and Reproductive Medicine, CHU Rouen, 37 bd Gambetta, 76000 Rouen, France, Service de Biologie de la Reproduction—CECOS, APHP Centre—Université de Paris, Site Cochin, Inserm U1016, 75014 Paris, France, Department of Gynecology-Obstetric, UFR SMBH Leonard de Vinci, CH René Dubos, 95000 Cergy-Pontoise, France, Université Sorbonne Paris Nord—Paris 13, 93200 Saint-Denis, France, Institut Francophone de Recherche et d’Etudes Appliquées à la Reproduction, Ifreares Toulouse, 31000 Toulouse, France, Service de Gynécologie [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Clinique Saint Roch, Department of Gynecology-Obstetric and Reproductive Medicine, 34000 Montpellier, France, Department of Reproductive Medicine and Fertility Preservation, AP-HP Hôpital Jean Verdier, 93143 Bondy, Centre d’Endométriose [Clinique Tivoli Ducos, Bordeaux], Clinique Tivoli Ducos [Bordeaux], EndoFrance, Association Française de lutte contre l’Endométriose, 70190 Tresilley, France, Department of Gynecology-Obstetric and Reproductive Medicine, CHU Poitiers, 86000 Poitiers, France, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Gynecology-Obstetric, CH Moulins Yzeure, 03000 Moulins, France, Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain-en Laye, 78300 Poissy, Research Unit 7285 Risk and Safety in ClinicalMedicine forWomen and Perinatal Health, Paris-Saclay University, 78300 Poissy, France, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Centre Expert en Endométriose [CHU Tenon] (GRC6 C3E), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Centre d’Endométriose, Clinique Tivoli Ducos, 33000 Bordeaux, France, TASSISTRO, Virginie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon]
Subjects: Infertility, medicine.medical_specialty, Process (engineering), Steering committee, Modified delphi, Disease, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Oocyte vitrification, Article, 03 medical and health sciences, 0302 clinical medicine, benign gynecologic disease, medicine, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, 030212 general & internal medicine, Fertility preservation, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, 030219 obstetrics & reproductive medicine, business.industry, General Medicine, medicine.disease, 3. Good health, Clinical Practice, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Consensus study, Family medicine, Medicine, business, Live birth, modified Delphi method
Abstract: International audience; International guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP.All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalizedcounseling for FP.
Published: 2021

34. Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated

Author: Olivier Mimoz, Benoit Veber, Matthieu Boisson, Dominique Falcon, Carole Ichai, Claire-Marie Drevet, Lilit Kelesyan, Thiên-Nga Chamaraux-Tran, Laurent Muler, Julien Pottecher, Marc Leone, Abdelouaid Nadji, Hervé Quintard, Claire Dahyot-Fizelier, Belaid Bouhemad, Nicolas Marjanovic, Sigismond Lasocki, Claire Roger, Thomas Kerforne, Jean-Yves Lefrant, Catherine Paugam-Burtz, Marc Ginet, Antoine Roquilly, Elodie Caumon, Emmanuelle Hammad, Florian Grimaldi, Pierre-Olivier Ludes, Jérémy Guenezan, Arnaud Foucrier, Sébastien Leduc, Guillaume Besch, Sabrina Seguin, Russell Chabanne, Karim Asehnoune, Philippe Gouin, Pierre-Gildas Guitard, Denis Frasca, Maxime Léger, Sebastien Pili-Floury, Raphaël Cinotti, Marie-Héléne Po, Joe de Keizer, Soizic Gergaud, Thomas Gaillard, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Département d'Anesthésie et Réanimation [Hôpital Beaujon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'Anesthésie-Réanimation [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Universitaire de Nice (CHU Nice), Aix Marseille Université (AMU), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Hôpital de Hautepierre [Strasbourg], Université de Strasbourg - Faculté de Médecine [Strabourg] (FMTS), Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts (IMAGINE), Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire [Grenoble] (CHU), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Clermont-Ferrand, Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), AGATE Study Group: Guillaume Besch, Bélaid Bouhemad, Elodie Caumon, Thien-Nga Chamaraux-Tran, Raphael Cinotti, Thomas Gaillard, Soizic Gergaud, Marc Ginet, Philippe Gouin, Florian Grimaldi, Pierre-Gildas Guitard, Emmanuelle Hammad, Lilit Kelesyan, Sébastien Leduc, Maxime Leger, Pierre-Olivier Ludes, Laurent Muler, Abdelouaid Nadji, Catherine Paugam-Burtz, Marie-Héléne Po, Hervé Quintard, Claire Roger, Antoine Roquilly, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Chauzy, Alexia, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Critical Care and Intensive Care Medicine, Tracheal tube, 03 medical and health sciences, 0302 clinical medicine, Intensive care, ventilator-associated, medicine, pneumonia, 030212 general & internal medicine, education, intensive care, Mechanical ventilation, education.field_of_study, business.industry, Tracheal intubation, Ventilator-associated pneumonia, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, medicine.disease, infection, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, 030228 respiratory system, Anesthesia, Cuff, tracheal cuff pressure, Injury Severity Score, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; Background: Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination.Research question: Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in patients with severe trauma?Study design and methods: In this open-label, randomized controlled superiority trial conducted in 13 French ICUs, adults (age ≥ 18 years) with severe trauma (Injury Severity Score > 15) and requiring invasive mechanical ventilation for ≥ 48 h were enrolled. Patients were randomly assigned (1:1) via a secure Web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants.Results: A total of 434 patients were recruited between July 31, 2015, and February 15, 2018, of whom 216 were assigned to the intervention group and 218 to the control group. Seventy-three patients (33.8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (adjusted subdistribution hazard ratio, 0.96; 95% CI, 0.76-1.20; P = .71). No serious adverse events related to the use of the pneumatic device were noted.Interpretation: Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in patients with severe trauma.Clinical trial registration: ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.
Published: 2021

35. Response

Author: Nicolas, Marjanovic, Jérémy, Guenezan, Olivier, Mimoz, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), and Chauzy, Alexia
Subjects: Pulmonary and Respiratory Medicine, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, [SDV]Life Sciences [q-bio], [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2021

36. Gender imbalance in intensive care: High time for action and evaluation!

Author: Hauw-Berlemont, Caroline, Salmon Gandonnière, Charlotte, Boissier, Florence, Aissaoui, Nadia, Bodet-Contentin, Laetitia, Fartoukh, Muriel, Jourdain, Mercedes, Le Marec, Julien, Tamion, Fabienne, Hamzaoui, Olfa, Aubron, Cécile, Group For The French Intensive Care Society, The Femmir (femme Médecins En Médecine Intensive Réanimation), Gestionnaire, Hal Sorbonne Université, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Lille, Recherche translationnelle sur le diabète - U 1190 (RTD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé (UBO UFR MSS), Université de Brest (UBO), The FEMMIR (Femme Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society : Caroline Hauw-Berlemont, Charlotte Salmon Gandonnière, Florence Boissier, Nadia Aissaoui, Laetitia Bodet-Contentin, Muriel Sarah Fartoukh, Mercedes Jourdain, Julien Le Marec, Fabienne Tamion, Olfa Hamzaoui & Cécile Aubron, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Critical Care, business.industry, RC86-88.9, [SDV]Life Sciences [q-bio], Research, Sexism, MEDLINE, 030208 emergency & critical care medicine, Medical emergencies. Critical care. Intensive care. First aid, Critical Care and Intensive Care Medicine, medicine.disease, [SDV] Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Editorial, 030228 respiratory system, Action (philosophy), Intensive care, Medicine, Humans, Medical emergency, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2021

37. The multi-source information system of the Poitou-Charentes population-based cancer registry. Design, development and applications in the era of massive health data

Author: Défossez, Gautier, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers, Pierre Ingrand, François Guilhot-Gaudeffroy, and STAR, ABES
Subjects: Registry, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Efficience, [SDV.CAN]Life Sciences [q-bio]/Cancer, Efficiency, Données massives, Algorithme, Information system, Algorithm, Big data, [SDV.CAN] Life Sciences [q-bio]/Cancer, Système d'information, Registre, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cancer
Abstract: Population-based cancer registries (PBCRs) are the best international option tool to provide a comprehensive (unbiased) picture of the weight, incidence and severity of cancer in the general population. Their work in classifying and coding diagnoses according to international rules gives to the final data a specific quality and comparability in time and space, thus building a decisive knowledge database for describing the evolution of cancers and their management in an uncontrolled environment. Cancer registration is based on a thorough investigative process, for which the complexity is largely related to the ability to access all the relevant data concerning the same individual and to gather them efficiently. Created in 2007, the General Cancer Registry of Poitou-Charentes (RGCPC) is a recent generation of cancer registry, started at a conducive time to devote a reflection about how to optimize the registration process. Driven by the computerization of medical data and the increasing interoperability of information systems, the RGCPC has experimented over 10 years a multi-source information system combining innovative methods of information processing and representation, based on the reuse of standardized data usually produced for other purposes.In a first section, this work presents the founding principles and the implementation of a system capable of gathering large amounts of data, highly qualified and structured, with semantic alignment to subscribe to algorithmic approaches. Data are collected on multiannual basis from 110 partners representing seven data sources (clinical, biological and medical administrative data). Two algorithms assist the cancer registrar by dematerializing the manual tasks usually carried out prior to tumor registration. A first algorithm generate automatically the tumors and its various components (publication), and a second algorithm represent the care pathway of each individual as an ordered sequence of time-stamped events that can be access within a secure interface (publication). Supervised machine learning techniques are experimented to get around the possible lack of codification of pathology reports (publication).The second section focuses on the wide field of research and evaluation achieved through the availability of this integrated information system. Data linkage with other datasets were tested, within the framework of regulatory authorizations, to enhance the contextualization and knowledge of care pathways, and thus to support the strategic role of PBCRs for real-life evaluation of care practices and health services research (proof of concept): screening, molecular diagnosis, cancer treatment, pharmacoepidemiology (four main publications). Data from the RGCPC were linked with those from the REIN registry (chronic end-stage renal failure) as a use case for experimenting a prototype platform dedicated to the collaborative sharing of massive health data (publication).The last section of this work proposes an open discussion on the relevance of the proposed solutions to the requirements of quality, cost and transferability, and then sets out the prospects and expected benefits in the field of surveillance, evaluation and research in the era of big data., Les registres du cancer sont au plan international l’outil de référence pour produire une vision exhaustive (non biaisée) du poids, de la dynamique et de la gravité du cancer dans la population générale. Leur travail de classification et de codage des diagnostics selon des normes internationales confère aux données finales une qualité spécifique et une comparabilité dans le temps et dans l’espace qui les rendent incontournables pour décrire l’évolution et la prise en charge du cancer dans un environnement non contrôlé. Leur travail repose sur un processus d’enquête rigoureux dont la complexité est largement dépendante des capacités à accéder et à rassembler efficacement toutes les données utiles concernant un même individu. Créé en 2007, le Registre Général des Cancers de Poitou-Charentes (RGCPC) est un registre de génération récente, débuté à une période propice à la mise en œuvre d’une réflexion sur l’optimisation du processus d’enregistrement. Porté par l’informatisation des données médicales et l’interopérabilité croissante des systèmes d’information, le RGCPC a développé et expérimenté sur 10 ans un système d’information multi-sources associant des méthodes innovantes de traitement et de représentation de l’information fondées sur la réutilisation de données standardisées produites pour d’autres finalités.Dans une première partie, ce travail présente les principes fondateurs et l’implémentation d’un système capable de rassembler des volumes élevés de données, hautement qualifiantes et structurées, et rendues interopérables sur le plan sémantique pour faire l’objet d’approches algorithmiques. Les données sont collectées pluri annuellement auprès de 110 partenaires représentant sept sources de données (cliniques, biologiques et médico-administratives). Deux algorithmes assistent l’opérateur du registre en dématérialisant une grande partie des tâches préalables à l’enregistrement des tumeurs. Un premier algorithme crée les tumeurs et leurs caractéristiques (publication), puis un 2ème algorithme modélise le parcours de soin de chaque individu selon une séquence ordonnée d’évènements horodatés consultable au sein d’une interface sécurisée (publication). Des approches de machine learning sont testées pour contourner l’éventuelle absence de codification des prélèvements anatomopathologiques (publication).La deuxième partie s’intéresse au large champ de recherche et d’évaluation rendu possible par la disponibilité de ce système d’information intégré. Des appariements avec d’autres données de santé ont été testés, dans le cadre d’autorisations réglementaires, pour enrichir la contextualisation et la connaissance des parcours de soins, et reconnaître le rôle stratégique des registres du cancer pour l’évaluation en « vie réelle » des pratiques de soins et des services de santé (preuve de concept) : dépistage, diagnostic moléculaire, traitement du cancer, pharmaco épidémiologie (quatre publications principales). L’appariement des données du RGCPC à celles du registre REIN (insuffisance rénale chronique terminale) a constitué un cas d’usage veillant à expérimenter un prototype de plateforme dédiée au partage collaboratif des données massives en santé (publication).La dernière partie de ce travail propose une discussion ouverte sur la pertinence des solutions proposées face aux exigences de qualité, de coût et de transférabilité, puis dresse les perspectives et retombées attendues pour la surveillance, l’évaluation et la recherche à l’ère des données massives en santé.
Published: 2021

38. Dasatinib dose optimisation based on therapeutic drug monitoring reduces pleural effusion rates in chronic myeloid leukaemia patients

Author: Martine Escoffre-Barbe, P. Rousselot, Pascale Cony-Makhoul, Stéphane Bouchet, Lambert Busque, Caroline Dartigeas, Franck E. Nicolini, Valérie Coiteux, Françoise Huguet, Laurence Legros, Lydia Roy, Delphine Rea, François Guilhot, Joelle Guilhot, Emilie Cayssials, Francois-Xavier Mahon, Luigina Mollica, Agnès Guerci, Martine Gardembas, Jean-Michel Cayuela, Anne Bergeron, Gabriel Etienne, Viviane Dubruille, Aude Charbonnier, Mathieu Molimard, Centre Hospitalier de Versailles André Mignot (CHV), Infectious Diseases Models for Innovative Therapies (IDMIT), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Hôpital Maisonneuve-Rosemont, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nancy (CHU Nancy), Centre Léon Bérard [Lyon], Institut Bergonié [Bordeaux], UNICANCER, Hôpital Paul Brousse, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Hôpital Claude Huriez [Lille], CHU Lille, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Recherche clinique appliquée à l'hématologie (URP_3518), Université de Paris (UP), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bordeaux Ségalen [Bordeaux 2], CHU de Bordeaux Pellegrin [Bordeaux], Bristol-Myers Squibb, CEA- Saclay (CEA), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Cité (UPCité), CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, medicine.drug_class, Pleural effusion, Dasatinib, Antineoplastic Agents, Gastroenterology, Tyrosine-kinase inhibitor, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Internal medicine, hemic and lymphatic diseases, Clinical endpoint, Humans, Medicine, Cumulative incidence, Prospective Studies, Adverse effect, Protein Kinase Inhibitors, Aged, 030304 developmental biology, Aged, 80 and over, Pharmacology, 0303 health sciences, Dose-Response Relationship, Drug, medicine.diagnostic_test, business.industry, Tyrosine kinases, Hematology, Middle Aged, medicine.disease, Effective dose (pharmacology), 3. Good health, Pleural Effusion, Treatment Outcome, Therapeutic drug monitoring, 030220 oncology & carcinogenesis, Chronic leukaemia, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Drug Monitoring, business, medicine.drug
Abstract: International audience; Dasatinib is a second-generation BCR-ABL1 tyrosine kinase inhibitor approved for patients with chronic myeloid leukaemia (CML). Dasatinib 100 mg per day is associated with an increased risk of pleural effusion (PlEff). We randomly evaluated whether therapeutic drug monitoring (TDM) may reduce dasatinib-associated significant adverse events (AEs) by 12 months (primary endpoint). Eligible patients started dasatinib at 100 mg per day followed by dasatinib (C)min assessment. Patients considered overdosed [(C)min ≥ 3 nmol/l) were randomised between a dose-reduction strategy (TDM arm) and standard of care (control arm). Out of 287 evaluable patients, 80 patients were randomised. The primary endpoint was not met due to early haematological AEs occurring before effective dose reduction. However, a major reduction in the cumulative incidence of PlEff was observed in the TDM arm compared to the control arm (4% vs. 15%; 11% vs. 35% and 12% vs. 39% at one, two and three years, respectively (P = 0·0094)). Molecular responses were superimposable in all arms. Dasatinib TDM during treatment initiation was feasible and resulted in a significant reduction of the incidence of PlEff in the long run, without impairing molecular responses. (NCT01916785; https://clinicaltrials.gov).
Published: 2021

39. Brain imaging determinants of functional prognosis after severe endocarditis: a multicenter observational study

Author: Yves-Olivier, Guettard, Alexandre, Gros, Hikaru, Fukutomi, Xavier, Pillois, Sebastien, Préau, Yoan, Lavie-Badie, Delphine, Marest, Raphaël P, Martins, Elisabeth, Coupez, Rémi, Coudroy, Benjamin, Seguy, Alexandre, Boyer, Thomas, Tourdias, Stein, Silva, CHU Bordeaux [Bordeaux], Neurocentre Magendie : Physiopathologie de la Plasticité Neuronale (U1215 Inserm - UB), Université de Bordeaux (UB)-Institut François Magendie-Institut National de la Santé et de la Recherche Médicale (INSERM), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], CHU Lille, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre hospitalier universitaire de Nantes (CHU Nantes), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], CHU Clermont-Ferrand, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent
Subjects: [SDV.IB] Life Sciences [q-bio]/Bioengineering, Topography, Endocarditis, Brain, Neuroimaging, Dermatology, General Medicine, Endocarditis, Bacterial, Prognosis, Stroke, Psychiatry and Mental health, Treatment Outcome, Risk Factors, Humans, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Neurology (clinical), Infective endocarditis, Nervous System Diseases
Abstract: International audience; Objective We developed a detailed imaging phenotype of the cerebral complications in critically ill patients with infective endocarditis (IE) and determine whether any specific imaging pattern could impact prognostic information. Methods One hundred ninety-two patients admitted to the intensive care units of seven tertiary centers with severe, definite left IE and neurological complications were included. All underwent cerebral imaging few days after admission to define the types of lesions, their volumes, and their locations using voxel-based lesion-symptom mapping (VLSM). We employed uni- and multi-variate logistic regression analyses to explore the associations among imaging features and other prognostic variables and the 6-month modified Rankin Scale (mRS) score. Results Ischemic lesions were the most common lesions (75%; mean volume, 15.3 +/- 33 mL) followed by microbleeds (50%; mean number, 4 +/- 7.5), subarachnoidal hemorrhages (20%), hemorrhagic strokes (16%; mean volume, 14.6 +/- 21 mL), and hemorrhagic transformations (10%; mean volume, 5.6 +/- 11 mL). The volume of hemorrhagic transformations, the severity of leukopathy, and the compromises of certain locations on the motor pathway from the VLSM were associated with a poor 6-month mRS score on univariate analyses. However, upon multivariate analyses, no such specific imaging pattern independently predicted the mRS; this was instead influenced principally by age (OR = 1.03 [1.004-1.06]) and cardiac surgery status (OR = 0.06 [0.02-0.16]) in the entire cohort, and by age (OR= 1.04 [1.01-1.08]) and Staphylococcus aureus status (OR= 2.86 [1.19-6.89]) in operated patients. Conclusions In a cohort of severely ill IE patients with neurological complications, no specific imaging pattern could be highlighted as a reliable predictor of prognosis.
Published: 2021

40. The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

Author: Henri Panjo, Arnaud Fauconnier, Xavier Fritel, Virginie Ringa, Marie Zins, F. Margueritte, Marcel Goldberg, Demarquay, Sandrine, Sexualité et soins (Genre, Sexualité, Santé) (CESP - INSERM U1018 - Equipe 7), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), and The French CONSTANCES cohort is funded by the Agence nationale de la recherche (ANR-11-INBS-0002 grant), the Caisse Nationale d’Assurance Maladie des travailleurs salariés-CNAMTS, the Institut de Recherche en Santé Publique/Institut Thématique Santé Publique, the Ministère de la santé et des sports, the Ministère délégué à la recherche, the Institut national de la santé et de la recherche médicale, the Institut national du cancer et Caisse nationale de solidarité pour l’autonomie. CONSTANCES is also partly funded by MSD, AstraZeneca and Lundbeck managed by INSERM-Transfert.
Subjects: Moderate to severe, medicine.medical_specialty, Cross-sectional study, Women's health, [SDV]Life Sciences [q-bio], Population, Reproductive age, chronic pelvic pain, dysmenorrhea, Article, 03 medical and health sciences, 0302 clinical medicine, women’s health, Medicine, 030212 general & internal medicine, education, education.field_of_study, 030219 obstetrics & reproductive medicine, non-menstrual chronic pelvic pain, business.industry, Obstetrics, Pelvic pain, dyspareunia, General Medicine, Confidence interval, [SDV] Life Sciences [q-bio], medicine.symptom, business, Cohort study
Abstract: Dysmenorrhoea, dyspareunia, and non-menstrual chronic pelvic pain (NMCPP) are symptoms that are probably underreported and neglected. This study aimed to assess the prevalence and overlapping relations between these symptoms among a general population of French women of reproductive age. A cross-sectional study among the nationwide CONSTANCES cohort study recruiting a representative sample of women within different French areas was constructed. Women aged 18–49 years (n = 21,287) who reported periods in the previous three months and experienced intercourse at least once were asked about prevalence of three types of chronic pelvic pain: mild, moderate and severe dysmenorrhea, dyspareunia assessed according to its frequency, NMCPP from a binary question. Between the start of 2012 through the end of 2017, 21,287 women were enrolled, 39.8% of them (95% confidence interval (CI), 39.2–40.5) reported moderate to severe dysmenorrhea, 20.3% (95% CI, 18.7–21.9) of the youngest group (18–24 years) reported severe dysmenorrhea. Dyspareunia was reported to happen often or always by 7.9% (95% CI, 7.5–8.2) and peaked among the youngest women at 12.8% (95% CI, 11.5–14.1). NMCPP was reported by 17.0% (95% CI, 16.5–17.5). Moreover, 7.5% (95% CI, 6.4–8.6) of the women reported two or more types of severe or frequent pain. More attention should be paid to this substantial proportion (7.5%) of French women of reproductive age who experience multiple, severe and frequent pelvic pain symptoms.
Published: 2021
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41. Early high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure in the ED: A before-after study

Author: Marc Frerebeau, Olivier Mimoz, Nicolas Marjanovic, Jean Macé, Farnam Faranpour, Pierre-Alexis Bourry, Jean-Pierre Frat, Mathieu Violeau, Jérémy Guenezan, Arnaud W. Thille, Centre Hospitalier Georges Renon [Niort] (CH Georges Renon Niort), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CCSD, Accord Elsevier
Subjects: Exacerbation, Respiratory rate, [SDV]Life Sciences [q-bio], medicine.medical_treatment, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Oxygen therapy, medicine, Respiratory system, Acute hypoxemic respiratory failure, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, medicine.diagnostic_test, Emergency department, business.industry, 030208 emergency & critical care medicine, General Medicine, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, High-flow oxygen therapy, Pulse oximetry, Dyspnea, Respiratory failure, Acute respiratory distress, Anesthesia, Emergency Medicine, business, Nasal cannula, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Objectives: To compare clinical impact after early initiation of high-flow nasal cannula oxygen therapy (HFNC) versus standard oxygen in patients admitted to an emergency department (ED) for acute hypoxemic respiratory failure.Methods: We performed a prospective before-after study at EDs in two centers including patients with acute hypoxemic respiratory failure defined by a respiratory rate above 25 breaths/min or signs of increased breathing effort under additional oxygen for a pulse oximetry above 92%. Patients with cardiogenic pulmonary edema or exacerbation of chronic lung disease were excluded. All patients were treated with standard oxygen during the first period and with HFNC during the second. The primary outcome was the proportion of patients with improved respiratory failure 1 h after treatment initiation (respiratory rate ≤ 25 breaths/min without signs of increased breathing effort). Dyspnea and blood gases were also assessed.Results: Among the 102 patients included, 48 were treated with standard oxygen and 54 with HFNC. One hour after treatment initiation, patients with HFNC were much more likely to recover from respiratory failure than those treated with standard oxygen: 61% (33 of 54 patients) versus 15% (7 of 48 patients), P < 0.001. They also showed greater improvement in oxygenation (increase in PaO2 was 31 mm Hg [0-67] vs. 9 [-9-36], P = 0.02), and in feeling of breathlessness.Conclusions: As compared to standard oxygen, patients with acute hypoxemic respiratory failure treated with HFNC at the ED had better oxygenation, less breathlessness and were more likely to show improved respiratory failure 1 h after initiation.
Published: 2019

42. Inhibitory control of threat remembering in PTSD

Author: Sandrine Kalenzaga, David Clarys, Wissam El-Hage, Nelly Goutaudier, Nemat Jaafari, Andrei-Cristian Tudorache, Geraldine Tapia, Badiâa Bouazzaoui, Centre de Recherches sur la Cognition et l'Apprentissage (CeRCA), Centre National de la Recherche Scientifique (CNRS)-Université de Tours-Université de Poitiers, Clinique Psychiatrique Universitaire [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Laboratoire de psychologie:Santé et qualité de vie, Université Bordeaux Segalen - Bordeaux 2, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Poitiers-Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Male, Emotions, Resource reallocation, [SHS.PSY]Humanities and Social Sciences/Psychology, Memory control, behavioral disciplines and activities, 050105 experimental psychology, Stress Disorders, Post-Traumatic, 03 medical and health sciences, 0302 clinical medicine, Arts and Humanities (miscellaneous), Memory, mental disorders, Inhibitory control, Brief Psychiatric Rating Scale, Humans, 0501 psychology and cognitive sciences, Control (linguistics), ComputingMilieux_MISCELLANEOUS, General Psychology, [SCCO.NEUR]Cognitive science/Neuroscience, 05 social sciences, Information processing, Emotional words, Motivated forgetting, 16. Peace & justice, Inhibition, Psychological, Posttraumatic stress, [SCCO.PSYC]Cognitive science/Psychology, Female, France, Cues, Psychology, 030217 neurology & neurosurgery, Clinical psychology
Abstract: Intrusive traumatic recollections suggest an inability in Posttraumatic Stress Disorder (PTSD) to control and notably to inhibit memories for trauma-related information. Supported by inhibitory deficits found on experimental settings in PTSD, memory functioning and memory biases in the disorder were usually explained through inhibitory and control deficits in the processing of trauma-related information. The present study aimed to directly assess this hypothesis by investigating memory control abilities for emotional information in PTSD. For this purpose, 34 patients diagnosed with PTSD were compared to 37 non-PTSD controls on an item-cued directed forgetting paradigm for emotional words combined with a Remember/Know recognition procedure. Results revealed enhanced amounts of Remember recognitions for trauma-related words in PTSD. Moreover, we replicated findings of memory control impairments in the disorder. However, such impairments only occurred for non-trauma-related words. Accordingly, it appeared that PTSD patients presented preserved memory control abilities for trauma-related words, at the expenses of other emotional valences. Surprisingly, PTSD patients presented a preserved ability to control and notably to inhibit their memory functioning for trauma-related material. In addition to potential theoretical and clinical relevance, these results are discussed in the light of resource reallocation hypotheses and vigilant-avoidant theories of information processing in PTSD.
Published: 2019

43. Treatment compliance with European guidelines and prognosis of Clostridium difficile infection according to age

Author: A. Caupenne, Evelyne Liuu, M. Lauda-Maillen, Marc Paccalin, M. Catroux, C. Burucoa, F. Cazenave-Roblot, M. Priner, Pierre Ingrand, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, and Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, medicine.medical_specialty, Poor prognosis, genetic structures, [SDV]Life Sciences [q-bio], 03 medical and health sciences, Treatment compliance, Recurrence, Internal medicine, Case fatality rate, Humans, Medicine, Age of Onset, Practice Patterns, Physicians', Survival rate, Prospective survey, Aged, Aged, 80 and over, 0303 health sciences, Clostridioides difficile, 030306 microbiology, business.industry, Age Factors, Middle Aged, Clostridium difficile, Prognosis, University hospital, 3. Good health, Europe, Infectious Diseases, Increased risk, Clostridium Infections, Female, Guideline Adherence, business
Abstract: OBJECTIVE Age>65 years is associated with the recurrence and poor prognosis of Clostridium difficile infection (CDI). Data on elderly patients (≥75 years) is scarce, and little is known about compliance with European guidelines in terms of specific treatment. We aimed to analyze the treatment and prognosis of CDI in two groups of patients aged
Published: 2019

44. Examining the Inter Hemispheric Transfer Time Test: A new computerized cognitive test to incorporate into therapeutic strategy for patients with brain metastases? A pilot study

Author: Antoine Berger, Foucaud Du Boisgueheneuc, Emmanuelle Reygagne, Pierre Ingrand, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CRDP Poitou-Charentes (CRDP POITOU-CHARENTES)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, R895-920, Stereotactic radiation therapy, Article, 030218 nuclear medicine & medical imaging, Medical physics. Medical radiology. Nuclear medicine, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Quality of life, medicine, Clinical endpoint, Radiology, Nuclear Medicine and imaging, Cognitive test, 10. No inequality, Stroke, RC254-282, ComputingMilieux_MISCELLANEOUS, business.industry, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Brain metastases, Cognition, medicine.disease, 3. Good health, Test (assessment), Radiation therapy, Oncology, 030220 oncology & carcinogenesis, Stereotactic, business
Abstract: Highlights • IHTTT is a rapid computerised cognitive test. • IHTTT is more sensitive than MMSE or FAB to evaluate executive functions. • Passing IHTTT could be predictive of progression-free survival. • IHTTT could be interesting as a way of better selecting the patients., Objective To evaluate the computerized Inter Hemispheric Transfer Time Test (IHTTT), a cognitive test designed for the detection of information processing speed impairment in patients undergoing stereotactic radiation therapy for brain metastases. Methods Inclusion criteria: age ≥18 years, brain metastases treated by stereotactic radiotherapy (SRT) with dose schedule: 33 Gy in 3 fractions, solid tumour, ≥70 Karnofsky Performance Status, Mini-Mental State Evaluation (MMSE) ≥ 24, no history of stroke brain injury. Twenty-nine patients were recruited from June 2014 to April 2015. All recruited patients were administered Frontal Assessment Battery at Bedside (FAB), IHTTT and QLQ-C30 quality of life questionnaire before SRT, at one-month, six-month and one-year follow-up. The primary endpoint was Interhemispheric Transfer Index (IHTI). Secondary endpoints included Interhemispheric Transfer Time (IHTT), MMSE, FAB, and quality of life. Results A significant evolution of cognitive function over time was assessed by the IHTTT: IHTT = 720 ± 27 ms at baseline, 728 ± 20 at one month, 736 ± 36 at 6 months, 799 ± 111 at one-year follow-up (p = 0.0010); IHTI = 13.1 ± 31.4, 11.5 ± 24.3, 50.6 ± 57.9, 91.0 ± 59.4 (p
Published: 2019

45. Detection of adolescent suicidality in primary care: an international utility study of the bullying‐insomnia‐tobacco‐stress test

Author: Dagmar M. Haller, Anne Laure Heintz, Pierre Ingrand, Benoit Tudrej, Paul Vanderkam, Anne Sophie Favre, Philippe Binder, Département de Médecine Générale, Université de Poitiers (DMG), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers-Université de Poitiers, Primary Care Unit [Geneva, Switzerland] (Faculty of Medicine), University of Geneva [Switzerland], Centre médical universitaire de Genève (CMU), University of Melbourne, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pinet, Nicolas, and Université de Genève = University of Geneva (UNIGE)
Subjects: Male, Internationality, [SDV.MHEP.PSM] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Suicide, Attempted, Tobacco Use, 0302 clinical medicine, Risk Factors, Sleep Initiation and Maintenance Disorders, Surveys and Questionnaires, Suicide attempt, Insomnia, Suicidal ideation, Referral and Consultation, Primary health care, general practice, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, 4. Education, School setting, 16. Peace & justice, 3. Good health, Test (assessment), Psychiatry and Mental health, Original Article, Female, Pshychiatric Mental Health, medicine.symptom, General practice, mass screening, suicide attempt, medicine.medical_specialty, Adolescent, Sexual Behavior, Primary care, Suicidal Ideation, 03 medical and health sciences, Stress test, medicine, Humans, Psychiatry, Biological Psychiatry, Mass screening, ddc:613, Primary Health Care, business.industry, Bullying, Original Articles, 030227 psychiatry, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Exercise Test, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 030217 neurology & neurosurgery
Abstract: International audience; Aim : General practitioners (GPs) are ideally placed to identify suicidality in adolescents. However, adolescents are often reluctant to confide in their GPs about these problems, and GPs are not comfortable when questioning them about suicide. We previously proposed the BITS test, a set of four opening and four additional questions, to alert doctors about possible suicidality in an adolescent. We validated its use in the identification of suicidality (“frequent suicidal ideation or suicide attempts at one time or another)” in 15‐year‐old adolescents in a school setting. The objective of the present study was to assess the detection utility of this method in 13‐to‐18‐year‐olds in primary care.Methods : We carried out a screening utility study in general practices in 17 French‐speaking sites in four countries and three continents. Each GP was instructed to use the bullying, insomnia, tobacco, stress (BITS) test with five to ten 13‐to‐18‐year‐old adolescents, consulting consecutively, for any reason. They subsequently asked them questions about their suicidality.Results : One hundred and two GPs tested a total of 693 adolescents; 13.0% of the adolescents (girls 15.4%, boys 9.9%) reported suicidality (1.6% known, 11.4% previously unknown). A score of at least 3 on the BITS scale was associated with suicidality (sensitivity: 65.9, specificity: 82.5%).Conclusions : The BITS test is a pragmatic instrument, alerting the GP to an adolescent's previously unknown suicidability, whatever the reason for consultation.
Published: 2019

46. Pap tests for cervical cancer screening test and contraception: analysis of data from the CONSTANCES cohort study

Author: Stéphanie Mignot, Virginie Ringa, Marie Zins, Solène Vigoureux, Pierre-Jean Saulnier, Henri Panjo, Xavier Fritel, Département de Médecine Générale, Université de Poitiers (DMG), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers-Université de Poitiers, Gender, Sexuality and Health team [Villejuif], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut national d'études démographiques (INED), Obstetrics & Gynecology Department [Le Kremlin-Bicêtre], Université Paris-Sud - Paris 11 - Faculté de médecine (UP11 UFR Médecine), Université Paris-Sud - Paris 11 (UP11)-Université Paris-Sud - Paris 11 (UP11), Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Descartes - Paris 5 (UPD5), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), The French CONSTANCES cohort is supported by the French National Research Agency (ANR-11-INBS-0002), Caisse Nationale d’Assurance Maladie des travailleurs salariés-CNAMTS, and is funded by the Institut de Recherche en Santé Publique/Institut Thématique Santé Publique, and the following sponsors: Ministère de la santé et des sports, Ministère délégué à la recherche, Institut national de la santé et de la recherche médicale, Institut national du cancer et Caisse nationale de solidarité pour l’autonomie, as well as Institute for research in public health (IReSP, CapaciT project)., ANR-11-INBS-0002,CONSTANCES,La cohorte CONSTANCES - Infrastructure épidémiologique ouverte pour la recherche et la surveillance(2011), Bodescot, Myriam, Infrastructures - La cohorte CONSTANCES - Infrastructure épidémiologique ouverte pour la recherche et la surveillance - - CONSTANCES2011 - ANR-11-INBS-0002 - INBS - VALID, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Paris (UP)
Subjects: 0301 basic medicine, Cancer Research, Multivariate analysis, Cross-sectional study, Uterine Cervical Neoplasms, 0302 clinical medicine, 5. Gender equality, Mass Screening, Cervical cancer screening, Early Detection of Cancer, medicine.diagnostic_test, Obstetrics, Middle Aged, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, 3. Good health, Contraception, Oncology, 030220 oncology & carcinogenesis, Pill, Sex life, Cohort, Female, France, Cohort study, Research Article, Papanicolaou Test, Adult, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, Adhesion to screening, Intrauterine device, lcsh:RC254-282, 03 medical and health sciences, Young Adult, [SDV.CAN] Life Sciences [q-bio]/Cancer, Genetics, medicine, Humans, Pap test, Aged, Vaginal Smears, business.industry, Patient Acceptance of Health Care, 030104 developmental biology, Cross-Sectional Studies, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Patient Compliance, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: International audience; BACKGROUND:In France, a Pap test for cervical cancer screening is recommended every three years for all sexually active women aged 25 to 65 years. Modes of contraception (any or no contraception, with or without a visit to a physician, and with or without a gynecological examination) may influence adhesion to screening: women who use intrauterine device (IUD) should be more up to date with their cervical cancer screening more often than those using other means of contraception. Our objectives were to analyze the association between modes of contraception and Pap tests for screening.METHODS:This cross sectional study is based on the CONSTANCES cohort enabled us to include 16,764 women aged 25-50 years. The factors associated with adhesion to cervical cancer screening (defined by a report of a Pap test within the previous 3 years) was modeled by logistic regression. Missing data were imputed by using multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status.RESULTS:Overall, 11.2% (1875) of the women reported that they were overdue for Pap test screening. In the multivariate analysis there was no significant difference between women using an IUD and those pills or implant of pap test overdue ORa:0.9 CI95% [0.8-1.1], ORa 1.3 CI95% [0.7-2.7] respectively. Women not using contraceptives and those using non-medical contraceptives (condoms, spermicides, etc.) were overdue more often ORa: 2.6 CI95% [2.2-3.0] and ORa: 1.8 CI95% [1.6-2.1] respectively than those using an IUD.CONCLUSION:Women seeing medical professionals for contraception are more likely to have Pap tests.
Published: 2019

47. Baroreflex sensitivity assessed with the sequence method is associated with ventricular arrhythmias in patients implanted with a defibrillator for the primary prevention of sudden cardiac death

Author: Véronique Le Marcis, Samy Hadjadj, Rodrigue Garcia, Pierre-Jean Saulnier, Bruno Degand, Nicolas Bidegain, François Le Gal, Stéphanie Ragot, Marine Tavernier, Dominique Laude, Mathilde Fraty, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CIC - Poitiers, and Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Time Factors, Supine position, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Myocardial Infarction, Pilot Projects, 030204 cardiovascular system & hematology, Ventricular Function, Left, Sudden cardiac death, Death, Sudden, Electrocardiography, 0302 clinical medicine, Risk Factors, Natriuretic Peptide, Brain, Natriuretic peptide, Medicine, 030212 general & internal medicine, Myocardial infarction, Prospective cohort study, Ejection fraction, General Medicine, Middle Aged, Implantable cardioverter-defibrillator, Defibrillators, Implantable, Plethysmography, Primary Prevention, Treatment Outcome, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, medicine.drug_class, Clinical Decision-Making, Electric Countershock, Baroreflex, Risk Assessment, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Humans, cardiovascular diseases, Aged, Retrospective Studies, business.industry, Patient Selection, Arrhythmias, Cardiac, Stroke Volume, medicine.disease, Peptide Fragments, Cross-Sectional Studies, business, Biomarkers
Abstract: Summary Background Left ventricular ejection fraction lacks accuracy in predicting sudden cardiac death, resulting in unnecessary implantation of cardioverter defibrillators for the primary prevention of sudden cardiac death. Baroreflex sensitivity could help to stratify patients at risk of ventricular arrhythmia. Aim To assess the association between cardiac baroreflex sensitivity and ventricular arrhythmias in patients implanted with an implantable cardioverter defibrillator for the primary prevention of sudden cardiac death after myocardial infarction. Methods This case-control single-centre study took place between 2015 and 2016. Cases (n = 10) had experienced ventricular arrhythmias treated by the implantable cardioverter defibrillator in the previous 3 years; controls (n = 22) had no arrhythmia during the same period. Baroreflex sensitivity was assessed using the temporal sequence method (mean slope) and cross-spectral analysis (low-frequency gain and high-frequency gain). Results The mean age was 65 years; 94% of the patients were men. 24-hour Holter electrocardiogram autonomous nervous system variables, left ventricular ejection fraction and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration did not differ between cases and controls. The mean slope was lower in cases than in controls (8 vs. 15 ms/mmHg [P = 0.009] in the supine position; 7 vs. 12 ms/mmHg [P = 0.038] in the standing position). The mean slope in the supine position was still significantly different between groups after adjustment for age, left ventricular ejection fraction and NT-proBNP (P = 0.03). By comparison, low-frequency gain and high-frequency gain did not differ between groups in either the supine or the standing position. Conclusion Patients with ventricular arrhythmias had a lower mean slope compared with those who were free of arrhythmia. A prospective study is needed to confirm this association.
Published: 2019

48. Exclusion of Intra-Atrial Thrombus Diagnosis Using D-Dimer Assay Before Catheter Ablation of Atrial Fibrillation

Author: Antoine Milhem, Pierre Ingrand, Frédéric Tréguer, Olivier Cesari, Antoine Da Costa, Dominique Pavin, Philippe Rivat, Nicolas Badenco, Sélim Abbey, Noura Zannad, Pierre François Winum, Jacques Mansourati, Philippe Maury, Hugues Bader, Arnaud Savouré, Frédéric Sacher, Marius Andronache, Caroline Allix-Béguec, Christian De Chillou, Frédéric Anselme, Alain Al Arnaout, Walid Amara, Mathieu Amelot, Clément Bars, Lucile Becoulet, Paul Bru, Philippe Chevalier, Jean-Philippe Darmon, Jean-Claude Deharo, Antoine Dompnier, Cécile Duplantier-Duchene, Fabrice Extramiana, Jean-Paul Faugier, Charles Guenancia, Jérôme Horvilleur, François Jourda, Gabriel Laurent, Nicolas Lellouche, Isabelle Magnin Poull, Olivier Piot, Antoine Roux, Yannick Saludas, Julien Seitz, Jérôme Taieb, Centre Hospitalier de La Rochelle (CHR), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinique Saintt Joseph, Clinique Saint Gatien, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CHU Pontchaillou [Rennes], Polyclinique Vauban, CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Nouvelles Cliniques Nantaises, Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Toulouse [Toulouse], Centre hospitalier de Pau, CHU Rouen, Normandie Université (NU), CHU Bordeaux [Bordeaux], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), and Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, medicine.medical_specialty, Heart Diseases, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, Risk Assessment, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, diagnostic performance, Internal medicine, Atrial Fibrillation, Preoperative Care, medicine, Clinical endpoint, Humans, Medical history, Heart Atria, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Stroke, Aged, Framingham Risk Score, Ejection fraction, business.industry, Thrombosis, Atrial fibrillation, Middle Aged, medicine.disease, 3. Good health, clinical biological score, Heart failure, Catheter Ablation, cardiovascular system, Cardiology, Female, preoperative transesophageal echocardiography, business, Echocardiography, Transesophageal
Abstract: International audience; Objectives: This study hypothesized that the association of D-dimer blood level and several clinical items in a new risk score could predict the absence of atrial thrombus.Background: Symptomatic and drug resistant atrial fibrillation (AF) can be treated by catheter ablation. The procedure-related risk of thromboembolism is limited by the pre-operative use of transesophageal echocardiography (TEE) to detect atrial thrombi.Methods: Patients admitted for catheter ablation of AF (n = 2,494) were prospectively included in a multicenter study. TEE was systematically performed before the procedure to search for atrial thrombus (primary endpoint). D-dimer level, CHADS2 score, left ventricular ejection fraction, pre-operative anticoagulation regimen, and medical history were collected. A logistic regression model was used to identify factors associated with the presence of atrial thrombus (hypertension, history of stroke, heart failure, D-dimer level >270 ng/ml). These factors were aggregated in a new score called atrial thrombus exclusion (ATE).Results: The incidence of atrial thrombus was 1.92%. CHADS2 score and D-dimer level were significantly associated with atrial thrombus (p < 0.0001 and p < 0.0001, respectively). A zero CHADS2 score failed to exclude all atrial thrombi (5 false negatives; sensitivity: 89.58%, specificity: 52.2%). No false negative was found with a zero ATE score, which had a specificity of 37% and a higher sensitivity (100%) than the CHADS2 score (p < 0.031) to predict the absence of intra-atrial thrombi on TEE. Conversely, the positive predictive value was poor, and the ATE score should not be used to conclude a positive diagnosis of thrombus.Conclusions: An ATE score of zero was strongly associated with the absence of atrial thrombus. This new score could be useful to rule out a diagnosis of atrial thrombus before catheter ablation of AF.
Published: 2019

49. Experts’ guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF)

Author: Quintard, Hervé, L'Her, Erwan, Pottecher, Julien, Adnet, Frederic, Constantin, Jean-Michel, de Jong, Audrey, Diemunsch, Pierre, Fesseau, Rose, Freynet, Anne, Girault, Christophe, Guitton, Christophe, Hamonic, Yann, Maury, Eric, Mekontso-Dessap, Armand, Michel, Fabrice, Nolent, Paul, Perbet, Sébastien, Prat, Gwenael, Roquilly, Antoine, Tazarourte, Karim, Terzi, Nicolas, Thille, Arnaud, Alves, Mikael, Gayat, Etienne, Donetti, Laurence, Institut de pharmacologie moléculaire et cellulaire (IPMC), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hôpital de Hautepierre [Strasbourg], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Clermont-Ferrand, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service d'Anesthesie - Réanimation, Les Hôpitaux Universitaires de Strasbourg (HUS)-Hôpital de Hautepierre [Strasbourg], CHU Rouen, Normandie Université (NU), Centre Hospitalier Le Mans (CH Le Mans), CHU Bordeaux [Bordeaux], Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital de la Timone [CHU - APHM] (TIMONE), CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord
Subjects: [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], lcsh:Medical emergencies. Critical care. Intensive care. First aid, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, lcsh:RC86-88.9
Abstract: International audience; Background: Intubation and extubation of ventilated patients are not risk-free procedures in the intensive care unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular or respiratory system. Under these circumstances, it is a high-risk procedure with life-threatening complications (20–50%). Moreover, technical problems can also give rise to complications and several new techniques, such as videolaryngoscopy, have been developed recently. Another risk period is extubation, which fails in approximately 10% of cases and is associated with a poor prognosis. A better understanding of the cause of failure is essential to improve success procedure.Results and conclusion: In constructing these guidelines, the SFAR/SRLF experts have made use of new data on intubation and extubation in the ICU from the last decade to update existing procedures, incorporate more recent advances and propose algorithms
Published: 2019

50. Imatinib Optimized Therapy Improves Major Molecular Response Rates in Patients with Chronic Myeloid Leukemia

Author: Hyacinthe, Johnson-Ansah, Benjamin, Maneglier, Françoise, Huguet, Laurence, Legros, Martine, Escoffre-Barbe, Martine, Gardembas, Pascale, Cony-Makhoul, Valérie, Coiteux, Laurent, Sutton, Wajed, Abarah, Camille, Pouaty, Jean-Michel, Pignon, Bachra, Choufi, Sorin, Visanica, Bénédicte, Deau, Laure, Morisset, Emilie, Cayssials, Mathieu, Molimard, Stéphane, Bouchet, François-Xavier, Mahon, Franck, Nicolini, Philippe, Aegerter, Jean-Michel, Cayuela, Marc, Delord, Heriberto, Bruzzoni-Giovanelli, Philippe, Rousselot, Hôpital Côte de Nacre [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier de Versailles André Mignot (CHV), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Hôpital Claude Huriez [Lille], CHU Lille, Centre Hospitalier Victor Dupouy, Centre Hospitalier de Meaux, Centre hospitalier de Dieppe, CH de Dunkerque, Centre hospitalier de Boulogne sur mer, Hôpital Notre Dame de Bon Secours, GH Saint-Joseph, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU de Bordeaux Pellegrin [Bordeaux], Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Bergonié [Bordeaux], UNICANCER, Centre Léon Bérard [Lyon], Hôpital Ambroise Paré [AP-HP], Recherche clinique appliquée à l'hématologie ((EA_3518)), Université Paris Diderot - Paris 7 (UPD7), Hopital Saint-Louis [AP-HP] (AP-HP), CIC Saint Louis (CIC-1427), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infectious Diseases Models for Innovative Therapies (IDMIT), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Admin, Oskar, and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: [SDV.MHEP.HEM] Life Sciences [q-bio]/Human health and pathology/Hematology, [SDV.CAN] Life Sciences [q-bio]/Cancer, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Imatinib, imatinib, therapeutic drug monitoring, chronic myelogenous leukemia, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Pharmaceutical Science, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Therapeutic drug monitoring, Chronic myelogenous leukemia
Abstract: The registered dose for imatinib is 400 mg/d, despite high inter-patient variability in imatinib plasmatic exposure. Therapeutic drug monitoring (TDM) is routinely used to maximize a drug’s efficacy or tolerance. We decided to conduct a prospective randomized trial (OPTIM-imatinib trial) to assess the value of TDM in patients with chronic phase chronic myelogenous treated with imatinib as first-line therapy (NCT02896842). Eligible patients started imatinib at 400 mg daily, followed by imatinib [C]min assessment. Patients considered underdosed ([C]min < 1000 ng/mL) were randomized in a dose-increase strategy aiming to reach the threshold of 1000 ng/mL (TDM arm) versus standard imatinib management (control arm). Patients with [C]min levels ≥ 1000 ng/mL were treated following current European Leukemia Net recommendations (observational arm). The primary endpoint was the rate of major molecular response (MMR, BCR::ABL1IS ≤ 0.1%) at 12 months. Out of 133 evaluable patients on imatinib 400 mg daily, 86 patients had a [C]min < 1000 ng/mL and were randomized. The TDM strategy resulted in a significant increase in [C]min values with a mean imatinib daily dose of 603 mg daily. Patients included in the TDM arm had a 12-month MMR rate of 67% (95% CI, 51–81) compared to 39% (95% CI, 24–55) for the control arm (p = 0.017). This early advantage persisted over the 3-year study period, in which we considered imatinib cessation as a censoring event. Imatinib TDM was feasible and significantly improved the 12-month MMR rate. This early advantage may be beneficial for patients without easy access to second-line TKIs.
Published: 2022

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