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Objective We aimed to compare baseline characteristics, coronary angiogram findings, and in-hospital outcomes between female and male patients with ST-segment elevation myocardial infarction (STEMI) under the age of 45 years. Background Although sex differences in risk factor profile have been documented for young patients with STEMI, limited data exist on the prevalence of spontaneous coronary artery dissection in these patients. Methods As part of an ongoing hospital-based registry of suspected STEMI, we analyzed the original data for 51 women under the age of 45 years matched with 93 men of similar age who underwent coronary angiography at two percutaneous coronary intervention centers, between January 2003 and December 2012. Two interventional cardiologists independently reviewed coronary angiograms for all patients. Results The mean age for all patients was 39 years (range, 24-44) and the overall prevalence of cigarette smoking, dyslipidemia, hypertension, and diabetes mellitus were 70, 32, 13, and 4%, respectively. Young women were more likely to present with spontaneous coronary artery dissection (22 vs. 3%, p = .003) and more of them experienced reinfarction during the hospital course (15 vs. 1%, p = .01). The in-hospital mortality rate was 2% for both sexes. Conclusions Spontaneous coronary artery dissection is an important cause of myocardial infarction in young female adults, accounting for 22% (95% confidence interval, 11-35%) of women with STEMI under the age of 45 years. The true prevalence of spontaneous coronary artery dissection might even be underestimated, because of the limited availability of advanced imaging techniques at the time of our study.

Introduction Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt.Methods Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon's response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those “sterility mistake” situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope.Results When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (pConclusions There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-.

Background Highly thrombotic coronary lesions continue to be a serious and clinically significant problem that is not effectively and completely addressed by current technology. Objectives We aimed to investigate whether a micro-net mesh (MNM) technology covering stent could preserve the index of microcirculatory resistance (IMR) after percutaneous coronary intervention (PCI) in patients with high thrombus burden. Methods and results Fifty-two patients with non-ST elevation myocardial infarction or ST Elevation Myocardial Infarction and high thrombus burden (TIMI thrombus grade ≥ 3) were randomized into two groups, PCI with a MNM covering stent (MNM group, n = 25) and PCI with any commercially available stent (DES group, n = 27). As the primary endpoint, IMR was measured immediately after PCI using a pressure-temperature sensor-tipped coronary wire. The secondary endpoint was left ventricular ejection fraction (LVEF) at 6 months of follow-up. The IMR in the MNM group was significantly lower in comparison to the DES group (33.2 [21.3, 48.9] vs. 57.2 [39.9, 98.0], p = 0.005). No significant differences were observed in baseline LVEF (54.5 ± 10.2% vs. 53.1 ± 6.87%, p = .57), while LVEF was significantly improved at follow-up in the MNM group (61.1 ± 7.1% vs. 53.9 ± 6.35%, p = .0001). Conclusion MNM technology significantly improved coronary microvascular dysfunction after PCI in patient with acute coronary syndrome and appears as a useful technological option for thrombus management.

Epistaxis is a common and a well-known symptom. Nasal packing is an effective treatment in most cases [1]. The COVID-19 disease treatment includes conventional or high flow nasal oxygen therapy and systemic anticoagulation [2]. Patients in intensive care unit may require therapeutic anticoagulation for venous thromboembolism, hyperinflammatory status, extracorporeal membrane oxygenation (ECMO) and multiple other pathologies. The use of therapeutic anticoagulation increases risk of nose bleeding, and its management may be challenging. CAVI-T (Figures 1 & 2) is a new asymmetrical low-pressure balloon that have shown promising results to control epistaxis in emergency. We report herein the management of severe epistaxis in two COVID-19 patients admitted to ICU for severe respiratory failure.

The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed., Graphical abstract

ObjectivesTo describe the activities of general practitioners (GPs) pertaining to primary prevention in the field of affective and sexual life, studying the advice they provide as well as their vaccination practices.DesignCross-sectional national survey.Setting/participantsThe study was carried out using the Swiss Primary Care Active Monitoring GPs’ network, a national GP network created in 2012. One hundred and seventy Swiss GPs, from a random sample from professional lists stratified by canton, participated in the present study.Primary and secondary outcome measuresPrevention practices against sexually transmitted infections (STIs) performed by GPs through advice provided as well as their vaccination practices. Predictive factor of these practices through their links with the doctors’ relevant characteristics and their opinions about STI prevention.ResultsApproximately 80% consider prevention in the area of affective and sexual life to be part of their duty and discuss it easily with patients. Most of them spontaneously give advice regarding STIs during a routine consultation. Regarding human papillomavirus (HPV) immunisation in adults, almost half of GPs report never doing it, while almost 75% often or always immunise their adult patients against hepatitis B. Higher numbers of consultations per day are associated with vaccinating more adults against HPV (OR 1.13 (1.05 to 1.23)) and against hepatitis A (OR 1.17 (1.05 to 1.31)). Vaccinating children against hepatitis B is associated with practising in rural areas (OR 4.64 (1.20 to 17.98)). GPs practising in the French-speaking region of Switzerland immunise children less against HPV (OR 0.40 (0.20 to 0.80)). Longer consultations are associated with providing advice on affective and sexual life during a first consultation (OR 1.08 (1.01 to 1.14)).ConclusionSwiss GPs are involved in primary prevention against STIs and consider it as their responsibility. Prevention practices are associated with GPs’ favourable opinions on prevention.

Introduction Les péritonites constituent une complication fréquente en dialyse péritonéale (DP) et sont associées à une morbi-mortalité importante. L’objectif de notre travail était d’étudier l’impact du volume de diurèse et du nombre d’échanges hebdomadaires (EH) sur le risque de péritonite chez des patients français en dialyse péritonéale continue ambulatoire (DPCA). Méthodes Ce travail a été effectué à partir des données du Registre de Dialyse Péritonéale de Langue Française (RDPLF). Nous avons inclus tous les patients du registre incidents en DPCA entre janvier 2010 et 30 novembre 2019 ayant eu au moins un bilan d’adéquation. Le risque de péritonite a été évalué d’une part en calculant pour chaque patient un taux de péritonite par année en DP, d’autre part en s’intéressant au délai de survenue de la première péritonite en prenant en compte les risques compétitifs (transplantation, transfert en hémodialyse, arrêt de la DP, quel qu’en soit la cause, et décès). Les patients ayant une diurèse inférieure à 500mL/jour étaient considérés oliguriques. Résultats Nous avons inclus 620 patients dans nos analyses. L’âge moyen était de 72,9 ans (écart type (ET) 15,1). Deux cent quarante-six patients (39,55%) ont eu au moins une péritonite. Aucune modification significative du risque de péritonite n’a été mise en évidence chez les patients oliguriques. En revanche, il a été montré un risque accru de péritonite chez les patients ayant plus de 22 EH (HR=1,55, P=0,0005 et HR=1,47, P=0,02 en prenant en compte les risques compétitifs). Il a également été observé un effet protecteur du diabète (HR=0,74, p=0,02 et HR=0,77, p=0,0497). Conclusion Nous n’avons pas montré d’effet du volume de diurèse sur le risque de péritonite. Le nombre d’EH semble constituer un facteur de risque important dès lors que celui-ci est supérieur ou égal à 22., Bulletin de la Dialyse à Domicile, Vol. 3 No 2 (2020): Bulletin de la Dialyse à Domicile

International audience; Coronary microvascular dysfunction has recently emerged as a major independent prognostic factor and can be invasively assessed by coronary flow reserve (CFR) and the index of microvascular resistance (IMR). The incremental prognostic value of myocardial ischemia from SPECT myocardial perfusion imaging (MPI) over clinical characteristics, cardiac risk factors, and stress test data for the prediction of hard cardiac events (myocardial infarction and cardiac death) has been well demonstrated over the last two decades regardless of the absence or presence of epicardial CAD. Recently developed semi-conductor, cardiac-dedicated cameras allow for decreased acquisition times and systematic procubitus and decubitus acquisitions thereby limiting the occurrence of false positives historically attributable to artefactual motion, attenuation, and digestive artifacts. It is therefore likely that pathophysiological causes rather than acquisition artifacts might underlie SPECT perfusion abnormalities. Here, we report four representative examples of patients presenting with ischemia in the setting of no obstructive CAD and normal fractional flow reserve together with elevated IMR and low CFR. The results indicate that ischemia from SPECT MPI could result from microvascular dysfunction in patients without obstructive CAD and should be considered as a prognostic factor for hard cardiac events.

Background Oral cavity is the most prevalent site of head and neck squamous cell carcinomas (HNSCCs). Most often diagnosed at a locally advanced stage, treatment is multimodal with surgery as the cornerstone. The aim of this study was to explore the molecular landscape of a homogenous cohort of oral cavity squamous cell carcinomas (OCSCCs), and to assess the prognostic value of tumor mutational burden (TMB), along with classical molecular and clinical parameters. Patients and methods One hundred and fifty-one consecutive patients with OCSCC treated with upfront surgery at the Institut Curie were analyzed. Sequencing of tumor DNA from frozen specimens was carried out using an in-house targeted next-generation sequencing panel (571 genes). The impact of molecular alterations and TMB on disease-free survival (DFS) and overall survival (OS) was evaluated in univariate and multivariate analyses. Results Pathological tumor stage, extranodal spread, vascular emboli, and perineural invasion were associated with both DFS and OS. TP53 was the most mutated gene (71%). Other frequent molecular alterations included the TERT promoter (50%), CDKN2A (25%), FAT1 (17%), PIK3CA (14%), and NOTCH1 (15%) genes. Transforming growth factor-β pathway alterations (4%) were associated with poor OS (P = 0.01) and DFS (P = 0.02) in univariate and multivariate analyses. High TMB was associated with prolonged OS (P = 0.01 and P = 0.02, in the highest 10% and 20% TMB values, respectively), but not with DFS. Correlation of TMB with OS remained significant in multivariate analysis (P = 0.01 and P = 0.005 in the highest 10% and 20% TMB values, respectively). Pathological tumor stage combined with high TMB was associated with good prognosis. Conclusion Our results suggest that a high TMB is associated with a favorable prognosis in patients with OCSCC treated with upfront surgery., Highlights • High TMB is associated with a favorable prognosis in patients with OCSCC treated with upfront surgery • Pathological tumor stage combined with high TMB is associated with good prognosis • TP53 was the most mutated gene (71%). Other frequent molecular alterations included the TERT promoter (50%) • TGFβ pathway alterations were associated with poor outcomes, although it was only observed in 4% of the patients

Several studies have assessed the knowledge of health professionals in recognition and treatment of anaphylaxis using case-based surveys with conflicting results [1-3]. The proportion of responders able to recognize anaphylaxis and treat with appropriate adrenaline ranged from 56% to 95% [1, 3]. The causes for this under optimal management are not clearly understood. In this context, EAACI anaphylaxis guidelines were recently updated. This article is protected by copyright. All rights reserved.

Background:ABX464 is a small oral molecule with a novel mode of action. It binds the Cap Binding Complex, involved in the biogenesis of RNAs and predominantly upregulates the expression of a microRNA miR-124 in PBMCs and T cells (1). miR-124 has been widely described for its anti-inflammatory properties, with many confirmed targets i.e. monocyte chemoattractant protein 1 (MCP-1, CXCL-1, SERPIN-E1, STAT-3, IL-6 receptor. It post-transcriptionally regulates the expression of MCP-1 in rheumatoid arthritis (RA) synoviocytes and decreases their proliferation (2). While miR-124 is decreased in synoviocytes of RA patients, its injection in joint improved arthritis in rats (3). miR-124 expression in macrophages leads to the induction and maintenance of anti-inflammatory M2 phenotype (4). Its effect in T cells remains controversial.Objectives:(i) To assess the effect of ABX464 on miR-124 expressionin vitroin macrophages andin vivoin patients; (ii) to assess the effect of ABX464 on arthritis in mice and (iii) to decipher the effect of ABX464 on human macrophages and T cells.Methods:miR-124 was measured in human monocyte-derived macrophages (huMDM) treated with ABX464 for 4 days and in patients with ulcerative colitis included in a phase IIa RCT in blood and rectal biopsies at day 56 by TaqMan qPCR. Collagen-induced arthritis (CIA) was induced using usual protocol and ABX464 was given by gavage 2 weeks at 40 mg/kg after the 2ndinjection of collagen and Freund adjuvant. HuMDM were exposed to 5 µM of ABX464 or DMSO (control) for 4 days, during a M1-polarization. Cytokines and chemokines were assessed in supernatants using both Proteome Profiler Array and Luminex. PBMCs were exposed to ABX464 (5 µM) for 6 days. Th1 (IFN-g+), Th17 (CCR6+IL-17+), Th2 (CRTH2+ IL-4+) and Tregs (CD25+CD125-/loFoxP3+) were assessed by flow cytometry. IL-6 receptor was assessed in CD4+ supernatant using ELISA.Results:ABX464 increased miR-124 in vitro by 3.41 folds in huMDM (p=0.001) compared to DMSO. The phase IIa RCT conducted in 32 patients with moderate to severe active ulcerative colitis showed a good safety profile and significant clinical efficacy. A strong increase of miR-124 was observed both in blood and rectal biopsies of patients treated with ABX464 (637 and 7.69 folds respectively, compared to placebo, pConclusion:We demonstrated that ABX464 increases miR-124 bothin vitroand in ulcerative colitis patients.In vitro, ABX464 decreased the expression of miR-124 target genes, that is MCP-1, CXCL-1, SERPIN-E1 in macrophages and decreases the number of Th17 as well as IL-6 soluble receptor in CD4+ T cells. A phase IIa RCT is currently ongoing in patients with rheumatoid arthritis and inadequate response to methotrexate and/or TNF-inhibitors (n=60). Results are expected during 2020 summer.References:[1]Vautrin A et al. Sci Rep. 2019;9:792[2]Nakamachi Y et al. Arthritis Rheum 2009; 60:1294-304[3]Nakamachi Y et al. Ann Rheum Dis 2016; 75:601-8[4]Veremeyko T et al. PLoS ONE 2013; 8:e81774Disclosure of Interests:Christina BEGON-PESCIA: None declared, Julie Mielle: None declared, Noélie Campose Employee of: ABIVAX, Karim Chebli Consultant of: ABIVAX, Laurent Manchon: None declared, Julien Santo Employee of: ABIVAX, Cécile Apolit Employee of: ABIVAX, Kévin Martin Grant/research support from: ABIVAX, Laure Lapasset Employee of: ABIVAX, Audrey Vautrin Employee of: ABIVAX, Didier Scherrer Employee of: ABIVAX, Aude Garcel Employee of: ABIVAX, Jamal Tazi Shareholder of: ABIVAX, Grant/research support from: ABIVAX, Consultant of: ABIVAX, Employee of: ABIVAX, Paid instructor for: ABIVAX, Speakers bureau: ABIVAX, Claire DAIEN Grant/research support from: from Pfizer, Abbvie, Roche-Chugaï, Novartis, Abivax, Sandoz, Consultant of: Abbvie, Abivax, BMS, MSD, Roche-Chugaï, Lilly, Novartis, Speakers bureau: Abbvie, Abivax, BMS, MSD, Roche-Chugaï, Lilly, Novartis

During their lives, women go through three different phases during which sex hormones play a fundamental role in contributing to specific cardiovascular and coronary risks. To evaluate this risk, we must take into account these various phases with their associated cardiovascular risk factors, and this during three key steps: contraception, pregnancy and menopause. Arterial risk linked to estrogen combined with progestin contraception, depends on the dosage of estrogen. The main cardiovascular risk factor responsible for increasing the risk of myocardial infarction is tobacco, especially after 35 years of age, contraindicating estrogen combined with progestin contraception at the benefit of progestin. Spontaneous dissections and coronary emboli are the most common coronary lesions linked with oestroprogestative contraception. Acute myocardial infarction during pregnancy occurs mostly in the peripartum or postpartum period; and is often caused by spontaneous coronary dissection lesions. Fertility treatment is not associated with an increased risk of developing cardiovascular disease later in life. Hormone therapy during menopause does not increase coronary risk in the first 10 years after menopause and may even have a protective effect, by sustaining arterial integrity. The transdermal route is to be preferred for its metabolic effect. Hormonal treatment during menopause is nonetheless contraindicated in the case of proven coronary disease and uncontrolled cardiovascular risk factors.

BackgroundAcute kidney injury (AKI) is still characterized by a high mortality rate. While most patients with AKI are admitted in conventional medical units, current available data are still obtained from studies designed for patients admitted in intensive care units (ICU). Our study aimed to elaborate and validate an in-hospital death prognosis score for AKI admitted in conventional medical care units.MethodsWe included two prospective cohorts of consecutive patients with AKI admitted between 2001 and 2004 (elaboration cohort (EC)) and between 2010 and 2014 (validation cohort (VC)). We developed a scoring system from clinical and biological parameters recorded at admission from the EC to predict in-hospital mortality. This score was then tested for validation in the VC.ResultsThree-hundred and twenty-three and 534 patients were included in the EC and VC cohorts, respectively. The proportion of in-hospital death were 15.5% (EC) and 8.9% (VC), mainly due to sepsis. The parameters independently associated with the in-hospital death in the EC were Glasgow score, oxygen requirement, fluid overload, blood diastolic pressure, multiple myeloma and prothrombin time.The in-hospital death prognosis score AUC was 0.845 +/− 0.297 (p ConclusionsOur in-hospital death prognosis score is the first to be prospectively developed and validated for AKI admitted in a conventional medical care unit. Based on current parameters, easily collected at time of admission, this score could be a useful tool for physicians and nephrologists to determine the in-hospital death prognosis of this AKI population.

L’initiation de la dialyse péritonéale (DP) pour les patients polykystiques peut s’avérer compliquée lorsqu’une néphrectomie est nécessaire pour préparer la greffe rénale. Nous présentons ici l’étude rétrospective de 3 patients adultes suivis dans le service de néphrologie de Besançon sur la période 2017-2018 pour une insuffisance rénale chronique stade 5 en rapport avec une polykystose rénale autosomique dominante (PKAD) et ayant débuté la DP en post-opératoire d’une néphrectomie avec mise en place simultanée d’un cathéter de DP. Sur les 3 patients, tous ont pu débuter la DP dans le 1er mois post-opératoire, sans avoir recours à l’hémodialyse. Le délai moyen entre la néphrectomie et l’initiation de la DP était de 8,7 jours. La DP était débutée en DPCA avec de petits volumes (1,5 litre), puis la DPA était initiée à petits volumes ; le délai moyen entre la néphrectomie et la mise en place d’un programme de DPA « standard » s’élevait en moyenne à 24,3 jours. Aucune complication majeure n’était rapportée, notamment pas de fuite de liquide de DP. A long terme, la survie de la technique était bonne puisqu’une patiente est sortie de la technique par le biais de la greffe, les 2 autres patients sont encore en DP. Les critères d’adéquation étaient satisfaisants pour les 3 patients. Pour conclure, cette série de 3 cas donne des résultats très encourageants quant à l’initiation de la DP en post-opératoire d’une néphrectomie avec pose simultanée de cathéter de DP chez les patients polykystiques., Bulletin de la Dialyse à Domicile, Vol. 2 No 1 (2019): Bulletin de la Dialyse à Domicile

Aims We aimed to investigate whether micro-net on stent could preserve the index of msicrocirculatory resistance (IMR) after primary percutaneous coronary intervention (PCI) in patients with acutemyocardial infarction (AMI). Methods and results Fifty deux patients with AMI were randomized into two groups: primary PCI with micro-net on stent (MGUARD group, n = 25) and primary PCI with any commercially available (DES group, n = 27). As the primary endpoint, IMR was measured immediately after primary PCI using a pressure-temperature sensor-tipped coronary wire. The secondary endpoint was the left ventricular ejection fraction (LVEF) at six-month follow-up. The IMR in MGUARD group was significantly lower than in DES group (39.6 ± 26.2 U vs. 75.4 ± 60.5 U, P = 0.01). No significant differences in baseline EF (56.2 ± 10.3% vs. 54.9 ± 7.73%, P = 0.7), however, there were significant differences in follow-up EF (63.2 ± 3.8% vs. 54.7 ± 7.79%, P = 0.001). Conclusion A micro-net on stent significantly improved CMVD compared with a traditional DES in primary PCI and appear as a useful technological option to manage the thrombus.

Background However, women younger than 50 years accounted for 11% of MI admitted in hospital and their incidence is increasing. Purpose The main objective of this study is to systematically collect and describe clinical, morphological and biological characteristics, in hospital mortality and 12 months outcomes. Methods and Results We performed a clinical prospective observational multicenter study including all female patients admitted for MI under the age of 50. Three hundred and fourteen patients were included in twenty-eight participating centers. Mean age was 42.9 (±5.7) years old. One hundred and ninety two presented with ST elevation MI and One hundred and twenty two with non ST elevation MI. A total of 75% were active smokers, 14.6% had diabetes, 26.4% high blood pressure but only 15.3% with antihypertensive therapy, 35% had a family history of cardiovascular disease. Their specific risk factor included 33% of prior complication of pregnancy, 45.5% were under hormonal contraception 15.6% were already menopaused. Among STEMI patient 90.6% presented with typical chest pain and 58.9% reported also associated symptoms (nausea, vomiting, asthenia, sweats, dizziness or palpitation). A total of 10.4% reported prior symptoms for more than 1 week before. At admission, 13% presented with cardiac arrest. Interestingly, for STEMI patients, pre-hospital antiplatelet drugs were not systematically administered. At angiography, normal coronary angiogram was found in 6.8% of STEMI and 10.7% of NSTEMI. 29.6% of the patients included had significant multivessel disease despite their young age. Spontaneous coronary artery dissection was reported in 14.6% of STEMI and 20.5% of NSTEMI. No death, but 3 strokes, 3 recurrences of MI and 1 serious bleeding occurred during the hospitalization. Conclusion A comprehensive and systematized analysis of MI in young woman would improve our understanding and enable physician to offer patients a more appropriate therapeutic and monitoring.

Resume La prescription de dispositifs auto-injectables d’adrenaline (AAI) associee a une education therapeutique individualisee est necessaire dans certaines situations allergologiques a haut risque d’anaphylaxie. Le but de notre etude etait d’evaluer les habitudes de prescription des AAI par les allergologues du reseau allergo-vigilance et l’adhesion aux recommandations francaises de 2003 et europeennes de l’EAACI de 2014. Methode En janvier 2015, un questionnaire electronique etait adresse aux 299 allergologues du reseau. Resultats Au total, 121 questionnaires (40 %) ont ete analyses. Selon les recommandations europeennes, 77 % des allergologues prescrivaient l’AAI dans au moins 5 des 6 indications absolues chez l’enfant et 90 % chez l’adulte ; environ la moitie d’entre eux prescrivaient pour les 6 indications absolues. Selon les recommandations francaises, 81 % des allergologues prescrivaient l’AAI dans au moins 4 des 5 indications chez l’enfant et l’adulte mais seulement 33 % d’entre eux validaient toutes les indications chez l’enfant, 28 % chez l’adulte. L’urticaire generalisee n’etait retenue comme une indication que par un tiers des allergologues. L’asthme non controle modere a severe etait une indication chez l’enfant et l’adulte pour, respectivement, 77 % et 66 % des allergologues. Une allergie alimentaire a l’adolescence n’etait une indication que pour 16 % des allergologues. Conclusion Les pratiques en matiere de prescription d’adrenaline en prevention dans l’allergie ont evolue par rapport aux recommandations francaises de 2003 et les recommandations europeennes de 2014 doivent etre diffusees. Une mise au point des recommandations francaises en matiere de prescription d’adrenaline est necessaire.

Introduction The hypothesis of this study was that patient selection for midshaft clavicle fracture (open reduction internal fixation with plate versus conservative) would give better functional outcome than random treatment allocation. Methods We performed a systematic literature search for primary studies providing functional score and non-union rate after conservative or surgical management of midshaft clavicle fractures. Six randomized controlled trial and 19 non-randomized controlled trial studies encompassing a total of 1348 patients were included. Results Patients treated with surgical management were found to have statistically superior Constant scores in non-randomized controlled trials than in randomized controlled trials (94.76 ± 6.4 versus 92.49 ± 6.2; p Discussion This review shows that patient selection for surgery may influence functional outcome after midshaft clavicle fracture. Our results also confirm that plate fixation provides better functional outcome and lower non-union rate.

Introduction: Compared to a lateral or posterior approach (PA), the direct anterior approach (DAA) does permit a better muscle preservation for total hip arthroplasty (THA). However, there is concern whether this advantage come with increased wound complication and infection leading to reoperation or sometimes major procedures. Method: We retrospectively reviewed all patients who underwent primary THA through the PA between January 2009 and April 2013 ( n = 796) and through the DAA between January 2011 and April 2013 ( n = 399) at our institution with a minimum of 2 years follow up regarding all wound complications and all infections. Results: Of the 796 patients in the PA group, there were 6 wound complications leading to reoperation and 6 infections; 4 early and 2 delayed onset. Among the infected cases, one was obese (body mass index [BMI] >30 kg/m2). Two procedures were teaching-based. Of the 399 patients in the DAA group, there were three dehiscences leading to reoperation, two of which were in obese patients. 6 infections were also found; 4 with early and 2 with delayed onset. Of the infected cases, three were obese. 4 procedures were teaching-based. Conclusion: In our series of patients undergoing THA, the DAA did not increase the rates of either wound complications leading to reoperation nor early or delayed infection compared to the PA.

International audience; BACKGROUND: Peanut allergy management is based on active avoidance and access to emergency treatment including self-injectable adrenaline. Knowing the dose at which a patient is likely to react is crucial for risk assessment and could significantly improve management by integrating a personalized approach.OBJECTIVE: To develop a threshold dose distribution curve model from routinely collected data.METHODS: The MIRABEL survey is an observational study of 785 patients with peanut allergy/sensitization conducted in France, Belgium and Luxemburg. The current analysis included the 238 participants for whom medical and oral food challenge data were available. Several statistical models (Kaplan-Meier, Cox model, Weibull and Lognormal with predictive factors, basic Weibull and Lognormal) were compared to select the best model and predictive factor combination associated with the threshold doses. Inferences were made with a Bayesian approach.RESULTS: Patients were mainly children (mean age: 9 years [IQR: 6-11]; 87% < 16 years) and males (62%). Median Ara h2 s IgE was of 8kUA/L [IQR: 1-55] and median skin prick test size of 10 mm [IQR: 7-13]. OFC was positive in 204 patients (86%). The median threshold dose was of 67 mg of peanut protein [IQR: 16-244]. The dose at which 1% of the patients are likely to react with objective symptoms was 0.26 [0.03; 2.24] mg of peanut protein. Gender, size of the skin prick test (SPT) and Ara h 2 specific IgE level had a significant impact on the threshold dose distribution curve. The Cox model was the most effective to predict threshold doses with this combination of factors. Girls react to lower doses than boys with a beta coefficient associated to the risk and a 95% credible interval of 0.44 [0.04; 0.77]. The higher the size of the SPT and the Ara h 2 specific IgE level are, the higher the risk of reacting to a small amount of peanut, with beta coefficients associated to the risk and 95% credible intervals of 0.05 [0.02; 0.08] and 0.01 [0.01; 0.02], respectively.CONCLUSION AND CLINICAL RELEVANCE: According to the model, routinely collected data could be used to estimate the threshold dose. The consequences could be the identification of high-risk patients who are susceptible to react to small amounts of peanut and a personalized management of peanut allergy integrating the risk of allergic reaction. Limitations of this study are that assessors of OFC outcome were aware of SPT and Arah2 results, and a further validation study is required to confirm the predictive value of these parameters.

Cancers of the upper aerodigestive tracts are the fourth most common cancer in France. The main risk factors are smoking and alcohol. They do not necessarily present specific signs, making their early diagnosis difficult. A change in the patient's general condition is a late sign leading to a poor prognosis of the disease.

International audience; Thrombosis) French multicenter prospective observational registry reported that a stent mechanical abnormality was present in 97% of subjects with ST explored by intracoro-nary optical coherence tomography (OCT) imaging. 5 Premature discontinuation and incomplete individual response to APT have previously been reported as major risk factors for ST. 6,7 However, the interactions between APT regimen and potential underlying stent abnormalities remain largely unknown, even though different mechanical substrates could favor a rheological environment that might promote thrombosis. For example, uncovered/poorly healed struts behave as foreign bodies that induce platelet A lthough its frequency has decreased over the recent past years, stent thrombosis (ST) remains a major complication of percutaneous coronary interventions (PCI) and still carries a high mortality. 1 ST is a mul-tifaceted process that can be triggered by different factors such as the patient's clinical characteristics, efficacy of anti-platelet therapy (APT) or underlying mechanical stent abnormalities. 2 However, coronary angiography has limited sensitivity to correctly identify these latter mechanisms and recent studies suggest that intracoronary imaging is a valuable option to achieve this purpose. 3,4 Therefore, the PESTO (Morphological Parameters Explaining Stent

Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge (OC) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE-dependent anaphylaxis was confirmed in six cases: positive intradermal tests (n = 4), a syndromic reaction during skin tests (n = 1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC. A nonimmune reaction was suspected in one case. An IgE-dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BATs may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAIDs. Tests for specific IgEs to most frequently used NSAIDs such as diclofenac and ibuprofen are urgently needed.

Summary Anaphylaxis is the most serious form of the IgE-dependent food allergy, with lethal risk. The incidence is sharply rising. Objective Analysis of the actual management of anaphylaxis, searching for the appropriateness with the International Guidelines highlighting the absolute need of epinephrine, and further suggestions for the improvement of treatment. Method A general review of international studies stemming from Emergency Departments (ED), Paediatric, Resuscitation, Cardiologic or Allergy Departments over 1999–2012, as well of International Guidelines about the management of anaphylaxis. Results The self-injectable epinephrine by the patients is under-used. Treatment by epinephrine in ED has a low concordance with recommended guidelines. The discharge prescriptions of self-injectable epinephrine and referral to allergy testing are quite insufficient. Conclusion The actual management of anaphylaxis does not fit with the International Guidelines. Anaphylaxis treatment protocols according to the international criteria should be applied in ED. Risk reduction strategies cannot rely only on the self-administration of epinephrine by the patient and should put forward a better efficiency of all first-aid care providers. A targeted educational intervention should be developed to improve the care of emergency medical services providers. They should have self-injectable-epinephrine available and should be coached to use it properly.

Summary In Western French Guiana, there was a dramatic increase in HIV prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between 1 January 2008 and 30 June 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4 3 the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts 3 and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.

Background. For many nephrologists, patients with polycystic kidney disease (PKD) have an increased risk of complications and technique failure on peritoneal dialysis (PD) due to enlarged kidneys. The literature showed that PD can be as good a therapeutic option as haemodialysis (HD) for patients with PKD. However, no study has focused on the impact of polycystic kidney size on outcomes for patients on PD. Methods. This is a retrospective monocentric study. Fifty-eight patients with PKD started dialysis between January 2000 and December 2010: 24 on PD and 34 on HD. Kidney size assessed by abdominal computed tomography scans was available for 45 patients (19 on PD and 26 on HD). PD technique survival, specific PKD complications and mechanical and infectious PD complications, as need for pre-transplant nephrectomy and kidney transplantation, were considered. Results. The two cohorts were similar in terms of age and body surface area. The median kidney size was not significantly different between PD and HD patients [19.1 cm (12.5–32.5) versus 16.5 cm (11.8–33.8), respectively, P = 0.13]. However, we identified an increased number of PD patients with larger kidneys [(>25 cm) (27.8% on PD versus 7.7% on HD (P = 0.07)]. Neither cystic (infection or haemorrhage) nor mechanical complications (hernias and leaks) were different in PD or HD. Ten patients experienced PD-related peritonitis, mainly due to non-enteric bacterial pathogens. The main reason for stopping PD and HD was transplantation. Six PD patients underwent nephrectomy in order to access the transplant programme. Among them, five were maintained on PD after surgical procedure with good adequacy dialysis criteria. Conclusions. We observed no deleterious impact of kidney size on outcomes on PD when compared with HD. A large kidney size in patients with PKD is not a contraindication to PD. Patients for whom a pre-transplant nephrectomy is mandatory can also safely opt for PD as a dialysis method.

All iodinated contrast media (CM) are known to cause both immediate (≤1 h) and nonimmediate (>1 h) hypersensitivity reactions. Although for most immediate reactions an allergic hypersensitivity cannot be demonstrated, recent studies indicate that the severe immediate reactions may be IgE-mediated, while most of the nonimmediate exanthematous skin reactions, appear to be T-cell mediated. Patients who experience such hypersensitivity reactions are therefore advised to undergo an allergologic evaluation. Several investigators have found skin testing to be useful in confirming a CM allergy, especially in patients with nonimmediate skin eruptions. If a patient with confirmed allergy to a CM needs a new CM exposure, a skin test negative CM should be chosen and premedication may be tried. However, none of these precautional measures is a guarantee against a repeat reaction. More research focusing on pathomechanisms, diagnostic testing and premedication is therefore clearly needed in order to prevent CM-induced hypersensitivity reactions in the future.

Objectives Exploring the discrepancy in sex-ratio among interventional cardiologists by analysing the population of the female interventionalist. Background Despite an increase number of women who graduate from medical school in France during the last generation today, women represent only 24% of all cardiologists and 3% are interventional cardiologists. To face this international gender-based issue of interventional cardiology, committees were established in US (WIN) and recently within the EAPCI: the Women EAPCI chaired by Drs Mehilli and Mauri. In France, the Intervention’Elles committee emerged in order to participate in this concern. Methods As a first initiative, the Intervention’Elles group launched an e-survey to obtain information on the population of French female interventional cardiologists, focused on demography, work patterns, maternity and radiation exposure. Results Mean age is 40 years old (±7,4), 68% are working in large volume center, 28% have also structural interventional activity. Only 40% have left arm coverage. Despite 80% of French female interventional cardiologists wear personal dosimeters only 45% of them have a dosimetry feedback. Interestingly, even if 54% of women have children (mean: 1.9 ± 1) 28% of them report that childbearing had interfered with their career plan. Conclusion This questionnaire identifies for the first time the women population in interventional cardiology in France and highlights some of the issues encountered in more detail. This first descriptive step would help to develop strategies for attaining gender equality in interventional cardiology.

BACKGROUND The MIRABEL survey is an observational study on peanut allergy in France, Belgium and Luxemburg. The objectives are to provide data on a large population, to analyse the consumer behaviour, to study the presence of peanut traces in pre-packed foods with/without precautionary allergen labelling (PAL), and to combine these data to quantify allergic risk and produce a cost/benefit analysis. This paper reports a real-life observatory of 785 patients (

Resume But de l’etude Une dissection aortique de type A ou B peut s’etendre aux arteres renales, entrainant une ischemie renale dont le traitement est habituellement endovasculaire. Le but de notre etude est de montrer l’interet de la volumetrie renale dans le suivi de ces patients. Patients et methodes Vingt-deux patients (16 hommes, âge moyen 63,4 ± 11,8 ans, IMC 25,2 ± 3,4 kg/m 2 ) ayant presente une dissection aortique de type A ou B etendue a une ou aux deux arteres renales et suivis au CHU de Grenoble ont ete inclus de facon consecutive. Tous les patients ont beneficie d’une arteriographie renale avec prise de pression intra-arterielle et d’un suivi par volumetrie renale (scanner Siemens ® ). Une ischemie renale est definie par une baisse de la volumetrie de 20 % ou plus. Resultats Seize patients (73 %) etaient hypertendus avant la dissection aortique parmi lesquels dix (62 %) etaient traites. Huit patients (36 %) ont un gradient de pression intrarenal significatif dont cinq (62 %) ont beneficie d’une angioplastie renale. La volumetrie renale est demeuree inchangee chez ces cinq derniers patients alors que six des 17 patients (36 %) n’ayant pas eu d’angioplastie ont vu leur volumetrie diminuer. Conclusion La volumetrie renale par scanner est une technique a la fois faisable et semblant d’interet pour le suivi des patients avec dissection aortique etendue aux arteres renales. Ces resultats devraient etre pris en compte pour poser l’indication d’un geste de revascularisation dans ce contexte.

After a bucket-handle meniscus tear, a partial meniscectomy by arthroscopy is recommended, when a meniscal suture is impossible. Short-term results of meniscectomy after bucket-handle meniscus tear, without cartilage or ligament additional injury, are mostly excellent: pain and blocking disappear, return to sports activities is possible. The aim of this retrospective study is to follow a partial meniscectomy evolution with a long follow-up between March 1990 and April 1994, and a senior surgeon operated 34 meniscectomies for bucket-handle meniscus tear by 34 patients (29 male and 5 female) with a mean age of 31.7 years (16-52 years) at time of surgery. The bucket-handle meniscus tear had a traumatic etiology on a knee with no cartilage lesion. The functional results were assessed by IKDC subjective score (International Knee Documentation Committee) and ARPEGE score (Association pour la Recherche et la Promotion de l'Etude du Genou). These scores were obtained by phone call questionnaire in March 2014 with a mean follow-up of 22.7 years (20-24 years). In this study, patients were reviewed and got a clinical examination to determine the Lequesne score, a radiological knee assessment according to Ahlback classification and a weight-bearing teleradiography. With an IKDC mean score of 85.8 after surgery, we observed that 29 patients go back to sports activities with the same level as before injury. The level of sports activity, with a regular practice after a mean follow-up of 22.7 years, was the same as immediately after surgery or just the level under for 85.3 % of patients. With ARPEGE score, 48.5 % of patients had a global excellent result and 38.2 % had a global good result after a long follow-up. With a mean Lequesne score of 2.38, osteoarthritis of knee is still clinical minimal after meniscectomy at long term. The score was worse after external meniscectomy (EM) than after an internal meniscectomy (IM). 57.7 % of patients have osteoarthritis on X-rays. In our study, functional results after partial meniscectomy for bucket-handle meniscus tear are similar than in the literature. More than half of our patients, reviewed after a long follow-up, had radiological osteoarthritis of knee with a variable clinical result, but often minimal to moderate, intensity modulated by the lower limb axis.

International audience; Peanut allergy is one of the most prevalent food allergies. The possibility of a lethal accidental exposure and the persistence of the disease make it a public health problem. Evaluating the intensity of symptoms is accomplished with a double blind placebo controlled food challenge (DBPCFC), which scores the severity of reactions and measures the dose of peanut that elicits the rst reaction. Since DBPCFC can result in life-threatening responses, we propose an alternate procedure with the long term goal of replacing invasive allergy tests. Discriminant analyses of DBPCFC score, the eliciting dose and the rst accidental exposure score were performed in 76 allergic patients using 6 immunoassays and 28 skin prick tests. A Multiple Factorial Analysis was performed to assign equal weights to both groups of variables and predictive models were built by cross-validation with LDA, k-NN, CART, penalized SVM, stepwise logistic regression and AdaBoost methods. We developed an algorithm for simultaneously clustering eliciting dose values and selecting discriminant variables. Our main conclusion is that antibody measurements o er information on the allergy severity, especially those directed against rAra-h1 and rAra-h3. Further independent validation of these results and the use of new predictors will help extend this study to clinical practices.

Laboratory identification of cytoplasmic inclusions in leucocytes as unusual manifestation of cryoglobulinemia has been previously reported (Maitra et al., 2000 American Journal of Clinical Pathology, 113, 107-112; Fohlen-Walter et al., 2002 American Journal of Clinical Pathology, 117, 606-614.). We would like to add two observations highlighting the following: (i) the peculiar picture of cryoglobulins in neutrophils and monocytes but sparing other white blood cell (WBC) and (ii) possibility of deposit occurrence with morphological identification in body fluids.

L’anaphylaxie est la forme la plus grave des allergies alimentaires. Des facteurs de risque endogenes ont ete identifies : âge avance, comorbidites (cardiopathies, asthme, mastocytose). Le risque lie a l’âge peut etre tributaire d’une consommation medicamenteuse accrue. Certaines classes pharmacologiques sont prescrites quotidiennement : beta-bloqueurs, inhibiteurs de l’enzyme de conversion de l’angiotensine (IEC), aspirine a dose anti-aggregante en cardiologie, anti-inflammatoires non steroidiens dans les indications rhumatologiques. La frequence d’une reaction allergique severe associee aux prises de ces medicaments est tres superieure a ce qu’elle est dans les allergies moderees. Le risque relatif (odds ratio ) etabli dans une etude cas-controle est de 10,8 pour l’aspirine, 8,2 pour les anti-inflammatoires non steroidiens, 6,8 pour les beta-bloqueurs, 13 pour les IEC. L’exercice potentialise de surcroit le risque medicamenteux. Les mecanismes de ces effets potentialisateurs s’exercent a differents niveaux : muqueuse intestinale, cellules effectrices de l’anaphylaxie, endothelium vasculaire, interference avec le mecanisme homeostasique de l’angiotensine. Les mesures preventives sont discutees en tenant compte du rapport benefice-risque de l’abstention de ces classes pharmacologiques.

Obstructive sleep apnoea (OSA) has been linked to increased cardiovascular risk. The present study examined the relationships between respiratory parameters and left ventricular abnormalities in OSA. 150 newly diagnosed OSA patients without any known cardiovascular disease were included in the study (mean ± sd age 49 ± 11 yrs, body mass index 27.1 ± 3.3 kg·m⁻², respiratory disturbance index 41 ± 18 h⁻¹). Haemodynamic, biological, respiratory, cardiac and arterial parameters were assessed at inclusion. 34 (22.7%) patients had a grade 1 left ventricular diastolic dysfunction. Patients with an abnormal diastole were older (p < 0.001) and 81% of them were hypertensive. The only respiratory parameter independently associated with the peak flow velocity in early diastole/peak flow velocity at atrial contraction ratio was mean nocturnal oxygen saturation. 17 (13%) patients had left ventricular hypertrophy. A multivariate analysis showed that clinic systolic blood pressure and mean nocturnal oxygen saturation were independently associated with left ventricular hypertrophy. In a logistic regression model, age ≥ 58 yrs (OR 3.29, 95% CI 1.78-5.64) and mean nocturnal oxygen saturation < 92% (OR 2.76, 95% CI 1.45-4.91) were associated with left ventricular diastolic dysfunction. Our findings demonstrate that left ventricular diastolic dysfunction frequently occurs in patients with OSA and that it is related to the severity of oxygen desaturation.

The incidence of severe allergic reactions is largely unknown and information about triggering allergens, aggravating factors, demography of patients and medical care is lacking. A European wide registry could provide a powerful tool to improve the management of severe allergic reactions from both a medical and a public health perspective. Analysis of existing registries regarding the type and quality of data being collected was used to develop a plan for a pan-European registry, including the type of system to be used and the range of data to be entered. Surveillance will provide evidence for the efficacy of risk management measures and may identify the emergence of new allergenic foods, and aid monitoring of novel foods, ingredients and technologies. Patients need a clear indication of factors that may increase their risk of having an adverse reaction, which such a registry can help compile. Based on the collected data, food businesses will be able to develop educational programmes for allergen risk assessment and allergen risk communication. Finally, and most importantly preventive measures can be developed and government agencies receive population based data which may be relevant for legislative purposes.

Resume Toute substance injectable administree au cours de la periode operatoire est susceptible d’induire une reaction d’hypersensibilite immediate susceptible d’engager le pronostic vital. Des investigations per- et postoperatoires doivent etre realisees pour confirmer le mecanisme de la reaction et identifier l’agent responsable. Elles incluent le dosage d’histamine, de tryptase et la recherche d’IgE specifiques au moment de la reaction, ainsi que la realisation de tests cutanes apres six semaines. La recherche d’une reactivite croisee doit etre systematique en cas d’allergie a un curare, afin d’etablir des recommandations precises en vue d’une anesthesie future. Les tests d’activation des basophiles, notamment par cytometrie en flux, appliques au diagnostic de la sensibilisation a un allergene medicamenteux et a l’exploration de la reactivite croisee connaissent un developpement rapide.

Between 1995 and 2008, a case-control study was conducted to determine the role of drugs as risk factors for severe food anaphylaxis in adults. Data including exercise, alcohol intake, and use of aspirin, non steroidal anti-inflammatory drugs, beta-blockers, and angiotensin-converting-enzyme inhibitors (ACEI) were prospectively recorded. Multivariate analysis was used to compare 76 cases of severe anaphylaxis (SA) with 235 cases of mild to moderate food allergy (mmFA). The M/F sex ratio was 54.6% in SA and 36% in mmFA (p < .003). SA represented 17.3% of all food allergies below 45 years and 54.6% over this age. Drug intake did not differ between the two age categories. Drug use was noted in 40.8% of SA and 14.9% of mmFA (p < .0005). Aspirin, NSAIDs, betablockers and ACEI were associated with respectively 15.8%, 6.6%, 10.5% and 5.3% of SA, and with 1.7%, 0.9%, 1.7% and 0.4% of mmFA (p < .003). The respective odds ratios were 10.8, 8.2, 6.8 and 13.0. No other drugs were associated with FA. Exercise and alcohol intake were associated to drugs with respectively 10.5% and 27.6% of SA and 0.4% and 8.1% of mmFA (p < .0005). Exercise drastically increased the risk of drugs. We conclude that aspirin, NSAIDs, betablockers and ACEI are significant risk factors for severe IgE-dependent food allergy. The underlying mechanisms are discussed. Adults with food allergy or sensitization should avoid taking aspirin and NSAIDs before meals and should receive drug families other than ACEI and betablockers for hypertension. In case of pre-existing heart disease, the benefit-risk ratio of ACEI and beta-blockers has to be carefully considered.

BACKGROUND Previous studies have demonstrated that hyperhomocyst(e)inaemia is present in patients with impaired renal function and is correlated with cardiovascular disease. Because conflicting data are available on the prevalence, determinants, and clinical significance of hyperhomocyst(e)inaemia in renal-transplant recipients, we conducted the largest cross-sectional study on homocysteine determinants and clinical correlates in renal transplant recipients. METHODS Plasma homocyst(e)ine concentrations and factors known to influence homocysteine metabolism were analysed in 224 renal transplant recipients. Atherosclerotic complications were evaluated with respect to plasma homocysteine concentrations. RESULTS Mean plasma homocyst(e)ine was 21.3+/-9.7 micromol/l. After adjusting for age, gender, transplant duration, and creatinine clearance, patients with and without cyclosporin A (CsA) had similar plasma homocyst(e)ine concentrations (16.9+/-5.9 micromol/l in CsA(+) patients vs 16.3+/-5.2 micromol/l in CsA(-) patients; P=0.3). We found a significant inverse relationship between plasma homocyst(e)ine and folate concentrations in both CsA(+) (r=-0.243; P

Background: The prevalence of severe anaphylaxis, between 1 and 3 per 10 000, has increased sharply over recent years, with a rate of lethality of 1%. The economic burden is unknown. Objective: The aim of this study was to estimate the economic costs of anaphylaxis, including direct costs of treatment, hospitalization, preventive and long-care measures, and the indirect cost: absenteeism. Methods: Analysis of 402 patients of anaphylaxis declared by 384 allergists was reported to the Allergy Vigilance Network. The global cost was estimated from the national data of hospital admissions: ICD-10 coding available for 2003, 2004 and 2005. Results: Three work/classroom days were lost per patient. Diagnosis required oral challenge with hospitalization in 18% of cases. The estimated mean total cost was 1895€ for food- and drug-related anaphylaxis (5610€ for the most severe), and 4053€ for Hymenoptera anaphylaxis. National statistics recorded 2575 patients in 2005; 22% more than in 2003. The estimated annual cost was 4 789 500 €. The possible reasons for this being an under-estimate include: data coming only from hospitalized patients, poor identification by medical teams unfamiliar with ICD-10 codes, peri-operative anaphylaxis being insufficiently declared, rush-immunotherapy and maintenance treatments for Hymenoptera anaphylaxis. Similarly, the extra cost of cow milk substitutes, as well as insurance costs where deaths are followed by litigation were not taken into account. Conclusions: The mean cost of anaphylaxis was 1895–5610€ in nonfatal patients. The prevalence was under-estimated because of many biases, leading to under-estimation of the national cost. Further studies would be necessary to evaluate the value of preventive strategies.

Udgivelsesdato: 2007-Aug Anaphylaxis is a growing paediatric clinical emergency that is difficult to diagnose because a consensus definition was lacking until recently. Many European countries have no specific guidelines for anaphylaxis. This position paper prepared by the EAACI Taskforce on Anaphylaxis in Children aims to provide practical guidelines for managing anaphylaxis in childhood based on the limited evidence available. Intramuscular adrenaline is the acknowledged first-line therapy for anaphylaxis, in hospital and in the community, and should be given as soon as the condition is recognized. Additional therapies such as volume support, nebulized bronchodilators, antihistamines or corticosteroids are supplementary to adrenaline. There are no absolute contraindications to administering adrenaline in children. Allergy assessment is mandatory in all children with a history of anaphylaxis because it is essential to identify and avoid the allergen to prevent its recurrence. A tailored anaphylaxis management plan is needed, based on an individual risk assessment, which is influenced by the child's previous allergic reactions, other medical conditions and social circumstances. Collaborative partnerships should be established, involving school staff, healthcare professionals and patients' organizations. Absolute indications for prescribing self-injectable adrenaline are prior cardiorespiratory reactions, exercise-induced anaphylaxis, idiopathic anaphylaxis and persistent asthma with food allergy. Relative indications include peanut or tree nut allergy, reactions to small quantities of a given food, food allergy in teenagers and living far away from a medical facility. The creation of national and European databases is expected to generate better-quality data and help develop a stepwise approach for a better management of paediatric anaphylaxis.

RESUME L’augmentation recente de l’anaphylaxie severe pose, avec acuite, la necessite d’une evaluation permanente des facteurs de risque et des dangers d’allergie alimentaire, en relation avec les modifications incessantes et rapides de l’environnement alimentaire. La securite alimentaire exige l’implication, a cote des organismes de regulation et des industries, de la communaute allergologique. Le Reseau Allergovigilance, institue par une equipe universitaire et de recherche, incluant 398 allergologues francais et belges, developpe une strategie selon trois axes. La declaration des cas severes d’anaphylaxie permet la surveillance de l’evolution de prevalence des differents trophallergenes. Elle permet d’evaluer la qualite de la prise en charge des urgences allergiques et apporte des donnees precises permettant l'estimation du cout economique de l’anaphylaxie. Le second objectif est de preciser par des enquetes nationales la prevalence de sensibilisation a des allergenes a risque : arachide, lupin, isolats de ble, pollens de plantes qui verront l’arrivee de varietes genetiquement modifiees, etc. Le troisieme objectif est le depistage et la surveillance a long terme des dangers lies a de nouveaux aliments et ingredients, ou issus de facteurs adjuvants de sensibilisation lies a des contaminants chimiques. La surveillance post-marketing des plantes alimentaires genetiquement modifiees beneficiera d’un tel reseau clinique, auquel s’associe une serotheque mise en place selon les propositions de l’OMS FAO. En lien avec l’AFSSA, la DGCCRF et des associations de patients, le Reseau Allergo-Vigilance concourt a l’analyse des facteurs de risque et a la prise en charge des dangers issus de l'allergenicite des proteines alimentaires.

Background Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description. Objective We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents. Methods The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. Results Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom– and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions. Conclusions The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.

Background: International registries report an aging population suffering from PAH (Pulmonary Artery Hypertension) engendering diagnosis difficulties linked with growing cases of group 2 related to left heart failure with preserved Ejection Fraction (PH-HFpE). Pulmonary Capillary Wedge Pressure (PCWP) measurement by right heart catheterization remains a technical challenge for patient classification; many centers still use digital PCWP given by cath lab software. Here, we have tried to demonstrate misclassification impact of this approximation. Methods: We investigated the PCWP-Left Ventricular End Diastolic Pressure (LVEDP) relationship in a prospective series of 31 patients undergoing heart catherization for suspicion of PAH. Digital and end expiration PCWP were measured in right and left pulmonary arteries for comparison with end expiration LVEDP. Results: We explored 31 patients, 65.4 ± 11 years old, 67.7% were female, with LVEF 60.6 ± 5.2%, Diagnosis of HFpEF was found in 62% of cases and PAH in 10% when using end expiration LVEDP. Right end expiration PCWP, left end expiration PCWP, right digital PCWP, left digital PCWP and end expiration LVEDP were respectively 16.2 ± 6.7mmHg, 16,6 ± 6.4mmHg, 12.2 ± 6.1mmHg (p

A 39-year-old man, active smoker with a history of hypercholesterolaemia, was referred for invasive coronary angiography for ST-segment elevation acute coronary syndrome. Coronary angiogram showed complete occlusion of the left anterior descending artery (LAD). Thromboaspiration was successfully performed with TIMI 3 flow at the end of the procedure. Therefore, no stenting procedure was immediately performed, and a control coronary angiography was performed …

Food allergy is a major public health issue. However, no regulatory measures exist when allergens are present at trace levels and the different risk components are poorly described. Thus, knowledge on exposure components such as the allergens present in foods and the consumption behaviour of allergic consumers and models to estimate the related risk need to be enriched. Mirabel proposes for the first time studying each risk component using an integrated approach in order to improve the quality of life of the allergic population. Field surveys were conducted in order to fill in the current gaps in unintentional allergen traces in food, allergic consumers' food behaviour, threshold doses of allergic reaction, allergy symptoms and severity. The aim is also to propose methodological and operational tools to quantify allergic risk, to test management scenarios and to produce a cost/benefit analysis. Medical data on the peanut allergies of 785 patients were collected in the MIRABEL survey and 443 patients answered the food consumption questionnaire. The population surveyed was mostly paediatric - 86% were children under 16 years of age, with a high percentage of males (60%). This project will generate tangible results on peanut allergen exposure and risk which could be used in future risk assessment work and particularly to provide science-based guidance to set up concentration limits for peanut traces on packages; L'allergie alimentaire est un enjeu majeur de santé publique. Ce texte présente en détail le protocole Mirabel concernant l’allergie à l’arachide. L'objectif de ce projet est de proposer des outils méthodologiques et opérationnels pour quantifier le risque allergique, pour tester des scénarios de gestion, et de produire une analyse coût / bénéfice concernant ces scénarios de gestion visant à réduire le risque. Les analyses à venir seront réalisées à partir des données médicales de 785 patients et des habitudes de consommation alimentaires de 443 patients.