Search

Robot Assisted Partial Nephrectomy (RAPN) is a standard of care for localized renal tumors. It allows a good carcinological control while limiting complications. Despite numerous benefits, the economic sustainability of robotic assistance remains a challenge in the French health care system. The introduction in our institution of two perioperative nurse-coordinated protocols for patients undergoing RAPN (Enhanced Recovery After Surgery: NP-RAAC in 2015 and Outpatient: Ambu-Rein in 2016) is associated with a shortening of the average length of hospital stay, thus reducing the cost of robotic assisted procedures. With the aim of improving efficiency of nursing support within these protocols, we have introduced digitalized nursing coordination by developing a urological perioperative application: UroConnect®. This device is offered to patients by the coordinating nurses during a preoperative visit. It provides information on the pathology and its surgical management. Self-completed questionnaires sent at key moments collect data from the first month after surgery and detect patients presenting difficulties or complications, allowing the nurses to respond with appropriate care. The application allows a secure discharge, a personalised follow-up and an increase in the patient's autonomy and compliance with care.

Background Neurofibromatosis type 2 (NF2) is characterized by bilateral vestibular schwannoma (VS) more often in adults but a severe paediatric form with multiple neurological tumours is also described. In this population, a early diagnosis is important to prevent the onset of neurological complications but is difficult, particularly without a familial history. Cutaneous manifestations, which may precede VS or neurological tumours by several years, may contribute to an early diagnosis, but specific studies are lacking. The objective of this study was to characterize cutaneous manifestations of NF2 in a paediatric population. Results This observational, descriptive and multicentric study was conducted from April 2019 to April 2020 in seven academic French hospitals. We included patients ≤ 18 years old who fulfilled the Manchester diagnostic criteria or had a pathogenic mutation identified in the NF2 gene. All patients underwent a dermatological examination guided by a standardized questionnaire. 21 children were included, of whom 20 had at least one skin tumour (mean number 5 ± 4.6 [range 0–15]), which led to a diagnosis in four cases. In the other 17 cases, the diagnosis of NF2 was based on neurosensory complications (n = 10), family screening (n = 4) or ocular signs (n = 3). Before the NF2 diagnosis, 15 children had at least one “undiagnosed” cutaneous tumour that did not lead to a specific management. Patients’ dermatological examination also revealed café au lait macules (n = 15), hypopigmented macules (n = 12) with more than 3 lesions in 4 cases, and purple reticulated macules of the trunk (n = 4). Conclusion Dermatological lesions are frequent and early in children with NF2 but rarely lead to the diagnosis. Cutaneous schwannomas are the most frequent but are often underdiagnosed. Café au lait macules are frequent, but atypical and mostly in small numbers. Multiple hypopigmented macules seem suggestive although inconsistent. The sensitivity of reticulated capillary malformation-like lesions remains to be assessed by further studies.

The phase stability of a 140GHz, 1kW pulsed gyro-amplifier system and the phase dependence on the cathode voltage were experimentally measured. To optimize the measurement precision, the amplifier was operated at 47 kV and 1 A, where the output power was ∼ 30W. The phase was determined to be stable both pulse-to-pulse and during each pulse, so far as the cathode voltage and electron beam current are constant. The phase variation with voltage was measured and found to be 130±30°/kV, in excellent agreement with simulations. The electron gun used in this device is non-adiabatic, resulting in a steep slope of the beam pitch factor with respect to cathode voltage. This was discovered to be the dominant factor in the phase dependence on voltage. The use of an adiabatic electron gun is predicted to yield a significantly smaller phase sensitivity to voltage, and thus a more phase-stable performance. To our knowledge, these are the first phase measurements reported for a gyro-amplifier operating at a frequency above W-band.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

International audience; This study compared the performance of near-infrared spectroscopy (NIRS) models on fresh and freeze-dried beef muscle samples to predict intramuscular connective tissue (IMCT) components and to determine whether the accuracy of the models differed among different muscles from beef cattle. The hypothesis was that the water content of muscle samples would negatively influence the accuracy of the models, which would differ among muscles. Fresh and freeze-dried samples (n = 171) of four muscles were used to develop NIRS models to predict the contents IMCT. For the total collagen content, the standard error of cross validation (SECV) for model using freeze-dried samples (0.75 mg OH-prol/g DM) was lower than that for model using fresh samples (0.84 mg OHprol/g DM). For cross-links and proteoglycans, the SECV for models using fresh sample spectra was lower than that for models using freeze-dried sample spectra. The accuracy of the prediction of the models also differed among predicted muscle types.

Objectives The early identification of patients with Acute Heart Failure Syndrome (AHFS) among patients admitted to the Emergency Department (ED) with dyspnoea can facilitate the introduction of appropriate treatments. The objectives are to identify the predictive factors for AHFS diagnosis in patients with acute dyspnoea (primary objective) and the clinical 'gestalt' (secondary objective) in ED. Methods PREDICA is an observational, prospective, multicentre study. The enrolment of patients admitted to the ED for nontraumatic acute dyspnoea and data collection on admission were recorded by the patient's emergency physician. The AHFS endpoints were assessed following a duplicate expert evaluation by pairs of cardiologists and emergency physicians. Step-by-step logistic regression was used to retain predictive criteria, and the area under the receiver operating characteristic (ROC) curve of the model was constructed to assess the ability of the selected factors to identify real cases. The probability of AHFS was estimated on a scale from 1 to 10 based on the emergency physician's perception and understanding (gestalt). Results Among 341 patients consecutively enrolled in three centres, 149 (44%) presented AHFS. Eight predictive factors of AHFS were detected with a performance test showing an area under the model ROC curve of 0.86. Gestalt greater than or equal to five showed sensitivity of 78% and specificity of 90% (AUC 0.91) and diagnosed 88% of AHF in our population. Conclusions We identified several independant predictors of final AHFS diagnosis. They should contribute to the development of diagnostic strategies in ED. However, unstructured gestalts seem to perform very well alone.

Background An ecstatic phenomenon is an altered state of consciousness with a sense of “hyper-reality”, and a complete present-moment awareness with a feeling of union with the Universe. A better understanding of the network mechanisms underlying this fascinating subjective experience may help to unravel some mysteries of human consciousness. Insula has been recently proposed to be a key region to elicit these symptoms. Objective/Hypothesis We studied functional connectivity changes in several brain areas during the induction of ecstatic auras by direct electrical stimulation of the dorsal anterior insular cortex in patients with refractory focal epilepsy implanted with intracerebral electrodes (stereotactic-EEG, SEEG) in the context of their pre-surgical evaluation. Methods Three patients were selected on the basis of the occurrence of ecstatic symptoms triggered by direct intracerebral electrical stimulation (ES) of the antero-dorsal part of the insula. ES was performed (50 Hz, 1.5–2.1 mA, in a bipolar fashion to each contact in the gray matter during a 3 s period) to map functional cortices and trigger habitual seizures. One stimulation inducing ecstatic changes in each patient was analyzed. Functional connectivity analysis was performed by measuring interdependencies (nonlinear regression analysis based on the h2 coefficient) between SEEG signals before and after stimulations. Results In all patients, only the stimulation of dorsal anterior insula was able to reproduce an ecstatic aura. We observed a significant increase of functional connectivity values between several brain regions in the immediate period following stimulations. The most commonly implicated region was the dorsal anterior insula. Out-degrees (a measure intended to identify leading structures in a network) identified the dorsal anterior insula as the most common leading region in the induced networks. Conclusion(s) Our findings bring additional support in favor of a major role played by the dorsal anterior insula in ecstatic experiences.

Resume Introduction Les injections de toxine botulique en medecine esthetique sont les produits les plus utilises, devant l’acide hyaluronique, et la medecine esthetique est en augmentation constante, y compris dans la population masculine. L’objectif de cette mise au point etait de montrer les specificites decrites dans la litterature concernant les injections de toxine botulique chez l’homme. Materiel et methode Une recherche systematique de la litterature a ete realisee grâce au moteur de recherche Pubmed. Les donnees ont ensuite ete collectees afin de connaitre les specificites des injections de toxine botulique chez l’homme en fonction de la morphologie du visage masculin et des desirs de ces patients. Resultats Les etudes realisees montrent qu’il est necessaire d’injecter des doses plus importantes chez l’homme que chez la femme pour obtenir un resultat satisfaisant, en raison d’une masse musculaire plus importante. Cette mise au point donne le nombre de points a realiser par zone d’injection, ainsi que le nombre de points a effectuer, en comparaison a la population feminine. Conclusion Les injections de toxine botulique a visee esthetique chez l’homme different par rapport a la femme. La prise en compte de ces particularites est indispensable a la satisfaction des patients.

A [Formula: see text] quasi-optical ring resonator consisting of an input coupler and three mirrors has been designed and tested. A low-loss silicon wafer in the ring provides output coupling of the stored power when irradiated by a pulse from a [Formula: see text] laser. The ring created [Formula: see text] output power pulses when excited by a [Formula: see text] continuously operating input source, achieving a power gain of 16. In a fully tuned ring, higher gain is achievable. If the ring was used with a pulsed input source having a pulse length of several times the fill time, the ring could be used as an efficient pulse compressor with similar high gain. The resonator has a wide range of applications, including, at low power, spectroscopy and, at high power, testing of accelerator structures and materials.

Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) is associated with a high mortality rate and recurrent hospitalizations. Purpose To present the first data of the patients using Satelia® Cardio solution Method Satelia® Cardio is a HF patient management solution with a remote monitoring system and a therapeutic guidance by a dedicated-nurse phone platform, supported by the ETAPES Program. The system is accessible from any device and requiring no installation. After the inclusion, the patient is contacted by the nurse, he then receives an SMS alerts following cardiologist prescription (on regular basis), with a link leading to a web page on which he will answer 7 questions and enter his current body weight. Satelia® Cardio algorithm is based on these data inputs, their variability, and the weight. In case of worsening of symptoms, the cardiologist will be notified. Since Covid-19 lockdown, more than 1400 patients have been monitored with the solution. Results 165 centers (306 cardiologists) are using Satelia® Cardio with 3540 HF patients monitored in the last 29 months. The patients with a mean age of 72 years (19-100) are predominantly males (67%), and mostly NYHA II/III (69%/31%) with a mean LVEF of 40%. The adherence to the system is very good (91%) with 78% of patients still monitored (n = 2787). The main reasons for stopping are related to the occurrence of death (205/753) or patient/HCP decision (392/753), or other reasons (156/753). Over the period of analysis, the HF patients answered to 163 700 questionnaires, generating 8210 alerts transmitted to the referent cardiologists. Conclusion Patient management solution with a remote monitoring system is key to improving the follow-up of HF patients. The solution Satelia® Cardio is an easy way to use a web application to monitor HF patients, especially on the current period of Covid-19 with a low rate of premature discontinuation. A further step will be to initiate studies to assess the potential benefits for both patients and HCPs of such remote monitoring solution in HF.

International audience; Until now, there are few information on vitamin B 2 concentration variability in milk. In this study, a novel analytical method to quantify total vitamin B 2 in milk was developed and applied on 676 samples. In parallel, spectral analysis (colorimetry and near infrared spectroscopy) were performed to develop prediction models of vitamin B 2 concentration in milk. The analytical method includes an acid and enzymatic extraction followed by vitamin B 2 quantification by Ultra High Performance Liquid Chromatography coupled with fluorimetry. Samples analysis showed a wide range of concentration from 0.78 to 4.58 mg/L with a mean of 2.09 ± 0.48 mg/L. Two prediction models based on colorimetric analysis allow estimation of vitamin B 2 concentration in milk. Thus, this work shows an analytical method and, for the first time, a prediction method to enable enhancement of researches on vitamin B 2 content of milk and its variation factors.

Context The use of cover crops provides agronomic and environmental benefits in crop–livestock systems. They can also constitute alternative forage resources for ruminants, particularly when climatic conditions limit grass supply. However, information on the nutritive value of these crops remains scarce. Aims The objective of the present study was to assess the fresh forage potential of several plant species (sainfoin, buckwheat, phacelia, berseem clover, crimson clover and vetch) commonly used as cover crops and harvested at two phenological stages, namely, vegetative stage (VS) and flowering stage (FS). Methods Chemical composition and fermentation parameters after in vitro ruminal incubation of the plant species were measured and compared with those of lucerne. Key results Chemical composition and in vitro organic-matter digestibility varied both with species (P < 0.001) and stage (P < 0.001). Crude protein concentration (g/kg dry matter) varied at VS from 212 (sainfoin) to 151 (phacelia), and at FS from 187 (vetch) to 88 (phacelia). The in vitro organic-matter digestibility at VS varied from 0.91 (buckwheat) to 0.82 (lucerne), and at FS from 0.81 (vetch) to 0.74 (lucerne). Buckwheat and sainfoin had the greatest concentrations of condensed tannins and total phenolic compounds. The incubation of phacelia, sainfoin and buckwheat resulted in a lower production of volatile fatty acids than did incubation with the other plant species. Methane production was lower at both stages for phacelia (–26%), buckwheat (–12%), sainfoin (–14%) and berseem clover (–13%) than it was for lucerne. Ammonia production expressed as total N proportion was significantly lower for sainfoin and buckwheat than for the other plant species. The reductions in methane and ammonia appeared to be linked to certain phenolic compounds for buckwheat and to condensed tannins for sainfoin. Conclusions The present study showed that these cover crop species hold nutritive characteristics as good as lucerne, indicating that they could be suitable for ruminant nutrition. Moreover, buckwheat and sainfoin have potential beneficial effects on methane and ammonia production. Implications These results constitute a first step towards a recommendation to farmers to use cover crops as forage.

Summary Introduction The sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery. Material and methods We conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5 mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time. Results Pain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P > 0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P > 0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P > 0.05). Conclusion Local instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5. Level of evidence Level II.

Introduction Les guidelines ESC/ERS 2015 recommandent un traitement combine d’emblee incluant une prostacyline parenterale dans l’hypertension arterielle pulmonaire (HTAP) a risque eleve de mortalite. L’interet d’une tritherapie initiale incluant une prostacyline parenterale repose deux etudes retrospectives de faibles effectifs (Sitbon O, et al. Eur Respir J 2014; D’Alto M, et al. Chest 2020). Les donnees de survie a long-terme avec cette strategie demeurent encore mal connues. Methodes Analyse retrospective a partir du registre francais de l’hypertension pulmonaire de tous les cas incidents d’HTAP initiees en tritherapie associant une prostacycline parenterale (epoprostenol par voie IV ou treprostinil par voie sous-cutanee), un antagoniste des recepteurs de l’endotheline et un inhibiteur de la PDE-5 entre 2007 et 2018. Recueil des donnees cliniques, fonctionnelles (classe fonctionnelle [CF] NYHA, distance parcourue au test de marche de six minutes [DM6]), biologiques (NT-proBNP) et hemodynamique (catheterisme cardiaque droit) au diagnostic, a la premiere et a la derniere reevaluation. Analyses de la survie globale et sans transplantation. Resultats Quatre-vingt-cinq patients (80 % de femmes, âge moyen 43 ± 15 ans) atteints d’HTAP (44 idiopathiques, 25 heritables, 10 associees a une connectivite, 3 hypertensions porto-pulmonaires, 3 autres). Le Tableau 1 montre les caracteristiques cliniques et hemodynamiques au diagnostic et leurs modifications au cours du suivi. Le suivi moyen etait de 4.6 ± 2.9 ans. Six patients sont decedes apres 2 mois (2), 8 mois (1), 13 mois (1) et 2 ans (2), et 16 ont beneficie d’une transplantation pulmonaire (11 HTAP idiopathiques et 5 heritables) apres 2.4 ± 1.8 ans. La survie globale etait de 96 %, 92 %, 92 % et 92 % a 1, 3, 5 et 10 ans; la survie sans transplantation de 94 %, 82 %, 78 % et 72 %. Dix-huit patients ont arrete le traitement par prostacycline parenterale en raison d’une amelioration hemodynamique majeure. Conclusion Nous confirmons qu’une tritherapie initiale incluant une prostacycline parenterale ameliore de facon majeure les symptomes, les capacites a l’exercice et l’hemodynamique dans une large cohorte de patients avec HTAP severe. Cette strategie est associee a un excellent pronostic a long terme avec une survie de 92 % a 10 ans.

IntroductionSacubitril/valsartan, a new treatment for chronic cardiac failure, has been available only in retrocession from approved pharmacies since it obtained market authorization. A specific communication pathway (pharmaceutic interview and hospital-to-community liaison) has been set up, to optimise the continuity of patient care and to inform community and hospital health professionals.ObjectivesEvaluate the pathway and the tools developed.MethodsEvaluation of pharmaceutical interventions (PI) and patient satisfaction with the process, of the usefulness of hospital-to-community liaison for community health professionals, and of extension of the process to other approved retrocession structures.ResultsEighty-one patients were enrolled; 61 pharmaceutic interviews were carried out at initiation of treatment (75%). Fifty-eight per cent of PIs (15/26) were accepted, avoiding dosage errors. Ninety per cent of patients who responded to the satisfaction survey (20/22) were very satisfied with this process. Only 18% of community health professionals contacted (13/92) were aware of this drug, and 53% (15/28 satisfaction questionnaire respondents) judged hospital-to-community liaison useful. Sixty-eight per cent of retrocession structures contacted (21/31) adopted the process.ConclusionSetting up pharmaceutic interviews and hospital-to-community liaison contributes to optimising patient management.; IntroductionSacubitril/valsartan, nouveau traitement de l’insuffisance cardiaque chronique, n’est disponible qu’en rétrocession depuis sa mise sur le marché. Un circuit spécifique (entretiens pharmaceutiques, lien ville-hôpital) a été mis en place afin d’optimiser la prise en charge des patients et d’informer les professionnels de santé libéraux et hospitaliers.ObjectifÉvaluer le circuit et les outils spécifiques mis en place.MéthodeÉvaluation des interventions pharmaceutiques (IP), de la satisfaction du patient vis-à-vis de cette démarche, de la pertinence du lien ville-hôpital par les professionnels de santé de ville et de la diffusion de la démarche à d’autres rétrocessions de centres hospitaliers.RésultatsQuatre-vingt-un patients ont été inclus. Soixante et un entretiens pharmaceutiques ont été réalisés lors de l’initiation de traitement (75 %). Cinquante-huit pour cent d’IP (15/26) ont été acceptées, évitant des erreurs de posologie. Quatre-vingt dix pour cent des patients ayant répondu au questionnaire de satisfaction (20/22) étaient très satisfaits de la démarche. Dix-huit pour cent des professionnels de santé de ville contactés (13/92) connaissaient ce médicament, et 53 % (15 sur 28 ayant répondu au questionnaire de satisfaction) ont jugé le lien ville/hôpital pertinent. Soixante-huit des rétrocessions contactées (21/31) ont transposé cette démarche.Conclusion La mise en place d’entretiens pharmaceutiques et d’un lien ville-hôpital participe à l’optimisation de la prise en charge des patients.

Introduction La maladie veino-occlusive pulmonaire (MVOP) est une forme rare d’hypertension pulmonaire, caracterisee par une atteinte veinulaire et capillaire pulmonaire predominante. Une association entre chimiotherapie, en particulier la mitomycine (MMC), et la MVOP a ete rapportee. L’objectif de ce travail est de decrire les caracteristiques et le pronostic des patients ayant developpe une MVOP induite par la MMC. Methodes Les donnees cliniques, fonctionnelles, radiologiques et hemodynamiques au diagnostic et pendant le suivi des patients atteints de MVOP induit par la MMC ont ete collectees a partir du Registre francais de l’hypertension pulmonaire et du programme VIGIAPATH. Les resultats sont exprimes en valeur mediane (minimum-maximum). Resultats Dix-sept cas de MVOP induit par la MMC ont ete identifies entre juin 2011 et decembre 2018. Au diagnostic, les patients presentaient une atteinte fonctionnelle majeure avec une dyspnee NYHA III ou IV chez 70 % des patients et un test de marche de 6 minutes (TM6) median de 258 m (min–max 0–465). Il existait une hypoxemie marquee avec une PaO2 en air ambiant a 54 mmHg (min–max 31–71) associee a une diminution majeure de la DLCO (31 % de la theorique, min–max 19,5–51). Le catheterisme cardiaque droit confirmait la presence d’une HTP precapillaire severe avec une pression arterielle pulmonaire moyenne a 38 mmHg (min–max 52–30), un index cardiaque a 2,28 L/min/m2 (min–max 1,51–3,99) et des resistances vasculaires pulmonaires (RVP) a 9,22 WU (min–max 5,10–17,14). Seize patients ont recu un traitement specifique de l’hypertension arterielle pulmonaire (5 monotherapie orale, 8 bitherapie orale et 3 tritherapie incluant un analogue de la prostacycline). A la premiere evaluation (delai median de 4,7 mois), il existait une amelioration fonctionnelle (distance lors du TM6 +42 m, p Fig. 1 ). Conclusion La MVOP est une complication rare mais grave du traitement par mitomycine. Le pronostic est sombre malgre l’arret de la MMC et les traitements specifiques de l’hypertension arterielle pulmonaire.

Background Cardiac resynchronization (CRT) as well as implantable cardiac defibrillator (ICD) in primary prevention should be considered in patients with heart failure and reduced ejection fraction (HFrEF) only when pharmacological treatment has been optimized. Purpose we sought to analyze pharmacological treatments according to the presence or not of CRT-P, CRT-D or ICD in real life HFrEF patients by using a multicenter survey. Methods the survey (NCT01956539) was carried out between 2015 and 2018 in 32 hospitals and included 2735 patients with HF who gave their consent during consultation or hospitalization. In this study, we analyzed only outpatients with chronic HFrEF treated for more than 6 months. Results among 1061 patients studied, 138 had CRT-P or CRT-D and 215 had ICD for primary prevention. The main clinical characteristics were: age 65±13 years, ischemic heart disease in, NYHA classes 1, 2, 3 and 4 in 15%, 52%, 23% and 10% cases respectively, systolic blood pressure 115mmHg [IQR 104–129], heart rate 70bpm [IQR 60–80], eGFR 64ml/min/1.73m2 [IQR 46–83]and LVEF was 30% [IQR 24–34]. The table shows the rate of use of evidence-based drugs and the dose for ACEi/ARB and betablockers, according to the presence of ICD or CRT. HFrEF CRT-P or D ICD (primary prevention) n=1061 n=138 n=215 Loop diuretics 78.2% 79.7% 74.9% ACEi or ARB 65.2% 75.4% 67.3% Sacubitril/valsartan 5.9% 8.5% 9.5% Betablockers 72.3% 83.9% 76.8% Mineralocorticoid antagonists 45.7% 63.6% 60.2% ACEi/ARB mean % maxi dose 77 81 83 Beta-blockers mean % maxi dose 74 63 79 Conclusion these results suggest that pharmacological treatment remains poorly optimized in a number of patients with HFrEF who received ICD or CRT

Aims: Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases. Methods: MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients. Stakeholders: Include patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors. Results: MASK is deployed in 23 countries and 17 languages. 26,000 users have registered. EU grants (2018): MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour). Lessons learnt: (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases. © 2019 The Author(s).

Background Heart failure (HF) is associated with a high mortality rate and recurrent hospitalizations. Purpose To present the first data of the patients using the innovative solution Satelia® Cardio (NP Medical/WeHealth™ Digital Medicine). Method Satelia® Cardio is a HF patient management solution with a remote monitoring system and a therapeutic guidance by dedicated nurse phone platform, supported by ETAPES Program. The system is accessible from any devices, requiring no installation, and the use is possible by non-connected patients. After the inclusion, the patient is contacted by the nurse, he then receives an SMS alert on regular basis, with a link leading to a web page to answer 7 questions, and to give his current body weight. Satelia algorithm is based on this signs,their variability, and the weight. In case of worsening of symptoms, the cardiologist will be notified. Results 124 centers (200 cardiologists) are using Satelia® Cardio with 1832 HF patients monitored in the last 18 months. The patients, mean age of 72 years (19-97) are predominantly males (69%), and mostly NYHA II/III (68%/30%). The adherence to the system is very good (81%) with 86% of patients still monitored (N = 1569). The main reasons for stopping are related to the occurrence of death (105/263) or non-fatal events (71/263), or patient decision (87/263). Over the period of analysis, the HF patients answered to 46 637 questionnaires, generating 2429 alerts transmitted to the referent cardiologists. Since Covid-19 lockdown, more than 600 patients have been monitored with the solution. Conclusion Patient management solution with a remote monitoring system is key to improving the follow-up of HF patients. The solution Satelia® Cardio is an easy way to use a web application to monitor HF patients, accepted by the patients with a low rate of premature discontinuation. A further step will be to initiate studies to assess the clinical impact of such remote monitoring solution in HF.

Surgical repair of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint after complete rupture is usually protected by cast immobilization, which hinders return to work. The goal of this study was to determine the duration of sick leave for patients who had 6 weeks of K-wire immobilization instead of cast immobilization after surgical repair of the UCL. This prospective, observational, non-comparative study included patients who had surgical repair of the UCL of the thumb MCP joint followed by K-wire immobilization. Manual laborers were excluded. The main outcome measure was the duration of sick leave. The other outcomes were the need to adapt to the work duties and the patient's subjective assessment of the result. The data were collected by telephone interview. Twenty-one patients were included, 13 (62%) of whom returned to work within 7 days. The average sick leave duration was 3 weeks and 2 days; 10% of patients required adaptation of the work duties. The average satisfaction score was 4.4 out of 5. The average follow-up was 3 years and 5 months. There were no complications. In conclusion, K-wire immobilization after surgical repair of the UCL of the thumb MCP joint, along with precautionary measures is an option that allows early return to work, except for manual labourers.

Introduction La transplantation renale est favorable au developpement d’un syndrome cardio-renal (SCR). Les SCR pourraient etre la cause de retards de reprise de fonction (RRF) mais l’incidence est inconnue. Description Le RRF etait defini par une dialyse dans les 7 jours suivant la transplantation et le SCR post-transplantation par une surcharge hydrosodee accompagnee d’une natriurese Methodes Etude de cohorte monocentrique de 2016 a 2018. Restriction sodee ( Resultats 528 patients ont ete transplantes, 126/528 (23,9 %) ont presentes un RRF dont 11/126 (8,7 %) secondaires a un SCR post-transplantation ( Fig. 1 ), diagnostique 2 [2-5] jours apres la transplantation. L’âge etait de 74 ans [68-77,5], 10/11 (91 %) etaient des hommes. Tous presentaient un antecedent d’hypertension arterielle et de cardiopathie. Le poids, le jour de la greffe et au diagnostic, etait respectivement de 80,4 [73,9-87,6] kg et 84,2 [78-114,8] kg (p = 0,90). La natriurese etait de 36 [32,5-48,5] mmol/L, la FeUree de 26,2 [21,7-31,5] %. Au diagnostic, la protidemie avait baisse par rapport a la greffe 60 [56,5-62,8] vs 70,5 [66-76] g/L (p = 0,02) et le BNP avait augmente (197 [120-634] vs 1637 [1020-2920] pg/mL ; p = 0,008). 4/11 (36 %) patients avaient une FEVG 35 mmHg. Les biopsies de greffons retrouvaient les lesions decrites dans les SCR. Le suivi median etait de 23 [18-31] mois. Le traitement diuretique a permis une recuperation de fonction renale chez 6/11 patients (55 %), 3/11 (27 %) sont decedes. Conclusion Le SCR post-transplantation est une cause nouvelle et frequente de RRF. L’excretion sodee est un element central du diagnostic. Un traitement medical standardise semble utile.

Purpose Risk scores in HFrEF are based on an analysis of prognostic markers at one point during the follow-up regardless of the patient's treatment evolution. However, patient's management and therapy response will change their prognosis. Objectives To appreciate the impact of therapy optimization on usual prognostic markers in patients with HFrEF and to compare the prognostic value of these markers before and after therapy optimization. Methods All patients hospitalized at our institution from 1st May 2011 to 30th April 2015 with LVEF Results Among the 328 patients included at M0, 81% were men, mean age was 57 years, 42% had ischemic HF, 39% were in NYHA class I or II, mean duration of HF was 6,5 ± 10,1 years, average BNP was 584 pg/mL (IQR 211-777) and LVEF was 28 ± 7%. The exposure to HF therapy was significantly higher at M6 when compared with M0. Primary outcome occurred in 20% of the patients at 1 year and in 35% at 3 years with an all-cause mortality of 2,6% and 10,4% respectively. During follow-up, there were significant changes on prognostic markers: 86% NYHA class I-II at M6 versus 39% at M0 (P Conclusion Assessment of usual markers after therapy optimization better predicts prognosis than the same markers collected 6 months earlier.

Botulinum toxin injections in aesthetic medicine are the most widely used products, ahead of hyaluronic acid, and aesthetic medicine is constantly increasing, including in the male population. The objective of this development was to show the specificities described in the literature concerning botulinum toxin injections in men.A systematic literature search was carried out using the Pubmed search engine. Data were then collected to determine the specificities of botulinum toxin injections in men according to the morphology of the male face and the wishes of these patients.The studies conducted show that it is necessary to inject higher doses in men than in women to obtain a satisfactory result, due to a higher muscle mass. This adjustment gives the number of points to be performed per injection site, as well as the number of points to be performed, compared to the female population.Botulinum toxin injections for aesthetic purposes in men are different from those in women. Taking these particularities into account is essential to patient satisfaction.

Ischemic heart disease is a leading cause of death in Europe. At the same time, older patients are at high risk for coronary heart disease and represent an increasing proportion of patients in the catheterization laboratory in the context of an ageing population. The elderly patients are also at higher bleeding risk, and were poorly represented in major randomized trials. Duration of dual antiplatelet therapy (DAPT), after percutaneous coronary intervention (PCI) should be modulated in a personalized way taking into account hemorrhagic and ischemic risk factors, using risk scores based on the latest recommendations of the European Society of Cardiology. Even if the optimal duration of DAPT after PCI is 6 months in case of stable coronary disease and 12 months in case of an acute coronary syndrome, it can be drastically reduced, up to one month in case of high hemorrhagic risk, or can be prolonged for more than 12 months in case of high ischemic risk. The use of latest generation drug eluting stents associated with a short duration of DAPT has thus demonstrated its safety compared to these durations. In case of triple therapy treatment, associating DAPT and anticoagulation therapy, DAPT is recommended to be as short as possible, potentially reduced to 1 month. Finally, the concomitant prescription of proton pump inhibitor is essential to prevent gastrointestinal bleedings. This literature review will discuss the hemorrhagic risk stratification and choice of DAPT in elderly patients.

The number of older adults treated for ST-segment elevation myocardial infarction (STEMI) is increasing. Nevertheless, their treatment might not be as optimal as younger adults. This study sought to evaluate demographic evolution, clinical characteristics and in-hospital outcomes of patients of patients aged 75years-old or older treated by primary angioplasty for STEMI.Retrospective study of all consecutive patients for STEMI between January 2012 and December 2017. Their clinical, biologic, echocardiographic and angiographic data, as well as in-hospital outcomes were collected and compared between two groups: younger and older than 75 year-olds.Five hundred and sixty-eight patients including 99 (17.4%) 75 year-old or older were included in the present study. Patients aged 75 or older had an increased delay of treatment between the time of the chest pain onset and revascularization (7.30±1,16 vs 4.77±0,36hours, P=0.0391), they were more frequently treated with clopidogrel rather than more potent anti P2Y12 antiplatelet therapies (55.6% vs 24.8%, P0.0001) and received less frequently anti-GP2B3A therapy (44.8% vs 23.2%, P0.0001). There was a trend for increased in-hospital mortality in the older group, despite non statistically significant (4.04% vs 1.5%, P=0.0847). Older adults had a worse clinical status with decreased post-STEMI left ventricular ejection fraction (44.42±1,38 vs 49.07±0,49, P=0,0019). They were also less treated with drug-eluting stents (51.5% vs 73.9%, P0.0001).Adults aged 75 years-old or older represent a subsequent proportion of patients admitted for STEMI. They had a worse initial clinical presentation associated with worse prognostic, as compared to younger adults. They experience delayed reperfusion therapy and suboptimal treatment as compared to younger adults.

BackgroundInstantaneous wave free ratio (iFR) does not require adenosine, but has a relatively wide intermediate range where functional assessment remains inconclusive. In this pilot study, we sought to enhance iFR through with the use of intracoronary (IC) saline (iFRs) and contrast media (iFRc) and determine whether these techniques correlated well with fractional flow reserve (FFR).MethodsPatients with coronary artery stenosis (CAS) associated with an iFR in the intermediate zone (≥0.86 and ≤0.93) were prospectively assessed with resting distal coronary pressure/aorta pressure (Pd/Pa), iFR, iFRs, iFRc and FFR.ResultsA total of 40 coronary lesions were studied (40 patients). Pearson correlation coefficients for FFR and iFR, FFR and iFRs, FFR and iFRc were respectively: 0.57 (P=0.0002), 0.80 (P

Introduction La sarcoidose est une maladie systemique pleomorphe caracterisee par la formation de granulomes dans divers organes. Meme si sa prevalence semble etre en augmentation, la localisation cardiaque est rare, mais particulierement grave. Le diagnostic et la prise en charge des sarcoidoses avec atteinte cardiaque reste mal standardise malgre les recommandations de la Heart Rhythm Society emises en 2014. Notre objectif etait de decrire le profil clinique, paraclinique, et evolutif de patients affectes d’une sarcoidose cardiaque et suivis dans notre centre hospitalier universitaire. Materiels et methodes Notre etude est retrospective et monocentrique. L’ensemble des patients presentant une sarcoidose avec atteinte cardiaque entre le 1er janvier 2000 et le 31 decembre 2018 ont ete inclus en deux temps ; une premiere selection a ete faite par recherche aupres du service « Programme de Medicalisation des Systemes d’Information », et du service de medecine nucleaire. Nous avons ensuite retenu les patients qui presentaient une atteinte cardiaque selon les criteres du ministere de la sante japonais ou de la Heart Rhythm Society avec sarcoidose extracardiaque prouvee histologiquement ; les patients dont le mode de revelation de la sarcoidose a ete l’atteinte cardiaque etaient inclus s’ils presentaient une association de signes cliniques et paracliniques evocateurs de sarcoidose cardiaque ou extracardiaque. Nous avons recueilli les donnees sociodemographiques, le mode de revelation de la sarcoidose, les caracteristiques cliniques et paracliniques de la sarcoidose cardiaque et des atteintes extracardiaques eventuellement associees, le traitement realise et l’evolution. Resultats Quatorze patients ont ete inclus dont 6 femmes et 8 hommes (sex-ratio F/H 0,75). L’âge moyen au diagnostic etait de 50 ans. Un seul patient avait une atteinte cardiaque isolee ; 12 patients presentaient au moins deux localisations associees a l’atteinte cardiaque ; les plus frequentes etaient ganglionnaires (13/14 patients, 93 %) et pulmonaires (10/14 patients, 77 %). Le diagnostic de sarcoidose a ete etabli sur une atteinte cardiaque initiale chez 6 patients. Chez 7 autres patients la sarcoidose a ete diagnostiquee du fait d’une une localisation extracardiaque, lors du bilan d’extension initial chez 2 d’entre eux, et au cours d’une manifestation cardiaque tardive chez les 5 autres. Neuf patients repondaient aux criteres de diagnostic japonais, et 12 aux criteres de la Hearth Rhythm Society. Le symptome le plus frequent etait la dyspnee (n = 9). L’ECG etait anormal dans 12 cas parmi les 13 disponibles : troubles de la conduction (n = 9), troubles du rythme (n = 11). L’ETT etait anormale chez 10 patients parmi les 14 ; les anomalies les plus frequentes etaient l’alteration de la fraction d’ejection du ventricule gauche (n = 6) et l’hypokinesie (n = 4). L’IRM cardiaque etait toujours pathologique parmi les 12 patients evalues ; les anomalies les plus frequentes etaient la prise de contraste myocardique tardive (n = 11) et l’hypokinesie (n = 7). La TEP scanner realisee chez dix patients etait a chaque fois anormale : hyperfixation myocardique (n = 6) et infiltration tissulaire cardiaque (n = 3). Le traitement comportait des corticoides associes a un immunosuppresseur dans 11 cas : methotrexate (n = 6), mycophenolate mofetil (n = 4) et endoxan (n = 1) ; 3 patients ont recu une corticotherapie seule. L’evolution a ete favorable chez 11 patients ; un patient a presente un echec therapeutique ; 2 patients ont presente une rechute. Conclusion Les sarcoidoses cardiaques restent rares, et sont rarement isolees. Les symptomes et les anomalies des examens de premiere intention sont tres peu specifiques voire absents. Dans ces circonstances, la realisation d’une IRM cardiaque ou d’une TEP scan doivent etre discutes. Si la prise en charge therapeutique est mal codifiee, dans notre serie l’association d’une corticotherapie a un traitement immunosuppresseur induit un taux de reponse de 78 % environ. Ces resultats doivent etre ponderes du fait d’un recul limite (18 mois).

In patients with acute atherothrombotic disease, diabetes or glucose intolerance is frequently found. Indeed, the number of people with diabetes in the world continues to increase and is expected to reach more than 500 million people by 2035. Diabetes is a pathology commonly associated with both microvascular and macrovascular complications. Although the mortality of coronary artery disease has decreased significantly over the past 20 years, mortality in patients with type 2 diabetes has changed little and atherothrombotic events remain the leading cause of death in diabetic patients. Although our understanding of vascular pathology has greatly evolved in recent years, the cellular and molecular mechanisms linking thrombogenicity and diabetes remain incompletely understood. Type 1 and type 2 diabetes are prothrombotic pathologies. This prothrombotic state is due to both hyperglycemia and chronic hyperinsulinism. Among the different agonists involved in the increased thrombogenicity of diabetic patients, abnormalities can be found in all phases of coagulation. Increased procoagulant factors and tissue factor associated with impaired fibrinolysis, platelet hyperreactivity, endothelial dysfunction, leukocyte activation, low-grade inflammation, and microparticle involvement, they all play a role in the establishment of this prothrombotic condition. This review sought to provide an update on the prothrombotic nature of diabetes and its consequences in therapeutics.

The aim of this literature review was to evaluate the effects of PRP injections into the scalp of patients with androgenic alopecia. A literature review was conducted using the Pubmed and Google Scholar databases with the search terms "platelet-rich plasma" or "platelet-rich fibrin" and "hair" or "alopecia" or "androgenic alopecia". The publications included had to clinically assess the efficacy of PRP injections in patients with androgenic alopecia. Out of the 32 publications retrieved, 14 publications were included, of which 3 randomized, 4 prospective controlled, 4 prospective uncontrolled and 3 retrospective studies. Seven out of 9 studies reported a significant increase of hair density ranging between 12.3 and 45.9 hairs/cm2, (i.e. 19-31% hairs/cm2). Four studies assessed hair loss with the traction test and found a negative result after treatment in more than 95% of patients. Regarding hair thickness, 1 study reported an increase in hair diameter of 46.4% and 1 reported an increase of 106.4% of the "Hair mass index". Overall, the use of PRP injections in patients with androgenic alopecia seems effective with respect to promoting lost hair regrowth, decreasing hair loss and increasing hair thickness. The effects appear to be progressive from the first injection session, to peak after 3 to 5 sessions and to be attenuated in the absence of further injections. No major adverse effect was reported in the 14 clinical studies.