Search

Background: Dioxin emissions from municipal solid waste incinerators are one of the major sources of dioxins and therefore are an exposure source of public concern. There is growing epidemiologic evidence of an increased risk for non-Hodgkin's lymphoma (NHL) in the vicinity of some municipal solid waste incinerators with high dioxin emission levels. The purpose of this study was to examine this association on a larger population scale.Methods: The study area consisted of four French administrative departments, comprising a total of 2270 block groups. NHL cases that had been diagnosed during the period 1990-1999, and were aged 15 years and over, were considered. Each case was assigned a block group by residential address geocoding. Atmospheric Dispersion Model System software was used to estimate immissions in the surroundings of 13 incinerators which operated in the study area. Then, cumulative ground-level dioxin concentrations were calculated for each block group. Poisson multiple regression models, incorporating penalized regression splines to control for covariates and dealing with Poisson overdispersion, were used. Five confounding factors were considered: population density, urbanisation, socio-economic level, airborne traffic pollution, and industrial pollution.Results: A total of 3974 NHL incident cases was observed (2147 among males, and 1827 among females) during the 1990-1999 time period. A statistically significant relationship was found at the block group level between risk for NHL and dioxin exposure, with a relative risk (RR) of 1.120 (95% confidence interval [CI] 1.002 - 1.251) for persons living in highly exposed census blocks compared to those living in slightly exposed block groups. Population density appeared positively linked both to risk for NHL and dioxin exposure. Subgroup multivariate analyses per gender yielded a significant RR for females only (RR = 1.178, 95% CI 1.013 - 1.369).Conclusion: This study, in line with previous results obtained in the vicinity of the incinerator located in Besançon (France), adds further evidence to the link between NHL incidence and exposure to dioxins emitted by municipal solid waste incinerators. However, the findings of this study cannot be extrapolated to current incinerators, which emit lower amounts of pollutants. [ABSTRACT FROM AUTHOR]

Background: At present, the diagnosis of acute coronary syndrome (ACS) can be made by emergency physicians using the usual complementary tests, since the current troponin and electrocardiogram (ECG) protocols have been extensively tested for their safety. However, the detection of coronary calcifications on CT associated with coronary obstruction may be of interest for the diagnostic strategy in the emergency department (ED). The aim of this study was to evaluate a strategy combining a non-ischemic ECG with an initial normal troponin assay and the diagnostic accuracy of chest CT in detecting coronary calcifications to rule out the presence of an acute coronary event in patients presenting with chest pain in the ED., Methods: This was a retrospective, single-center study carried out in an ED in France and included all patients over 18 years of age presenting with chest pain between 1 June 2021 and 31 December 2021 with a non-ischemic ECG and a negative first troponin assay. The primary endpoint was the diagnostic performance of the combing strategy in ruling out ACS. The secondary endpoints were the sensitivity and specificity of calcifications in acute coronary syndrome, comparison with the diagnostic performance of a second troponin assay and the rate of reconsultation, rehospitalisation and investigations within 2 months of the ED., Results: Of the 280 patients included, 141 didn't have calcifications. A total of 14 events were found with a negative predictive value for the combining strategy of 99.8% [95%CI: 98.2 - 100]. Sensitivity and specificity were 98.4% [95%CI: 83.8 - 100] and 53% [95%CI: 47 - 58.9], respectively. Among patients with no calcification, 8.2% were admitted to hospital and none suffered an acute coronary event. A total of 36 patients (12.8%) consulted a doctor within 2 months, with 23 investigations, all of which were negative in the non-calcification group., Conclusions: A strategy combining the detection of coronary calcifications on chest CT in patients with a non-ischemic ECG and a single troponin assay is effective to rule out ACS in the ED, and may perform better then ECG and troponin alone., (© 2024. The Author(s).)

Objectives: The emergence of artificial intelligence (AI) is catching the interest of hospital pharmacists. A massive collection of health data is now available to train AI models and hold the promise of disrupting codes and practices. The objective of this systematic review was to examine the state of the art of machine learning or deep learning models that detect inappropriate hospital medication orders., Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE and Embase databases were searched from inception to May 2023. Studies were included if they reported and described an AI model intended for use by clinical pharmacists in hospitals. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST)., Results: 13 articles were selected after review: 12 studies were judged to have high risk of bias; 11 studies were published between 2020 and 2023; 8 were conducted in North America and Asia; 6 analysed orders and detected inappropriate prescriptions according to patient profiles and medication orders; and 7 detected specific inappropriate prescriptions, such as detecting antibiotic resistance, dosage abnormality in prescriptions, high alert drugs errors from prescriptions or predicting the risk of adverse drug events. Various AI models were used, mainly supervised learning techniques. The training datasets used were very heterogeneous; the length of study varied from 2 weeks to 7 years and the number of prescription orders analysed went from 31 to 5 804 192., Conclusions: This systematic review points out that, to date, few original research studies report AI tools based on machine or deep learning in the field of hospital clinical pharmacy. However, these original articles, while preliminary, highlighted the potential value of integrating AI into clinical hospital pharmacy practice., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Design: National cross-sectional study., Objective: Thoracic kyphosis (TK) is related to sagittal parameters as pelvic tilt (PT), lumbar lordosis (LL) and pelvic incidence (PI). The equation TK = 2 (PT+LL-PI) was validated for adolescents. The purpose of this study was to investigate if this equation correctly predicts TK regardless of age., Methods: Sagittal alignment parameters were assessed on full spine radiographs of 2599 individuals without spine pathology (1488 females, 1111 males). Calculated TK (CTK) = 2 (PT+LL-PI) and measured TK (MTK) were compared by calculating the gap and using a linear regression between both parameters. Subgroup analyses were performed for gender, age, TK groups (≤20°, 21°-40°, 41°-60°, >60°), and PI groups (<45°, 45°-60°, >60°)., Results: Average values in the total population were: MTK 45.0°, CTK 36.9°. Average TK gap was 8.1°, 5.2° in females (intercept 11.7, slope .61) and 11.9° in males (intercept 7.1, slope .58). The mean gap was 3.6° for 15-34 years, 5.7° under 15 years and it increased progressively after 35 years with a maximum of 19.9° over 80 years. The gap also increased with the amount of MTK: -3.5° for TK<20° up to 17.3° for TK >60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI <45° and TK ≤20°., Conclusion: The formula TK=2 (PT+LL-PI) yielded moderate accuracy for adolescents and young adults, but did not fit for over 35 years and under 15. The amount and variance in TK increased in elderly subjects, which made the formula less accurate.

Study Design: Descriptive radiographic analysis of a prospective multi-center database., Objective: This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity., Methods: After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45°, intermediate PI 45-60°, high PI > 60°, and then stratified by age (20-34, 35-49, 50-64, > 65 Y.O). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation., Results: Mean age was 53.5 years (845 females, 695 males, range 20-93 years).In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups.In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects.For all subjects, kyphosis and pelvic tilt (PT) increased with age.There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT., Conclusion: This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.

Introduction: In asymptomatic subjects, variations of cervical sagittal alignment parameters according to age and spinopelvic organization have been reported. A large range of compensation phenomena has been observed in degenerative spinal deformity in order to maintain horizontal gaze, but it remains unclear how age and spinopelvic morphology could additionally influence cervical alignment. The aim of this observational retrospective study was to describe the distribution of cervical sagittal alignment parameters according to age and pelvic incidence in subjects with and without degenerative spinal deformity in order to precisely evaluate cervical compensation phenomena in adult spinal deformity (ASD)., Material and Methods: Radiographs of 478 subjects (327 females and 151 males) were distributed into 235 asymptomatic and 243 deformed subjects. Occipito-cervical parameters were McGregor-C1, McGregor-C2, C1-C2 and occipito-C2 angles. The cervicothoracic inflection point (CTIP) was determined. Caudal cervical sagittal alignment parameters were: C2-C7 lordosis, C2-apex (superior arch), apex-CTIP (inferior arch), occipito-C3 and occipito-C4 angles, C7-slope and T1-slope. The distribution of parameters was analyzed using a Bayesian inference (significant when Pr > 0.975 or Pr < 0.025). Comparisons between asymptomatic and deformed subjects were done after matching on age (40-60 years; > 60 years) and on PI (< 45°; 45-60°; > 60°)., Results: Among occipito-cervical parameters, there was no significant change in McGregor-C1 angle. However, McGregor-C2 angle was significantly higher in the ASD group (Pr = 0.0029), with influence of age (Pr = 0.023), but PI influence. C1-C2 lordosis was significantly higher in the ASD group compared to the asymptomatic group (Pr < 0.0007), without influence of age or PI noticed. C2-C7 lordosis was also higher in the ASD group (Pr < 0.025) with a role of age and PI (Pr < 0.025). Cervical lordosis in the superior arch was significantly higher in the ASD group (Pr > 0.999), without influence of age or PI. In the inferior arch, the lordosis angle was not modified according to the group, but there was an influence of age (Pr < 0.0007). C7-slope and T1-slope were higher according the age group (Pr < 0.0012), without influence of the group or PI., Conclusion: This observational study highlights cervical sagittal alignment adaptations in degenerative spinal deformity, matched on age and pelvic incidence. The inferior cervical spine seemed to be modified with a higher lordosis, increasing with age responding to the age-related thoracic kyphosis increase. In addition to that, the superior cervical spine hyperextends more in adult degenerative deformity to maintain horizontal gaze., Level of Evidence: III., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Correction of adult scoliosis by instrumentation with double rods and interbody grafts aims to reduce the risk of pseudarthrosis with rod fracture. An increase in instrumentation rigidity can lead to an increase in stresses at the proximal and distal ends of the construct. The aim of this study was to analyze the incidence and clinical repercussions of proximal junctional kyphosis (PJK), proximal junctional failure (PJF) and iliac screw loosening., Materiel and Methods: An analysis of patients operated on for adult scoliosis with instrumentation to the pelvis using 4 rods and interbody cages was carried out from a prospective register. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Scoliosis Research Society 22 (SRS-22) clinical scores and radiological parameters were collected preoperatively, postoperatively at 3 months, 1 year and 2 years. The appearance of PJK, PJF or distal screw loosening was sought; the clinical impact and the risk factors were analyzed by Bayesian inference., Results: Fifty-one patients with a mean age of 64.5 years were included. The clinical scores improved significantly (Pr>0.95) at 2 years: VAS back 6.9 versus 2.6, VAS leg 4.9 versus 2.5, ODI 48.2 versus 25.4, SRS-22 2.4 versus 3.5. The radiological parameters were corrected (Pr>0.95): Cobb angle 63.9° versus 22.8°, spinosacral angle (SSA) 112.4° versus 118.8°, T1-pelvic angle (TPA) 24, 8° versus 20.8°, lumbar lordosis 43.8° versus 51.0°, thoracic kyphosis 45.2° versus 53.6°. Thirteen patients (25.5%) presented with PJK and 11 (21.6%) with PJF. Seven patients (13.7%) presented with iliac screw loosening. None of these complications was associated with a significant deterioration in clinical scores. Cranial migration of the lumbar apex increased the risk of distal screw loosening: Odds-Ratio 10.31 (Pr>0.999). Two patients were re-operated on for PJF and one patient for iliac screw loosening (5.9%). No rod fracture with pseudarthrosis was found., Conclusion: Instrumentation with double rods and interbody grafts was associated with a rate of 47.1% of mechanical repercussions at the extremity of the construct. However, these complications were not associated with a significant deterioration in clinical scores., Level of Evidence: III., (Copyright © 2023. Published by Elsevier Masson SAS.)

Background and Objectives: Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT). However, although ULD CT appears to be an attractive alternative to radiography, its organizational impact in ED remains unknown. Our objective was to compare the relevant timepoints in ED management of CT and chest radiography. Materials and Methods: We conducted a retrospective study in two ED of a University Hospital including consecutive patients consulting for a CAP between 1 March 2019 and 29 February 2020 to assess the organizational benefits of ULD chest CT and chest radiography (length of stay (LOS) in the ED, time of clinical decision after imaging). Overlap weights (OW) were used to reduce covariate imbalance between groups. Results: Chest radiography was performed for 1476 patients (mean age: 76 years [63; 86]; 55% men) and ULD chest CT for 133 patients (mean age: 71 [57; 83]; 53% men). In the weighted population with OW, ULD chest CT did not significantly alter the ED LOS compared with chest radiography (11.7 to 12.2; MR 0.96 [0.85; 1.09]), although it did significantly reduce clinical decision time (6.9 and 9.5 h; MR 0.73 [0.59; 0.89]). Conclusion: There is real-life evidence that a strategy with ULD chest CT can be considered to be a relevant approach to replace chest radiography as part of the diagnostic workup for CAP in the ED without increasing ED LOS.

Previous work has successfully used machine learning and natural language processing for the phenotyping of Rheumatoid Arthritis (RA) patients in hospitals within the United States and France. Our goal is to evaluate the adaptability of RA phenotyping algorithms to a new hospital, both at the patient and encounter levels. Two algorithms are adapted and evaluated with a newly developed RA gold standard corpus, including annotations at the encounter level. The adapted algorithms offer comparably good performance for patient-level phenotyping on the new corpus (F1 0.68 to 0.82), but lower performance for encounter-level (F1 0.54). Regarding adaptation feasibility and cost, the first algorithm incurred a heavier adaptation burden because it required manual feature engineering. However, it is less computationally intensive than the second, semi-supervised, algorithm.

Introduction: Low-back pain requires comprehensive care using a biopsychosocial model. The psychologic dimension plays an important role, but the link between sagittal alignment and a given psychopathological profile is little studied. The aim of this study was to analyze the psychopathological profiles and sagittal parameters of a population with low-back pain and to assess the link., Material and Methods: 205 patients, with a mean age of 49.6 years (range, 18-70 years), presenting chronic common low-back pain without radicular involvement, were included prospectively. Mood scores comprised: the self-administered "Hospital Anxiety and Depression Scale" (HAD), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D) and Young Mania Rating Scale (YMRS). Radiological parameters, measured on lateral full-spine radiographs, included: L1-S1 lordosis, T1-T12 kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 slope, and Roussouly type., Results: Mean HAM-A score was 16.1; 54% of patients had scores ≥14, indicating anxiety disorder. Mean HAM-D score was 10.8; 55% of patients had scores ≥10, indicating depressive disorder. Mean YMRS score was 2.6; only 1 patient had a score ≥20, indicating manic disorder. The 112 patients with HAM-A score >14 showed mean 51.6° L1-S1 lordosis (p=0.356), 48.3° T1-T12 kyphosis (p=0.590), -4.3mm C7 SVA (p=0.900), and 29.3° T1 slope (p=0.451). In case of HAM-A <14, there were no significant differences. The 113 patients with HAM-D score >10 showed significant differences in T1-T12 kyphosis (mean 49.0°; p<0.05) and T1 slope (30.2°; p<0.05); mean L1-S1 lordosis was 50.5° (p=0.861) and C7 SVA 1.6mm (p=0.462). In case of HAM-D <10, T1-T12 kyphosis was 45.5° (p<0.05) and T1 slope 26.2° (p<0.05); mean lordosis was 50.9° (p=0.861) and mean C7 SVA -7.1mm (p=0.259). Multivariate analysis found no significant link between Roussouly type and psychiatric scores: HAD (p=0.715), HAM-A (p=0.652), and HAM-D (p=0.902)., Conclusion: More than 50% of patients with common low-back pain presented a mood disorder. Depressive disorder was associated with greater T1-T12 kyphosis and T1 slope. There was no relationship between psychiatric scores and overall sagittal alignment., Level of Evidence: II., (Copyright © 2022. Published by Elsevier Masson SAS.)

Study Design: Retrospective cross-sectional study., Objective: The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations., Summary of Background Data: The Roussouly classification was validated for adults. Alignment types may vary during growth., Materials and Methods: Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression., Results: The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age., Conclusion: Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4., Level of Evidence: Level III., Competing Interests: Y.P.C. is consultant for Stryker, Clariance, SpineVision, Philips and Ceraver; he received royalties and grants unrelated to this study from Stryker and Clariance. B.I. is consultant for Zimmer Biomet, Medtronic and Implanet. B.B. is associate editor for OTSR Elsevier-Masson and consultant for Medicrea, Medtronic, Implanet, Vexim Stryker, and 3M. F.L. is consultant for Spineart and SMAIO. Guillaume Riouallon is consultant for Medtronic, Stryker and NewClip; he received royalties from Euros. V.C. is shareholder of Follow Health SA and consultant for Clariance. I.O. is consultant for Medtronic and Depuy Synthes; he received grants from DePuy Synthes unrelated to this study and royalties from Clariance, Alphatec and Spineart. L.B.is consultant for Neo and Euros; he received grants from DePuy Synthes unrelated to this study. F.S. received funding to attend meetings from Medicrea, Medtronic and Euros. J.-C.L.H. is consultant for Medtronic and BD Bard; he received royalties and grants unrelated to this study from Medtronic. V.F. is consultant for Clariance; he received royalties Medicrea and Clariance. A.F. is consultant for OSD. The remaining authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC). While the number of cases has increased steadily in the DRC over the last 30 years, the environmental risk factors that drive the spatiotemporal dynamics of MPX transmission remain poorly understood. This study aimed to investigate the spatiotemporal associations between environmental risk factors and annual MPX incidence in the DRC. All MPX cases reported weekly at the health zone level over a 16-year period (2000-2015) were analyzed. A Bayesian hierarchical generalized linear mixed model was conducted to identify the spatiotemporal associations between annual MPX incidence and three types of environmental risk factors illustrating environment as a system resulting from physical, social and cultural interactions Primary forest (IRR 1.034 [1.029-1.040]), economic well-being (IRR 1.038 [1.031-1.047]), and temperature (IRR 1.143 [1.028-1.261]) were positively associated with annual MPX incidence. Our study shows that physical environmental risk factors alone cannot explain the emergence of MPX outbreaks in the DRC. Economic level and cultural practices participate from environment as a whole and thus, must be considered to understand exposure to MPX risk Future studies should examine the impact of these factors in greater detail., (© 2022. EcoHealth Alliance.)

Study Design: Retrospective cross-sectional study., Objective: The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI)., Summary of Background Data: Variability with age has been reported. It remains unclear how gender and spinopelvic morphology could additionally influence global alignment parameters., Materials and Methods: Radiographs of 2599 individuals (5-93 y) were analyzed. Translation parameters were: Sagittal Vertical Axis (SVA)-C7, SVA-C2, SVA-Center Acoustic Meatus (CAM), C7/Sacrofemoral Distance (SFD) ratio. Inclination parameters were: C7-Vertical Tilt (VT), T1-VT and T9-VT, Odontoid-Hip Axis (OD-HA), OD-CAM. Pelvic compensation parameters were: T1-Pelvic Angle (TPA), Global Tilt (GT), Spino-Sacral Angle (SSA). Global sagittal alignment (GSA) was considered among formulae. The distribution of parameters was analyzed using a Bayesian inference. Correlations with spinopelvic parameters were investigated., Results: SVA-C7, SVA-C2, SVA-CAM were larger in males and high PI, and increased significantly after 50 years (Pr>0.9999). C7/SFD decreased during growth and was larger in low PI (Pr=0.951). There was no correlation with spinopelvic parameters. Age-related variations of inclination parameters were nonsignificant. T1-VT and T9-VT increased with PI and were significantly larger in high PI (Pr>0.95). C7-VT was significantly larger in low PI (Pr>0.9999). OD-HA and OD-CAM were constant and increased after 80 years. TPA and GT increased with PI (Pr>0.9999) and age after 35 years (Pr>0.9999). SSA decreased nonsignificantly after 50 years. TPA correlated with PI (ρ=0.6130) and pelvic tilt (PT) (ρ=0.8375). GT correlated with PI (ρ=0.5961) and PT (ρ=0.8996). SSA correlated with sacral slope (ρ=0.9026). GSA was larger in high PI (Pr>0.9999) and increased after 35 years (Pr>0.9999). GSA correlated with PT (ρ=0.7732)., Conclusion: Translation parameters increase with age, more prominently in males and high PI. Variations of inclination parameters are smaller. Pelvic compensation parameters and GSA increase with age and are closely related to PT and spinopelvic morphology., Level of Evidence: Level III., Competing Interests: Y.P.C. is consultant for Stryker, Clariance, Philips and Ceraver; he received royalties and grants unrelated to this study from Stryker and Clariance. B.I. is consultant for Zimmer Biomet, Medtronic and Implanet. F.L. is consultant for Spineart and SMAIO. G.R. is consultant for Medtronic, Stryker and NewClip; he received royalties from Euros. V.C. is shareholder of Follow Health SA and consultant for Clariance. I.O. is consultant for Medtronic and Depuy Synthes; he received grants from DePuy Synthes unrelated to this study and royalties from Clariance, Alphatec and Spineart. L.B. is consultant for Neo and Euros; he received grants from DePuy Synthes unrelated to this study. F.S. received funding to attend meetings from Medicrea, Medtronic, and Euros. J.-C.L.H. is consultant for Medtronic and BD Bard; he received royalties and grants unrelated to this study from Medtronic. V.F. is consultant for Clariance; he received royalties Medicrea and Clariance. A.F. is consultant for OSD. B.B. is associate editor for OTSR Elsevier-Masson and consultant for Medicrea, Medtronic, Implanet, Vexim Stryker, and 3M. The remaining authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Diabetic Peripheral Neuropathy (DPN), highly prevalent among patients with diabetes, is characterized by peripheral nerve dysfunction. Reactive Oxygen Species (ROS) overproduction has been suggested to orchestrate diabetic complications including DPN. Untargeted antioxidant therapy has exhibited limited efficacy, highlighting a critical need to explore ROS sources altered in a cell-specific manner in DPN. Cytochromes P450 (CYP) enzymes are prominent sources of ROS. Particularly, the 20-HETE synthase, CYP4A, is reported to mediate diabetes-induced renal, retinal, and cardiovascular injuries. This work investigates the role of CYP4A/20-HETE in DPN and their mechanisms of action. Non-obese type 2 Diabetic mice (MKR) were used and treated with a CYP4A-inhibitor (HET0016) or AMPK-activator (Metformin). Peripheral nerves of MKR mice reflect increased CYP4A and 20-HETE levels, concurrent with altered myelin proteins and sensorimotor deficits. This was associated with increased ROS production and altered Beclin-1 and LC3 protein levels, indicative of disrupted autophagic responses in tandem with AMPK inactivation. AMPK activation via Metformin restored nerve integrity, reduced ROS production, and regulated autophagy. Interestingly, similar outcomes were revealed upon HET0016 treatment whereby ROS production, autophagic responses, and AMPK signaling were normalized in diabetic mice. Altogether, the results highlight hyperglycemia-mediated oxidative injury in DPN through a novel CYP4A/20-HETE/AMPK pathological axis. PERSPECTIVE: To our knowledge, this is the first study to highlight the role of CYPs/20-HETE-induced oxidative injury in the pathogenesis of diabetic peripheral neuropathy. Targeting the identified pathological axis CYP4A/20-HETE/AMPK may be of clinical potential in predicting and alleviating peripheral nerve injury in patients with Type 2 Diabetes Mellitus., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment., Methods: A total of 2599 individuals (5-93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1-C2 lordosis. Caudal cervical parameters were: C2-C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated., Results: Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1-C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2-C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2-C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95)., Conclusion: Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Unfavorable conditions at hemodialysis inception reduce the survival rate. However, the relative contribution to outcomes of predialysis follow-up, symptoms, emergency start or central venous catheter (CVC) is unknown., Methods: We analyzed the determinants of survival according to dialysis initiation conditions in the nationwide REIN registry, using two methods based either on clinical classification or data mining. We divided patients into four groups according to dialysis initiation (emergency vs planned, symptoms or not, previous follow-up). "Followed planned starters" began dialysis as outpatients and with an arteriovenous fistula (AVF). "Followed symptomatic non-urgent starters" were patients who started earlier because of any non-urgent symptomatic event. "Followed urgent starters" had seen a nephrologist before inception but started dialysis in an emergency condition. "Unknown urgent starters" were patients without any follow-up and who had a CVC at inception., Results: "Followed urgent" starters had the lowest 2-year survival rate (66.8%) compared to "followed planned" (77.3%), "followed symptomatic non urgent" (79.2%), and "unknown urgent" (71.7%). Compared to other groups, the risk of mortality was lower in followed symptomatic non urgent (HR 0.86 95% CI 0.75-0.99) and higher in followed urgent starters (HR 1.05 (95% CI 0.94-1.18). In data mining Classification And Regression Tree regrouping in five categories, the lowest 2-year survival (52.3%) was in over 70-year-old starters with a CVC. The survival was 93.2% in under 57-year-old patients without active cancer, 82.5% in 57-70-year-old individuals without cancer, 72.4% in over 70-year-old patients without CVC and 61.4% in under 70-year-old subjects with cancer. The hazard ratio of data mining categories varied between 2.12 (95% CI 1.73-2.60) in 57-70-year-old subjects without cancer and 4.42 (95% CI 3.64-5.37) in over 70-year-old patients with CVC. Therefore, regrouping incident patients into five data mining categories, identified by age, cancer, and CVC use, could discriminate the 2-year survival in patients starting hemodialysis., Conclusions: Although each classification captured different prognosis information, both analyses showed that starting hemodialysis on a CVC has more dramatic outcomes than emergency start per se., (© 2021. Italian Society of Nephrology.)

To assess the validity of Yaakov Stern's theory, which postulates that the first cognitive deficits of Alzheimer disease are delayed in patients with high cognitive reserve, compared to those with low cognitive reserve, but this is subsequently associated with faster cognitive decline when cerebral lesions have reached a certain degree of severity. A retrospective study of 318 patients with Alzheimer disease without associated cerebral disorders, was performed at the Memory Clinic of the University Hospital of Strasbourg. The patients were divided into five groups according to their degree of cognitive reserve, as assessed by their level of education (primary, middle school, intermediate, high school and higher education). Cognitive status was assessed by scores on the Mini Mental Status Examination (MMSE) at the first examination and during follow-up lasting four years or longer. Slopes of cognitive decline were computed and compared between groups using ß linear regression. Patients in the higher education group had higher MMSE scores than those in the other groups at the first consultation, but a statistically significant steeper slope during the follow-up. Our results are consistent with Stern's theoretical model, which assumes that high cognitive reserve is accompanied by compensation mechanisms which hinder the onset of clinical cognitive decline in patients with Alzheimer disease, but that is then associated with a faster decline at a later stage when the reserve is exhausted.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic continues to have great impacts on the care of non-COVID-19 patients. This was especially true during the first epidemic peak in France, which coincided with the national lockdown. The aim of this study was to identify whether a decrease in stroke admissions occurred in spring 2020, by analyzing the evolution of all stroke admissions in France from January 2019 to June 2020., Methods: We conducted a nationwide cohort study using the French national database of hospital admissions (Information Systems Medicalization Program) to extract exhaustive data on all hospitalizations in France with at least one stroke diagnosis between January 1, 2019, and June 30, 2020. The primary endpoint was the difference in the slope gradients of stroke hospitalizations between pre-epidemic, epidemic peak, and post-epidemic peak phases. Modeling was carried out using Bayesian techniques., Results: Stroke hospitalizations dropped from March 10, 2020 (slope gradient: -11.70), and began to rise again from March 22 (slope gradient: 2.090) to May 7. In total, there were 23,873 stroke admissions during the period March-April 2020, compared to 29,263 at the same period in 2019, representing a decrease of 18.42%. The percentage change was -15.63%, -25.19%, -18.62% for ischemic strokes, transient ischemic attacks, and hemorrhagic strokes, respectively., Discussion/conclusion: Stroke hospitalizations in France experienced a decline during the first lockdown period, which cannot be explained by a sudden change in stroke incidence. This decline is therefore likely to be a direct, or indirect, result of the COVID-19 pandemic., (© 2022 S. Karger AG, Basel.)

Introduction: Simulation workshops for surgical training of residents are becoming popular. The gold standard for teaching thoracolumbar pedicle screw placement are cadaver labs; however, the availability of human bodies is limited. The primary objective of this study was to determine if training on a synthetic bone model improves the apprenticeship of accurate pedicle screw placement. The secondary objective was to check the influence of residents' previous experience in spine surgery., Hypothesis: The main hypothesis was that theoretical learning with practical application on synthetic bone was superior to theoretical learning alone., Methods: Twenty-three orthopedic residents were taught about free-hand pedicle screw placement using a theoretical presentation. Six residents had previous experience with screwing techniques. After randomization in two groups, 11 residents (group 1) participated in a workshop on synthetic bone, whereas 12 residents received only theoretical instruction (group 2). Each resident was asked to place two thoracic screws (T7-T11) and two lumbar screws (L1-L5) on a cadaver. Screw placement accuracy was analyzed using the Gertzbein classification on computed tomography (grades 0 and 1=accurate positioning; grades 2 and 3=malposition>2mm)., Results: Rates of accurate screw positioning were 64.0% and 62.5% for thoracic levels, and 72.7% and 66.6% for lumbar levels in group 1 and 2, respectively. There was no significant difference in malposition rates on cadavers between the groups (p=0.1809). A resident who was first trained by simulation had a chance of decreasing the Gertzbein score with an odds-ratio of 1.7714 [0.7710-4.1515]. The odds ratio was 4.5188 [0.0456-0.8451] when comparing residents with previous experience in spinal surgery to novice residents., Discussion: Theoretical teaching associated with a simulation model is relevant for learning a surgical technique. A single simulation workshop on synthetic bone seems insufficient to improve pedicle screw placement accuracy compared to theoretical teaching alone. Progressive experience and the repetition of technical gestures during hands-on supervised learning in spine surgery with a senior surgeon had an influence on the accuracy of pedicle screw placement., Level of Evidence: II., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: In situ contouring is one of the surgical techniques used for scoliosis reduction. The initial correction could change over time, with deterioration of the sagittal balance. The purpose of this study was to analyze the loss of correction after degenerative lumbar scoliosis surgery using in situ contouring., Materials and Methods: Full spine radiographs of 73 patients (mean age 63.3 years, mean follow-up 27 months) were analyzed before surgery, after surgery, and at the final follow-up. The following radiographic parameters were measured: C2-C7 lordosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic tilt, pelvic incidence, sacral slope, SVA C7, SVA C2, Cobb angle. Bayesian inference was used to compare the changes in these parameters. A probability>0.95 was considered as a significant change., Results: After surgery, lumbar lordosis increased from -28.4° to -37.8° (probability 0.999), then decreased to -32.1° at the final follow-up (probability 0.953). Thoracic kyphosis increased from 29.6° to 37.4° after surgery (probability 1.00) and continued to increase to 41.6° at the final follow-up (probability 0.999). SVA C7 increased from 38.5mm to 62.3mm (probability 0.999) and pelvic tilt from 19.4° to 25.1° (probability 1.00) during the follow-up period. Ten patients had to be reoperated because of a surgical site infection. Infection (14%) was associated with an increase of SVA C7 (probability 0.989) and thoracic kyphosis (probability 0.987). Nonunion (16%) was associated with a decrease in lumbar lordosis (probability 0.756)., Conclusion: Correction of degenerative lumbar scoliosis by in situ contouring resulted in sagittal balance correction; however, some of this correction was lost during the follow-up period. The main risk factors were deep wound infection and nonunion., Level of Evidence: IV, Retrospective study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

To appraise the validity of the Yaakov Stern's theory, which postulates that the first cognitive deficits of Alzheimer's disease are delayed in patients with high cognitive reserve, compared to those with low cognitive reserve, but is subsequently associated with faster cognitive decline when cerebral lesions have reached some degree of severity. A retrospective study of 318 patients with Alzheimer's disease without associated cerebral disorders, was performed in the Memory Clinic of the University Hospital of Strasbourg. The patients were divided into 5 groups according to the degree of cognitive reserve assessed by the level of education (primary, middle school, intermediary, high school and higher education). Cognitive status was assessed by the scores on the Mini Mental Status at the first examination and during a 4-year or more follow-up. Slopes of cognitive decline were computed and compared between groups by ß linear regression. Patients in the higher education group had higher MMSE scores than those in the other groups at the first consultation, but a statistically significant steeper slope during the follow-up. Our results are congruent with the Stern's theoretical model, assuming that high cognitive reserve brings into play compensation mechanisms which hinder the onset of clinical cognitive decline in patients with Alzheimer's disease, but then is associated with a faster decline at a later stage when the reserve is exhausted.

Biostatistics are omnipresent in the scientific and medical literature and are an essential skill for any health student. We have developed a practical training tool - GMRC Shiny stats - an interactive application specifically dedicated to medical data statistical analysis. The application has been designed to provide an analysis workflow corresponding to the usual progression of an experienced statistician during data analysis. The most common statistical analyses can be performed (descriptive statistics, inferences according to frequentist methods, survival analyses, correlation, agreement measurements, etc.). GMRC Shiny stats is intuitive and user-friendly and assists students in choosing the most appropriate statistical tests. With all these functionalities, students can learn statistical analysis by doing. Getting involved in the statistical analysis and processing of their own data is likely to improve their biostatistics skills., (Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Background: The strong geographic variations in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease are not solely related to variations in the population's needs, such as the prevalence of diabetes or the deprivation level. Inequitable geographic access to health services has been involved in different countries but never in France, a country with a generous supply of health services and where the effect of the variability of medical practices was highlighted in an analysis conducted at the geographic scale of districts. Our ecological study, performed at the finer scale of townships in a French area of 8,370,616 inhabitants, investigated the association between RRT incidence rates, socioeconomic environment and geographic accessibility to healthcare while adjusting for morbidity level and medical practice patterns., Methods: Using data from the Renal Epidemiology and Information Network registry, we estimated age-adjusted RRT incidence rates during 2010-2014 for the 282 townships of the area. A hierarchical Bayesian Poisson model was used to examine the association between incidence rates and 18 contextual variables describing population health status, socioeconomic level and health services characteristics. Relative risks (RRs) and 95% credible intervals (95% CrIs) for each variable were estimated for a 1-SD increase in incidence rate., Results: During 2010-2014, 6,835 new patients ≥18 years old (4231 men, 2604 women) living in the study area started RRT; the RRT incidence rates by townships ranged from 21 to 499 per million inhabitants. In multivariate analysis, rates were related to the prevalence of diabetes [RR (95% CrI): 1.05 (1.04-1.11)], the median estimated glomerular filtration rate at dialysis initiation [1.14 (1.08-1.20)], and the proportion of incident patients ≥ 85 years old [1.08 (1.03-1.14)]. After adjusting for these factors, rates in townships increased with increasing French deprivation index [1.05 (1.01-1.08)] and decreased with increasing mean travel time to reach the closest nephrologist [0.92 (0.89-0.95])., Conclusion: These data confirm the influence of deprivation level, the prevalence of diabetes and medical practices on RRT incidence rates across a large French area. For the first time, an association was found with the distance to nephrology services. These data suggest possible inequitable geographic access to RRT within the French health system., Competing Interests: The authors have declared that no competing interests exist.

Since a French organization (2016) has defined "the territorial hospital groupings", public hospitals must share medical-economic knowledge and decision-makers expect prospective analyses. PoleSat aims, quick hospital-catchment area modellings, completed by population analyses. Modellings are based on "diagnostic and interventional vascular catheterizations" acts and Nouvelle-Aquitaine, and they are carried out 3 times, through the graphical user interface's main-setting values, coupled with 3 activity-scenarios. Scenario results cannot confirm the NA02-Atlantique's H0. The experts have approved PoleSat's method as a robust help-tool; therefore they project to repeat its usages.

Periodic catatonia (PC) is a psychomotor phenotype with a progressive-remitting course. While it can fit any disorder diagnosis of the schizoaffective spectrum, its core features consist of a mix of hypo- and hyperkinesias resulting in distortions of expressive movements such as grimacing and parakinesias. The replication of cerebral blood flow (CBF) increases in the left supplementary motor area (L-SMA) and lateral premotor cortex (L-LPM) in acute and remitting PC patients indicates that these increases could be used as diagnostic biomarkers. In this proof-of-concept study, 2 different MRI sequences were repeated on 3 separate days to get reliable measurement values of CBF in 9 PC and 26 non-PC patients during different cognitive tasks. Each patient was compared to 37 controls. In L-SMA [-9; +10; +60] and L-LPM [-46; -12; +43], a test was positive if the t value was >2.02 (α < 0.05; two tailed). The measurements had good analytical performance. Regarding the tests, their sensitivities and specificities were significantly different from the chance level on both measures, except for L-SMA sensitivities. When combining all the tests, among regions and methods, sensitivity was 98% (95% credible interval [CI] 76-100%) and specificity 88% (72-97%). Bayesian inferences of its negative predictive values for PC were >95% regardless of the context, while its positive predictive values reached 94% but only when used in combination with clinical criteria. The case-by-case analysis suggests that non-PC patients with neurological motor deficits are at risk to be false positive., (© 2019 S. Karger AG, Basel.)

Cancer was recently annexed to diabetic complications. Furthermore, recent studies suggest that cancer can increase the risk of diabetes. Consequently, diabetes and cancer share many risk factors, but the cellular and molecular pathways correlating diabetes and colon and rectal cancer (CRC) remain far from understood. In this study, we assess the effect of hyperglycemia on cancer cell aggressiveness in human colon epithelial adenocarcinoma cells in vitro and in an experimental animal model of CRC. Our results show that Nox (NADPH oxidase enzyme) 4-induced reactive oxygen species (ROS) production is deregulated in both diabetes and CRC. This is paralleled by inactivation of the AMPK and activation of the mammalian target of rapamycin (mTOR) C1 signaling pathways, resulting in 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) accumulation, induction of DNA damage, and exacerbation of cancer cell aggressiveness, thus contributing to the genomic instability and predisposition to increased tumorigenesis in the diabetic milieu. Pharmacologic activation of AMPK, inhibition of mTORC1, or blockade of Nox4 reduce ROS production, restore the homeostatic signaling of 8-oxoguanine DNA glycosylase/8-oxodG, and lessen the progression of CRC malignancy in a diabetic milieu. Taken together, our results identify the AMPK/mTORC1/Nox4 signaling axis as a molecular switch correlating diabetes and CRC. Modulating this pathway may be a strategic target of therapeutic potential aimed at reversing or slowing the progression of CRC in patients with or without diabetes.-Mroueh, F. M., Noureldein, M., Zeidan, Y. H., Boutary, S., Irani, S. A. M., Eid, S., Haddad, M., Barakat, R., Harb, F., Costantine, J., Kanj, R., Sauleau, E.-A., Ouhtit, A., Azar, S. T., Eid, A. H., Eid, A. A. Unmasking the interplay between mTOR and Nox4: novel insights into the mechanism connecting diabetes and cancer.

Background: Patients with spondylodiscitis are treated with antibiotics and braces for 6 to 12 weeks. Braces aim to decrease pain and prevent kyphotic deformity due to vertebral body collapse. Percutaneous instrumentation could be an alternative to influence pain and patient's autonomy., Purpose: The purpose of this study was to analyze back pain, quality of life, sagittal deformity, and complications after percutaneous instrumentation in spondylodiscitis., Patients and Methods: VAS for back pain, EQ-5D, radiographic sagittal index were assessed retrospectively for 28 patients who had a standardized follow-up at 5 days, 6 weeks, 3 months, 1 and 2 years. Probabilities>0.95 indicated significant changes (Bayesian model)., Results: VAS was 7.0 preoperatively, 3.2 (day 5), 2.2 (6 weeks), 1.9 (3 months), 1.6 (1 year), 1.4 (2 years): probabilities>0.95 within 6 weeks. EQ-5D was 0.229 preoperatively, 0.563 (6 weeks), 0.687 (3 months), 0.755 (1 year), 0.787 (2 years): probabilities>0.95 within 1 year. Sagittal index was 15.1° preoperatively, 9.6° postoperatively: probability>0.95. Inter-body fusion was: complete 60.7%, partial 17.9%, and nonunion 21.4%. Antibiotic treatment was stopped at 6 weeks in 82.1%, at 3 months in 17.9%, without septic complication., Conclusion: Percutaneous instrumentation improved pain control, quality of life and prevented kyphosis. Antibiotic treatment was not influenced. Septic complications were not observed., Level of Evidence: IV., (Copyright © 2019. Published by Elsevier Masson SAS.)

Medical geo-informatics allows the Health world to address major challenges thanks to attractive concepts, methods and user-friendly IT. PoleSat-web-2018 presents a decision support system - a modelling "variable geometry" IT tool for simulation of hospital spatial planning. The outputs enable quasi-instantaneous analytic visualization at several geographic levels. PoleSat-web-2018 provides prospective views of hospital catchments (by grouping, closing) and proves to be relevant for the French planners of the Ministry of Health.

Purpose: This retrospective study investigates sagittal alignment after pedicle subtraction osteotomy (PSO). The purpose was to investigate factors associated with malalignment recurrence., Methods: Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measurements were taken preoperatively, 3 months postoperatively, at follow-up: SVA C2 and C7, C2-C7 lordosis, T4-T12 kyphosis, L1-S1 lordosis, PSO lordosis, pelvic incidence, pelvic tilt, sacral slope. Follow-up CTs were screened for pseudarthrosis and gas in sacroiliac joints., Results: PSO lordosis increased from 11.8° to 40.8° (p < 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° (p < 0.0001) and decreased to 49.7° (p = 0.0008). Pelvic tilt decreased from 29.2° to 16.5° (p < 0.0001) and increased to 22.5° (p < 0.0001). SVA C7 decreased from 105.1 to 35.5 mm (p < 0.0001) and increased to 64.8 mm (p = 0.0005). Twenty-eight patients (42%) had an SVA C7 increase of more than 70 mm in the postoperative course: recurrence group. These patients were older: 62.8 years versus 52.3 years (p = 0.0031). Loss of lordosis was 11.9° (recurrence group) versus 5.0° (non-recurrence group). Eleven patients (17%) had pseudarthrosis. Pelvic incidence increased by 9.3° (recurrence group) versus 3.8° (non-recurrence group). In 23 patients (35%), pelvic incidence increased > 10°. Gas was evidenced in sacroiliac joints in 22 patients (33%)., Conclusion: Postoperative anterior malalignment recurrence may occur after PSO. Elderly patients were at risk of recurrence. Loss of lumbar lordosis linked to pseudarthrosis represented another factor. With malalignment recurrence, anterior trunk rotation and pelvic retroversion might additionally have augmented moments across sacroiliac joints with subsequent ligament laxity and pelvic incidence increase. These slides can be retrieved under Electronic Supplementary Material.

Geomatics becomes a major field of science facing challenges to assist medical informatics and health decision makers thanks to attractive concepts, methods and easy, user-friendly-way IT technologies. PoleSat&#95;2018 presents a web-based graphical user interface with an embedded optimized and automated algorithm. It is primarily geared for geomatics non-specialists and allows computer simulations by modelling scenarios of hospital grouping and/or closure. The consultation, reflection, prospective views, offered in a very short time to policy makers will find a successful support for health planning strategic decisions.

Background: Previous studies comparing the outcomes in haemodialysis (HD) with those in peritoneal dialysis (PD) have yielded conflicting results., Methods: The aim of the study was to compare the survival of planned HD versus PD patients in a cohort of adult incident patients who started renal replacement therapy (RRT) between 2006 and 2008 in the nationwide REIN registry (Réseau Epidémiologie et Information en Néphrologie). Patients who started RRT in emergency or stopped RRT within 2 months were excluded. Adjusted Cox models, propensity score matching and marginal structural models (MSMs) were used to compensate for the lack of randomization and provide causal inference from longitudinal data with time-dependent treatments and confounders including transplant censorship, modality change over time and time-varying covariates., Results: Among a total of 13 767 dialysis patients, 13% were on PD at initiation of RRT and 87% were on HD. The median survival times were 53.5 months or 4.45 years and 38.6 months or 3.21 years for patients starting on HD and PD, respectively. Regardless of the model used, there was a consistent advantage in terms of survival for HD patients: hazard ratio (HR) 0.76 [95% confidence interval (95% CI) 0.69-0.84] with the Cox model using propensity score; HR 0.67 (95% CI 0.62-0.73) in the Cox model with censorship for each treatment change; and HR 0.82 (95% CI 0.69-0.97) with MSMs. However, MSMs tended to reduce the survival gap between PD and HD patients., Conclusion: This large cohort study using various statistical methods to minimize the bias appears to demonstrate a better survival in planned HD than in PD.

Background: Lyme borreliosis in humans results in a range of clinical manifestations, thought to be partly due to differences in the pathogenicity of the infecting strain. This study compared European human clinical strains of Borreliella afzelii (previously named Borrelia afzelii) using multilocus sequence typing (MLST) to determine their spatial distribution across Europe and to establish whether there are associations between B. afzelii genotypes and specific clinical manifestations of Lyme borreliosis. For this purpose, typing was performed on 63 strains, and data on a further 245 strains were accessed from the literature., Results: All 308 strains were categorized into 149 sequence types (STs), 27 of which are described here for the first time. Phylogenetic and goeBURST analyses showed short evolutionary distances between strains. Although the main STs differed among the countries with the largest number of strains of interest (Germany, the Netherlands, France and Slovenia), the B. afzelii clinical strains were less genetically structured than those previously observed in the European tick population. Two STs were found significantly more frequently in strains associated with clinical manifestations involving erythema migrans, whereas another ST was found significantly more frequently in strains associated with disseminated manifestations, especially neuroborreliosis., Conclusions: The MLST profiles showed low genetic differentiation between B. afzelii strains isolated from patients with Lyme borreliosis in Europe. Also, clinical data analysis suggests the existence of lineages with differential dissemination properties in humans.

Background: Longitudinal studies of dementia with Lewy bodies (DLB) are rare. Clinically, DLB is usually considered to worsen into Alzheimer's disease (AD). The aim of our study was to compare the rate of the cognitive decline in DLB, AD, and the association of the two diseases (AD + DLB)., Methods: Using the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment database, which includes all the patients seen at all memory clinics (medical consultation and day hospitals) in four French regions, and beta regression, we compared the longitudinal the Mini-Mental State Examination scores of 1159 patients with AD (n = 1000), DLB (n = 131) and AD + DLB (association of the two) (n = 28) during follow-up of at least 4 years., Results: The mean follow-up of the patients was 5.88 years. Using beta regression without propensity scores, the comparison of the decline of patients with AD and patients with DLB did not show a significant difference, but the decline of patients with AD + DLB was worse than that of either patients with DLB (P = 0.006) or patients with AD (P < 0.001). Using beta regression weighted by a propensity score, comparison of patients with AD and patients with DLB showed a faster decline for patients with DLB (P < 0.001). The comparison of the decline of patients with AD + DLB with that of patients with DLB (P < 0.001) and patients with AD (P < 0.001) showed that the decline was clearly worse in the patients with dual disease., Conclusions: Whatever the analysis, the rate of decline is faster in patients with AD + DLB dual disease. The identification of such patients is important to enable clinicians to optimise treatment and care and to better inform and help patients and caregivers.

Objectives: Our goal is to validate and to verify the reliability of the French and English versions of the Insomnia Severity Index (ISI) in Lebanese adolescents., Study Design: A cross-sectional study was implemented., Methods: 104 Lebanese students aged between 14 and 19 years participated in the study. The English version of the questionnaire was distributed to English-speaking students and the French version was administered to French-speaking students. A scale (1 to 7 with 1 = very well understood and 7 = not at all) was used to identify the level of the students' understanding of each instruction, question and answer of the ISI. The scale's structural validity was assessed. The factor structure of ISI was evaluated by principal component analysis. The internal consistency of this scale was evaluated by Cronbach's alpha. To assess test-retest reliability the intraclass correlation coefficient (ICC) was used., Results: The principal component analysis confirmed the presence of a two-component factor structure in the English version and a three-component factor structure in the French version with eigenvalues > 1. The English version of the ISI had an excellent internal consistency (α = 0.90), while the French version had a good internal consistency (α = 0.70). The ICC presented an excellent agreement in the French version (ICC = 0.914, CI = 0.856-0.949) and a good agreement in the English one (ICC = 0.762, CI = 0.481-890). The Bland-Altman plots of the two versions of the ISI showed that the responses over two weeks' were comparable and very few outliers were detected., Conclusion: The results of our analyses reveal that both English and French versions of the ISI scale have good internal consistency and are reproducible and reliable. Therefore, it can be used to assess the prevalence of insomnia in Lebanese adolescents.

Background: In the normal adult spine, a link between thoracolumbar and cervical sagittal alignment exists, suggesting adaptive cervical positional changes allowing horizontal gaze. In patients with thoracic hyperkyphosis, cervical adaptation to sagittal global alignment might be different from healthy individuals. However, this relationship has not clearly been reported in hyperkyphotic deformity., Purpose: The purpose of this study was to identify cervical sagittal alignment types observed on radiographs in young adults with thoracic hyperkyphosis. The relationship between cervical and thoracolumbar alignment as well as the effect of posterior instrumentation and adaptive positional changes of the mobile cervical segment were retrospectively analyzed., Patients and Methods: Twenty-three patients (32.7 years; 5-year follow-up) were included. Full spine radiographic measurements were: T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, SVA C7, SVA C2, lordosis between C0-C2, C2-C7, C2-C4 and C4-C7. A Bayesian model and Spearman correlation were used., Results: Two alignment types existed: cervical lordosis (group A) and cervical kyphosis (group B). Preoperatively, T4-T12 kyphosis and L1-S1 lordosis were significantly higher in group A: 76.6° versus 59.4° and -72.8° versus -65.8° (probability of>5° difference P (β>5)>0.95). Pelvic incidence was higher in group A (49.8° versus 44.2°) and C0-C2 lordosis in group B (-29.4° versus -21.6°). A significant correlation existed between: T4-T12 kyphosis and C2-C7 lordosis, L1-S1 lordosis and pelvic incidence, C2-C7 lordosis and T1 slope, C2-C7 lordosis and T1-T4 kyphosis. Postoperatively, T4-T12 kyphosis decreased by 33.1° P (β>5)=0.9995), L1-S1 lordosis decreased by 17.7° (P (β>5)=0.961), T1-T4 kyphosis increased by 14.1° (P (β>5)=0.973). SVA C2 (translation) increased by 13.8mm. C0-C2 lordosis (head rotation) remained unchanged. Six patients changed cervical alignment. PJK occurred in 15 patients, unrelated to cervical alignment or proximal instrumentation level., Discussion: Two cervical alignment types, lordotic or kyphotic, were observed thoracic hyperkyphosis patients. This alignment was mainly triggered by the amount of thoracic kyphosis and lumbar lordosis, linked to pelvic incidence. Moreover, the inclination of the C7-T1 junctional area plays a key role in the amount of cervical lordosis. The correction of T4-T12 kyphosis induced compensatory modifications at adjacent segments: T1-T4 kyphosis increase (PJK) and L1-S1 lordosis decrease. Global spino-pelvic alignment and head position did not change in the sagittal plane. The cervical spine tented to keep in its preoperative position in most patients., Level of Evidence: Level IV., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Despite the involvement of general practitioners, the mailing of several recall letters and of the faecal occult blood test (FOBT) kit, the uptake remains insufficient in the French colorectal cancer-screening programme. Some studies have demonstrated a greater efficacy of tailored telephone counselling over usual care, untailored invitation mailing and FOBT kit mailing. We evaluated the feasibility and the effectiveness of telephone counselling on participation in the population-based FOBT colorectal cancer-screening programme implemented in Alsace (France)., Methods: Underusers were randomized into a control group with untailored invitation and FOBT kit mailing (n=19,756) and two intervention groups for either a computer-assisted telephone interview (n=9367), system for tailored promotion of colorectal cancer screening, or a telephone-based motivational interview (n=9374)., Results: Only 5691 (19.9%) people were actually counseled, so that there was no difference in participation between the intervention groups taken together (13.9%, 95% confidence interval [CI] [13.5-14.4]) and the control group (13.9%, 95% CI [13.4-14.4]) (P=1.0) in intent-to-treat analysis. However, in per-protocol analysis, participation was significantly higher in the two intervention groups than in the control group (12.9%, 95% CI [12.6-13.2]) (P<0.01), with no difference between computer-assisted telephone interview (24.6%, 95% CI [22.7-26.4]) and motivational interview (23.6%, 95% CI [21.8-25.4]) (P=0.44)., Conclusion: There was no difference of effectiveness between tailored telephone counselling and untailored invitation and FOBT kit mailing on participation of underusers in an organized population-based colorectal cancer screening programme. A greater efficacy of telephone counselling, around twice that of invitation and FOBT kit mailing, was observed only in people who could actually be counseled, without difference between computer-assisted telephone interview and motivational interview. However, technical failures hampered telephone counselling, so that there was no difference in intent-to-treat analysis. The rate of technical success of telephone interviews should be evaluated, and enhanced if insufficient, before implementation of telephone counselling in population-based cancer screening programmes., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The aim of this study was to assess the impact of area deprivation and primary care facilities on colorectal adenoma detection and on colorectal cancer (CRC) incidence in a French well-defined population before mass screening implementation. The study population included all patients aged 20 years or more living in Côte d'Or (France) with either colorectal adenoma or invasive CRC first diagnosed between 1995 and 2002 and who were identified from the Burgundy Digestive Cancer Registry and the Côte d'Or Polyp Registry. Area deprivation was assessed using the European deprivation index on the basis of the smallest French area available (Ilots Regroupés pour l'Information Statistique). Healthcare access was assessed using medical density of general practitioners (GPs) and road distance to the nearest GP and gastroenterologist. Bayesian regression analyses were used to estimate influential covariates on adenoma detection and CRC incidence rates. The results were expressed as relative risks (RRs) with their 95% credibility interval. In total, 5399 patients were diagnosed with at least one colorectal adenoma and 2125 with invasive incident CRC during the study period. Remoteness from GP [RR=0.71 (0.61-0.83)] and area deprivation [RR=0.98 (0.96-1.00)] independently reduced the probability of adenoma detection. CRC incidence was only slightly affected by GP medical density [RR=1.05 (1.01-1.08)] without any area deprivation effect [RR=0.99 (0.96-1.02)]. Distance to gastroenterologist had no impact on the rates of adenoma detection or CRC incidence. This study highlighted the prominent role of access to GPs in the detection of both colorectal adenomas and overall cancers. Deprivation had an impact only on adenoma detection.

Background: Vertebroplasty prefilling or fenestrated pedicle screw augmentation can be used to enhance pullout resistance in elderly patients. It is not clear which method offers the most reliable fixation strength if axial pullout and a bending moment is applied. The purpose of this study is to validate a new in vitro model aimed to reproduce a cut out mechanism of lumbar pedicle screws, to compare fixation strength in elderly spines with different cement augmentation techniques and to analyze factors that might influence the failure pattern., Materials and Methods: Six human specimens (82-100 years) were instrumented percutaneously at L2, L3 and L4 by non-augmented screws, vertebroplasty augmentation and fenestrated screws. Cement distribution (2 ml PMMA) was analyzed on CT. Vertebral endplates and the rod were oriented at 45° to the horizontal plane. The vertebral body was held by resin in a cylinder, linked to an unconstrained pivot, on which traction (10 N/s) was applied until rupture. Load-displacement curves were compared to simultaneous video recordings., Results: Median pullout forces were 488.5 N (195-500) for non-augmented screws, 643.5 N (270-1050) for vertebroplasty augmentation and 943.5 N (750-1084) for fenestrated screws. Cement augmentation through fenestrated screws led to significantly higher rupture forces compared to non-augmented screws (P=0.0039). The pullout force after vertebroplasty was variable and linked to cement distribution. A cement bolus around the distal screw tip led to pullout forces similar to non-augmented screws. A proximal cement bolus, as it was observed in fenestrated screws, led to higher pullout resistance. This cement distribution led to vertebral body fractures prior to screw pullout., Conclusion: The experimental setup tended to reproduce a pullout mechanism observed on radiographs, combining axial pullout and a bending moment. Cement augmentation with fenestrated screws increased pullout resistance significantly, whereas the fixation strength with the vertebroplasty prefilling method was linked to the cement distribution., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: The widespread use of electronic health records (EHRs) has generated massive clinical data storage. Association rules mining is a feasible technique to convert this large amount of data into usable knowledge for clinical decision making, research or billing. We present a data driven method to create a knowledge base linking medications to pathological conditions through their therapeutic indications from elements within the EHRs., Methods: Association rules were created from the data of patients hospitalised between May 2012 and May 2013 in the department of Cardiology at the University Hospital of Strasbourg. Medications were extracted from the medication list, and the pathological conditions were extracted from the discharge summaries using a natural language processing tool. Association rules were generated along with different interestingness measures: chi square, lift, conviction, dependency, novelty and satisfaction. All medication-disease pairs were compared to the Summary of Product Characteristics, which is the gold standard. A score based on the other interestingness measures was created to filter the best rules, and the indices were calculated for the different interestingness measures., Results: After the evaluation against the gold standard, a list of accurate association rules was successfully retrieved. Dependency represents the best recall (0.76). Our score exhibited higher exactness (0.84) and precision (0.27) than all of the others interestingness measures. Further reductions in noise produced by this method must be performed to improve the classification precision., Conclusions: Association rules mining using the unstructured elements of the EHR is a feasible technique to identify clinically accurate associations between medications and pathological conditions.

Study Design: Retrospective radiographical analysis of cervical and thoracolumbar sagittal alignment in young adults with idiopathic scoliosis., Objective: To analyze cervical alignment types, the relationship between cervical and thoracolumbar alignment and the effect of posterior instrumentation., Summary of Background Data: Thoracic scoliosis with hypokyphosis may decrease cervical lordosis. Additional adaptive positional changes of the mobile cervical segment may exist, because sigmoid cervical patterns are observed. Sagittal alignment of the instrumented thoracolumbar spine may influence cervical alignment., Methods: Pre- and postoperative full-spine radiographs of 52 patients were analyzed at 8-year average follow-up. Sagittal thoracolumbar measurements were T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA) C7, and SVA C2. Cervical measurements were C0-C2, C2-C6, C2-C4, C4-C6, and C2-T1 lordosis, chin-brow vertical angle., Results: Five cervical alignment types were identified: lordotic, hypolordotic, kyphotic, sigmoid with cranial lordosis, and sigmoid with cranial kyphosis. Spinopelvic parameters and global thoracolumbar balance remained unchanged postoperatively. The average C2-C6 lordosis increased by 6.4° (P < 0.0001). Twenty-seven of the 52 patients changed cervical alignment postoperatively. SVA C2-C7 difference changed in this subgroup (P = 0.0159). In 21 of the 27 patients, SVA changed more than 5 mm at C2 (P = 0.0029), and in 25 of the 27 patients at C7 (P < 0.0001). A correlation existed between T4-T12 kyphosis and L1-S1 lordosis, C2-C4 and L1-S1 lordosis, L1-S1 lordosis, and pelvic tilt. T1-T4 kyphosis and T1 slope correlated with C2-T1 lordosis, but proximal junctional kyphosis was not linked to a specific cervical alignment type., Conclusion: Postoperative adaptive changes occurred at C7 and C2 by shifting anteriorly or posteriorly, resulting in different radiographical cervical shapes. The amount of lumbar lordosis may influence cervical lordosis, which needs to be considered for surgical correction. Adaptive hip movements may influence thoracolumbar and cervical alignment. The amount of proximal thoracic kyphosis influenced cervical lordosis. Global thoracic hypokyphosis might influence cervical alignment, but it was not evidenced., Level of Evidence: 4.