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Anti-PD1-/PDL1-induced chronic intestinal pseudo-obstruction: three cases treated with vedolizumab after corticosteroid failure with mixed results
No full textInternational audienceImmune checkpoint inhibitors (ICI), i.e., anti-PD1/PDL1 and anti-CTLA-4, have reshaped the prognosis of many cancers. Increased use of ICI has led to the onset of new adverse events. Neurological immune-related adverse events are rare, heterogenous, and potentially life-threatening. Chronic intestinal pseudo-obstruction (CIPO) is an immune-related autonomic plexus neuropathy that may be caused by infiltration of the myenteric plexus by CD8 + T cells. It is a rare and potentially fatal side effect that can be difficult to diagnose early because of initial nonspecific clinical presentation including vomiting, nausea, diarrhea, and constipation. Some rare cases have been described in the literature reporting a frequent resistance to corticosteroids making it necessary to use other immunosuppressive therapy. Vedolizumab is an antibody (Ab) blocking integrin α4-β7 used to treat inflammatory bowel disease. We report the first three cases of ICI-induced CIPO-treated with vedolizumab after corticosteroid failure, with very limited benefits (only one patient with transitory improvement). Based on our results in three cases, vedolizumab does not currently appear to be a therapeutic option. Earlier administration with a standardized dose and frequency schedule may provide better outcomes
Analysis of the Prevalence of Missed Nursing Care Using Three Workload Assessment Methods: A Nationwide Cross‐Sectional Study Among Intensive Care Nurses
No full textInternational audienceBackground: Increased workload is associated with a higher prevalence of missed nursing care.Aim: Describe the prevalence of missed care in intensive care units (ICUs) and identify the workload scale most strongly associated with this prevalence.Study design: A cross-sectional survey was combined with a longitudinal study conducted in 2024, between 15 January and 15 April, in France to assess the workload. A total of 1271 nurses working in 61 ICUs completed the questionnaire one time per shift.Results: A total of 72.3% of nurses reported at least one missed care. The Nursing Activities Score provided the strongest association with the prevalence of missed care compared to patient-to-nurse ratio and the Practice Environment Scale of the Nursing Work Index.Conclusion: The prevalence of missed care and nursing workload was high. Nurses tended to focus on direct patient care.Relevance to clinical practice: Continuously assessing the prevalence of missed care can be a valuable tool for managing workload in ICUs
Investigating biographical post-bariatric surgery uncertainties in the light of changes in bodily practices: a mixed-method, multicentric and longitudinal research protocol
No full textInternational audienceIntroduction The effects of bariatric surgery have largely been studied from a medical viewpoint, seeking to measure changes in anthropometric, physiological or quality-of-life factors after the operation. Few studies, however, have focused on the dynamics of lifestyle changes. Yet we know that changing lifestyle habits—which are often part of the established social configurations at the origin of morbid obesity—is essential for a sustainable recovery from obesity. We also know that the major bodily transformations that occur in the six to twelve months following surgery produce a high degree of biographical uncertainty and affect social interactions. From a sociological perspective, the authors propose to study the processes of disruption and re-establishment of lifestyle habits in the first 24 months following bariatric surgery. Methods and analysis The ChiBarAPS study relies on a mixed-method longitudinal survey, comprising three components: qualitative, quantitative, literature and data review. It aims to document three main dimensions, which must be articulated to understand the dynamics of change: (1) the work undertaken by patients on themselves in order to identify and measure the evolutionary effects of surgery, as well as to adapt to them; (2) the experience of using pre- and post-surgery information and support systems, and evaluating their effects on the agency of the people who have undergone surgery; (3) the evolution of social participation and lifestyle habits. The qualitative component concerns a cohort of 30 patients, interviewed in depth (2 hours) on these three dimensions, 6 months, 12 months and 24 months after the operation. The quantitative part uses questionnaires applied to a second group of 200 patients, following the same timeline. Ethics and dissemination This study complies with reference methodology MR004 of the French National Data Protection Authority and was registered by the Data Protection Officer of the University of Montpellier on the activity registry of the institution (24 April 2024). Ethics approval has been obtained from the University of Montpellier ethics research board (n°UM2024-037). Informed consent will be obtained from all participants before data collection. The project has received funding from the French National Research Agency (n°ANR-23-CE41-0020-01) from February 2024 to the end of January 2028. The first results of the research will be disseminated from 2026 onwards to researchers, health professionals and patient support organisations. The results of the study will then be published in peer-reviewed scientific journals, both national and international
Relaxing the PI-RADS dominant sequence rule improves the characterization of high-grade prostate cancer on multiparametric MRI
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Multiple Excitation Wavelengths PpIX Fluorescence Spectroscopy for Gliomas Delineation Assisted by Machine Learning
No full textInternational audienceA method for preprocessing and classifying fluorescence measurements to distinguish tumorous from healthy tissue is proposed, as 5-ALA fluorescence-guided surgery, effective for high-grade gliomas, is less useful for low-grade gliomas without visible fluorescence.</div
Enhanced Butyl Levulinate Synthesis from Cellulose under High-Gravity Conditions: Catalyst and Solvent Optimization
No full textInternational audienceThe global shift toward a more sustainable chemical industry highlights lignocellulosic biomass as a promising feedstock for high-value biofuels. Although, the valorization of its main component cellulose comes with limitations regarding its recalcitrant nature and humins formation. A significant focus is on efficient cellulose depolymerization to bio-based fuel additives such as alkyl levulinates.This study investigates cellulose conversion to butyl levulinate under high-gravity conditions (80 g/L). Using a co-catalyst system of metal sulfates Fe2(SO4)3 · xH2O and Al2(SO4)3 · 18 H2O, enhanced with co-solvent γ-valerolactone, cellulose was successfully valorized and product molecules were formed.The employment of γ-valerolactone as a co-solvent in experiments improved product concentrations in the final reaction mixture by 30 %. The comparison of catalytic performance between Fe2(SO4)3 · xH2O and Al2(SO4)3 · 18 H2O shows overall less effect in terms of product formation but more importance in following intermediate profiles by the inhibiting effect of Al2(SO4)3 · 18 H2O. Analysis of the sugar intermediates at elevated reaction conditions (20 bar, 200 °C) shed light on the role of glucoside and fructoside as primary intermediates to butyl levulinate instead of the glucose and fructose isomerization products.These findings advance the understanding of cellulose-to-biofuel conversion, offering a pathway to optimize efficiency and scalability in industrial applications
Isokinetic Testing After Anterior Cruciate Ligament Injury Showed a Greater Hamstrings/Quadriceps Ratio at 240°/S Over 6 Months From Injury but No Difference of Limb Symmetry Index
No full textInternational audiencePurpose: To assess preoperative quadriceps and hamstring strength at various time points after anterior cruciate ligament (ACL) injury but before ACL reconstruction.Methods: Patients who underwent isokinetic muscle strength testing before planned ACL reconstruction were included. Patients were placed in 1 of the following 3 groups on the basis of time from injury to testing: <3 months, 3 to 6 months, and 6 to 12 months. Among these 3 groups, hamstring and quadriceps limb symmetry index (LSI) and hamstring/quadriceps (H/Q) ratios were compared. A total of 100 patients were included (<3 months [n = 55]; 3-6 months [n = 31]; and 6-12 months [n = 14]).Results: There were no significant differences between patients in the 3 groups in regards to age, body mass index, or flexion range of motion, but there was a greater proportion of female patients in the 6 to 12 month group than the other groups. No significant differences in quadriceps or hamstring strength were noted among the 3 groups. H/Q ratio was significantly greater in the 6 to 12 month group than the less than 3 months and 3 to 6 months groups, with concentric testing at 240°/s. No correlation was found between patient sex and LSI or H/Q ratios.Conclusions: Patients who underwent isokinetic muscle strength testing 6 to 12 months after ACL injury had a greater H/Q ratio at 240°/s than those who were testing within 6 months of injury. No differences in hamstring or quadriceps LSI were noted on the basis of time.Clinical relevance: An understanding of the factors that influence preoperative isokinetic muscle strength testing (including time from injury to surgery) is important, given associations noted between preoperative strength and postoperative strength recovery after ACL reconstruction
Infective endocarditis: it takes a team
No full textInternational audienceInfective endocarditis (IE) is a relatively rare but life-threatening systemic infection, which remains associated with high morbidity and mortality. The epidemiology of IE has shifted to involve an increasing numbers of older patients with both cardiovascular and other types of prosthetic devices, multiple comorbid conditions often requiring invasive procedures, increasingly virulent pathogens, in particular Staphylococcus aureus, or that can harbour anti-microbial resistance, and an escalation of injection drug use in many areas of the world. In parallel, advancements in diagnostic and therapeutic options have led to complex strategies in patients’ management. Despite these epidemiologic shifts, clinical trials have been rare and most of the evidence guiding IE management derives from expert consensus or analysis of large registries. Because of this, a multi-disciplinary IE team-based approach has been recommended as the standard of care. The aim of this review is to explore the rationale for a multi-disciplinary team-based approach to the management of IE. This approach has proved to be potentially beneficial based on multiple investigations that have evaluated patient outcomes. In addition, implementation strategies, feasibility and options of the team approach have also been highlighted
Synthèse du webinaire de la SFN « Les Oméga-3 » tenu le jeudi 24 octobre 2024 en partenariat avec Saint Hubert – Lesieur
No full textInternational audienceLes acides gras poly-insaturés (AGPI) oméga-3 constituent une famille d’acides gras essentiels dont le précurseur indispensable – c’est-à-dire qu’il doit obligatoirement être apporté par l’alimentation – est l’acide alpha-linolénique (ALA). En France, les recommandations nutritionnelles préconisent un apport quotidien de 2 g pour l’acide alpha-linolénique et de 500 mg pour la somme des 2 principaux oméga-3 à longue chaîne : l’acide eicosapentaénoïque (EPA) plus l’acide docosahexaénoïque (DHA). Les oméga-3 présents dans notre alimentation, de par leur nature et leur abondance, jouent un rôle dans la prévention de plusieurs pathologies. Les taux sanguins d’oméga-3 et plus particulièrement d’EPA/DHA ont un intérêt prédictif sur l’évolution de maladies, notamment celles liées aux troubles métaboliques, cardiovasculaires (CV) ou inflammatoires et à certaines fonctions cérébrales. Les apports en oméga-3 chez les adultes en France restent insuffisants, atteignant en moyenne à peine la moitié des recommandations (Anses. Étude individuelle nationale des consommations alimentaires 3 [INCA 3]). Les apports trop faibles en acides gras oméga-3 déséquilibrent également leur ratio avec les acides gras oméga-6. En effet, le ratio oméga-6/oméga-3 devrait être de 5 mais il est plutôt rapporté autour de 10–12 dans les populations occidentales.Le webinaire intitulé « Oméga-3 » a été l’occasion de rappeler les fondamentaux biochimiques et métaboliques des acides gras poly-insaturés oméga-3 et oméga-6. Il a permis de faire le point sur les dernières avancées concernant leur rôle dans la santé CV et le fonctionnement du système nerveux. L’intérêt scientifique du rapport oméga-6/oméga-3 et de l’indice oméga-3 (omega-3 index) a également été discuté
Long-term efficacy and safety of secukinumab in patients with moderate-to-severe hidradenitis suppurativa: week 104 results from the SUNSHINE and SUNRISE extension trial
No full textInternational audienceAbstract Background The SUNSHINE and SUNRISE phase III trials demonstrated sustained clinical efficacy of secukinumab in patients with moderate-to-severe hidradenitis suppurativa (HS) through 52 weeks. Patients completing the core trials could enter a 4-year extension trial. Objectives To evaluate the long-term efficacy, safety/tolerability and maintenance of clinical response to secukinumab through week 104 in the extension trial. Methods Patients with a hidradenitis suppurativa (HS) clinical response (HiSCR) at week 52 of the core trials (extension trial baseline visit) entered a randomized withdrawal period. HiSCR responders receiving subcutaneous secukinumab 300 mg every 2 or 4 weeks (SECQ2W/SECQ4W) through week 52 in the core trials were randomized 2 : 1 to continue secukinumab (SECQ2W-R-Q2W or SECQ4W-R-Q4W) or receive placebo (SECQ2W-R-PBO or SECQ4W-R-PBO) through week 104. The primary endpoint was time to loss of response (LOR; newly defined for this trial) through week 104 in week 52 HiSCR responders (SECQ2W-R-Q2W vs. SECQ2W-R-PBO and SECQ4W-R-Q4W vs. SECQ4W-R-PBO). Time to LOR was tested at 1.25% (one-sided) for each comparison (one-sided familywise alpha of 2.5%) through week 104. If LOR was met, patients could remain in the trial on open-label secukinumab treatment. Additional endpoints included safety and HiSCR. The trial was registered with ClinicalTrials.gov (NCT04179175). Results Overall, 84.3% of patients who completed the core trials entered the extension trial; 55.9% were week 52 HiSCR responders. The primary endpoint was not met for either secukinumab dosing regimen. The estimated risk reduction for LOR was 13% (SECQ2W-R-Q2W vs. SECQ2W-R-PBO; one-sided P = 0.25) and 30% (SECQ4W-R-Q4W vs. SECQ4W-R-PBO; one-sided P = 0.04). The median time to LOR was numerically longer in the secukinumab arms vs. placebo {SECQ2W-R-Q2W [283 days; 95% confidence interval (CI) 176, –] vs. SECQ2W-R-PBO [239 days; 95% CI 120, –]; SECQ4W-R-Q4W [365 days 95% CI 225, –] vs. SECQ4W-R-PBO [171 days; 95% CI 113–337]}. In week 52 HiSCR responders reporting LOR, 44% (SECQ2W-R-Q2W), 58% (SECQ2W-R-PBO), 40% (SECQ4W-R-Q4W) and 34% (SECQ4W-R-PBO) were achieving HiSCR at the time of LOR. Overall, the safety of secukinumab was consistent with the core trials. Conclusions The primary endpoint of this trial was not met. HiSCR was maintained in many patients at the time of LOR. The safety of secukinumab was consistent with the previously characterized safety profile in the core trials