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Stenosis Development After Circumferential Colorectal Endoscopic Submucosal Dissection: A Multicenter Analysis of Predictive Factors and Outcomes
No full textInternational audienc
An international questionnaire highlights and supports the case for including girls in Creatine Transporter Deficiency research
No full textInternational audienceOver the last 15 years, significant progress has been made for Creatine Transporter Deficiency (CTD) patients, with increased awareness and visibility, better diagnosis, and improved care. Research projects have paved the way for clinical trials on the horizon. However, girls with CTD have been overlooked. Because they are considered a negligible cohort with less serious symptoms compared to males, girls with rare X-linked disorders have never been a priority for diagnosis and research. This results in underdiagnosis, systematic exclusion from clinical studies, and a considerable impact on the development of female patients. As a patient association, Xtraordinaire aims to counter these beliefs and to show that females deserve as much attention as males. Our first initiative identified girls with CTD within our community and led to the development of an international questionnaire to collect more specific data in this population. Of the 22 families who completed the questionnaire, the delay between symptom onset (mean age 1.8 years) and diagnosis (mean age 11.8 years) highlighted the difficulty of diagnosis for girls, often given several wavering diagnoses before reaching a CTD diagnosis. Almost half of families (47%) had difficulties securing a specialist appointment. Our questionnaire emphasized that girls with CTD have identical symptoms to males and similar delays in development milestones. These data have generated interest, and researchers have started to include girls in their studies. We strongly believe that upcoming studies on females will enrich our knowledge, further our understanding of CTD, help better diagnose girls, and develop adapted treatments
Monkey Do, Monkey See? The Effect of Imitation Strategies on Visuospatial Perspective-Taking and Self-Reported Social Cognitive Skills
No full textInternational audienceClassical social cognitive conceptions suppose that the existence of common representations between agents constitutes the basis that represents the world from others’ perspectives. Alternatively, recent contributions support that the ability to distinguish self- from other’s representation would rather be at the origins of social inferences abilities. In the present study we compared the effects of two types of imitation training: mirror imitation (for which gesture could be represented in common referential) and anatomically congruent imitation (which requires not only a representation of the gesture of the model but also distinguishing between one’s own and others’ representations). We observed that a 4 min training of anatomically congruent imitation, but not of mirror imitation, improved performance on a visual perspective-taking test. This short training did not significantly impact self-reported measures of social cognitive skills. These results suggest that a unique transversal cognitive mechanism of co-representing and switching between self-related and other-related representations could be involved at both the motor and the mental-state levels. Opportunities for innovative social cognitive interventions at the motor level are discussed
Cabozantinib for Hepatocellular Carcinoma in Real-World Practice (CLERANCE): A Prospective, Interventional Study
No full textInternational audienceBackground: Cabozantinib is recommended after sorafenib failure in systemic therapy of hepatocellular carcinoma (HCC), based on the results of CELESTIAL. Herein, CLERANCE was designed to evaluate the safety and efficacy of cabozantinib after prior sorafenib failure in real-life setting.Methods: This prospective French multicenter phase-4 trial (NCT03963206) recruited 110 patients with unresectable HCC when a decision of cabozantinib was made in tumor board. The primary endpoint was incidence of grade-3/4 treatment-related adverse events (TRAEs). Secondary endpoints included overall survival, objective response rate, progression-free survival, time to progression, and profiles of cabozantinib tolerance and management.Results: Final analysis focused on the 99 patients who started cabozantinib. Patients were mainly males, Child-Pugh A, and modified-ALBI grade-1/2a/2b. Sorafenib had been discontinued after 4.2 months median administration. Grade-3/4 TRAEs were reported in 61.3% of patients. The objective response rate was 7% with 58% of disease control rate, and median progression-free survival 6.2 months, time to progression 8.2 months, overall survival 11.5 months since the start of cabozantinib and 23.2 months since the start of the first systemic line. Baseline modified-ALBI grade-1+2a and alpha-fetoprotein <400 ng/mL were independent markers of better outcome in multivariate analysis. The median duration of cabozantinib administration was 5.2 months, median daily dose 40 mg, 66% patients needing dose reductions.Conclusions: In CLERANCE, tolerability and efficacy of cabozantinib were similar to those observed in CELESTIAL. We obtained more details in the management of cabozantinib doses, identified surrogate markers of better outcome, and underlined prolonged overall survival for patients able to undergo subsequent lines
Fluorescence spectroscopy precorrection model robust to large variability of optical properties: application to point of care quantitative liver graft viability assessment
No full textOptical properties correction models for fluorescence spectroscopy faced limitation in high variability of optical properties contexts. Typically, the point of care assessment of liver graft viability remains a critical challenge in transplantation medicine, where current methods rely on subjective visual inspection and delayed laboratory biomarkers. While optical approaches offer promising solutions to this challenge, the unique characteristics of liver grafts, which undergo highly varying conditions from procurement to transplantation, ranging from blood perfusion to ischemic phases and perfusion with transparent solutions, create an extremely wide dynamic range of optical properties that challenges state-of-the-art optical models. We present a novel method combining fluorescence spectroscopy and diffuse reflectance discord measurements in the context of large variability of optical properties and adapted to liver graft viability assessment. Our approach corrects for tissue optical properties using a dual-modality system that measures both fluorescence and diffuse reflectance spectra, enabling accurate quantification of metabolic fluorophores such as NADH and FAD. The method was validated on tissue-mimicking phantoms with varying optical properties and demonstrated superior performance compared to state-of-the-art correction techniques, with quantification accuracy improved by at least a factor of 1.5 and a capacity to detect more than 92% of the fluorophores present in the different phantoms. Clinical validation was performed on porcine ischemia-reperfusion models, showing promising results for real-time tissue viability monitoring during organ preservation and transplantation procedures
Optical Properties Corrected Fluorescence Spectroscopy for Liver Graft Viability Monitoring
No full textInternational audienceWe present a novel method combining fluorescence spectroscopy and diffuse reflectance measurements for liver graft viability assessment. Our approach corrects for tissue optical properties, enabling accurate fluorophore quantification. The method was validated on tissue-mimicking phantoms and porcine ischemia-reperfusion models
More than two-thirds of patients with prostate cancer have the same or even a greater survival than the general male population: a French population-based study from Francim network of cancer registries
No full textInternational audienceAlthough cancer stage is a major prognostic factor, there are few studies providing population-based estimated of prostate cancer survival by stage at diagnosis, especially at a national level. Leveraging from a large sample of 10,783 cases of prostate cancer diagnosed over the period 2008-2015 from the French network of cancer registries, we provide the first estimates of prostate cancer net survival (NS) by PSA levels for mainland France. These results support that men with more advanced prostate cancers, approached by higher PSA values, had worse survival than men from the general population for the same age and geographical area. However, this group represented only 30 % of the whole cases. In the majority of cases, which are characterized by lower PSA values and probably less advanced cancer, survival rates were similar and even higher to those of men from the general population for the same age and geographical area.La survie par cancer de la prostate en fonction du stade au diagnostic reste peu décrite, surtout au niveau populationnel. A partir d’un échantillon de 10783 cas de cancer de la prostate diagnostiqués entre 2008 et 2015 provenant du réseau français des registres des cancers, nous fournissons les premières estimations de la survie nette par taux de PSA, comme proxy du stade, pour la France métropolitaine. Ces résultats confirment que seuls les cas avec des valeurs de PSA plus élevées avaient une survie plus faible que les hommes de la population générale de même âge et vivant dans la même zone géographique. En effet, pour environ 70 % des cas, avec des valeurs de PSA plus faibles et un cancer probablement moins avancé, les taux de survie étaient similaires voire meilleurs que ceux attendus chez les hommes de la population générale de même âge et même zone géographique
Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making
No full textInternational audienceObjectives To assess the effects of and related evidence certainty of interventions for attention deficit/hyperactivity disorder (ADHD) across an individual’s lifespan, and to develop a continuously updated web platform for people with lived experience of ADHD as a method to disseminate living evidence synthesis for shared decision making.Design Umbrella review and platform for shared decision making.Data sources Six databases from inception to 19 January 2025. Study authors were contacted for additional information when necessary.Eligibility criteria for selecting studies Systematic reviews that used meta-analyses of randomised controlled trials were eligible if they compared a drug or non-drug intervention with a passive control in individuals with a diagnosis of ADHD. Primary outcomes were severity of ADHD symptoms, analysed by rater type (clinician-rated, parent-rated, teacher-rated, or self-rated) and time point (short term (12 weeks, or study endpoint), medium term (26 weeks), and long term (52 weeks)),acceptability (participants dropping out for any reason), and tolerability (participants dropping out owing to any side effects). Secondary outcomes included daily functioning, quality of life, comorbid symptoms, and key side effects (decreased sleep and appetite).Data synthesis Eligible meta-analyses were re-estimated with a standardised statistical approach. Methodological quality was assessed using AMSTAR-2. Evidence certainty was evaluated using an algorithmic version of the GRADE framework, adapted for drug and non-drug interventions.Results 115 of 414 full text articles were deemed eligible and 299 were excluded; the eligible articles comprised 221 unique combinations of participants, interventions, comparators, and outcomes. For each combination, the most recent and methodologically robust meta-analysis was selected for re-estimation, which gave 221 re-estimated meta-analyses in total, derived from 47 meta-analytic reports. In the short term, alpha-2 agonists, amphetamines, atomoxetine, methylphenidate, and viloxazine showed medium to large effect sizes in reducing the severity of ADHD symptoms in children and adolescents, with moderate to high certainty evidence. Methylphenidate showed consistent benefits across raters (standardised mean difference >0.75, 95% confidence interval (CI) 0.56 to 1.03; moderate or high certainty evidence). These interventions showed lower tolerability than the placebo, but this effect was not significant for methylphenidate and atomoxetine. In adults, atomoxetine, cognitive behavioural therapy, methylphenidate (and, when restricting analyses to high quality trials, amphetamines) showed at least moderate certainty evidence of efficacy on ADHD symptoms, with medium effect sizes. Methylphenidate, amphetamines, and atomoxetine had worse tolerability than placebo (methylphenidate, risk ratio 0.50, 95% CI 0.36 to 0.69; amphetamines, 0.40, 0.22 to 0.72; atomoxetine, 0.45, 0.35 to 0.58). Some non-drug interventions (acupuncture and cognitive behavioural therapy in children and adolescents, and mindfulness in adults) showed large effect sizes for ADHD symptoms, but with low certainty evidence. No high certainty, long term evidence was found for any intervention. An online platform showing effects and evidence certainty of each intervention across age groups, time points, and outcomes (https://ebiadhd-database.org/) was developed.Conclusions This review provides updated evidence to inform patients, practitioners, and guideline developers how best to manage ADHD symptoms. The online platform should facilitate the implementation of shared decision making in daily practice
DASS-21 Stress, but Not Anxiety or Depression, Is Associated with Premenstrual Stress
No full textInternational audienceBackground/Objectives: Most women experience premenstrual symptoms. We examined how the eleven DSM-5 premenstrual symptoms relate to concurrent indicators of psychological distress. Methods: In this retrospective cross-sectional study, 847 participants completed a premenstrual symptom checklist and the DASS-21 between 2011 and 2021. Associations between each DSM-5 premenstrual symptom and DASS-21 depression, anxiety, and stress scores were estimated using univariable and multivariable models, adjusting for the other two DASS-21 subscales and prespecified confounders. Results: Eight of the eleven premenstrual symptoms, loss of interest, impaired concentration, depressed mood (p < 0.01), loss of control, anxiety, sleep disturbance, emotional lability, and irritability (p < 0.05), were independently associated with higher DASS-21 stress scores. After adjusting for stress, no associations were observed with DASS-21 anxiety or DASS-21 depression. Conclusions: In this sample, stress was the principal psychological correlate of multiple premenstrual symptoms. These findings indicate co-occurrence rather than causation: the cross-sectional design does not establish directionality, and the observed patterns are compatible with several possibilities (such as stress contributing to, resulting from, or sharing common determinants with premenstrual symptoms). The lack of independent associations with DASS-21 anxiety and depression suggests these symptoms are not merely concurrent expressions of acute anxiety or depressive states. Prospective longitudinal studies are needed to test causal pathways
High risk, low rest: a new framework for monitoring sleep vulnerability in emergency medicine
No full textInternational audienceBackground Shift work in emergency care settings disrupts circadian rhythms and sleep, increasing health risks and performance. A key aspect of addressing these challenges lies in predicting the burden of shift work to develop safer schedules. This study introduces the Shift Load Index (SLI) as an advanced and sensitive metric for quantifying recovery constraints and examined its association with objective sleep outcomes in emergency healthcare professionals. Methods A two-phase observational field study was conducted with 72 nurses and physicians from two French emergency departments. In the theoretical validation phase, 140 work shifts were analyzed using the SLI and compared to validated FAID Quantum fatigue scores. In the behavioral validation phase, weekly actigraphy data from 35 participants were analysed to assess time in bed, total sleep time, and Sleep Regularity Index (SRI). We employed generalized linear mixed-effects models to assess the association of SLI with sleep outcomes. Results SLI scores significantly predicted FAID Quantum scores (all p < 0.001). Emergency healthcare professionals obtained on average 6h 09 min of sleep for 8h09min in bed, with irregular sleep patterns (mean SRI = 52%). Higher SLI scores were associated with reduced time in bed ( β = −33.19, p < 0.001), shorter sleep ( β = −18.30, p < 0.001), and lower SRI ( β = −1.06, p < 0.001). SRI and total sleep time, as independent factors, together explained 48% of SLI variance (including random effects, 18% by fixed effects only). Discussion Higher shift load is associated with both reduced sleep quantity and regularity. The SLI provides a useful tool to assess recovery burden, with potential applications in optimizing shift schedules and informing fatigue risk management strategies for emergency healthcare professionals