HAL-HCL
Not a member yet
19000 research outputs found
Sort by
Long-term mortality and morbidity after carotid endarterectomy for symptomatic and asymptomatic carotid stenosis
No full textInternational audienceOBJECTIVES: To investigate whether the occurrence of ischemic stroke due to carotid stenosis is a marker of the severity of atherosclerotic disease and of an excess risk of cardiovascular morbidity and mortality, and of all-cause mortality, after carotid endarterectomy. METHODS: Patients who had undergone a carotid endarterectomy (CEA) from June 2015 to august 2016 were included. Patients were classified into two groups, namely symptomatic and asymptomatic. Neurological event, myocardial infarction and death during early follow-up were monitored. Major adverse cardiovascular events (MACE), major limb events (MALE), and all-cause mortality were compared for patients with a CEA for an asymptomatic carotid stenosis versus those with a symptomatic stenosis. RESULTS: Among the 190 patients included, 86 (51%) had a CEA for an asymptomatic stenosis and 84 (49%) for a symptomatic stenosis. During the first 30 days, the rate of all-cause death or ischemic stroke was similar in both groups (1%, p=0.986). After 30 days, there were a total of 35 MACE (21.3%) and 15 MALE (9.1%) during mean follow-up of 53 (22.6) months. Overall cardiovascular morbidity and mortality was 30.4%, and did not differ between groups (p=0.565). New ischemic stroke occurred in 11 patients (9.1%) and was significantly more frequent in the asymptomatic group (9 (14.8%) vs 2 (3.6%) in the symptomatic group, (OR: 4.96; CI 95% [1.04-23.77]; p = 0.013)). Overall all-cause mortality was 24% in both groups (p=0.93) CONCLUSION: The occurrence of ischemic stroke of carotid origin prior to revascularization does not appear to be associated with an excess risk of cardiovascular morbidity or mortality or all-cause mortality after surgery
Characteristics of Human Metapneumovirus Infection Compared to Respiratory Syncytial Virus and Influenza Infections in Adults Hospitalized for Influenza-Like Illness in France, 2012–2022
No full textInternational audienceBackground: We aimed to compare the characteristics of human metapneumovirus (hMPV) infection with influenza A and B virus (FLUV) and respiratory syncytial virus (RSV) infections in adults hospitalized with influenza-like illness (ILI).Methods: We conducted a post hoc analysis of adult patients hospitalized with community-acquired ILI who were enrolled in the FLUVAC study at 5 French referral hospitals from 2012 to 2022.Results: At least 1 respiratory virus was detected in 3620 of 6618 patients (55%), including FLUV (1524/3620 [42%]), RSV (248/3620 [7%]), and hMPV (162/3620 [5%]). hMPV+ patients, when compared to FLUV+ patients were more likely to develop at least 1 complication (60% [86/143] vs 50% [716/1435]; P = .02), especially acute heart failure, which occurred twice as often in hMPV+ during the hospital stay (22% [32/143] vs 11% [160/1434]; P < .001). The rates of respiratory (30% [43/143] vs 32% [70/216]; P = .73) or cardiac (22% [32/143] vs 15% [33/216]; P = .09) complications did not differ between hMPV+ and RSV+ patients. The in-hospital all-cause death rate was similar among all 3 populations (4% hMPV+, 4% FLUV+, and 5% RSV+).Conclusions: Hospitalized hMPV infections affect older patients with multiple chronic conditions who face frequent cardiac and pulmonary complications during hospitalization more frequently than with influenza and similar to RSV
Expert consensus‑based clinical practice guidelines for nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP)
No full textInternational audienceThe objective of this work was to develop guidelines for nutritional support in critically ill adults and children (excluding neonates and burn patients) unable to maintain an adequate oral intake. We aimed to provide up-to-date recommendations based on high-level evidence including the results of recent landmark randomized controlled trials. Experts from the French Intensive Care Society (SRLF), the French Society of Clinical Nutrition and Metabolism (SFNCM), and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP) used the GRADE methodology to develop the guidelines. Twenty-four Patient Intervention Comparator Outcome (PICO) questions were identified, resulting in 34 adult and 29 pediatric recommendations. Of the 34 recommendations for adults, three were based on high-level evidence, 12 on moderate-level evidence, and 19 on expert opinion. The corresponding numbers for the 29 pediatric recommendations were one, five, and 23. All recommendations achieved strong agreement among the experts. These guidelines emphasize the importance of individualized nutritional support strategies that incorporate recent high-quality evidence to optimize the outcomes of critically ill patients
Mast cells act as pro-angiogenic and pro-tumorigenic players in pituitary gonadotroph tumors
No full textInternational audienceAbstract Background The tumor microenvironment (TME) represents a promising avenue to understand gonadotroph tumors and develop therapeutic tools. Here, we aimed to gain insight into the tumorigenesis mechanisms driven by the gonadotoph TME. Methods Single-cell and spatial-omics were combined with histological analysis. Mice engrafted with tumor cells were used for functional validation. Results using single-cell and spatial transcriptomic data from gonadotroph tumors and normal tissues, we identified mast cells in the microenvironment of gonadotroph tumors and confirmed their physical and functional interaction with endothelial cells. Quantification of mast cells in 40 patients suggested their pro-tumoral role as tumors relapsing after surgery harbored more mast cells. More interestingly, the distribution of mast cells was associated with the presence of a higher number of blood vessels, with an increased microvessel density (MVD), and with blood vessels with thicker walls. Ligand-receptor network analysis highlighted VEGFA as a modulator of mast/endothelial cell communication, a result confirmed by the identification of intratumoral mast cells expressing VEGFA in mouse and human gonadotroph tumors. Finally, using mice engrafted with gonadotroph tumor cells, we demonstrated that the depletion of mast cells reduces tumor volume through increased apoptosis. These observations were associated with increased hemorrhagic areas and a significant reduction of the number of blood vessels and MVD as evidenced in human gonadotroph tumors. Conclusion we demonstrate that mast cells represent a new actor of the gonadotroph TME, and highlight their pro-angiogenic and pro-tumorigenic roles as potential targets for the therapeutic treatment of gonadotroph tumors
Incidence of nosocomial pneumonia in two intensive care units of a French University Hospital from 2016 to 2022 in the era of COVID-19 pandemic
No full textInternational audienceBackground: Hospital-Acquired Pneumonia (HAP) are common in intensive care units (ICUs). The COVID-19 pandemic led to a global increase in healthcare-associated infections (HAI) among ICU patients. The aim of this study was to evaluate the trends in HAP incidence over a seven-year period of surveillance in two ICUs at a French University Hospital, and to assess the impact of COVID-19 (as well as the associated bacterial ecology).Methods: A prospective surveillance of HAI in ICUs was conducted during the 1st quarter of each year between 2016 and 2022 (2020: reference year). Socio-demographic, clinical and bacteriological data were collected and the incidence of HAP was calculated. Poisson regressions were done and crude and adjusted incidence rate ratio were calculated.Results: 1,797 patients were included, with 61.3% of male and a median age of 67 years. The median duration of intubation was 4 days (7 days in 2021 and 5 days in 2022). The proportion of COVID-19 patients was 45.7% in 2021 and 24.1% in 2022. Compared to 2020, the incidence of HAP increased in both 2021 [cIRR: 2.34 (95%CI: 1.30-4.23) and aIRR: 2.26 (95%CI: 1.25-4.08)] and 2022 [cIRR: 1.79 (95%CI: 0.97-3.32) and aIRR: 1.66 (95%CI: 0.90-3.07)]. The most commonly identified microorganisms were Enterobacteriaceae (42.4%), with a significantly higher incidence of HAP due to Enterobacteriaceae in COVID-19 patients.Conclusions: These results indicate an increase of HAP incidence in 2021 and 2022, mainly caused by Enterobacteriaceae in COVID-19 patients. This trend needs to be confirmed or refuted in the post-pandemic era
DiCART TM device to measure capillary refill time: a validation study in patients with acute circulatory failure
No full textInternational audienceCapillary Refill Time (CRT) is a valuable metric to assess cutaneous perfusion. Its prognostic value in patients with acute circulatory failure has been reported as improved when the measurement is standardized. The DiCART™ device is a fully automated CRT measurement tool requiring validation. We conducted a comparative interventional single-center study including 25 patients with acute circulatory failure, to evaluate the agreement between CRT measured by an automated measurement device (CRTDiCART) and CRT measured clinically (CRTCLIN). CRT was measured on the fingertip, chest, and knee. Three measurements were performed at each location to obtain an average for each site. The measurements were conducted both clinically and using the DiCART™ device by two different operators, each blinded to the results. Agreement was determined using intraclass correlation coefficient (ICC) and Bland and Altman analysis. The ICC between CRTCLIN and CRTDiCART was 0.46 (95% Confidence Interval (CI) 0.32, 0.59) across all measurement sites; the mean bias was 0.23s (95% CI -0.17, 0.64), with upper Limit of Agreement (LoA) 2.77s (95% CI 2.44, 3.20) and lower LoA - 2.30s (-2.73, -1.97). Intra observer ICC was 0.85 (95% CI 0.74, 0.91) for CRTCLIN and 0.43 (95% CI 0.15, 0.64) for CRTDICART. Inter observer ICC was 0.86 (95% CI 0.76, 0.92) for CRTCLIN and was 0.41 (95% CI 0.14, 0,63) for CRTDICART. The DiCART™ device showed poor agreement with clinical CRT in patients with acute circulatory failure, which does not support its use in routine practice
Meniscal tear analysis in anterior cruciate ligament rupture: A retrospective comparison of early versus delayed intervention
No full textInternational audienceIntroduction: Combined anterior cruciate ligament (ACL) and meniscal tear patterns and their effect on knee stability have been widely researched, however, their evolution and repairability from time of injury have been scarcely addressed. When addressed with delay, meniscal lesions associated with ACL tears may increase in severity and irreparability. This study aims to investigate the incidence, rate and pattern of meniscus tears in the context of ACL deficient knees and to assess the meniscal condition in early versus late ACL reconstruction (ACLR). The hypothesis was that an increased time between trauma and ACLR was associated with different meniscal tear patterns. Material and Methods: Between 2012 and 2022, ACL reconstruction was performed in 1,840 cases. Out of the reviewed 1,317 ACLR’s 726 exhibited concomitant meniscal lesions. The mean age was 32 years ±10. Meniscal tear status was evaluated during arthroscopy according to the ISAKOS classification. Patients were divided into 2 groups according to injury-to-surgery time: 2 months (610; 84%). Results: Vertical meniscal lesion was the prevalent pattern regardless of the meniscus involved and the time from injury to ACLR, accounting for 50 to 76% of the patients. No significant difference was found comparing patterns rates between early and delayed treatment groups for both compartments. There was a significant difference in the distribution of circumferential areas of meniscal tears when comparing the medial with the lateral compartment. However, no significant difference in circumferential distribution of medial or lateral meniscus tears are present when performing surgery within or beyond 2 months. Conclusion: There was no difference in meniscal tear patterns between early and delayed ACLR. The most frequent meniscal tear pattern was the vertical tear. No difference was found in circumferential distribution of meniscal tears between early and delayed ACLR. However, the circumferential distribution of meniscal tears was different comparing medial and lateral meniscus
Economic Burden and Healthcare Trajectories of Patients Awaiting Heart Transplantation in a French Tertiary Center
No full textInternational audienceHeart transplantation (HT) is the gold standard treatment of end-stage heart failure, but organ shortage remains a challenge. This retrospective cohort study assesses the economic burden and healthcare pathways of patients awaiting HT in a French tertiary center. Direct healthcare resources were collected and valued, and a state sequence analysis was performed. Ninety-two adult patients were included, with 67 (73%) undergoing HT within a median waiting time of 2 months. The mean cost per patient was €21,324.05 with an average of 2.71 hospitalizations. Four clusters were identified. Type 1 patients (n = 43) underwent HT within 1 month, with a mean cost of €5,820.12 per patient. Only 4 (25%) Type 2 patients (n = 16) underwent HT within 30 months, as they were not prioritized for HT, with a mean cost of €22,285.32 per patient. Type 3 patients (n = 20) underwent HT within 10 months, but incurred higher costs (€27,541.11) compared to Type 2 patients over a shorter period. Despite high transplant priority, Type 4 patients (n = 13) died before HT within 3 months, with a mean cost of €61,858.45 and 3 hospitalizations. This work highlights the economic burden of organ shortage. The use of novel heart preservation devices (such as ex-vivo perfusion systems) could help to expand the donor pool and alleviate this burden, but these aspects need to be further investigated
