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Determinants of successful completion and short-term benefits associated with temporary alcohol abstinence during Dry January in France: A prospective cohort study
No full textInternational audienceObjective: Temporary alcohol abstinence campaigns (TAAC), such as Dry January, aim to encourage behavioural change in the general population. Despite its popularity, a comprehensive evaluation of the French version has not yet been conducted. This prospective study aimed to identify characteristics associated with successful completion of the challenge (i.e., remaining alcohol-free throughout January), and to assess improvements in drinking refusal self-efficacy, sleep quality, and mental and physical health.Methods: A sample of 2123 French adults participating in Dry January 2024 completed both a baseline and a one-month follow-up questionnaire online. A broad range of variables were assessed, including demographic and contextual factors, alcohol use patterns and motives, drinking refusal self-efficacy, and health-related outcomes.Results: Key factors positively associated with successful completion included previous participation, registration, and higher baseline self-efficacy in resisting alcohol in social situations. Among registrants, greater engagement with support emails significantly increased the likelihood of abstinence. In contrast, smoking and identifying one's drinking as excessive were linked to lower odds of completion. The campaign was associated with improvements in drinking refusal self-efficacy, mental well-being, sleep quality, and physical health - particularly among participants who completed the full month without alcohol.Conclusions: This study offers the first evaluation of the French version of Dry January, highlighting the factors influencing challenge completion and short-term benefits of participation. The findings add support to the value of TAAC as scalable and impactful public health tools and underscore the importance of tailored support strategies to maximize participant success and behavioural change
Contemporary neoadjuvant strategies for rectal cancer: The GRECCAR snapshot study
No full textInternational audienceAim Neoadjuvant treatment for rectal cancer has evolved markedly with the growing adoption of total neoadjuvant therapy ( TNT ), organ‐preservation strategies and selective omission of radiotherapy. Recent trials support risk‐based personalization, but its application in real‐world settings remains poorly documented. The aim was to describe current neoadjuvant treatment practices for mid‐low rectal cancer in French expert centres and identify tumour‐ and patient‐related factors influencing decisions. Method This observational study included patients with non‐metastatic rectal adenocarcinoma ≤10 cm from the anal verge, discussed in tumour boards (October 2022 to March 2023) across GRECCAR centres. Tumours were classified as early, intermediate‐risk or locally advanced rectal cancer (LARC). Neoadjuvant treatments were analysed according to tumour extension, location and age. Results Among 463 patients from 27 centres, the most frequent regimen was induction chemotherapy, mainly FOLFIRINOX, followed by long‐course chemoradiotherapy (CRT) (65%). This approach was used in 51%, 66% and 71% of patients in the early, intermediate‐risk and LARC groups, respectively ( p = 0.0060). TNT was more frequently administered for low‐ than mid‐rectal cancers, especially in LARC (86% vs. 71%, p = 0.016). In patients >75 years, CRT + consolidation chemotherapy and radiotherapy alone were proportionally more frequent. Among the early rectal cancers, those treated with induction chemotherapy + CRT had more advanced features than those treated with CRT alone (cT3: 80% vs. 43%, cN+: 62% vs. 10%, tumour size: 3.4 vs. 2.3 cm; all p < 0.001). Conclusion TNT with induction chemotherapy is the predominant neoadjuvant approach in French expert centres. Tumour classification, location and patient age significantly influence treatment choices, reflecting a shift towards personalized context‐specific care
Robotic total knee arthroplasty with functional positioning safely addresses major coronal deformities: Comparable complications and survivorship
No full textInternational audienceAbstract Purpose Robotic‐assisted total knee arthroplasty (TKA) has emerged as a reliable strategy to improve surgical accuracy and enable functional alignment (FA), also referred to as functional knee positioning (FKP). However, its application in patients with major coronal plane deformities remains under‐investigated. This study aimed to evaluate complication rates, implant survival, radiographic outcomes and patient‐reported measures in patients with severe deformities undergoing robotic‐assisted TKA with FA/FKP principles compared to matched controls. Methods A retrospective comparative study was conducted on patients who underwent robotic‐assisted TKA between March 2021 and February 2023 at a single high‐volume centre. Patients with ≥15° varus or ≥10° valgus deformity were included in the study group and matched 1:1 with controls presenting neutral alignment. All procedures used the Mako robotic‐arm‐assisted system with standardised FA/FKP principles. Clinical outcomes included knee society score (KSS), forgotten joint score (FJS‐12), Kujala anterior knee pain scale (AKPS) and range of motion. Radiographic measurements and robotic data were assessed. Complications, reoperations and revision rates were analysed. Results Eighty‐eight patients (44 per group) were analysed, with a mean follow‐up of 2.8 ± 0.9 years. Complication and revision rates were comparable between groups (revision: 2.3% vs. 0%, p = 0.987). Patients with major deformities achieved higher FJS‐12 scores (83.9 ± 20.2 vs. 74.9 ± 19.0, p = 0.040), although the difference did not exceed the minimal clinically important difference (MCID = 9.9). Postoperative mHKA was less neutral in the deformity group (176.8° ± 4.7 vs. 180.0° ± 3.0, p = 0.002), without adverse impact on implant survival. Conclusions Robotic‐assisted TKA performed with FA/FKP principles appears to be a feasible option for patients with severe varus or valgus deformities. Despite residual alignment variability, complication and revision rates remained comparable to standard cases, and patient‐reported outcomes suggested greater perceived functional improvement. Level of Evidence Level III
LUNG CARCINOIDS (Lung Neuroendocrine Tumors).
No full textInternational audienceAbstract This narrative review written by experts aims to provide a comprehensive synthesis of current knowledge and guidelines on lung carcinoids, emphasizing the multidimensional approach required for effective diagnosis and management. The manuscript will: i) Define and classify lung carcinoids in accordance with the latest WHO classification system, and emphasize the importance of molecular markers for precise subtyping; ii) Analyze epidemiological trends, discuss prevalence, incidence, and mortality rates, alongside key risk factors including genetic predispositions (MEN1) and precursor lesions such as diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH); iii) Investigate the etiology and carcinogenesis of lung carcinoids, including insights into the molecular hallmarks and pathways that underlie tumor development and progression; iv) Detail clinical presentations, distinguishing pulmonary symptoms from secretory syndromes (carcinoid syndrome and Cushing’s syndrome), supported by visual aids to elucidate symptom prevalence and implications; v) Present an integrated diagnostic approach, encompassing state-of-the-art imaging modalities (CT, MRI, 68Ga-SSA-PET-CT) and advanced molecular pathology techniques; vi) Outline evidence-based treatment strategies, addressing early-stage interventions, systemic therapies, locoregional therapies, and emerging modalities such as immunotherapy and agnostic approaches; vii) Explore the role of multidisciplinary management, highlighting the critical importance of tumor boards dedicated to lung carcinoids and provide a checklist of key items for comprehensive case discussion and decision-making; viii) Conclude with future perspectives, identifying gaps in current knowledge and suggest directions for research to enhance diagnosis, treatment, and overall patient quality of life
Identifying high-risk relapse in early-stage I to II ovarian cancer using the CA125 ELIMination rate constant K (KELIM) score: a Gynecologic Cancer InterGroup individual patient-data meta-analysis.
No full textInternational audienceObjective: Despite curative surgery and adjuvant chemotherapy, a significant number of early stage I to II ovarian cancers relapse. The CA125 ELIMination rate constant K (KELIM) is a pragmatic indicator of tumor intrinsic chemosensitivity in advanced epithelial ovarian cancer. We assessed the prognostic value of KELIM in patients with early-stage ovarian cancer, with respect to 5-year recurrence-free survival and overall survival, using the Meta-Analysis in Ovarian Cancer, which is the Gynecologic Cancer InterGroup individual patient-data meta-analysis of randomized trials evaluating different adjuvant chemotherapy regimens.Methods: Individual patient KELIM values were previously estimated in 5884 patients from the Meta-Analysis in Ovarian Cancer. The prognostic value of KELIM was assessed using univariable & multivariable analyses in patients with resected International Federation of Gynecology and Obstetrics stage I and II disease.Results: Overall, 1143 patients were identified, including clear cell (46.7%); serous (23.7%); endometrioid (12.4%); and mucinous carcinomas (3.9%). In multivariable analyses, a favorable KELIM score (≥1.0) was associated with higher 5-year recurrence-free survival (68.3% vs 55.9%; HR 0.61, 95% CI 0.48 to 0.77) and 5-year overall survival (80.7% vs 72.8%; HR 0.50, 95% CI 0.36 to 0.68), as was the histological sub-type. In exploratory analyses, KELIM score was a prognostic factor regarding 5-year recurrence-free survival and overall survival across all sub-types (especially clear cell carcinoma and serous, with HR ranging from 0.45 to 0.63) with baseline CA125 ≥15 IU/L, except for mucinous histology.Conclusions: The pragmatic KELIM score is an independent prognostic factor in patients with a non-mucinous stage I to II ovarian cancer optimally resected and treated with adjuvant chemotherapy. KELIM may help identify the patients at higher risk of relapse and death requiring closer follow-up or treatment intensification
Cemented Fixation in Arthroplasty for Hip Fractures Does Not Increase Cardiopulmonary Complications: A Secondary Analysis of the HIP ATTACK Trial
No full textInternational audienceBackground Cemented fixation in arthroplasty to treat hip fractures is now widely recommended, but it is not universally used. Some surgeons may feel that the risk of bone cement implantation syndrome and its cardiopulmonary sequalae are too high, in part, because the evidence provides little detail on postoperative myocardial injury and other medical complications after cement use. Questions/purposes We aimed to use data from the HIP ATTACK trial (an RCT in which patients with a hip fracture were randomized to accelerated time to surgery versus normal timing of surgery) for a secondary analysis to answer the following questions on arthroplasty for patients with hip fractures: (1) Are patients who undergo cemented hip arthroplasty for hip fractures more likely to experience cardiopulmonary events than patients who undergo uncemented hip arthroplasty? (2) Are patients who undergo cemented hip arthroplasty for hip fractures more likely to experience myocardial injury, identified by elevated troponin levels, than patients who undergo uncemented hip arthroplasty? Methods We performed a post hoc analysis of the HIP ATTACK trial for a subset of patients who were treated with THA or hemiarthroplasty for a femoral neck fracture because the trial collected postoperative troponin levels to allow us to identify myocardial injury. The HIP ATTACK trial consisted of 2970 patients. We limited our source cohort to the 1049 patients who underwent hip arthroplasty and were not lost to follow-up (four patients who had undergone arthroplasty were lost to follow-up). We excluded two patients with unknown fixation and six patients with “other arthroplasty.” We limited our analysis to femoral neck fractures, which excluded 75 more patients. Of the 966 patients who received hip arthroplasty, 61% (593) had cemented fixation. Patients with cemented fixation were older than patients with cementless fixation (median [IQR] 82 (74 to 88) versus 79 (71 to 86); p = 0.003). Race was self-reported by patients and differed between patients with cemented and cementless fixation. A higher proportion of patients who received cementless fixation had undergone THA (compared with hemiarthroplasty) than patients in the cemented fixation group (24% [91] versus 11% [66]; p < 0.001). We used logistic regression to estimate the association between cement use and a composite outcome consisting of all-cause mortality and various cardiopulmonary outcomes. We included cardiopulmonary outcomes possibly associated with bone cement implantation syndrome; there were only a small number of patients who had only nonsevere outcomes. We had 80% power to detect an OR of ≥ 1.6. We adjusted for all baseline differences between both groups except for anesthesia (as it was not associated with the outcome) and duration of surgery (as it is a function of cement use). Results After controlling for age, sex, race, and relevant comorbidity, we found that cement use was not associated with differences in the composite outcome at 90 days (OR 1.0 [95% confidence interval (CI) 0.7 to 1.4]; p = 0.99) or 1 year (OR 1.0 [95% CI 0.7 to 1.4]; p = 0.95) or with postoperative elevated troponin (OR 1.4 [95% CI 1.0 to 1.9]; p = 0.06) on Day 1. Conclusion There was no difference in cardiopulmonary outcomes among patients with arthroplasty to treat their hip fracture by fixation method. These findings further support the recommendations to use cemented femoral fixation in THA and hemiarthroplasty for patients with hip fractures. Surgeons with limited experience with cemented femoral fixation should familiarize themselves with these skills. Future studies should assess what barriers to cemented fixation exist and how they can be mitigated. Level of Evidence Level III, therapeutic study
Transcatheter valve replacement in carcinoid heart disease: A potential change of paradigm
No full textInternational audienceAbstract OBJECTIVES To evaluate the feasibility and early clinical outcomes of transcatheter valve replacement in high-surgical-risk patients with carcinoid heart disease. Material and methods This study included 15 procedures performed in 9 patients with symptomatic carcinoid heart disease between 2021 and 2025. Valve involvement included the pulmonary valve in 9 cases, the tricuspid valve in 5 cases, and the aortic valve in 1 case. Valve selection (SAPIEN 3, TOPAZ, LUX) was individualized according to anatomical considerations. All 9 patients received intravenous periprocedural octreotide. Outcomes included procedural success, NYHA class, and echocardiographic evaluation of valve and ventricular function. RESULTS Single-valve replacement was performed in 4 patients (2 pulmonary and 2 tricuspid). Double-valve replacement involving the pulmonary and tricuspid valves was performed in 4 patients, and 1 patient underwent triple-valve replacement (aortic, pulmonary, and tricuspid). One high-risk patient required conversion after a tricuspid procedure but ultimately recovered after a prolonged hospital stay. At a median follow-up of 9.9 months (IQR 3.5), all patients showed clinical improvement. One patient developed a transient tricuspid paravalvular thrombus without dysfunction or clinical consequence. Echocardiography demonstrated a reduction in right ventricular diameter. No case of endocarditis was observed. One patient died 4 months post-procedure from tumour progression. CONCLUSIONS This first series of transcatheter valve replacements in carcinoid heart disease suggests that a complete percutaneous approach is feasible, safe, and potentially beneficial. These early results warrant confirmation in larger cohorts with longer follow-up and may represent a paradigm shift in the management of carcinoid valve disease
Evaluating the applicability of ESGO quality indicators in the surgical management of endometrial cancer: Insights from a Francogyn cohort
No full textInternational audienceBackground: Endometrial cancer (EC) is a significant health concern in France, necessitating high-quality surgical care to improve patient outcomes. The European Society of Gynaecological Oncology (ESGO) established quality indicators (QIs) to standardize and improve management.Objective: This study evaluates the applicability of ESGO QIs in a real-world setting across 13 centers in France.Methods: This retrospective multicenter cohort study included 2789 patients surgically treated for EC from 2001 to 2020. Demographic data, surgical techniques, adherence to ESGO QIs and trends over time were analyzed. Key indicators analyzed included multidisciplinary team discussions, pre-operative imaging adequacy, surgical techniques employed, and molecular classifications.Results: All patients were discussed in multidisciplinary meetings. Adequate preoperative imaging was achieved in 80.63 % of cases. Minimally invasive surgery was performed in 66.12 % of early-stage patients, showing a significant year-on-year increase from 12 % in 2001 to 85 % in 2020. Among obese patients, 60.78 % underwent laparoscopic procedures, with a conversion rate to open surgery of 3.57 %. Molecular classification results highlighted 35 % of patients as low risk and 32 % as high risk.Conclusion: Our findings indicate that adherence to actual ESGO QIs has substantially improved the quality of surgical management for endometrial cancer in France, despite some areas requiring further enhancement. A coordinated political approach is essential to address existing barriers and ensure consistent implementation of these quality standards across all centers, ultimately aiming to elevate patient care and outcomes in the French healthcare system
Autoantibodies neutralizing type I IFNs in patients with fulminant herpes simplex virus hepatitis
No full textInternational audienceFulminant viral hepatitis (FVH) is a devastating condition caused by hepatotropic viruses such as hepatitis A virus (HAV), hepatitis B virus (HBV), and HSV-1/2. We studied 149 FVH patients (73 males and 76 females, aged 1–76) for blood autoantibodies (auto-Abs) neutralizing type I interferons (IFNs; IFN-α2, -β, -ω). Six of 16 (37.5%) HSV-triggered FVH patients carried such auto-Abs on admission, including three with a previously known autoimmune disease. These patients contrasted with 133 HAV- (n = 46) or HBV-triggered (n = 87) patients, none of whom had such detectable auto-Abs. Odds ratios for HSV-triggered FVH in individuals with auto-Abs ranged from 35.3 (95% CI: 13.0–96.2; P < 10–7) for those neutralizing only 100 pg/ml IFN-α/ω to 1,895 (CI: 448.5–8,002; P < 10–12) for those neutralizing both IFN-α and IFN-ω at 10 ng/ml. Over one third of HSV-triggered FVH cases in this international cohort were due to preexisting auto-Abs. This finding highlights auto-Abs against type I IFNs as a major determinant of HSV-FVH and paves the way for targeted preventive or therapeutic interventions
Treatment of Transient Hypothyroxinemia of Prematurity Does Not Improve Neurodevelopment at Two Years of Age
No full textInternational audienceABSTRACT Aim Transient hypothyroxinemia of prematurity (THOP) has been associated with suboptimal neurodevelopment. We aimed to assess neurodevelopment in very preterm infants with treated and untreated THOP. Methods This study was a multicentre, cohort study, based on prospectively collected data in four French level III neonatal intensive care units. Infants born before 32 weeks of gestation between 2009 and 2020 who underwent a thyroid function test were included. THOP was defined as low free thyroxine and unelevated thyroid stimulating hormone. Infants were classified as no THOP, treated THOP, and untreated THOP. The primary outcome was suboptimal neurodevelopment at 2 years of age evaluated by clinical examination. Results Three hundred and seventy‐three infants (54% male) born at a median gestational age of 28 weeks of gestation were included. There was no significant difference in neurodevelopment at 2 years of age when comparing the no THOP to the THOP group (Odds Ratio (OR) 1.4, 95% confident Interval (CI) 0.8–2.3) nor when comparing the treated with the untreated THOP group (OR 0.8, 95% CI 0.3–1.9). Results remained unchanged after adjusting for confounding factors. Conclusion In very preterm infants treated THOP was not associated with improved neurodevelopment compared to untreated THOP. Numerous biases could have limited treatment effect