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Clinical impact of congestion in patients admitted for cardiogenic shock
No full textInternational audienceBackground: Recent guidelines have proposed dichotomizing acute heart failure and cardiogenic shock phenotypes based on signs/symptoms of hypoperfusion/congestion. Aim: We aimed to assess the prognostic significance of congestion and its early evolution during the first 24 hours in a nationwide cardiogenic shock cohort. Methods: FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. Patients were classified as cold and wet or cold and dry according to congestive signs. Death at 30 days was analysed according to baseline phenotype.Results: Among 593 patients with cardiogenic shock included, 70.7% were male; the median age was 67.0 (58.0-77.0) years, and 521 patients (87.9%) presented with congestion. Congestive patients had higher rates of previous cardiac disease (60.5% vs. 43.1%; P < 0.01) and chronic kidney disease (24.2% vs. 12.5%; P = 0.04). No differences were found regarding Society for Cardiovascular Angiography and Interventions class distribution and lactate concentrations. Congestion was associated with an increased 30-day all-cause death rate (hazard ratio: 1.99, 95% confidence interval: 1.05-3.78; P = 0.04), particularly among patients with persistent congestion beyond 24 hours (hazard ratio: 2.29, 95% confidence interval: 1.20-4.36; P = 0.01). Conversely, patients with resolved congestion at 24 hours had similar outcomes to non-congestive patients (hazard ratio: 0.76, confidence interval: 0.31-1.88; P = 0.56). The negative impact of congestion was confirmed in multivariable Cox regression analysis. Conclusions: Congestion and its persistence beyond 24 hours of management are frequent in patients with cardiogenic shock, and are significantly associated with an increased 30-day all-cause death rate, which may reflect either a direct harmful effect of congestion or difficulties in achieving decongestion in sicker patients. Further studies are warranted to clarify optimal decongestion strategies in patients with cardiogenic shock.</div
Lateral Retinacular Release During MPFL Reconstruction: A Randomized Clinical Trial
No full textInternational audienceBackground: Reconstruction of the medial patellofemoral ligament (MPFL) has become the gold standard treatment for patellofemoral instability. A lateral retinacular release (LRR) may be performed in conjunction with MPFL reconstruction (MPFLR); however, its effect on outcomes is unclear. Purpose/Hypothesis: This study aimed to evaluate the effect of LRR on the outcomes of MPFLR. It was hypothesized that isolated MPFLR would not be inferior to MPFLR with LRR in terms of the subjective International Knee Documentation Committee (IKDC) score and patellar tilt (PT). Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients aged 18 to 45 years undergoing MPFLR without associated osseous procedures were randomized to isolated MPFLR or MPFLR with arthroscopic LRR. Outcome measures were subjective IKDC score and PT assessed by computed tomography with the quadriceps relaxed (PTQR) and contracted (PTQC). Results: Out of 140 patients randomized and included, 3 were excluded from analysis because of the performance of unexpected osseous procedures or the use of a graft other than a gracilis autograft; 9 patients were lost to follow-up; and 3 patients could not complete the study due to medical reasons. A total of 125 patients (89%) were evaluated at a median follow-up of 36 months (range, 24-144 months) postoperatively. The mean subjective IKDC score was 78.1 ± 16 (range, 29-98) in the MPFL + LRR group and 80.7 ± 15 (range, 33-100) in the Isolated MPFL group ( P = .309). Postoperatively, the PTQR was 20.9° ± 9.1° in the LRR group and 17.3° ± 7.2° in the isolated MPFL group ( P = .097). The PTQC was 24.4° ± 10° in the MPFL + LRR group and 21.5° ± 8.9° in the isolated MPFL group ( P = .149). Three complications were noted in each group. Conclusion: Routine performance of LRR in association with MPFLR in the absence of bony procedures does not lead to improved patient-reported outcomes or significant alteration of the PT. Study Registration: ClinicalTrials.gov NCT01719666
Surgical approach does not influence instability risk in primary total hip arthroplasty with monobloc dual mobility cup
No full textInternational audienceBackground: The impact of the surgical approach on the risk of dislocation in total hip arthroplasty (THA) remains controversial, particularly when monobloc dual mobility cups (DMCs) are used. This study aimed to compare dislocation and complication rates between the postero-lateral and direct anterior approaches with a DMC in primary elective THA, based on data collected from a single center.Methods: Between 2010 and 2022, 1,378 consecutive primary THAs were performed using a monobloc DMC. There were 824 performed by direct anterior approach (DAA) and 554 by postero-lateral approach (PLA). Exclusion criteria were cemented implants, patients treated for femoral neck fracture, developmental hip dysplasia, osteosynthetic complications, and follow-up of less than one year. Complications and revisions were analyzed retrospectively. The mean follow-up was 39 months (range, 12 to 157).Results: There was no statistically significant difference between the risk of dislocation with the anterior approach (n = 0; 0%) compared with the posterior approach (n = 2; 0.4%) (P = 0.16). There were more major complications, such as femoral fractures, in the PLA group in an older, more overweight, and higher ASA (American Society of Anesthesia) score population.Conclusion: In total hip arthroplasty using monobloc dual-mobility cups, the dislocation rate with the postero-lateral approach is no higher than with the direct anterior approach. The low incidence of dislocations in this large cohort supports the benefits of using monobloc DMCs
Comment je fais…pour sécuriser et faciliter l’extraction de l’utérus au cours d’une hystérectomie cœlioscopique
No full textInternational audienc
Human PrP E219K as a new and promising substrate for RT-QuIC amplification of human prion strains: a first step towards strain discrimination
No full textSummary Prion diseases are fatal neurodegenerative diseases that affect mammals through the transconformation of a host protein, the prion protein (PrP), into a toxic and pathogenic conformer termed PrP Sc . Until now, the diagnosis is only confirmed with a post-mortem histology study of the central nervous system. Among the methods to detect the etiological agent, in vitro amplification techniques have emerged as very sensitive, highly specific and rapid tools, even though some prion strains remain refractory or difficult to amplify. Here we report the use of a new recombinant substrate for Real-Time Quaking Induced Conversion (RT-QuIC), a natural polymorphism of human prion protein with a lysine at position 219 instead of a glutamic acid, PrP E219K. This substrate amplifies the six sporadic human strains responsible for Creutzfeldt-Jakob Disease (CJD) and the strain responsible for its variant form in a few hours and over a large dilution range of the seeds. Moreover, based on the lag time of the amplification reactions, the PrP E219K substrate allows to discriminate between sporadic and variant CJD strains, a first step towards an ante-mortem typing of the prion strain affecting a patient
Fluocinolone acetonide 0.2 μg/day intravitreal implant in non-infectious uveitis affecting the posterior segment: EU expert user panel consensus-based clinical recommendations ( vol 14, 22, 2024)
No full textInternational audienc
Efficacy and safety of multiple fluocinolone acetonide implants in diabetic macular oedema: comparison between first and second intravitreal injections
No full textDetection, evaluation and management of the sequelae of infectious encephalitis in adults
No full textInternational audienc
Temporal Evolution of Functional Immune Reconstitution after Allogeneic HSCT
No full textInternational audienceImmune reconstitution (IR) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently monitored by measuring the absolute number of immune effectors. However, this approach does not capture functional immune capacities. In this study, we aimed to evaluate the temporal evolution of functional IR alongside traditional immune cell count measurements. Whole-blood stimulation with TruCulture tubes (Myriad Rbm, Austin, TX, USA) containing lipopolysaccharides or staphylococcal enterotoxin B was performed on 55 allo-HSCT recipients at 6 and 12 months post-transplant, and on 10 healthy volunteers. The expression of 144 immune-related genes was quantified using NanoString technology (NanoString Technologies, Seattle, WA, USA) . The temporal follow-up of functional immune profiles was analyzed over time according to demographics, clinical characteristics, and immune cell counts. The evaluation of IR in allo-HSCT recipients up to 12 months post-transplant showed a significant discrepancy between quantitative and qualitative assessments. While immune cell counts improved, eg. the proportion of recipients reaching normal CD4 + T cell values, increasing from 25% to 46%, transcriptomic profiles showed persistent functional alterations. More than 78% of less-induced genes observed at 6 months still exhibited a reduced expression at 12 months post-transplant. Transcriptomic immune profiling divulged diverse functional outcomes linked to clinical characteristics, which were not reflected by cell count assessments alone. Herein, we emphasize that quantitative assessment of immune effectors alone is not informative enough to classify allo-HSCT recipients regarding functional immune capacity. Our findings highlight the value of implementing immune functional</div
Peripheral neuropathy during long-term suppressive therapy with tedizolid: a case series
No full textInternational audienceAbstract Background and objectives Due to its potentially better long-term haematologic tolerance compared to linezolid, tedizolid represents an attractive option for prolonged antibiotic therapy in complicated/chronic Gram-positive infections. However, there is little information regarding the risk of peripheral neurological toxicity, representing another obstacle to the extended use of oxazolidinones. Reporting neurologic adverse events occurring during tedizolid therapy for chronic implant-associated infections. Patients and methods Patients experiencing tedizolid-associated neurologic adverse events were retrospectively described in a case series. Results Five patients (four males; age range, 65–75 years) receiving tedizolid (200 mg q24h) as long-term suppressive therapy for chronic implant-associated infection presented with peripheral neuropathy. In four cases, tedizolid was used after discontinuation of linezolid for toxicity, including one case of neuropathy. Three had at least one additional risk factor for neuropathy (including two diabetes, one of them with diabetes-related nephropathy). Neuropathic symptoms [paraesthesia (n = 2), worsening of pre-existing neuropathy (n = 2), dysesthesias (n = 1)] appeared after a median of 12.4 (IQR, 8.2–13.3) months of tedizolid treatment. Electromyoneurography (EMNG) confirmed axonal sensory polyneuropathy in all but one patient for which EMNG was still within normal ranges, but compatible with incipient neurotoxicity. Tedizolid was stopped in all patients, three patients required specific treatment for neuropathic pain. At last follow-up [2.4 (IQR, 1–2.5) years from tedizolid discontinuation], clinical recovery from neuropathy was noted in three patients. The two patients with persistent neuropathy symptoms were diabetic; one showed EMNG improvement. Conclusions Prolonged used of tedizolid may be associated with peripheral neurologic toxicity, which should be monitored in at-risk patients