HAL-HCL
Not a member yet
19000 research outputs found
Sort by
Addressing the Global Challenge of Nitrous Oxide Misuse Through a Multidisciplinary Approach: Example of the PROTOSIDE Network
No full textInternational audienceNitrous oxide (N2O) was originally used for medical and industrial purposes, but its recreational use has dramatically increased, raising a major global public health concern. Chronic inhalation is associated with neurological, metabolic, and psychiatric complications, as well as addiction. To address these challenges, the PROTOSIDE network was developed to provide a multidisciplinary approach to management and prevention. This initiative relies on competence centers integrating specialists in emergency medicine, neurology, clinical biochemistry, and addiction medicine. PROTOSIDE aims to standardize diagnostic protocols, optimize patient care pathways, and strengthen addictovigilance. A strong emphasis is placed on prevention, including awareness campaigns and collaboration with healthcare professionals and educators. By facilitating access to advanced biochemical analyses (homocysteine, methylmalonic acid) and promoting international guidelines, PROTOSIDE represents an innovative model for a global response to N2O misuse. This integrated approach enhances clinical management, reduces complications, and harmonizes public health strategies
Coprime dual-velocity encoding for extended velocity dynamic range in 4D flow magnetic resonance imaging
No full textInternational audienceBackground: In the field of cardiovascular imaging, four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) provides non-invasive assessment of blood flow. Dual velocity encoding (dual-VENC) strategies have emerged to obtain quantitative information on both low and high blood flow velocities simultaneously. However, these strategies often encounter difficulties in coping with large velocity ranges. This work presents a dual-VENC 4D flow CMR sequence that utilizes the coprime rule to define the VENC ratio. Methods: A dual-VENC 4D flow CMR sequence and reconstruction algorithm were developed and validated in vitro at two different field strengths, using a flow phantom generating realistic complex flow patterns. A digital twin of the phantom allowed comparison of the MRI measurements with computational fluid dynamics (CFD) simulations. Three patients with different cardiac pathologies were scanned in order to evaluate the in vivo feasibility of the proposed method. Results: The results of the in vitro acquisitions demonstrated significant improvement in velocity-to-noise ratio (VNR) with respect to single-VENC acquisitions (110 ± 3%) and conventional dual-VENC de-aliasing approach (75 ± 3%). Furthermore, the effectiveness of aliasing correction was demonstrated even when both sets of images from the dual-VENC acquisition presented velocity aliasing artifacts. We observed a high degree of agreement between the measured and simulated velocity fields.Conclusion:The strength of this approach lies in the fact that, unlike the conventional de-aliasing method, no data is discarded. The final image is obtained by a weighted average of the VENC low and VENC high datasets. Consequently, setting the value of the VENC high to prevent aliasing is no longer necessary, and higher VNR gains are possible
Steatotic liver disease after pediatric liver transplantation
No full textInternational audienceMetabolic dysfunction–associated steatotic liver disease is becoming an increasingly frequent cause of chronic liver disease in children. It has been reported as a complication of liver transplantation in adults but remains poorly evaluated in liver-transplanted children. The aim of this study was to assess the prevalence and characteristics of steatotic liver disease in a large cohort of liver-transplanted children and to identify factors associated with it. In this single-center study of patients with pediatric liver transplants (n=122) with a median follow-up time of 14.0 years, steatosis was found in 41 protocol biopsies (33.6%). The median time to the discovery of steatosis was 5.0 years posttransplantation, with a median age of 9.0 years at the time of diagnosis. Steatosis was predominantly mild to moderate and tended to resolve spontaneously on subsequent biopsies (48.8% of cases showed resolution). Steatosis mostly corresponded to metabolic dysfunction–associated steatotic liver disease (56.1%), but other patients had cryptogenic steatosis. The study found no association between the presence of steatosis and the immunosuppressive regimen, but a significant association between the onset of steatosis and an older donor age ( p <0.001). Therefore, steatotic liver disease is a noteworthy histological feature during the follow-up of pediatric liver transplant recipients, yet it had a low burden on the health of the patients in this cohort. However, it needs to be monitored in the context of the increasing prevalence of metabolic syndrome
Toxic microbiome and progression of chronic kidney disease: insights from a longitudinal CKD-Microbiome Study
No full textInternational audienceBACKGROUND: The gut microbiota has been linked to non-communicable diseases, including chronic kidney disease (CKD). However, the relationships between gut microbiome composition changes, uraemic toxins (UTs) accumulation, and diet on CKD severity and progression remain underexplored. OBJECTIVE: To characterise relationships between gut microbiome composition and functionality, UTs diet, and CKD severity and progression, as well as assess microbial contributions to UTs accumulation through mice faecal microbiota transplantation (FMT). DESIGN: This study profiled the gut microbiome of 240 non-dialysis patients with CKD (CKD-REIN cohort) using shotgun metagenomics, with follow-up in 103 patients after 3 years, with comparisons with healthy volunteers from the Milieu Intérieur cohort. A multiomics approach identifies features associated with CKD severity (and progression), with validation in an independent Belgian cohort. Experimental models used FMT to test CKD gut microbiome effects on UTs and kidney fibrosis. Changes in gut microbiome over time were evaluated, and the impact of diet on these changes was assessed. RESULTS: Compared with matched healthy controls, patients with CKD exhibited gut microbiota alteration, with enrichment of UT precursor-producing species. Patients with severe CKD exhibited higher UT levels and greater enrichment of UT (precursor)-producing species in the microbiota than patients with moderate CKD. Over time, UT (precursor)-producing species increased, and a plant-based low protein diet appeared to mitigate these changes. FMT from patients with CKD to antibiotic-treated CKD model mice increased serum UT levels and exacerbated kidney fibrosis. CONCLUSIONS: This study highlights the role of the microbiome and UTs in CKD, suggesting a potential therapeutic target to slow disease progression
Intra-operative haemodynamic monitoring and management of adults having noncardiac surgery: A statement from the European Society of Anaesthesiology and Intensive Care
No full textInternational audienceThis article was developed by a diverse group of 25 international experts from the European Society of Anaesthesiology and Intensive Care (ESAIC), who formulated recommendations on intra-operative haemodynamic monitoring and management of adults having noncardiac surgery based on a review of the current evidence. We recommend basing intra-operative arterial pressure management on mean arterial pressure and keeping intra-operative mean arterial pressure above 60 mmHg. We further recommend identifying the underlying causes of intra-operative hypotension and addressing them appropriately. We suggest pragmatically treating bradycardia or tachycardia when it leads to profound hypotension or likely results in reduced cardiac output, oxygen delivery or organ perfusion. We suggest monitoring stroke volume or cardiac output in patients with high baseline risk for complications or in patients having high-risk surgery to assess the haemodynamic status and the haemodynamic response to therapeutic interventions. However, we recommend not routinely maximising stroke volume or cardiac output in patients having noncardiac surgery. Instead, we suggest defining stroke volume and cardiac output targets individually for each patient considering the clinical situation and clinical and metabolic signs of tissue perfusion and oxygenation. We recommend not giving fluids simply because a patient is fluid responsive but only if there are clinical or metabolic signs of hypovolaemia or tissue hypoperfusion. We suggest monitoring and optimising the depth of anaesthesia to titrate doses of anaesthetic drugs and reduce their side effects
Robotic Total Knee Arthroplasty with Functional Alignment Yields Comparable Outcomes Across Age and Gender Groups
No full textInternational audienceObjectives: Age and gender can influence total knee arthroplasty (TKA) outcomes, complications, and revision rates. Functional alignment (FA), a personalized approach guided by robotic systems, has emerged as a strategy to optimize outcomes by addressing patient-specific anatomy and laxities. However, limited evidence exists regarding the influence of age and gender on outcomes of FA-guided robotic-assisted TKA.Methods: This retrospective study evaluated 353 patients who underwent robotic-assisted TKA guided by FA principles with a minimum of 2 years of follow-up. Patients were divided into groups based on age (≥75 years vs. <75 years) and gender (males vs. females). Outcomes assessed included functional scores [Knee Society Score (KSS) and Forgotten Joint Score (FJS)], complications, and revision rates. Coronal alignment was evaluated using pre- and postoperative full-length weight-bearing X-rays and the data from the robotic system.Results: Preoperative clinical and radiographic evaluations showed no statistically significant differences between age groups. Females had more valgus preoperative alignment compared to males. Postoperatively, functional outcomes (KSS and FJS) and coronal alignment were comparable across all groups, with the only exception of the female group which reported statistically significant higher FJS scores (P = 0.02) despite similar KSS scores. Complication and revision rates did not differ in a statistically significant manner between groups.Conclusions: This study demonstrated that robotic-assisted TKA guided by FA yields comparable outcomes, complication rates, and revision rates across gender and age groups. These findings suggest that FA may help reduce demographic disparities by providing consistent outcomes across diverse patient populations
Avis relatif à l’état des connaissances sur la toxicité rénale de l’acide glyoxylique présent dans les produits lissants
No full textAnses. (2025). Avis de l’Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail relatif à l’état des connaissances sur la toxicité rénale de l’acide glyoxylique présent dans les produits lissants. (saisine 2024-AUTO-0079). Maisons-Alfort : Anses, 43 p.Depuis le 1er janvier 2024, l’Anses est en charge des missions de vigilance et d’expertise relatives aux produits cosmétiques et de tatouage, ainsi que des substances que ces produits contiennent.Le 6 janvier 2024, l’Agence a reçu dans le cadre du dispositif de cosmétovigilance, qu’elle met en œuvre au titre de l’article L.5131-12, le signalement d’un cas d’insuffisance rénale aiguë associée à un produit lissant capillaire contenant de l’acide glyoxylique.Compte tenu de :- la sévérité de l’effet indésirable rapporté (insuffisances rénales aiguës récidivantes ayant conduit à plusieurs hospitalisations),- la publication de ce cas par les médecins néphrologues ayant suivi la patiente,proposant un lien de causalité entre cet effet et l’acide glyoxylique,- l’existence de cas similaires rapportés en Israël,l’Anses s’est s’autosaisie afin de mener un état des lieux des connaissances sur la toxicité rénale de l’acide glyoxylique présent dans les produits lissants.Depuis ce premier cas, d’autres cas d’insuffisances rénales aiguës faisant suite à l’application ,d’un produit lissant contenant de l’acide glyoxylique ont été rapportés à l’Anses et analysés.Par ailleurs, l’Académie nationale de médecine a publié le 6 juin 2024 un communiqué relatif aux risques pour la santé du lissage chimique des cheveux [1].Les produits lissants sont des produits cosmétiques, tels que définis dans l’article 2 du règlement (CE) n°1223/2009 relatif aux produits cosmétiques [2]. L’article 3 de ce règlement stipule qu’un produit cosmétique mis à disposition sur le marché doit être sûr pour la santé humaine lorsqu'il est utilisé dans des conditions d'utilisation normales ou raisonnablement prévisibles. Ainsi, avant la mise sur le marché d’un produit cosmétique, l’industrie doit veiller àce que sa sécurité soit évaluée sur la base des informations appropriées.Dans ce cadre réglementaire communautaire, la Commission européenne peut mandater le comité scientifique pour la sécurité des consommateurs (CSSC) pour émettre des avis sur la sécurité de certaines substances cosmétiques. Cette sollicitation peut découler notamment de préoccupations émergeant en matière de sécurité, et conduire à un encadrement par interdiction ou restriction des conditions d’utilisation d’une substance. Dans le cadre de sonanalyse des signalements ci-dessus, l’Anses a constaté que l’acide glyoxylique n’a pas été évaluée par le CSSC et ne fait l’objet d’aucune restriction d’usage.Aussi, cette expertise vise à documenter la nécessité de conduire une évaluation des risques au niveau européen afin de garantir la sécurité des consommateurs, via la mise en place d’éventuelles dispositions réglementaires, telles que l’inscription de l’acide glyoxylique à l’annexe II (substances interdites) ou III (substances avec restrictions d’usage) du règlement susmentionné.[1] https://www.academie-medecine.fr/lissage-chimique-des-cheveux-et-risques-pour-la-sante/[2] « produit cosmétique », toute substance ou tout mélange destiné à être mis en contact avec les partiessuperficielles du corps humain (épiderme, système pileux et capillaire, ongles, lèvres et organesgénitaux externes) ou avec les dents et les muqueuses buccales en vue, exclusivement ouprincipalement, de les nettoyer, de les parfumer, d’en modifier l’aspect, de les protéger, de les mainteniren bon état ou de corriger les odeurs corporelles
CIRCULATING TUMOR DNA FOR MONITORING PRIMARY MEDIASTINAL B‐CELL LYMPHOMA IN COMPLEMENT TO PET: A PROSPECTIVE MULTICENTER LYSA STUDY
No full textInternational audienc
Automatic analysis of negation cues and scopes for medical texts in French using language models
No full textInternational audienceObjectiveCorrect automatic analysis of a medical report requires the identification of negations and their scopes. Since most of available training data comes from medical texts in English, it usually takes additional work to apply to non-English languages. Here, we introduce a supervised learning method for automatically identifying and determining the scopes and negation cues in French medical reports using language models based on BERT.MethodsUsing a new private corpus of French-language chest CT scan reports with consistent annotation, we first fine-tuned five available transformer models on the negation cue and scope identification task. Subsequently, we extended the methodology by modifying the optimal model to encompass a wider range of clinical notes and reports (not limited to radiology reports) and more heterogeneous annotations. Lastly, we tested the generated model on its initial mask-filling task to ensure there is no catastrophic forgetting.ResultsOn a corpus of thoracic CT scan reports annotated by four annotators within our team, our method reaches a F1-score of 99.4\% for cue detection and 94.5\% for scope detection, thus equaling or improving state-of-the art performance. On more generic biomedical reports, annotated with more heterogeneous rules, the quality of the automatic analysis of course decreases, but our best-of-the class model still delivers very good performance, with F1-scores of 98.2\% (cue detection), and 90.9\% (scope detection). Moreover, we show that fine-tuning the original model for the negation identification task preserves or even improves its performance on its initial fill-mask task, depending on the lemmatization.ConclusionConsidering the performance of our fine-tuned model for the detection of negation cues and scopes in medical reports in French and its robustness with respect to the diversityof the annotation rules and the type of biomedical data, we conclude that it is suited for use in a real-life clinical context
Supplémentation quotidienne ou intermittente en vitamine D chez les personnes avec ou à risque d’ostéoporose: Position du GRIO
No full textInternational audienceAdvantages and disadvantages of intermittent versus daily vitamin D supplementation especially in adults with or at risk of osteoporosis are discussed by the Osteoporosis Research and Information Group (GRIO). The analysis of the literature suggests that intermittent long-term high doses vitamin D supplementation (such as 60,000 IU/month or more), may increase the risk of falls, fracture and premature death in certain populations, while daily doses of 800-1000 IU with calcium decrease falls and non-vertebral fractures in the elderly with vitamin D deficiency. In patients with or at risk of osteoporosis we hence recommend measuring the 25(OH)D concentration prior to supplementation and to provide vitamin D supplementation (with optimization of calcium intake if needed) to obtain a concentration between 30 and 60 ng/mL. We recommend the use of an initial loading dose, especially in those who need a quick repletion of vitamin D store (symptoms of osteomalacia and/or 25(OH)D concentration <12 ng/mL, patients eligible for treatment with potent antiresorptive therapy), followed by a maintenance dose. A daily supplementation should be the rule when possible. When daily forms are however not available or not reimbursed, we recommend, like other experts, to continue using intermittent dosing with the smallest available dose (≤ 50 000 IU) and the shortest interval between doses as a stopgap until reimbursement or adequate daily pharmaceutical forms (pills or soft capsules of 1000, 2000 IU) are available.Le Groupe de recherche et d’information sur les ostéoporoses examine les avantages et les inconvénients d’une supplémentation intermittente ou quotidienne en vitamine D chez les adultes atteints ou à risque d’ostéoporose. L’analyse de la littérature suggère qu’une supplémentation intermittente prolongée avec des doses élevées de vitamine D (p. ex. 60 000 UI/mois ou plus) peut accroître le risque de chute, de fracture et de décès prématuré dans certains groupes, tandis que la prise quotidienne de 800 à 1 000 UI, associée à du calcium, réduit les chutes et les fractures non vertébrales chez les personnes âgées présentant un déficit en vitamine D. Pour les personnes atteintes ou à risque d’ostéoporose, nous préconisons donc de mesurer la concentration de 25(OH)D avant de prescrire une supplémentation, et de calculer la dose de vitamine D (avec apport en calcium associé si besoin) de manière à obtenir une concentration de 30 à 60 ng/ml. Nous recommandons de commencer par une dose de charge, en particulier s’il est nécessaire de reconstituer rapidement les réserves de vitamine D (symptômes d’ostéomalacie et/ou concentration de 25(OH)D < 12 ng/ml, personnes éligibles à un traitement antirésorptif puissant), suivie d’une dose d’entretien. Une supplémentation quotidienne est dans la mesure du possible à privilégier. Cependant, si les formes quotidiennes ne sont pas disponibles ou non remboursées, nous recommandons, à l’instar d’autres experts, de poursuivre une administration intermittente avec la plus faible dose possible (≤ 50 000 UI) et l’intervalle le plus court possible entre deux prises, en attendant que des formes pharmaceutiques quotidiennes adéquates (comprimés ou gélules de 1 000 ou 2 000 UI) soient remboursées ou disponibles