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Modulation of dopaminergic transmission and brain activity by frontotemporal tDCS: A multimodal PET-MR imaging study
No full textInternational audienc
Impact of the coronavirus disease 2019 pandemic on acute cardiac care units: A French nationwide observational database study comparing 2020 and 2022
No full textInternational audienceBackground: The coronavirus disease 2019 (COVID-19) pandemic, which began in late 2019, significantly impacted acute cardiac care, particularly in intensive cardiac care units (ICCUs), but extensive details about these changes remain scarce.Aim: By comparing data from the pandemic era (2020) with the postpandemic era (2022), we aimed to understand the extent of changes in intensive cardiac care units as a result of COVID-19.Methods: This observational study included all patients admitted to intensive cardiac care units in France during 2020 and 2022. Data were extracted from the French national hospital discharge database (PMSI), encompassing diagnoses, procedures, demographics and deaths. Multivariable logistic regression was used to assess in-hospital all-cause deaths.Results: Our analysis reveals that patient characteristics, treatments and deaths remained largely stable, with only minor shifts in non-surgical interventions. The overall impact of COVID-19 on intensive cardiac care unit care was limited, contrasting with some literature suggesting more pronounced changes. Smaller centres treated a higher proportion of older patients with heart failure, but had fewer admissions for coronary artery disease, leading to longer hospital stays. The in-hospital death rate remained steady at around 4%, with age and co-morbidities as significant predictors.Conclusions: This study underscores the resilience of intensive cardiac care unit care in France throughout the COVID-19 pandemic, and emphasizes the need for continuous evaluations of resource allocation and care strategies aimed at high-risk populations
Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit
No full textInternational audienceBackground Although shock following cardiac arrest is common and contributes significantly to mortality, the influence of the modalities used to manage the hemodynamic situation, particularly with regard to fluid balance, remains unclear. We evaluated the association between positive fluid balance and outcome after out-of-hospital cardiac arrest (OHCA). MethodsWe conducted a multicenter study from August 2020 to June 2022, which consecutively enrolled adult OHCA patients in 17 intensive care units. The primary endpoint was 90-day survival. Multivariate Cox analysis, propensity score matching and landmark analysis were performed, along with several sensitivity analyses. ResultsOf the 816 patients included in our study, 74% had a positive fluid balance, and 291 of 816 patients (36%) were alive at 90-day. A positive fluid balance was associated with mortality after adjusted multivariate analysis (HR = 1.8 [1.3 -2.3], p < 0.001), after propensity score matching (n = 193 matched patient pairs, HR = 1.6 [1.1 -2.1], p = 0.005) and after landmark analysis. We reported a dose-dependent association between fluid balance and mortality. Patients with a positive fluid balance were more likely to need renal replacement therapy (10% vs. 2%, p = 0.001) and had a lower minimum P a O 2 /F i O 2 ratio in the first seven days (158 vs. 180, p < 0.001). ConclusionsAfter cardiac arrest, a positive fluid balance is consistently associated with a worse outcome. Pending further data, a restrictive fluid therapy strategy may be beneficial in post-OHCA patients.</div
Effectiveness and Safety of a Second JAK Inhibitor in Ulcerative Colitis: The J2J Multicentre Study
No full textInternational audienceBackground While three Janus kinase inhibitors (JAKi) have demonstrated efficacy in ulcerative colitis (UC), scarce data exist regarding JAKi intraclass switching. Aim To evaluate the effectiveness and safety of a second JAK inhibitor in UC. Methods This was a multicentre, retrospective, observational cohort including patients with moderate to severe UC who received a second‐line of JAKi after failure or intolerance of a first. The primary outcome was steroid‐free clinical remission (SFCR) at Weeks 8–14, defined as a partial Mayo score of 2 or less with no individual sub‐score above 1. Results Among the 169 patients from 28 participating centres, 105 received upadacitinib, 54 filgotinib and 10 tofacitinib as a second‐line of JAKi. Overall, 81/169 achieved SFCR at Weeks 8–14: 58/105 with upadacitinib, 18/54 with filgotinib and 5/10 with tofacitinib ( p = 0.03). In the multivariate analysis, upadacitinib was independently associated with higher odds of SFCR than filgotinib (OR = 3.15, 95% CI [1.52–6.79]). With a median follow‐up duration of 96 days, drug persistence at 6 months was 72.8% with upadacitinib, 57.2% with filgotinib and 66.7% with tofacitinib ( p = 0.099). 24.3% of patients (41/169) experienced at least one adverse event leading to treatment withdrawal in 9 patients (5%). No cases of death, cancer, or major acute cardiovascular events were reported. Conclusion A second‐line of JAKi provided clinical remission in about half of patients after induction, and was well tolerated
Effect of gastroenterology resident use of a social network workgroup on skills in characterizing colorectal neoplasia: Prospective study
No full textInternational audienceAbstract Accurate endoscopic characterization of colorectal lesions is essential for predicting histology but remains difficult. We studied the impact of a social network workgroup on level of characterization of colorectal lesions by gastroenterology residents. We prospectively involved residents who characterized 25 and 40 colorectal lesions in two different questionnaires over 1 year. Three groups were considered: regulars who were already part of the workgroup before the first evaluation, newcomers who joined in during evaluation, and reluctant who did not. Participants rated each lesion according to the CONECCT classification (hyperplastic polyp [IH], sessile serrated lesion [IS], adenoma [IIA], high-risk adenoma or superficial adenocarcinoma [IIC], borderline invasive adenocarcinoma [IIC+], or deeply invasive adenocarcinoma [III]) and their progression score over 1 year was assessed. Correct histological status was defined by pathology reports or combined criteria between histology and expert opinion for high-risk adenoma or adenocarcinoma. Of the 117 participants, 82.9% completed the two questionnaires, with 16.5% regulars, 71.1% newcomers, and 12.4% reluctant. For similar starting levels, progression in characterization was +2 (95% confidence interval [CI] 1–3; P <0.001) for newcomers and +2 (95% CI –0.5–4); P = 0.122) for reluctant. The regulars had a higher starting level with a +0.5 (95% CI –2 to 2; P = 0.691) progression score. Gastroenterology resident 1-year use of a social network workgroup does not improve their skills in characterizing colorectal neoplasia. Further intensive training is needed to improve the characterization level of gastroenterology residents
Management of Gram-positive multiresistant bacteria prosthetic joint infection: a narrative review on current and innovative strategies
No full textInternational audienceBackgroundProsthetic joint infection (PJI) is a devastating complication of arthroplasty surgery, mostly caused by Gram-positive pathogens, including Staphylococcus aureus and coagulase-negative staphylococci. Multidrug resistance is of major concern in this setting: (a) it can negatively impact outcome, restricting the use of the most effective antimicrobials; (b) it may influence the choice of surgical strategies; and (c) it restrains the therapeutic options to newly labelled antimicrobials with limited experience in PJI.ObjectivesTo provide a comprehensive overview of the clinical impact of antimicrobial resistance in Gram-positive PJI and on current and innovative therapeutic strategies.SourcesThe review is based on PubMed searches for relevant topics, including multiresistant staphylococci PJI and the discussed specific therapeutic approaches. Given the very few randomized trials in this setting, discussion is mostly based on observational studies and the experience and opinion of the authors.ContentMethicillin resistance is an important concern in staphylococcal PJI, especially in coagulase-negative staphylococci. However, its impact on the outcome is controversial. Conversely, rifampicin and/or fluoroquinolone resistance are associated with worse prognosis and might be considered when defining difficult-to-treat pathogens in the PJI setting. There is very little experience with recently developed anti-Gram-positive antimicrobial in PJI, but evaluations of their antibiofilm activities are promising, and some of them might represent significant advances regarding antimicrobial tolerance (such as tedizolid) or pharmacokinetic profiles (such as dalbavancin) during long-term treatment required for PJI. Evaluation of innovative strategies in this setting is crucial, including repositioning of current surgical options using local antimicrobial delivery, pharmacokinetic monitoring and modelling to optimize antimicrobial therapy, suppressive antimicrobial treatment and/or phage-based approaches.ImplicationsPJIs caused by resistant Gram-positive bacteria—including rifampicin- and/or fluoroquinolone-resistant staphylococci—may be associated with a poorer prognosis. It is therefore essential to optimize medical and surgical management, and to find new therapeutic alternatives
Prognostic impact of metabolic tumor volume using the SUV4.0 segmentation threshold in 1,960 lymphoma patients from prospective LYSA trials
No full textInternational audienc
Treatment by Preplanned Virtual Autotransplantation of a Microdont Immature Third Molar to a Maxillary Central Incisor Socket Using a 3D Printed Tooth Replica: A Case Report
No full textAn 18-year-old female patient presented to emergency dental clinic for avulsion of maxillary left central incisor (#21) in a car accident. In the presence of an immature left maxillary microdontic third molar (#28), a preplanned virtual autotransplantation using an implant planification software was chosen to replace #21. A guided osteotomy using a 3D printed thermoplastic replica was performed to reduce the extra-oral time to < 1 min. Indirect restorations with lithium disilicate veneers were made for both central incisors. After 4 years, the esthetic integration remained satisfactory. The case presented, involving the replacement of an avulsed #21 with an immature microdontic third molar #28, illustrates the possibilities of extending the indications for autotransplantation using virtually planned surgery
