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Colchicine for secondary prevention of vascular events: a meta-analysis of trials
No full textInternational audienceAbstract Background and Aims Randomized trials of colchicine in secondary prevention of atherosclerotic cardiovascular disease have shown mixed results. Methods A systematic review and study-level meta-analysis of randomized controlled trials was performed comparing colchicine vs no colchicine in a secondary-prevention atherosclerotic cardiovascular disease population. A fixed-effect inverse variance model was applied using the intention-to-treat population from the included trials. The primary outcome was the composite of cardiovascular death, myocardial infarction, or stroke. Results Nine trials, including 30 659 patients (colchicine 15 255, no colchicine 15 404) with known coronary artery disease or stroke, were included. Compared with no colchicine, patients randomized to colchicine had a relative risk (RR) of 0.88 [95% confidence interval (CI) 0.81–0.95, P = .002] for the primary composite outcome, including a RR of 0.94 for cardiovascular death (95% CI 0.78–1.13, P = .5), a RR of 0.84 for myocardial infarction (95% CI 0.73–0.97, P = .016), and a RR of 0.90 for stroke (95% CI 0.80–1.02, P = .09). Colchicine was associated with a RR of 1.35 for hospitalization for gastrointestinal events (95% CI 1.10–1.66, P = .004) with no increase in hospitalization for pneumonia, newly diagnosed cancers, or non-cardiovascular death. Conclusions In patients with prior coronary disease or stroke, colchicine reduced the composite of cardiovascular death, myocardial infarction, or stroke by 12%
Multidrug-resistant Organisms and Bacillus cereus Colonization in a Neonatal Intensive Care Unit: A Cohort Study
No full textInternational audienceBackground: Surveillance of neonate microbiota carriage, particularly multidrug-resistant organisms (MDROs) and Bacillus cereus , could help prevent infection. We evaluated the presence of these in the stools of hospitalized infants, duration of isolation and risk of infection in infants with digestive carriage of MDROs or B. cereus. Methods: In a population-based retrospective study, we analyzed the results of weekly stool cultures performed from birth to discharge, in all hospitalized newborns from January 2018 to September 2020, in a single tertiary unit. Information regarding infections was collected. Results: In total, 1409 infants were included; 220 (15.6%) were carriers of MDROs and/or B. cereus : 74.1% (163/220) carried MDROs only, 20.5% (45/220) carried B. cereus only and 5.5% (12/220) were cocarriers. Eighteen MDROs were identified; Enterobacter cloacae (43.6%, 82/188) was the most frequent. There was no B. cereus infection in infants with B. cereus in the stool; 7.4% (13/175) of infants with MDROs were infected. Conclusions: MDROs and B. cereus were commonly found in stools in a large population of hospitalized neonates. Identification of carriage and duration of this according to the germ can help to adapt the isolation protocol duration to limit constraints for parents and caregivers and to guide antibiotic therapy
Integrating Environmental Impact in Health Technology Assessment: An Exploratory Study
No full textInternational audienceTo what extent a care pathway, due to its associated pollution, may be more detrimental to future health than beneficial to contemporary patients is still an open question. We present a methodological framework to integrate pollutant-induced future health damages in health technology assessment (HTA) metrics like quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for a better evaluation of the cost effectiveness of care pathways.None
Comparison of two strategies of glucocorticoid withdrawal in patients with rheumatoid arthritis in low disease activity (STAR): a randomised, placebo-controlled, double-blind trial
No full textInternational audienceObjectives To compare two strategies—a hydrocortisone replacement strategy and a prednisone tapering strategy—for their success in glucocorticoid discontinuation in patients with rheumatoid arthritis (RA) with low disease activity (LDA). Methods The Strategies for glucocorticoid TApering in Rheumatoid arthritis (STAR) study was a double-blind, double-placebo randomised controlled trial including patients with RA receiving a stable dose of glucocorticoid 5 mg/day for ≥3 months and were in LDA for ≥3 months. Patients were randomly assigned in a 1:1 ratio to either replace prednisone with 20 mg/day of hydrocortisone for 3 months, then reduce to 10 mg/day for 3 months before discontinuation or to taper prednisone by 1 mg/day every month until complete discontinuation, contingent on maintaining LDA. The primary outcome was the percentage of patients achieving glucocorticoid discontinuation at 12 months. Other secondary outcomes were proportion of flares, need for additional glucocorticoid use, disease activity, patient-reported outcomes and the results of adrenocorticotropic hormone (ACTH) stimulation tests. Results Of the 102 patients randomised in the trial (mean age 62.4 years, 70.6% females), 53 had hydrocortisone replacement and 49 tapered prednisone. At 12 months, 29 patients (55%) in the hydrocortisone replacement group and 23 patients (47%) in the prednisone tapering group achieved glucocorticoid discontinuation (p=0.4). No difference was observed between groups in the secondary outcomes. No cases of acute adrenal insufficiency were observed; however, 17 patients still had an abnormal ACTH stimulation test at 12 months, with no differences between arms. Conclusion A hydrocortisone replacement strategy was not superior to a prednisone tapering strategy for achieving glucocorticoid discontinuation success in patients with RA in LDA. Trial registration number NCT02997605
Ten‐year minimal follow‐up of lateral opening wedge distal femoral osteotomy for lateral femorotibial osteoarthritis: Good survivorship and high patient satisfaction
No full textInternational audienceAbstract Purpose This study aimed (1) to determine complications and survival rates of lateral opening wedge distal femoral osteotomy (LOW‐DFO) in the long term, (2) to assess their clinical outcomes in the long term and (3) to identify risk factors of failure. Methods Between 1991 and 2011, 62 LOW‐DFOs were performed in the same department. Inclusion criteria were all isolated LOW‐DFO performed for isolated lateral tibiofemoral osteoarthritis and valgus malalignment, with a minimum 10‐year follow‐up. Thirty‐eight patients were included, with a mean age of 48 ± 9 years. All patients had clinical and radiological assessments. The survival curves were calculated based on the following endpoints: unicompartmental or total knee arthroplasty. Results The mean follow‐up was 15.2 ± 4.4 [10–29] years. The mean preoperative mechanical FemoroTibial Axis (mFTA) was 188.8° ± 3.2° [184°–197°], primarily due to femur deformity (mean lateral distal femoral axis [LDFA] 83.2° ± 2.8°). Bone union was achieved in 89.5% of patients ( n = 34) at a mean delay of 6.5 ± 6.7 months. The complication rate was 26% (five stiffness, one nonunion, three secondary displacements and one deep vein thrombosis). Nine revision surgeries (24%) were recorded. Survival rates at 5 and 10 years were 92.1% and 78.9%, respectively. The mean delay between DFO and total knee arthroplasty (TKA) was 11.6 ± 5.7 [1–27] years. Nineteen patients (50%) were free of TKA at the last follow‐up. KSS scores were improved significantly. Return to sports was obtained in 92% of cases ( n = 35), with a mean delay of 11 ± 8 months. Seventy‐four per cent of patients were satisfied or very satisfied with the surgery. Eighty‐four per cent would be willing to undergo the surgery again. Older age ( p = 0.032) was a significant risk factor for TKA conversion. Conclusion LOW‐DFO is an efficient procedure to manage lateral knee osteoarthritis in young patients with valgus deformity, with a good survival rate at 10 years and high patient satisfaction. Level of Evidence Level III
Comparison of antioxidant efficiencies in oil‐in‐water emulsion using extracellular vesicles from olive co‐products or liposomes as antioxidants carriers
No full textInternational audienceOlive extracellular vesicles and synthetic liposomes were evaluated as carriers of antioxidants to stabilize oil-in-water emulsions against oxidative degradation. For this, hydroxytyrosol, rosmarinic acid and their lipophilic counterparts, (hydroxytyrosyl dodecanoate esters or eicosyl rosmarinate esters) were loaded into these carrier vesicles and the antioxidant efficiencies of these formulations were compared with those of the corresponding antioxidants alone. Using the conjugated autoxidizable triene assay (CAT assay), our results shows that loaded synthetic liposome mimicking the lipid membrane composition of olive extracellular vesicle allowed to enhance the antioxidant effect of the loaded antioxidant especially with the two lipophilic hydroxytyrosol and rosmarinic acid esters. On the contrary, the loading of the studied antioxidant into the olive extracellular vesicles did not result in an improvement of the antioxidant activity. The antioxidant effects of loaded vesicles were also evaluated in rapeseed oil (1% w/w)-in-water emulsions that were stored at 40 C for 21 days and for which oxidative status was monitored by the quantification of primary and secondary oxidation compounds. In that case, the boosting effect of liposomal carriers was not confirmed. This could be due to a different type of emulsions compared to the one used with the CAT assay as different surfactants and oxidation inducers were employed. Additionally, the limited physical stability of the carrier could be involved as liposomes loaded with the most lipophilic antioxidants, namely hydroxytyrosyl dodecanoate and eicosyl rosmarinate were shown to be instable for period exceeding 10 days of storag
Newborn Screening for Cystic Fibrosis Is Associated With the Lowest Healthcare Costs: A 10‐Year Observational Follow‐Up Study in France
No full textInternational audienceABSTRACT Objectives This study aims to study the healthcare (HC) costs associated with cystic fibrosis (CF) in children diagnosed prenatally (ANT), through newborn screening (NBS), after birth due to meconium ileus (MI), or later based on symptoms (LS). Additionally, it seeks to clinically characterize children with CF (chCF) with different trajectories of HC costs. Study Design A retrospective observational study was conducted on data from the French CF Registry (FCFR) and the French National Claims Database (SNDS) linked from 2006 to 2021. HC costs related to CF diagnosis circumstances were estimated per year of life among chCF up to age 10. Group‐based trajectory modeling was performed to identify subgroups with similar cost trajectories. Results Between 2006 and 2011, data from 1065 chCF were recorded in the FCFR. Nine hundred seventy‐three (91.4%) were matched with SNDS, and 779 (73.1%) had at least 10 years of follow‐up. During the first year, HC costs of chCF diagnosed with NBS were lower than for those diagnosed with MI and ANT (all p < 0.05). However, by the tenth year HC were no longer different between groups. Three groups with different cost trajectories were identified. Groups with the highest costs had a lower lung function at 6 and 10 years and the lowest weight and height z ‐scores at 2 and 10 years (all p < 0.05). Conclusion NBS is associated with the lowest HC costs during the first year of life
Residual sleepiness and impaired alertness in treated obstructive sleep apnoea: role of hypoxic burden and sleep fragmentation
No full textInternational audienceThe pathophysiology of residual sleepiness in treated obstructive sleep apnoea (OSA) remains poorly understood. Animal models suggest that it may involve neuronal damage due to intermittent hypoxia and sleep fragmentation. In a cohort of 122 continuous positive airway pressure (CPAP) treated OSA patients referred for maintenance of wakefulness test, we explored the determinants of (objective) alertness and those of (subjective) sleepiness assessed by Epworth Sleepiness Scale. We found that in logistic models, residual hypoxic burden was significatively associated with objective impaired alertness (OR=1.005, 95% CI 1.002 to 1.008), p=0.003), whereas arousal index >25/h was significatively associated with subjective residual sleepiness (OR=1.23, 95% CI 1.05to 1.43, p=0.02). This suggests that hypoxia and sleep fragmentation may be involved in different dimensions of residual hypersomnolence in treated OSA
Actualités de la rééducation post-AVC
No full textInternational audienceStroke is a common condition with an increasing incidence. It is the leading cause of acquirednon-traumatic disability and the second leading cause of dementia, despite improved initialmanagement enabled by advancements such as thrombolysis, thrombectomy, and the esta-blishment of specialized units. Post-stroke recovery occurs through various mechanisms,involving both vascular processes and brain plasticity. Two main processes are distinguished:true recovery and compensation. Motor rehabilitation after stroke has seen an increase inpublications, although with very low-to-low levels of evidence. Rehabilitation should focus ontask-oriented, functional, and repetitive practices to improve grasping, balance, and walkingfunctions. This intensification can be achieved through constraint-induced therapy for the upper limb, motor imagery, or exoskeleton devices for walking, along with muscle strengthening and aerobic exercises. The addition ofextrinsic neuromodulation techniques (such as high-frequency repetitive transcranial magnetic stimulation) or intrinsic methods(like motor imagery) targeting brain plasticity may further enhance the benefits of rehabilitation. The latest recommendations fromthe French National Authority for Health (HAS) emphasize coordinated and intensive care from the acute phase of a stroke. Thisincludes early evaluation to enable a personalized approach that considers social and environmental factors, as well as access tospecialized rehabilitation facilities for multidisciplinary care tailored to the patient's goals. Cognitive and mood disorders should besystematically assessed to propose appropriate cognitive remediation programs. Integrating technological innovations andintensifying care in specialized facilities are key challenges to improving regional equity and enhancing the quality of life forpatientsL'accident vasculaire cérébral (AVC) est une pathologie fréquente dont l'incidence est enaugmentation. Il représente la première cause de handicap acquis non traumatique et ladeuxième cause de démence, malgré une prise en charge initiale améliorée grâce à desavancées comme la thrombolyse, la thrombectomie et la création d'unités spécialisées. Larécupération post-AVC se fait via différents mécanismes à la fois vasculaires et de plasticitécérébrale. Deux processus sont distingués : la récupération vraie et la compensation. Larééducation motrice post-AVC fait l'objet d'une augmentation du nombre de publications avecun niveau de preuve très faible à faible. Une rééducation avec une pratique orientée à la tâche,ayant un sens fonctionnel, répétitif doit être recherché pour améliorer les fonctions de préhen-sion, d'équilibre et de marche. Cette intensification peut être réalisée par l'usage de la contrainteinduite pour le membre supérieur, l'imagerie motrice ou les dispositifs d'exosquelettes pour lamarche avec une pratique associée de renforcement musculaire et d'exercices aérobie. L'ajoutdes techniques de neuromodulation extrinsèque (la stimulation magnétique répétitive transcrâ-nienne de haute fréquence) ou intrinsèque (imagerie motrice) ciblant la propriété de plasticitécérébrale peut compléter les bénéfices attendus en réponse à la rééducation. Les dernièresrecommandations de la HAS insistent sur une prise en charge coordonnée et intensive dès laphase aiguë d'un AVC incluant une évaluation rapide qui permet une approche individualisée, enprenant en compte les facteurs sociaux et environnementaux et l'accès à des structuresspécialisées en réadaptation pour une prise en charge pluridisciplinaire, adaptée et centréesur les objectifs du patient. Les troubles cognitifs et thymiques doivent être recherchés de façonsystématique pour proposer des programmes de remédiation cognitive adaptés. L'intégrationd'innovations technologiques et l'intensification des soins en structures spécialisés, représententdes enjeux clés pour renforcer l'équité territoriale et améliorer la qualité de vie des patients