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Neurological outcomes and disability predictors in paediatric herpes simplex virus encephalitis: a multicentre cohort from French tertiary hospitals
No full textInternational audienceObjective: To identify factors associated with the neurological outcome of HSVE in children.Materials and methods: In this retrospective multicentric observational study, clinical, paraclinical data at onset and neurological outcomes at last follow-up of children (≥28 days and <18 years old) with HSVE, were studied. Univariate and multivariate analyses were performed to identify factors associated with neurological outcome.Results: 49 children (mean age of 4.9 ± 5.5 years) were included. At last follow-up of 5.9 ± 3,13 years, 2 children died (4 %) and 37 (76 %) children presented with poor neurological outcome with epilepsy (57 %), intellectual disability (51 %) and language disorders (47 %). Rehabilitation was necessary for 76 % and 59 % had abnormal academic performances. At onset, younger age and seizures were significantly associated to language disorders (p < 0.01), motor disabilities (p = 0.01), and intellectual disabilities (p = 0.01) in univariate analysis. Abnormal MRIs were more frequent in children with neurological sequalae (p = 0.01). Multivariate analyses identified that: (1) epilepsy occurred more frequently in females (p = 0.03), with insular lesions (p = 0.048); (2) language disorders were more common in children who had seizures at onset (p 0.02); (3) motor disorders were more frequent in younger children (p = 0.03) with thalamic lesions (p = 0.04).Conclusion: Our findings indicate that despite decrease in mortality rates, neurological disabilities in children with HSVE still persist at high levels. This underscores the need to enhance HSVE management strategies. Moreover, the identified risk factors associated with poor neurological outcomes can aid in identifying high-risk children, facilitating the implementation of alternative treatment approaches such as immunotherapy or intensive rehabilitation
Application of the anti-IgLON5 disease composite score to assess severity, clinical course, and mortality in a French cohort
No full textAbstract Anti-IgLON5 disease presents with diverse symptoms, whose severity can be measured by the anti-IgLON5 disease composite score (ICS). This study applied the ICS to a retrospective anti-IgLON5 disease cohort ( n = 52; median age 72 years, 63% male) diagnosed in the French Reference Center on Autoimmune Encephalitis (2016–2024), aiming to describe severity and clinical course, and to assess its potential to predict mortality. At diagnosis, the ICS distribution (median 18) aligned with previous publications and correlated with the time to diagnosis (median 19 months); all patients had symptoms in ≥ 2 ICS domains: bulbar (88%), sleep (84%), movement disorders (90%), cognition (64%), and/or other (78%). Of 46 patients with follow-up data, 7 (16%) died shortly after diagnosis; for the others, changes in the ICS mirrored the clinical course: at last visit, it decreased in improving patients (16/46, 35%; median 12 vs 17; p = 0.004), increased in worsening patients (11/39, 24%; median 26 vs 21; p = 0.006) and did not change significantly in stable patients (12/46, 26%; median 16 vs 15; p = 0.222). In the ROC analyses, 2-year mortality was predicted by the total ICS at diagnosis (AUC 69.51, 95% CI [50.19; 88.83]; optimal cut-off > 20, sensitivity 59%, specificity 77%), and by the bulbar score at diagnosis (AUC 74.68, 95% CI [56.17, 93.19]; optimal cut-off > 3, sensitivity 83%, specificity 62%). The ICS is a reproducible tool for assessing anti-IgLON5 disease severity and clinical course. Higher total and bulbar ICS at diagnosis are associated with increased mortality risk, underscoring the need for early and intensive management of bulbar dysfunction
Detection of Kidney Allograft Rejection Using Urinary Chemokines
No full textInternational audienceBackground: Urinary chemokines CXCL9 and CXCL10 have shown promise for detecting kidney allograft rejection, but the demonstration of their added value beyond standard of care patient monitoring requires further study.Methods: We prospectively enrolled adult patients who underwent kidney transplantation in 7 transplant referral centers between July 2018 and December 2019 (ClinicalTrials.gov, NCT03582436). We quantified urinary CXCL9 and CXCL10 protein levels at the time of kidney allograft biopsies in the first year post-transplantation using an automated immunoassay platform. The primary outcome was allograft rejection defined according to the international Banff 2019 classification.Results: Overall, 733 kidney transplant patients (64% male, 36% female) were included in the main analysis, with 1,549 biopsies paired with a urine sample. The cumulative incidence of rejection was 10%. For detecting allograft rejection, urinary CXCL9 and CXCL10 demonstrated areas under the receiver operating characteristic curve (AUROC) of 0.70 (95% confidence interval [CI], 0.64-0.75) and 0.64 (95% CI, 0.58-0.71), respectively. Adding urinary CXCL9 to a standard of care model improved discrimination for allograft rejection (AUROC 0.75 [percentile bootstrap CI 0.70-0.79] to 0.78 [percentile bootstrap CI 0.73-0.83]), while urinary CXCL10 did not. There was no improvement of overall fit with the addition of urinary CXCL9 (Brier score changed from 0.056 [95% CI, 0.046-0.067] to 0.054 [95% CI, 0.045-0.064]), as this tended to overestimate the risk for allograft rejection. In sensitivity analyses restricting to only acute/active forms of rejection or to a single randomly selected biopsy per patient, urinary chemokines did not show additional value beyond the standard of care. In addition, existing chemokine-based models showed low to moderate performance for the detection of allograft rejection.Conclusions: Urinary CXCL9 demonstrated limited clinical utility, while urinary CXCL10 provided no additional value beyond standard of care monitoring for detecting allograft rejection within the first year after kidney transplantation
Communication and diffusion of the 2022 French Urolithiasis Guidelines (CLAFU): Lessons from a national audit
No full textInternational audienceObjectives: The French 2022 Urolithiasis (CLAFU) Guidelineswere recently released. We aimed to evaluate the impact and diffusion of these CLAFU guidelines among the French urologists. Methods: French certified and in-training urologists were invited to participate in an online survey between April and May 2024, including 18 questions assessing demographics, practice trends, awareness of the new guidelines, their dissemination and impact on daily practice. After being reviewed by an expert panel, the survey circulated through social media/mail. Statistics included a descriptive analysis and subgroup analyses (private practice [PP] vs public/ academic hospital-based [PAH] practice, certified urologists vs in-training). Results: Two hundred and twenty-eight urologists participated in the survey, 86% of whom were aware of the 2022 CLAFU guidelines. Eighty-three percent were certified urologists, with 54% and 46% of them working in PP and PAH, respectively. Urinary stones' management represented 11-30% of the daily practice for 55% of participants, and 31-50% for 25% of them. Seventy-four percent and 19% declared to use CLAFU and EAU guidelines daily, respectively. Participants preferred the summary over the full version (51% vs 31%). Guidelines' median impact on practice was 6/10 (4-8). Participants suggested new communication modalities: podcasts (55%) and/or educational videos (53%). PP and PAH presented similar needs for new communication modalities (51% vs 56%) and guidelines' impacts on practice (6/10 vs 7/10), but PAH preferred the full version (35% vs 26%), while PP preferred the summary (42% vs 59%, P = 0.04). Certified and in-training urologists presented similar needs for new communication modalities (67% vs 50%), and guidelines' impact (7/10 vs 6/10), but in-training urologists preferred guidelines' full version. Conclusion: This survey demonstrastes an overall interest for the 2022 CLAFU guidelines among French urologists. More interactive dissemination formats (audio or video) should be used for updates and diffusion. Level of evidence: 4. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies
Transition of patients with hereditary nephropathies from pediatric to adult care
No full textInternational audienceAbstract Adolescents and young adults with chronic kidney disease (CKD), particularly those with genetic kidney diseases, face unique challenges as they transition from pediatric to adult nephrology care. This period is marked not only by changes in healthcare providers but also by significant developmental, psychosocial, and medical complexities. In response, the ERA Working Group on Genes and Kidney and the ESPN Working Group on Inherited Kidney Diseases have collaborated to develop practical advice for healthcare professionals involved in transition care across Europe and beyond. This document outlines key principles and offers practical recommendations to support a successful transition, emphasizing the need for early planning, patient education, individualized approaches, and multidisciplinary coordination. Special considerations are highlighted for patients with genetic kidney diseases, including those with syndromic manifestations, reproductive implications, and the need for continuity of care across specialties. The document also identifies knowledge gaps, proposes directions for future research and collaboration, and encourages the implementation of transition protocols adapted to national and local healthcare systems. By harmonizing practices and fostering shared responsibility between pediatric and adult nephrology teams, this joint initiative aims to improve health outcomes, patient empowerment, and long-term engagement in care for young people with CKD
Oncoral Follow-Up for Outpatients Treated with Oral Anticancer Drugs Assessed by Relative Dose Intensity
No full textInternational audienceObjectives: The multidisciplinary city-hospital Oncoral follow-up of cancer outpatients has been set up to ensure the safety of oral anticancer drugs (OADs). The aim of this study was to assess Oncoral by Relative Dose Intensity (RDI) in patients with hematological malignancies treated with ibrutinib as a model. Methods: The study included all outpatients treated with ibrutinib and followed in Oncoral between January 2016 and June 2020. Patients benefited from interviews leading to pharmacist and nurse interventions (PNI) on drug-related problems as adverse events (AE), drug–drug interactions (DDI), and drug intake. Results: In total, 83 patients were enrolled. At least one PNI was performed for 86.7%, focusing on drug intake and DDIs (54.5%), the management of AEs (27.0%), and community–hospital coordination (18.5%). Major DDIs with ibrutinib were found in 10 patients, with at least one moderate interaction in 28%. Grade 3–4 AEs mainly concerned cytopenia and infection. Adherence tended to decrease after the first 6 months. At 6 months, the mean RDI was 93.7 ± 11.3%; RDI reductions occurred in 43% patients. RDI was lower in patients who discontinued treatment before day 90 and worsened over time in patients still being treated at month 6 (Friedman’s test, p < 0.01). Age and gender were predictors of early treatment termination (OR 1.10 [1.03; 1.19] and 6.44 [1.65; 37.21]). The estimates of 30-month OS and PFS were 73.8% (95% CI [64.7%; 84.2%]) and 61.8% (95% CI [51.8%; 73.7%]). Conclusions: The Oncoral follow-up is a secure, coordinated pathway assessed by RDI. Multidisciplinary follow-up should be the gold-standard for outpatients receiving OADs
Using machine learning to identify speech markers of subjective cognitive impairment in breast cancer survivors
No full textSee also link: Access to full-text view-only.International audiencePurpose: Cancer-related cognitive impairment (CRCI) refers to cognitive changes described by cancer patients. While subjective cognitive difficulties in survivors are well screened by questionnaires, CRCI remains seldom diagnosed by neuropsychological tests. New objective approaches are needed to detect CRCI. The goal of this study is to find the speech markers that can best detect CRCI.Methods: Forty-four women who completed breast cancer treatment and 13 controls were asked to narrate a picture-based story. Speech productions were recorded and analyzed using semi-automatic methods. Fourteen speech features were extracted and incorporated in machine learning models to classify CRCI assessed using the FACT-Cog questionnaire. In addition, all participants underwent psychological assessment to control for confounding factors. Results The combination of speech-to-silence ratio, mean duration of silent pauses, and mean duration of filled pauses best predicted cancer survivors with CRCI (ROC = 0.74, accuracy = 73.7%). Bayesian Generalized Linear Models further showed that silence in participants’ speech depended on whether they had CRCI and reported depression assessed using the HADS. Credibility Intervals of regression coefficients showed only a trend for reported depression (95% CI [− 0.36, − 0.00]), while scores were below clinical thresholds for depressive disorders for all groups. Conclusions Long silent pauses in discourse may be a sign of cancer-related cognitive impairment in survivors of breast cancer.Implications for Cancer Survivors: This study demonstrates the benefits of using speech analysis as a fast, ecological, and non-invasive technique for assessing CRC
Modèles de fondation pour la segmentation d’images IRM cardiaque : une révolution en marche ?
No full textInternational audienceLa segmentation d'images médicales représente un défi clé dans le cadre d'applications cliniques comme l’aide au diagnostic. Le modèle nnUNet est devenu une référence grâce à ses performances de haute qualité et à sa capacité à s’adapter automatiquement aux bases de données médicales. Cependant, il nécessite un entraînement sur des centaines, voire des milliers de cas annotés, ce qui peut être fastidieux. Les modèles de fondation offrent une alternative prometteuse. Étant entraînés sur de vastes bases de données, ils semblent faire preuve d’une grande flexibilité, s’adaptant à de nouvelles données sans entraînement ou avec un nombre limité d’images annotées.Dans ce travail, nous comparons les performances de MedSAM, un modèle de fondation spécialisé dans la segmentation d’images médicales, à celles de nnUNet. Ces modèles sont évalués sur des bases de données IRM cardiaques en séquences ciné (ACDC) et rehaussement tardif (MYOSAIQ). Différentes stratégies d'entraînement de MedSAM et de SamMed2d sont testées afin de produire les meilleurs résultats possibles sur nos données. Des stratégies d’initialisation de boîtes englobantes (prompts) parfaites et avec 10 positions aléatoires autour du masque de référence sont investigués.Notre étude met en évidence les limites inhérentes aux modèles de fondation appliqués à la segmentation d’images médicales, notamment la dépendance des résultats à la qualité des prompts
Immunological and Clinical Markers of Post‐acute Sequelae of COVID‐19: Insights from Mild and Severe Cases 6 Months Post‐infection
No full textInternational audiencePost‐acute sequelae of COVID‐19 (PASC) are a complex clinical condition that requires a better understanding of its underlying biological mechanisms. In this study, we assessed hundreds of virological, serological, immunological, and tissue damage biomarkers in two cohorts of patients who had experienced either mild ( n = 270) or severe ( n = 188) COVID‐19, 6 to 9 months post‐initial infection, and in which 40% and 57.4% of patients, respectively, developed PASC. Blood analysis showed that the main differences observed in humoral, viral, and biological biomarkers were associated with the initial COVID‐19 severity, rather than being specifically linked to PASC. However, patients with PASC displayed altered CD4 + and CD8 + memory T cell subsets, with higher cytokine‐secreting cells and increased terminally differentiated CD45RA + effector memory T cells (TEMRA). Elevated SARS‐CoV‐2‐specific T cells responsive to nucleocapsid/membrane proteins with a TEMRA phenotype were also observed. A random forest model identified these features and initial symptom duration as top variables discriminating PASC, achieving over 80% classification accuracy
Delphi Consensus Among French Obesity Experts on Clinical Recommendations for Drug Prescription in Patients With Severe Obesity
No full textInternational audienceIntroduction Although the physiologic alterations seen in obesity often affect the pharmacokinetics and pharmacodynamics of drugs, most clinical trials do not consider these aspects specifically for this population. To date, there is no list of potentially inappropriate medications for patients living with obesity. The aim of this study was to use the Delphi method to identify useful recommendations for the prescription of some specific drug classes in patients living with severe obesity. Methods We identified five therapeutic groups of drugs using data from the HEGP Clinical Data Warehouse. We conducted a literature review and sought the opinions of local experts to produce potential recommendations. We selected volunteer medical experts from the French network FORCE and set up a two‐round Delphi method, concluded by a synthesis meeting, to establish a list of recommendations. In each round, the experts were asked to rate the potential recommendations. Results Forty‐three proposed recommendations were evaluated in the first round. The experts approved four recommendations with a strong consensus and 16 with a relative consensus. In the second round, they approved six recommendations with a strong consensus and 13 with a relative consensus. Conclusion This is the first study to use the Delphi method to produce a summary of consensus recommendations for several drug classes in patients living with severe obesity. It provides an expert‐based consensus on the use of the five most commonly prescribed therapeutic drug classes and develops a list of recommendations for drug prescription in patients living with severe obesity