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Real‐Life Cohort of Patients With Resected High‐Risk Melanoma Treated by Adjuvant Anti‐ PD1 Therapy
No full textInternational audienceABSTRACT Background Programmed cell death protein‐1 (PD1) antibodies are currently the standard treatment for resected high‐risk melanoma, yet recurrence rate remains high. Objectives This real‐life observational study aimed to describe the outcomes of patients with resected high‐risk melanoma following adjuvant anti‐PD1 immunotherapy and identify factors associated with recurrence risk. Materials and Methods A total of 235 patients with resected stage III/IV melanoma treated with adjuvant nivolumab or pembrolizumab were included. Imaging scans and cerebral imaging were performed every 12 weeks to detect recurrences. Adverse events were collected. Univariate and multivariate analyses were performed to identify predictive factors of recurrence. Overall survival (OS) and recurrence‐free survival (RFS) were estimated. Results Among the 235 patients, 103 experienced at least one recurrence (43%); first recurrences were predominantly locoregional (47%). The predictive factor for recurrence identified by multivariate analysis was ulceration (RR 2,03, 95% CI [1,20; 2,86]). RFS was estimated at 75% [70–81] at 12 months and at 64% [58–71] at 24 months. RFS at 12 months was significantly lower in patients with ulcerations (RFS at 83%) compared to those without ulceration (RFS at 66%), p < 0.01. Overall survival (OS) was estimated at 91% [87%–94%] at 12 months and 84% [79%–89%] at 24 months. The OS after a first recurrence was estimated at 69% [60%–80%] at 12 months and decreased to 43% [32%–57%] at 24 months. After a first locoregional recurrence, surgery with a year of adjuvant immunotherapy (40%) was the favoured therapeutic approach. For distant recurrences, clinical trial enrolment was preferred (21%). Double curative immunotherapy was the preferred strategy for cerebral recurrences (30%). Conclusions In this cohort, nearly half of the patients underwent recurrences and RFS at 24 months was 64%. The RFS and OS data were comparable o those reported in the pivotal study Ulceration was the only significant predictive factor for recurrence, associated with decreased RFS at 24 months
An international observational study validating gene-expression sepsis immune subgroups
No full textInternational audienceBackground Sepsis gene-expression sub-phenotypes with prognostic and theranostic potential have been discovered. These have been identified retrospectively and have not been translated to methods that could be deployed at the bedside. We aimed to identify subgroups of septic patients at high-risk of poor outcome, using a rapid, multiplex RNA-based test. Methods Adults with sepsis, in the intensive care unit (ICU) were recruited from 17 sites in the United Kingdom, Sweden and France. Blood was collected at days 2–5 (S1), 6–8 (S2) and 13–15 (S3) after ICU admission and analyzed centrally. Patients were assigned into ‘high' and ‘low' risk groups using two models previously developed for the Immune-Profiling Panel prototype on the bioMérieux FilmArray® system. Results 357 patients were recruited (March 2021–November 2022). 69% were male with a median age of 67 years, APACHE II score of 21 and a 30% 90-day mortality rate. The proportions of high-risk patients decreased over the three sampling times (model 1: 53%, 40%, 15% and model 2: 81%, 74%, 37%). In model 1, 90-day mortality was higher in a high-risk group at each time (S1: 35% vs 24%, p = 0.04; S2: 43% vs 20%, p < 0.001; S3: 52% vs 24%, p = 0.007). In model 2, mortality was only significantly different at the second sampling time (S1: 30% vs 27%, p = 0.77; S2: 34% vs 14%, p = 0.002; S3: 35% vs 23%, p = 0.13). Conclusions Gene-expression diagnostics can identify patients with sepsis at high-risk of poor outcomes and could be used to identify patients for precision medicine trials. Registration ISRCTN11364482 Registered 24th September 2020
Heterogeneity of Clinical Phenotypes in Severe Acute Respiratory Infections Owing to Respiratory Syncytial Virus: A Need to Look Beyond Hospitalization
No full textInternational audienceTo use a pre-COVID-19 birth cohort database to describe the clinical heterogeneity of severe acute respiratory infection (SARI) cases of the past seasons as a basis to investigate further distribution of clinical phenotypes in the era of immunization for respiratory syncytial virus (RSV)
It is time to consider the climate crisis in haematology
No full textInternational audienceClimate crisis (CC), pollution and destruction of biodiversity represent a major threat to present and future societies. Global pollution is the single largest cause of environmental deaths, with approximately 9 million premature deaths estimated per year..
Association between ultra-processed food consumption and inflammation: insights from the STANISLAS cohort
No full textInternational audiencePurposeHigh consumption of ultra-processed food (UPF) is associated with an increased risk of developing chronic diseases. Inflammation may be one of the underlying mechanisms behind this association. However, only a limited number of studies have investigated the association between UPF consumption and a few selected inflammation biomarkers, yielding inconsistent results. This study aimed to assess the cross-sectional association between UPF consumption (as a whole and 10 sub-categories), and 78 circulating proteins related to inflammation.MethodsThe present study included 1594 adult participants from the STANISLAS cohort. UPF consumption was estimated using the NOVA classification, and linear regression models were used to assess their association with circulating proteins.ResultsUPFs accounted for 28% of the total energy intake and 5.7 servings on average per day. In the unadjusted model, 15 circulating proteins had a significant association with UPF consumption. After adjustment, only (FGF-19) was significantly associated with UPF consumption (β = − 0.02[− 0.03; − 0.003]).ConclusionUPF consumption was negatively associated with Fibroblast Growth Factor 19 (FGF-19) serum levels. When considering UPF sub-categories, no circulating proteins were associated with dairy products and dairy desserts. Of note, circulating proteins were differentially associated depending on the sub-category of UPF. Further studies are needed to better understand the link between UPF and inflammation
Distinct phenotypes of patients and healthcare resource utilization after hospitalization for COVID-19: an observational study
No full textInternational audienceLittle is known about postdischarge healthcare resource use (HCU) among patients hospitalized for coronavirus disease 2019 (COVID-19). The objective was to identify distinct profiles of patients based on postdischarge cares
Beyond the coronal plane in robotic total knee arthroplasty—Part 1: Variations in tibial slope and distal femoral flexion do not affect outcomes
No full textInternational audienceAbstract Purpose Robotic‐assisted total knee arthroplasty (TKA) and new alignment principles are transforming traditional implant positioning, not only in the coronal plane but also in the sagittal and axial planes. The impact of differences between a patient's native tibial slope (TS) and distal femoral flexion (DFF) compared to the final implant positioning remains unclear. This study aims to evaluate whether variations in TS (ΔTS) and DFF (ΔDFF) play a role in clinical outcomes and implant survival. Methods This retrospective study analysed patients who underwent robotic‐assisted TKA following functional alignment (FA) principles between March 2021 and January 2023. A total of 310 patients were included. Preoperative and postoperative data, including radiographic and robotic measurements, were collected. Clinical outcomes (KSS, FJS‐12 and AKPS), range of motion (ROM), complication rates, and implant survival were compared between groups at a minimum of 2 years follow‐up. Results At the final follow‐up (mean 2.93 ± 0.62 years), no significant differences were found in clinical scores or ROM between groups with different ΔTS or ΔDFF values. Complication rates and implant survival (99%) were also similar. However, patients with ΔTS > 5° had a slightly increased femoral valgus alignment, while those with ΔDFF ≤ 5° had lower preoperative ROM, with the femoral implant positioned in varus. Conclusions Variations between native and implant TS and DFF in robotic‐assisted TKA do not negatively impact functional outcomes or implant survival. A personalised sagittal alignment approach within the concept of FA represents a progression to a functional knee positioning based on three dimensions. Further research is needed to explore the long‐term effects of sagittal alignment on TKA performance. Level of Evidence Level III
HyperProbe consortium: transforming tumour neurosurgery with innovative hyperspectral imaging
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Suicide reattempts in adolescents and young adults after a first suicide attempt. Results from the SURAYA prospective cohort study
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Dreaming in patients with epilepsy: a cross‐sectional cohort study
No full textInternational audienceSummary Epilepsy impacts cognition during wakefulness. As epileptic activity is present and even augmented during sleep, epilepsy could also influence sleep‐related cognitive processes. However, whether epilepsy modulates sleep‐related experiences like dreaming remains poorly known. Here, we prospectively investigated the characteristics and determinants of dreaming in patients with epilepsy. Consecutive adult patients with epilepsy and no major cognitive deficit were recruited in an epilepsy outpatient clinic. They completed a questionnaire about their dreams, sleep and epilepsy over the past year. Medical data on epilepsy characteristics were gathered from the medical file. A generalised linear model was used to explore the determinants of dream recall frequency (DRF). We included 300 patients, with a mean (standard deviation [SD]) age of 40.4 (13.4) years and 51.3% female; 28.6% had more than one seizure/month, and 34.7% already had seizures during sleep. Patients recalled dreams on an average of 1.6 (1.5) days/week and 11% had one or more nightmare/week. Younger age, higher number of nocturnal awakenings, and lower seizures frequency predicted a higher DRF. In patients with focal epilepsy (65.3%), the localisation of the epileptic focus in the parieto‐occipital area was negatively associated with DRF. Regarding dream content, 34.0% of patients reported having already dreamt about epilepsy. Dreams of seizures were associated with sleep‐related seizures ( p = 0.034) and dreams of epilepsy were associated with nightmare frequency ( p = 0.004). Our results show that patients with epilepsy share several determinants of DRF (age, awakenings, role of the parieto‐occipital area) with healthy subjects. In addition, epilepsy‐related factors (seizure frequency, focus localisation) also impact DRF. Investigating dreams in patients with epilepsy can provide information on their epilepsy and their sleep