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Prediction of MRI in intra-operative findings for spinal meningeal diseases
No full textInternational audienceBackgroundA large variety of spinal meningeal diseases have been described in the literature, and differential diagnosis is often complex, requiring a good knowledge of the different entities and accurate neuroimaging. The purpose of this article was to depict the most relevant diagnostic features on the commonly utilized MRI sequences for the main and most frequent pathologies of the spinal arachnoid and to correlate them with intraoperative findings.Material and methodsFive cases harboring each different spinal meningeal diseases were analyzed, illustrated, extensively described, and discussed: arachnoid web, arachnoiditis, idiopathic spinal cord herniation, intradural arachnoid cyst, extradural arachnoid cyst. All the cases were surgically treated in the same institution (Neurological Hospital, Lyon, France). We underlined imaging clues for differential diagnosis to help physicians to elaborate the right diagnosis and guide the surgical management.ResultsMRI was efficient to determine the nature of the arachnoid or/and dural disease as well as to predict precisely the intra-operative findings. Six key-radiological features were selected, helping differential diagnosis: localization (intra/extradural/both), aspect of the spinal cord (compressive effect/displacement/scalpel sign), arachnoid bride, CSF turbulent flow, vertebral scalloping, absence of gadolinium-enhancement.ConclusionMRI demonstrated excellent correlation with intra-operative findings for all the five spinal meningeal diseases analyzed. Although rare, these pathologies must be recognized by clinicians considering that appropriate treatment most often permit to relieve the symptom
Which antimicrobial treatment for patients with bloodstream infection during ECMO support?
No full textInternational audienceOjective: We aim to describe a large, multicenter cohort of patients with bloodstream infection (BSI) acquired during extracorporeal membrane oxygenation (ECMO) support.Methods: We conducted a retrospective observational study in 12 Europeans ICUs. Only patients who developed a BSI of unknown source during ECMO support were included in the present analysis. Primary aim was to describe BSI epidemiology in patients with ECMO support. Secondary objectives were to describe antimicrobial susceptibility of incriminated micro-organisms.Results: One hundred and eighty-two patients were included. Main reason for ECMO support was ARDS, followed by cardiogenic shock and post-cardiotomy. Half of the patients (51.9%) received early antimicrobial therapy. Main incriminated microorganisms were Enterococcus sp. (37.4%), Enterobacterales (26.9%), coagulase negative Staphylococci (15.9%) and Gram negative bacilli (11.5%). Multi drug resistant organisms (MDRO) were incriminated in 26 (14.3%) BSI and were mainly extended spectrum producing-Enterobacterales (17/26). Antimicrobial therapy was considered as appropriate in 130 patients (71.4%). Patients who received inappropriate antimicrobial therapy were more frequently infected with MDRO. Only 59 (32.4%) of cases were susceptible to 3rd generation cephalosporin while association of piperacillin/tazobactam with vancomycin was considered appropriate in 155 cases (85.2%) as compared with 168 cases (92.3%) for carbapenems combined with vancomycin.Conclusion: Enterococcus sp. was incriminated in about a third of BSI among patients with ECMO support. High appropriateness would only be obtained with piperacilline/tazobactam or carbapenems in association with vancomycin while 3rd generation cephalosporin would have failed in the majority of BSI cases.Clinical trial number: Not applicable
Community and Hospital‐Based Laboratory Surveillance for Influenza, Respiratory Syncytial Virus, and SARS‐CoV‐2 During the 2023–2024 Season, Lyon, France
No full textInternational audienceInfluenza, respiratory syncytial virus (RSV) and SARS‐CoV‐2 are among the main respiratory viruses circulating in the population, with a significant burden on public health. While individuals at higher risk are more likely to develop severe symptoms leading to hospitalization, viral circulation in the community remains less extensively monitored. This study compared viral circulation between RELAB, a recently established community‐based laboratory surveillance network ( n = 22 843 tested patients) and hospital surveillance at the Hospices Civils de Lyon, France ( n = 23 046 tested patients), for the season 2023–2024. For influenza and SARS‐CoV‐2, similar trends were observed in at‐risk populations (children under 5 years and adults over 65 years) in both settings. Circulation of these two viruses was first detected in the community and insights from the young adult population (19–64 years) were only captured in the community network. Circulation of RSV was more intense in terms of number of cases and started in the pediatric population, and consequently was more represented in the hospital setting. In conclusion, this study highlighted the complementarity between community and hospital surveillance, as different populations and periods of viral circulation were observed
Cement or press-fit? Impact of patellar fixation technique on outcomes after primary TKA: a systematic review
No full textInternational audienceIntroduction: The optimal fixation technique for patellar components in primary total knee arthroplasty (TKA); cemented versus press-fit, remains controversial. While early press-fit designs were associated with complications, second-generation implants with improved osseointegration features have renewed interest in cementless fixation. Methods: This systematic review included studies comparing cemented and press-fit patellar fixation in primary TKA. A comprehensive literature search identified 202 studies, of which eight met predefined inclusion criteria. Data were extracted on survivorship, revisions, complications, and patient-reported outcome measures (PROMs). Results: Across 1666 knees, survivorship was comparable between cemented and press-fit groups. Several studies reported 100% short-term survivorship in cementless cohorts. Four studies identified statistically significant PROM differences, but findings were inconsistent and context-dependent. No clear advantage was found for either fixation type in terms of overall pain, function, or satisfaction. Cementless patellae demonstrated no increased risk of aseptic loosening or patellar fracture. Complications were infrequent and more often reported in cemented groups. Discussion: These findings showed no significant difference in failure or PROMs between fixation methods. While surgical preference remains a driver of implant choice, current evidence does not support a universal superiority of one fixation method over the other
Posttraumatic Growth in Intensive Care Unit Health Care Professionals After COVID-19
No full textInternational audienceImportance Posttraumatic growth (PTG) refers to positive psychological changes following adversity, including deeper relationships and a greater appreciation for life. Objective To assess PTG among intensive care unit (ICU) health care professionals 4 years after the COVID-19 pandemic and explore its association with resilience, anxiety, and depression. Design, Setting, and Participants This cross-sectional study invited ICU health care professionals (nursing staff, medical staff [residents, interns, clinical fellows, and senior intensivists], and other professionals providing patient care) in ICUs in general or university-affiliated hospitals in France and Belgium to complete online questionnaires between March 15 and May 15, 2024. Exposures PTG, resilience, anxiety, and depression. Main Outcomes and Measures The primary outcome was PTG, and secondary outcomes were anxiety, depression, and resilience. Participants completed validated self-reported questionnaires, including the Posttraumatic Growth Inventory (PTGI), Hospital Anxiety and Depression Scale (HADS), and 10-item Connor-Davidson Resilience Scale (CD-RISC 10). Visual analog scales (VASs) assessed professional experiences and psychological impact. Multivariate linear regression identified factors associated with PTG. Results Among 1371 health care professionals in 23 ICUs, 850 (62%) responded (median age, 39 years [IQR, 32-46 years]; 574 [68%] women). The median PTGI score was 50 (IQR, 33-64), with nursing staff reporting higher PTG than medical staff (51 [IQR, 34-65] vs 47 [IQR, 28-61]; P = .02), mainly in personal strength, spiritual change, and appreciation of life. Anxiety and depression symptoms were present in 492 respondents (58%) and 219 respondents (26%), respectively. Lower PTG was associated with psychological fatigue (regression coefficient, 1.43; 95% CI, 0.91-1.96; P < .001), ICU conflicts (regression coefficient, 0.62; 95% CI, 0.05-1.19; P = .03), and perceived deterioration in family-centered care (regression coefficient, −7.47; 95% CI, −1.10 to −13.80; P = .02). Higher PTG was correlated with higher resilience (Spearman correlation coefficient, 0.24; 95% CI, 0.17-0.30; P < .001) and was associated with a change in personal life since the pandemic (regression coefficient, 1.80 [95% CI, 1.13-2.47] per VAS point; P < .001). Conclusions and Relevance In this cross-sectional study performed 4 years after the start of the COVID-19 pandemic, ICU health care professionals, particularly nursing staff, exhibited significant PTG. Resilience, rather than psychological distress, emerged as a key driver of PTG, and deterioration in family-centered care was a major contributing factor, underscoring the need for targeted well-being and resilience-building strategies to enhance health care professionals’ mental health and professional fulfillment while also improving patient and family care
Is 2 h of Hypothermic Machine Perfusion for Pancreas Preservation Effective in Improving Graft Reperfusion?
No full textInternational audienceBackground: Static cold storage (SCS) remains the standard method for organ preservation. The development of parenchymal edema during prolonged hypothermic machine perfusion (HMP) was a major barrier to the introduction of this technique for the preservation of pancreases. A short period of HMP could optimize the pancreas for reperfusion while minimizing the side effects related to perfusion. Our objective is to evaluate the impact of short-term HMP on the pancreatic reperfusion. Methods: A preclinical study using a controlled donation after circulatory death porcine model was conducted. After procurement, the pancreases were preserved under hypothermic conditions for 2 h either by SCS (n = 4) or HMP (n = 4). After these 2 h of preservation, the pancreases were reperfused using a normothermic machine perfusion (NMP) for 2 h. During NMP, oxygenation, perfusion parameters, biochemical analyses, a glucose stimulation insulin secretion test, and an evaluation of ischemia/reperfusion injury by photoacoustic tomography were assessed. Results: During NMP, resistance indices were significantly lower in the HMP group compared with the SCS group, even after 2 h of reperfusion. The tissue oxygen partial pressure was higher throughout NMP after HMP preservation. Lactate and amylase levels were equal between the 2 groups. Lipase levels were higher in the HMP group. The glucose stimulation test showed no difference between the 2 groups. Photoacoustic tomography assessment showed no endothelial damage in either group. Conclusions: Our study suggests that a short-term HMP applied to pancreases for 2 h is effective in reducing resistance indexes and improving oxygenation
Non-motor Subtypes in Candidates for Subthalamic Deep Brain Stimulation for Parkinson’s Disease
No full textInternational audienceIntroduction: Patients with Parkinson’s Disease (PD) vary markedly in terms of non-motor symptoms (NMS) as the disease progresses. To improve PD management and clinical-trial assessment, we aimed to determine NMS endotypes in a cohort of patients with advanced PD.Methods: We conducted an ancillary cluster analysis of the 2013–2018 cohort (n=722) of PREDISTIM. In this French multicenter interventional cohort, consecutive candidates for subthalamic deep brain stimulation undergo thorough assessment of motor symptoms (MS) and NMS at the inclusion visit. The NMS data are based on the MDS-UPDRS, Montreal Cognitive Assessment (MoCA), and several psychiatric scales: Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and Lille Apathy Rating Scale (LARS). Cluster analysis with 17 NMS was conducted to identify groups with homogenous NMS profiles.Results: Three distinct NMS clusters were identified. The largest had mild MS. The smallest had moderate MS and the most severe NMS, including cognitive and psychiatric dysfunction. The middle-large group had moderate MS and NMS but was distinguished by having the worst sleeping problems. The clusters did not differ in onset age or patient age and may be underpinned by disparate patterns of anatomical brain damage.Conclusion: The mainly-motor (Cluster 1), mainly non-motor (Cluster 3), and intermediate (Cluster 2) NMS endophenotypes must be replicated in an independent cohort but may help stratify patients for management (pharmacological, deep-brain stimulation, and non-pharmacological treatments) and inclusion and assessment in clinical trials
Engineering the Future of Stem Cells in Vascular Reconstruction: A Leap Towards Functional Endothelialized Tissue-Engineered Vascular Conduits
No full textInternational audienceThe transition from reconstructive to regenerative strategies in vascular surgery has intensified the need for grafts that are biocompatible, growth-capable, and resistant to thrombosis. Addressing this challenge, Park et al. introduce a groundbreaking method for engineering fully biological, endothelialized tissue-engineered vascular conduits (TEVCs) using decellularized human umbilical arteries (dHUAs) coated with human induced pluripotent stem cell-derived endothelial cells (hiPSC-ECs). These constructs undergo shear stress training in bioreactors, mimicking physiological blood flow to enhance endothelial functionality and anti-thrombotic properties. Upon implantation in animal models, the grafts showed long-term patency, resistance to thrombosis, and progressive replacement of hiPSC-ECs by host endothelial cells, highlighting their regenerative and integrative potential. The study emphasizes the pivotal role of hemodynamic conditioning and key regulators such as KLF2 in promoting endothelial quiescence and vascular homeostasis. It further explores alternative strategies like endothelial colony-forming cells (ECFCs) and microfluidic systems for flow-induced maturation. Clinically, this approach offers a promising, scalable avenue for patient-specific, immune-compatible vascular grafts applicable in congenital heart disease, dialysis access, vascular grafts and coronary bypass. While challenges such as long-term durability and mechanical reinforcement remain, this research marks a transformative step toward functional, off-the-shelf vascular grafts. Park et al.’s work bridges biomimicry with regenerative medicine, paving the way for next-generation vascular therapies rooted in endothelial mechanobiology and personalized bioengineering
Patient-reported outcomes in patients with hematologic malignancies treated with CAR T-cell therapy in Europe
No full textInternational audiencePatient-reported outcomes (PROs) give direct insights into the treatment's impact on patient's life and are an essential addition to clinical outcomes. However, since the advent of CAR T-cell therapy (CAR-T), PROs have been underreported. Particularly little is known about long-term health-related quality of life (HRQoL) and dimensions as mental- and social wellbeing, working-life and financial burden. Therefore, we evaluated multidimensional PROs in a cross-sectional study among European patients who received CAR-T for hematologic malignancies. Patients completed validated questionnaires (EQ-5D-5L/EORTC-QLQ-C30/PCL-5/modified-iPCQ) and ad hoc items on treatment experiences, unmet care needs and HRQoL. The survey was available online (January-October 2023) in 7 languages. Outcomes were compared with the European general population, a matched CAR-T naive cohort with hematologic malignancies and across subgroups, using established thresholds for clinically important differences/problems and regression models. Patients from 10 European countries participated (N=389; CAR-T>1 year ago:56%). Mean EQ-VAS and EQ-index were 73.1(SD:18.5) and 0.842(SD:0.177). HRQoL was similar/better than reference cohorts, except for role-, social-, and cognitive-functioning. Physical-functioning problems were most frequently reported(41%), particularly by women, elderly, and those who experienced neurotoxicity. The latter subgroup also reported more cognitive- and social-functioning problems. Anxiety regarding disease recurrence(76%), infections(66%) and long-term side-effects(59%) was common and 4% met provisional PTSD-diagnosis criteria. Among working-age patients, 72% could continue paid work after CAR-T. Younger patients(32%) reported more financial difficulties than older patients(9%). This study shows favorable general HRQoL after CAR-T compared to reference cohorts. However, a notable proportion of patients experienced problems in physical-, mental- and social wellbeing. We identified high-risk subgroups and care needs that should be addressed during CAR-T follow-up
La Fabrique de Vésale : à la découverte de l’exemplaire des Hospices Civils de Lyon: Commentaires sur l’histoire de cet exemplaire, sa description matérielle et sa restauration
No full textBeyond the Work that is "The Fabrica" by Andreas Vesalius, its substance is today reduced to a few hundred books scattered around the world. With so few copies, each copy is unique and has its own history. History of previous owners, its readers and the purpose for which each of these books was used for. The copy presented is a second edition, printed in 1555 in the workshops of the printer Oporinus. Discovered during an inventory at the Hospices Civils de Lyon in 2022, this copy of "The Fabrica" was exhibited in 2024 on the occasion of the centenary of the “Association Générale de l’Internat de Lyon” (AGIL). From a printing house in Basel to the library of a University Hospital, let's discover together the history of this copy.Au-delà de l’œuvre qu’est « La Fabrique » d’André Vésale, sa matérialité se résume aujourd’hui à quelques centaines de livres éparpillés dans le monde. Avec si peu d’exemplaires, chacun est unique et porte en lui son histoire, celle de ses propriétaires et des usages de ses lecteurs. L’exemplaire présenté est une deuxième édition, imprimée en 1555 dans les ateliers de l’imprimeur Oporinus. Retrouvé dans les archives des Hospices Civils de Lyon lors d’un inventaire, cet exemplaire de « La Fabrique » a été exposé en 2024 à l’occasion du centenaire de l’Association Générale de l’Internat de Lyon (AGIL). D’une imprimerie de Bâle à la bibliothèque d’un Centre Hospitalier Universitaire, découvrons ensemble l’histoire de cet exemplaire