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Wearable airbag for powered two-wheelers: what is the profile of users involved in road traffic crashes and how does it affect their fatality risk?
No full textInternational audienceBackground: Traffic fatalities within Powered Two-Wheelers (PTW) users are mostly due to head and thoracic injuries. This study assesses airbag use prevalence among PTW users involved in Road Traffic Crashes (RTCs) in France and aims to estimate airbag effectiveness in protecting against fatality risk. Methods: A cross-sectional study was conducted using French national police crash data from 1 January 2019 to 31 December 2022, including a total of 69,350 PTW users. Pearson Chi-squared and Mann-Whitney tests were used to compare airbag users and non-users. Multiple logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95%CI) assessing the relationship between airbag use, adjustment factors, and crash-related fatality. Results: Airbag use in our population was 0.83%, with an increasing rate over the study period. Airbag users were older than non-users, used higher engine displacement PTWs, and crashed more often in rural settings and on roads with higher speed limits. The proportion of fatalities was higher among airbag users (4.7%) than among non-users (3.8%). After adjustment, the fatality risk was not statistically different between airbag users and non-users, although a 20 % lower risk was observed for airbag users (OR[95%CI]) = 0.80[0.53-1.21]). Conclusion: Wearable airbag use was low, though equipped motorcyclists increased over the study period. Airbag users involved in RTCs had different profiles from non-users, which may partly explain their higher fatality rate. While we did not show a significant protective effect of airbag on fatality risk, the limited number of airbag users in our population is an important limitation to consider in the detection of the airbag effect. Practical Application: Our findings underscore the need for future evaluations to better estimate airbag effectiveness by focusing on torso injury risk and the related fatality risk in larger populations with precise data on injuries, crash circumstances and demographic characteristics
Prevalence, natural history and surgical outcome of spinal meningiomas in NF2-related schwannomatosis
No full textInternational audiencePurpose: Meningiomas are the second most common type of tumor associated with Neurofibromatosis Type 2 Schwannomatosis (NF2-SWN). While the characteristics of intracranial meningiomas have been extensively studied, data on the epidemiological and histological features of spinal meningiomas (SM) remain limited.Methods: An observational, retrospective study was conducted on NF2-SWN patients who underwent surgical resection of SMs at three NF2-SWN reference centers. Data were compared to a cohort of patients operated on for sporadic SM at Pitié-Salpêtrière Hospital. To evaluate the prevalence of spinal meningiomas in NF2-SWN, we analyzed the craniospinal MRIs of NF2-SWN patients followed at the Pitié-Salpêtrière Hospital.Results: Nineteen NF2-SWN patients who underwent surgery for 29 SMs between 1996 and 2024 were included (median age at surgery: 22 years; IQR:10-43). The most common location was the thoracic spine (22 cases, 76%). NF2-SWN patients were significantly younger than those with sporadic SMs (32 vs. 64 years; p < 0.001), and the female predominance was less pronounced (2:1 vs. 9:1; p = 0.01). Patients with sporadic tumors had a significantly shorter time to surgery (6.3 vs. 36.5 months; p < 0.001). No significant differences were observed between the two groups regarding tumor location, dural attachment, grade, histological subtype, rate of complete resection (85% vs. 89%; p = 0.5), or recurrence risk (8% vs. 9%; mean follow-up: 7.5 years; p = 0.9). Among the 115 NF2-SWN patients with at least one brain and spinal MRI, 39 (34%) had a SM. Patients with SM more frequently harbored intracranial meningiomas (95%) compared to NF2-SWN patients without SM (64%; p < 0.001).Conclusion: Spinal meningiomas are common in NF2-SWN, mostly found in association with intracranial meningiomas and correlate with a higher tumor burden and more severe disease phenotype. However, these tumors progress slowly, rarely require surgical intervention, and do not demonstrate higher histopathological aggressiveness compared to sporadic spinal meningiomas
Cost-utility analysis of second line acromegaly treatment in France
No full textInternational audienceObjectiveThis updated French cost-utility analysis aimed to assess the efficacy of the second-line pharmacological treatment – pegvisomant, pasireotide or pegvisomant combined with first generation somatostatin analogues (FGSA) – considering first-line treatment (surgery, FGSA, cabergoline and combination), radiotherapy and the impact of treatment on tumor volume.MethodsThe original three-state Markov model was revised to include an additional health state, representing patients controlled without pharmacological treatment following successful radiotherapy. The model also accounted for the history of first-line treatments as additional costs upon patients’ entry. A cohort of 1000 simulated patients was followed over a lifetime horizon from a collective perspective. Treatment efficacy is defined on normalization of insulin growth factor-1 and was determined through a network meta-analysis. Cost and utility data were sourced from French databases and literature.ResultsAll the evaluated treatments were included in an efficiency frontier. The incremental cost-utility ratio (ICUR) of pegvisomant compared to pasireotide was 27,805€ per quality-adjusted life year (QALY) gained. The ICUR of pegvisomant combined with FGSA compared to pegvisomant was 253,854€/QALY. Sensitivity analyses showed the robustness of the results. The addition of radiotherapy has shown improved quality of life and lower costs for all second-line treatments.ConclusionThis model explores the cost-effectiveness of second-line pharmacological treatments of acromegaly accounting for the overall management recommended in France. Radiotherapy appears as a key therapeutic option allowing long-term remission of patients even after pharmacological treatment failure. This study is an additional tool for treatment choice including both a clinical and economic perspective.Significance statementThe aim of this study is to assess the cost-utility of second-line treatments of acromegaly accounting for the overall management recommended in France, considering surgery, first-line treatments, radiotherapy and the impact of treatments on tumor volume, in addition to IGF-1 normalization. All evaluated treatments were included in an efficiency frontier. This addition has shown that radiotherapy and the impact on tumor volume are decisive in the management of second-line treatments for acromegaly. Indeed, radiotherapy enables patients to achieve complete remission, i.e. without the need for drug treatment. This is an important factor for patients, given that acromegaly treatments are chronic and usually lifelong. This study is an additional tool for treatment choice including both a clinical and economic perspective
Subcutaneous vedolizumab dose intensification in inflammatory bowel disease patients: the OPTI-VEDO multicenter study from the GETAID
No full textInternational audienceBackground and Aims While this strategy is frequently used for other biologics, real-world evidence on subcutaneous (SC) vedolizumab (VDZ) dose intensification in inflammatory bowel disease (IBD) is lacking. This study aimed to assess the effectiveness and safety of SC VDZ intensification. Methods We conducted a retrospective study in 25 centers including all patients with active ulcerative colitis (UC) or Crohn’s disease (CD) (defined by PRO2), and incomplete or loss of response to SC VDZ 108mg EOW when the drug was intensified. The primary outcome was steroid-free clinical response (SFCr) defined by at least 50% of PRO2 improvement, no treatment change, no surgery, and SC VDZ persistence at 3 months. Results Out the 154 included patients (66% UC, 34% CD), prior anti-TNF exposure was reported in 85% of CD and 50% of UC patients. SC VDZ was intensified for an incomplete response in 73% of CD and 53% of UC patients, mostly at 108mg weekly (95%). At 3 months, SFCr was achieved in 35% of CD and 43% of UC patients. In multivariate analysis, factors associated with response were secondary loss of response in CD, and prior anti-TNF exposure in UC. At 12 months, 51% of CD and 37% of UC patients maintained SC VDZ. Adverse events occurred in 10 patients including one severe pneumonia and one angioedema. Conclusions In this real-world study evaluating SC VDZ intensification, a SFCr was observed in at least one third of IBD patients at 3 months, suggesting the benefit of this strategy in clinical practice
The Arrival of Exome Sequencing in French Prenatal Diagnosis: An Exploratory Qualitative Study Among Professionals in Prenatal Diagnosis Centers: Prenatome-SHS
No full textInternational audienceOBJECTIVE: Following the first French multicenter pilot study (AnDDI-Prenatome) focused on the implementation of prenatal exome sequencing (pES), this ancillary study aims to explore the ethical and clinical issues raised by pES within multidisciplinary prenatal diagnosis centers. METHODS: 33 healthcare professionals involved in the management of couples undergoing prenatal diagnosis (PND) took part in focus groups (2 with clinical geneticists, 3 with professionals from multidisciplinary prenatal diagnosis centers (MPDC), 1 with biologists). Each focus group was analyzed using the thematic analysis method. RESULTS: Professionals emphasized the importance of having a clear understanding of pES and the criteria for its prescription. Geneticists highlighted the need for a framework to clarify the implications of consent for patients and stressed the importance of offering structured support to assist couples in their decision-making process. Biologists and geneticists expressed a desire for effective multidisciplinary coordination of the care pathway, particularly in situations where the results were uncertain. CONCLUSION: These results will help to establish French recommendations for the prescription of pES
Histology of colonic submucosal lesions reveals a high proportion of benign lesions that do not require R0 en bloc endoscopic resection
No full textInternational audienceSubmucosal lesions in the colon are much rarer than those in the rectum. Their nature is poorly understood, as is the best technique for their excision. Based on that of rectal lesions, it most often aims for R0 en bloc resection, but without formal proof of efficacy. The aim of this study was to evaluate histology of these lesions and determine whether submucosal lesions of the colon always require R0 en bloc endoscopic resection. We conducted a retrospective international study of all colonic submucosal lesions with confirmed histology by resection or biopsy. We assessed the proportion of lesions correctly managed by endoscopy, so that the proposed resection technique offered a level of tumor resection quality appropriate to the definitive histology of the lesion. One hundred patients with 105 colonic submucosal lesions from 13 European centers were included. Histology revealed 91.4% (96/105) non-malignant lesions and 8.6% (9/105) malignant lesions. Endoscopic techniques used were curative in 41.7% (5/12) of cases requiring resection, non-curative in 58.3% (7/12), and endoscopic resection was not necessary in 88.7% (93/105). There was no delayed surgery for adverse events. Most colonic submucosal lesions are non-malignant and do not warrant advanced endoscopic resection. A new therapeutic approach could be first-line use of a low-risk, low-cost histological diagnostic technique followed in a second phase by a more advanced technique in the event of a malignant histological result. Further studies are needed to evaluate this step-up strategy
Un programme de travail partenarial pour l’épidémiologie des cancers : bilan 2014-2019
No full textInternational audienceIn France, the epidemiological surveillance of cancers is based on a multi-source surveillance system and a joint working program in partnership defined and performed by the French network of cancer registries (Francim), the Biostatistics-Bioinformatics Unit of Hospices Civils de Lyon, the French national public health agency and the French National Cancer Institute. This article presents the results of the 2014-2019 Cancer program. A questionnaire was completed for each of the 56 PTP projects, covering the implementation and financial resources committed. Among the 49 achieved projects were new estimates of incidence and survival produced at the national level for 70 types of cancer, with age-specific trends. Estimates of incidence were made at the district level for all French departments, even in districts not covered by a registry. The distribution of stage at diagnosis and social disparities in cancer incidence and survival were studied. The analysis of conditional net survival led to a better assessment of the risk of dying from cancer, which allowed improving access to insurance coverage and introducing a 'right to be forgotten' to people having a prior history of cancer. Contributing to the national and regional public policies with this innovative data, the outputs of the 2014-2019 Cancer program are successful. This makes a major contribution for the future of cancer surveillance, building on the ten-year French cancer control Strategy 2021-2030. The sustainability of registries, data protection, the crossing of databases and the implementation of a surveillance system at a geographical level lower than the district, remain challenging.En France, la surveillance épidémiologique des cancers repose sur un système de surveillance multi-sources et un programme de travail partenarial (PTP) définis et réalisés par le Réseau français des registres des cancers (Francim), le Service de biostatistique-bioinformatique des Hospices Civils de Lyon, Santé publique France et l’Institut national du cancer. Cet article présente le bilan du PTP Cancer 2014-2019. Un questionnaire portant sur la réalisation et les moyens financiers engagés a été complété pour les 56 projets du PTP. Parmi les 49 projets réalisés figurent des estimations nationales d’incidence et de survie produites pour 70 types de cancers avec des tendances par âge. Des estimations départementales d’incidence ont été produites pour l’ensemble des départements incluant les zones non couvertes par un registre. La répartition des stades au diagnostic et l’effet de la défavorisation sociale sur l’incidence et la survie ont été étudiés. L’analyse de la survie nette conditionnelle a conduit à mieux évaluer le risque de décéder du cancer dans le cadre de l’assurabilité des patients et à instaurer un « Droit à l’oubli » pour les personnes avec antécédent de cancer. Contribuant aux politiques publiques nationales et régionales par des données innovantes, le bilan du PTP Cancer 2014-2019 est fructueux. Il assure un apport majeur pour construire la future surveillance, en s’appuyant sur la Stratégie décennale de lutte contre les cancers 2021-2030. La viabilité des registres, la protection des données, le croisement des bases de données et le développement d’une surveillance infra-départementale, font partie des nombreux enjeux
Diagnostic laparoscopy and cytoreduction surgery in ovarian cancer FIGO III–IV: The impact on survival of one-stage versus two-stage sequence
No full textInternational audienceObjectives: This is a retrospective study designed to assess the impact of two-stage versus single-stage surgical management on survival in patients with FIGO III-IV ovarian neoplasia receiving surgical management.Methods: This is a retrospective, multicenter study, based on the FRANCOGYN group database. Two groups were studied, the first having primary surgical management in a single operation, and the second having two-stage sequence primary surgical management.Results: 208 patients were included in the study. In terms of overall survival, in univariate analysis, there was a statistically significant difference in favor of single-stage surgical management, but this was not demonstrated in multivariate analysis (p = 0,228). Similarly, in terms of recurrence-free survival, there was no statistically significant difference between the two groups studied (p = 0,123).Conclusion: Performing exploratory laparoscopy at the same time as cytoreduction surgery does not significantly improve recurrence-free survival in patients with FIGO III-IV ovarian cancer. This trend was also observed in the overall survival analysis
Lateral approach for total knee arthroplasty in patients with valgus deformity: A step-by-step surgical technique
No full textInternational audienceBackground: The lateral approach in total knee arthroplasty (TKA) is indicated primarily for patients with valgus knee deformity, as it allows direct access to the lateral anatomy and systematic correction of associated pathologies. Surgical Technique: This technique involves strategic lateral soft tissue releases, which improve exposure to the posterolateral corner, enhance tibial rotation, and support patellar alignment without compromising medial vascularity or requiring a tibial tubercle osteotomy for joint exposure. Critical steps in the lateral TKA approach include maintaining a capsular-synovial overlap and preserving the Hoffa fat pad for optimal joint closure, releasing the lateral soft-tissue structures, and using a contralateral tibial cutting guide for enhanced access and protection of the patellar tendon. Discussion: These techniques collectively allow for a balanced, stable joint with effective alignment and soft tissue management. Outcomes of the lateral approach in valgus TKA are comparable to those of the medial approach, with similar functional outcomes, range of motion, and surgical time. Some studies even report superior patellar tracking and function scores with the lateral approach. Complication rates are low, though attention is required to avoid peroneal nerve injury in severe deformities. Future research involving large, randomized controlled trials is recommended to substantiate these favorable outcomes and guide long-term treatment strategies for valgus TKA
Association between cognitive reserve and spatial ability across the lifespan
No full textInternational audienceSpatial navigation is a promising cognitive marker for several cognitive disorders. However, its clinical utility is still limited because spatial abilities are also influenced by nonpathological factors. Among these, the Cognitive Reserve (CR) stands out due to its strong influence on cognitive aging trajectories. However, the association between CR and spatial navigation across the lifespan has never been assessed. In this study, we collected spatial navigation data along with CR measures in a population with diverse demographic profiles. We found a strong decline in spatial ability with age, but no overall effect of the CR. We systematically analyzed the association between each CR item and spatial ability and found that the subscore related to reading habits was significantly associated with spatial navigation performance, even after correcting for multiple comparisons. We discuss the implications of these findings for early and personalized screening for cognitive disorders using a spatial navigation task