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Gentle Introduction to Network Analysis for Clinical Research: a model centered on relations
No full textInternational audienc
Saturated fat from dairy sources and cardio-metabolic health: insights from the STANISLAS cohort
No full textInternational audiencePurpose. The health impact of dairy products is debated due to their high saturated fatty acid (SFA) content. Emerging evidence suggests that dairy products intake may reduce cardiovascular disease risk, despite their SFA-rich lipids, leading to the "dairy food matrix" concept. Nevertheless, the impact of lipid and SFA intake from whole dairy sources on cardiometabolic health remains poorly understood. This study investigated the cross-sectional association of SFA intake from various types of dairy products and dairy fat sources with cardio-metabolic outcomes.Methods. Data from 1619 participants of the STANISLAS cohort, who underwent extensive metabolic and cardiovascular phenotyping and completed a 133-item food frequency questionnaire covering dairy products and other dairy fat sources, were used. Associations of total dietary lipid, total dietary SFA, and SFA intakes from dairy products and dairy fat sources with metabolic outcomes (metabolic syndrome, hyperlipidemia, type 2 diabetes, prediabetes) and subclinical cardiovascular damages (i.e., arterial stiffness, atherosclerosis, left ventricular mass, diastolic dysfunction) were assessed using mixed models. Results. Median [interquartile range] lipid consumption via dairy products and dairy fat sources was 23 [15, 34] g/day. Higher total dietary lipid intake was associated with lower arterial stiffness (exp(β) [95%CI]: 0.96 [0.92-0.99]). Total dietary SFAs and SFAs from dairy products were both inversely associated with left ventricular mass (exp(β) [95%CI]: 0.85 [0.74-0.98], and 0.99 [0.99-0.99], respectively). SFAs from dairy fat sources, particularly from Butter, were inversely associated with hyperlipidemia (OR [95%CI]: 0.96 [0.93-0.99] for hypertriglyceridemia, 0.96 (0.93-0.99) for elevated LDLc, 0.95 (0.92-0.98) for elevated non-HDLc, 0.93 (0.89-0.96) for elevated Apolipoprotein B). SFAs from Yogurt was inversely associated with Apolipoprotein B (OR [95%CI]: 0.92 (0.86-0.98). Statements and Declarations Competing interests M.-C. M. received research funding from CNIEL, Sodiaal-Candia R&I, and Danone Nutricia Research, congress travel funding from CNIEL and symposium honorarium from IMGC, which are not related to the present epidemiological study.</div
Impact of CDA Dynamics on Clinical Outcome of Patients With AML or High‐Risk MDS Treated With Nucleoside Analogs
No full textInternational audienc
Barriers and facilitators to early post-stroke rehabilitation in stroke units: A nationwide survey in France
No full textInternational audienc
Clustering and visualisation of the GABRIEL network expertise in the field of infectious diseases
No full textInternational audienceIntroduction The Global Approach to Biology Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL) network is an international scientific network of 21 centres coordinated by the Merieux Foundation (Lyon, France). Mapping and characterising the similarities and differences in expertise and activities across four major infectious diseases (tuberculosis, antimicrobial-resistant infections, acute respiratory infections and emerging pathogens) among these centres would help to provide a better understanding of the network’s capacity. It will also highlight how the applied methodology can enhance information sharing within research networks. Methods Each centre responded to a questionnaire on their core activities and research themes. An advanced multivariate analysis was performed to relate all items together and highlight new synergies among members of the GABRIEL network. Similarities were found using a clustering algorithm and data were visualised using alluvial plots. Results This strategy enabled to find new patterns in the GABRIEL network for the implementation of new projects on global health, regardless of geographical proximity or historical connections. Five clusters based on core activities, consisting of 6, 1, 3, 9 and 2 research units, respectively, have been identified, with clusters 1 and 4, including the majority of the units. Four clusters have been defined based on the four major infectious diseases, comprising 7, 3, 5 and 6 research units, respectively. Conclusions The same methodology could also be applied to identify proximities on other networks of experts or between members of different networks for more efficient research or surveillance global programmes
Diagnostic Utility of Kappa Free Light Chain Index in Adults With Inaugural Optic Neuritis
No full textInternational audienceBackground and ObjectivesA simple, quick, and reproducible procedure for distinguishing multiple sclerosis (MS), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD) at inaugural optic neuritis (ION) could be highly valuable in guiding early management. MethodsWe included all adults admitted to the MS center of Marseille for ION between March 2016 and April 2024, with CSF analysis including the kappa free light chain (K-FLC) index. Receiver operating characteristic curves were used to measure the diagnostic ability of the K-FLC index. ResultsTwo hundred twenty-seven adults were admitted for ION; 210 (93%) had a K-FLC index measurement. MS was diagnosed in 84 (40%); clinically isolated syndrome suggestive of MS in 77 (36.5%), including 20 with future conversion to MS (CISwc); MOGAD in 26 (12.5%); NMOSD in 13 (6%); and other inflammatory disorders in 10 (5%). A K-FLC index ≥6.7 differentiated MS/ CISwc from other diagnoses with specificity 86% and sensitivity 95% (area under the curve [AUC] 0.94). A K-FLC index <4.9 differentiated MOGAD from other diagnoses with specificity 63% and sensitivity 92% (AUC 0.78) and MOGAD from MS/CISwc with specificity 96% and sensitivity 92% (AUC 0.97). Among all patients, 93 (44%) had a K-FLC index <4.9: 24 of these (26%) had MOGAD and 5 (5.5%) MS/CISwc. Among the remaining patients with a K-FLC index ≥4.9 (n = 117), 2 (1.7%) had MOGAD (K-FLC index of 7.9 and 16.2) and 99 (85%) MS/CISwc. Among patients with normal MRI (n = 96), 73 (76%) had a K-FLC index <4.9: 22 of these (30%) had MOGAD, and none showed conversion to MS. Among the remaining patients with a K-FLC index ≥4.9 (n = 23), 2 (8.5%) had MOGAD and 7 (30.5%) showed conversion to MS. The K-FLC index did not differentiate NMOSD from other diagnoses and only moderately differentiated NMO from MS/CISwc (AUC 0.80). DiscussionThe K-FLC index is an accessible biomarker to guide early diagnosis in patients with ION. The probability of MOGAD in patients with ION and a K-FLC index ≥4.9 is low even in case of normal brain/spinal cord MRI. Classification of EvidenceThis study provides Class II evidence that for patients with ION, the K-FLC index can distinguish between MS/CISwc and MOGAD.</div
Medium chain fatty acids are potent binding competitors to improve protein-bound uremic toxin clearance during hemodialysis
No full textInternational audienceIntroduction: Protein-bound uremic toxins (PBUTs) remain a concerning burden in patients with kidney failure since their removal during hemodialysis is limited due to their tight binding to albumin. Here, we tested whether medium chain fatty acids (MCFAs), potent ligands of human serum albumin (HSA), could be used as binding competitors of PBUTs to increase their removal during a hemodialysis session.Methods: A simulated hemodialysis session was performed using bovine blood spiked with PBUTs in the presence of various MCFAs. Blood was sampled serially to measure the concentrations of PBUTs indoxyl sulfate (IS) and p-cresyl sulfate (p-CS). Results:The binding of MCFAs to HSA was investigated in silico and using fluorescent probe displacement. The free fraction of IS and p-CS were measured after ultrafiltration of HSA solutions and uremic plasma in the presence of MCFAs (0.25-3 mmol/L). Among the four MCFAs tested, octanoate and decanoate were the most prone to interact with HSA Sudlow site II, one of two main binding sites on HSA. The in vitro incubation of HSA solutions and uremic plasma with MCFAs increased the free fraction of IS and p-CS. The per-dialytic infusion of octanoate significantly improved the fractional removal of p-CS from 38% to 88% and IS from 36% to 91%. Conclusions:MCFAs can effectively compete with PBUTs for binding to HSA. The per-dialytic administration of octanoate, which strikingly increased the removal of PBUTs, could constitute an efficient and cost-effective strategy to improve the possible clearance of these compounds and prevent their accumulation in patients with kidney failure.</div
Associations Among Diet, Health, Lifestyle, and Gut Microbiota Composition in the General French Population: Protocol for the Le French Gut – Le Microbiote Français Study
No full textInternational audienceBackground: Over the past 2 decades, the gut microbiota has emerged as a key player in human health, being involved in many different clinical contexts. Yet, many aspects of the relationship with its host are poorly documented. One obstacle is the substantial variability in wet-laboratory procedures and data processing implemented during gut microbiota studies, which poses a challenge of comparability and potential meta-analysis.Objective: The study protocol described here aimed to better understand the relationship between health, dietary habits, and the observed heterogeneity of gut microbiota composition in the general population. "Le French Gut -Le microbiote français" aimed to collect, sequence, and analyze 100,000 fecal samples from French residents using a high-quality shotgun metagenomic pipeline, complemented with comprehensive health, lifestyle, and dietary metadata.Methods: "Le French Gut -Le microbiote français" is a prospective, noninterventional French national study involving individuals, the creation of a biological collection (feces), and the exploitation of data from questionnaires and the National Health Data System (Système National des Données de Santé). This national study is open to all metropolitan French adult residents, excluding those who have undergone a colectomy or digestive stoma, or who have had a colonoscopy or taken antibiotics in the last 3 months. This is a home-based trial in which volunteers complete a questionnaire with insights about their health and habits, and in which stool samples are self-collected. Data analysis is structured into 6 work packages, each focusing on a specific aspect of the gut microbiome, including its composition and associations with lifestyle, quality of life, and health.Results: This paper outlines the study protocol, with recruitment having started in September 2022 and expected to continue until the end of December 2025. As of January 2025, a total of 20,000 participants have been enrolled. The first scientific publications based on the data analysis are expected by mid-2025.Conclusions: “Le French Gut” aims to provide a reference database and new ecosystem tools for understanding the relationship between the gut microbiota, its host, and diet. We expect to be able to find new signatures or targets and promote the design of innovative preventive strategies, personalized nutrition, and precision medicine
Uncommon Cardiac Myxoma Arising from the Right Ventricle-Imaging Insights
No full textInternational audienceNo abstract availabl
153P Evolution of second-line practices in the era of immunotherapy: Real-life data from the French prospective CHIEF cohort
No full textInternational audienceBackgroundAdvanced hepatocellular carcinoma (HCC) is a global health challenge, and while immunotherapy-based combination are now standards of care as first-line treatment, there is a paucity of data regarding second-line treatment following immunotherapy. We aimed to study the access to second-line treatment, comparing patients initially treated with Sorafenib (Sor) to those with atezolizumab-bevacizumab (AB).MethodsThis study included patients from the real-world prospective CHIEF cohort and aimed to get insight into Systemic treatment sequences in patients with advanced HCC (STRETCH). Median overall survival (mOS) and median progression free survival (mPFS) were defined since the beginning of the 2d line setting.ResultsBetween September 2019 and September 2024, 1103 patients received either AB (n=899) or Sor (n=204) as first-line treatment. Most patients were Child-Pugh A (77.1% AB vs. 70.3% Sor; p=0.06); BCLC-C (66.3% AB vs. 84.3% Sor; p<0.001) and ALBI grade 2 (61.2% AB vs. 64.9% Sor; p=0.021). mOS and mPFS were 22.3 [18.5–27.4] and 5.6 [5.2–6.4] months for AB, compared to 9.4 [7.3–12.7] months (p<0.0001) and 3.5 [3.1–4.0] months (p=0.11) for Sor. Among 456 patients progressing on AB, 42.1% received second-line treatment versus 60.0% of 130 patients progressing on Sor (p<0.0003). In second-line, after AB, patients receiving tyrosine kinase inhibitors (TKI) had an mOS of 13.0 [9.8–15.5] months (n=136, 70.8%), while those on immunotherapy (n=24) or combinations (n=24) had non-reached mOS (p=0.00088). The mOS for second-line TKI was similar regardless of first-line treatment (8.6 months after Sor; p=0.082). No significant differences were found between Sor (n=78), lenvatinib (n=35), regorafenib, or cabozantinib (n=23) (p=0.83), though lenvatinib showed a trend for improved mPFS.ConclusionsThis unique prospective cohort provides real-world data on second-line treatment practices. Access to second-line treatment was lower after AB than Sor, but survivals under second-line TKI were similar. While second-line immunotherapy following immunotherapy shows promising results, these are likely influenced by patient selection for rechallenge