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Assessment and Surgical Correction of Posterior Tibial Slope in Revision Anterior Cruciate Ligament Surgery: An International Expert Delphi Consensus Statement
No full textInternational audiencePurpose: The aim was to provide international guidelines to enhance decision-making regarding the definition and evaluation of increased posterior tibial slope (PTS) and the role of anterior closing wedge high tibial osteotomy (ACWHTO) in the setting of revision anterior cruciate ligament reconstruction (ACLR). Methods: This guideline is based on responses from 46 international orthopedic surgeons with expert experience in knee pathologies and osteotomy. Based on a literature review, each expert drafted and commented on a set of core statements. The provided comments were blinded and discussed within the working group to refine the statements. In a subsequent round of surveys, all experts discussed with the final 32 statements. Consensus was achieved when at least 80% of survey respondents fully agreed. Results: With respect to ACWHTO for PTS reduction, there was consensus achieved for using the medial plateau as a measurement for PTS measuring, aiming for PTS correction of 5 - 7 degrees, individualizing osteotomy wedge thickness, and performing ACWHTO and revision ACLR in a single stage. There was no consensus on the type of radiographs to be used, a cut-off value for increased PTS, an absolute indication for ACWHTO the osteotomy technique, nor type of fixation. The International consensus statements aim to bridge the gap between research and clinical application to enhance clinicians’ decision-making in revision ACLR management and to focus future areas of required research. Conclusion: The literature review confirmed a paucity of evidence to guide clinicians in the diagnosis and surgical management of increased PTS. An agreement could be achieved for 25/32 statements (78%) on the definition and assessment of PTS, indication, planning, surgical decision-making, and peri- and postoperative management for ACWHTO. While no consensus could be achieved for the definition of a cut-off value for pathological PTS, consensus was reached for a variety of statements on diagnostic and surgical aspects
Factors predictive of epidemic waves of COVID-19 in Africa during the first 2 years of the pandemic
No full textInternational audienc
Outcome and recurrence patterns of low-risk gonadal germ cell tumors in children and adolescents
No full textInternational audiencePediatric low-risk gonadal germ cell tumors (LR-GCTs) are typically managed with close surveillance following surgery alone. However, the patterns of relapse and prognostic factors for relapse remain insufficiently understood. We reviewed 72 patients under 19 years old diagnosed with low-risk ovarian (OGCT) or testicular (TGCT) GCT between May 27, 2014, and December 31, 2022, from the TGM13observatory (EudraCT 2013-004039-60). Among 30 OGCT (median age 13 years), 15 were dysgerminomas and 15 were non-dysgerminomatous OGCT (NDOGCT), with 10 patients having incomplete abdominal staging. Eleven relapses were observed, nine of which were locoregional. The three-year progression-free survival (PFS) was 73 % (95 % CI: 44e89) for dysgerminomas and 53 % (95 % CI: 26 e74) for NDOGCT (p ¼ 0.22). Among the 42 testicular tumors (median age 3 years), all but one were NSGCTs. Ten relapses occurred, resulting in one death. The three-year PFS for testicular GCTs was 76 % (95 % CI:59e86). Relapse patterns differed by age: in toddlers, relapses predominantly occurred in the lungs, while in adolescents, relapses were primarily in the para-aortic lymph nodes. The median time to relapse was six months. No significant prognostic factors for relapse were identified, including older age (>11 years), incomplete staging for OGCT, and the presence of lymphovascular invasion or embryonal carcinoma for TGCT. Survival after relapse remains excellent, and further research with a larger sample of children is needed to better identify risk factors for relapse in pediatric LR-GCTs
A Prospective Pilot Clinical Study reveals a promising non-toxic anti-biofilm activity of Gentamicin-EDTA-Na₂ Central Venous Catheter Lock Solution
No full textObjectives The treatment of long-term intravenous catheter-related bloodstream infections (LTIVC-related BSI) often requires catheter removal or a conservative treatment using intra-catheter locks, with a 50-60% success rate. We previously demonstrated the synergistic effect of a combination of gentamicin and EDTA-Na 2 against bacterial biofilms. We performed a phase 1/2 clinical trial to assess the tolerance and efficacy of the genta-EDTA-Na 2 locks for the conservative treatment of LTIVC-related BSI.Methods Prospective study including adult patients with a monomicrobial uncomplicated LTIVC-related BSI caused by a gentamicin-susceptible coagulase-negative staphylococci, Enterobacterales or Pseudomonas aeruginosa . Primary objective: assess the safety and efficacy at Day 40 (D40) of genta-EDTA-Na 2 locks by evaluating the frequency of clinical and microbiological cure 30 days after the end of treatment (D40). Results Eight patients were included. A complete follow-up was obtained for 7 patients, 6 of which met cure criteria. The single patient whose follow-up was incomplete met all criteria for cure at D23. A single microbiological failure occurred (relapse of P. aeruginosa LTIVC-related BSI). Two patients experienced at least one serious adverse event; none were attributed to the genta-EDTA-Na 2 locks. Conclusion Genta-EDTA-Na 2 used as intra-catheter locks is a promising anti-biofilm candidate to be studied in a randomized controlled trial
GAN-based synthetic FDG PET images from T1 brain MRI can serve to improve performance of deep unsupervised anomaly detection models
No full textInternational audienceBackground and Objective. Research in the cross-modal medical image translation domain has been very productive over the past few years in tackling the scarce availability of large curated multimodality datasets with the promising performance of GAN-based architectures. However, only a few of these studies assessed task-based related performance of these synthetic data, especially for the training of deep models. Method. We design and compare different GAN-based frameworks for generating synthetic brain [18F]fluorodeoxyglucose (FDG) PET images from T1 weighted MRI data. We first perform standard qualitative and quantitative visual quality evaluation. Then, we explore further impact of using these fake PET data in the training of a deep unsupervised anomaly detection (UAD) model designed to detect subtle epilepsy lesions in T1 MRI and FDG PET images. We introduce novel diagnostic task-oriented quality metrics of the synthetic FDG PET data tailored to our unsupervised detection task, then use these fake data to train a use case UAD model combining a deep representation learning based on siamese autoencoders with a OC-SVM density support estimation model. This model is trained on normal subjects only and allows the detection of any variation from the pattern of the normal population. We compare the detection performance of models trained on 35 paired real MR T1 of normal subjects paired either on 35 true PET images or on 35 synthetic PET images generated from the best performing generative models. Performance analysis is conducted on 17 exams of epilepsy patients undergoing surgery. Results. The best performing GAN-based models allow generating realistic fake PET images of control subject with SSIM and PSNR values around 0.9 and 23.8, respectively and in distribution (ID) with regard to the true control dataset. The best UAD model trained on these synthetic normative PET data allows reaching 74% sensitivity. Conclusion. Our results confirm that GAN-based models are the best suited for MR T1 to FDG PET translation, outperforming transformer or diffusion models. We also demonstrate the diagnostic value of these synthetic data for the training of UAD models and evaluation on clinical exams of epilepsy patients. Our code and the normative image dataset are available
Structural, material and functional organisation of centres performing paediatric anaesthesia
No full textInternational audienceObjective: The French Society of Anesthesiology and Critical Care (Société Française d'Anesthésie et de Réanimation (SFAR)) and the French association of paediatric intensive care anaesthetists (Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF)) have joined forces to provide guidelines for professional practice on the structural, material, and functional organisation of centres performing pediatric anesthesia.Design: A consensus committee of 16 experts from the SFAR and the ADARPEF was convened. The experts declared no conflict of interest before and throughout the process. The entire guidelines process was conducted independently of any industry funding. The authors were asked to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence.Methods: Four fields were defined: 1) structure and logistics; 2) equipment and materials; 3) training; and 4) functional organisation. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out on works published from 2000 to 2022, using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. Because of the very small number of studies that could provide the necessary power for the most important endpoint (i.e., morbidity), it was decided, before drafting the recommendations, to adopt a Recommendations for Professional Practice (RPP) format rather than a Formalised Recommendations of Experts (RFE) format. The recommendations were formulated according to the GRADE® methodology, before being voted on by all the experts according to the GRADE grid method.Results: The experts' synthesis work and the application of the GRADE® method resulted in 34 recommendations dealing with the structural, material and functional organization of centers performing pediatric anaesthesia. After three rounds of rating and several amendments, an agreement was reached on all the recommendations.Conclusions: Strong agreement exists among the experts to provide recommendations aimed at improving the structural, material and functional organization of centers performing paediatric anaesthesia
Different behavior of electrosurgical currents between air and saline immersion therapeutic endoscopy
No full textInternational audienc
Selective decontamination regimens in French ICUs: association with reduced infection and resistance emergence
No full textInternational audienceBackground: Despite randomized controlled trials with favorable results, few intensive care units (ICUs) implemented selective decontamination (SD) for ICU-acquired infection prevention. We aimed to evaluate, SD implementation and associated-effects in a large network of French ICUs.Methods: This study was conducted using the healthcare-associated infection surveillance cohort “REA-REZO” involving 193 participating ICUs. All patients receiving invasive mechanical ventilation for > 24 h were included. In addition to standard of care (SOC), six ICUs applied a SD strategy during the study period. The primary endpoint was the rate of ICU-acquired infection. A propensity-score matched analysis was conducted using non-parsimonious regression model. The secondary endpoint was the rate of colonization by multidrug resistant organisms (MDRO) during the ICU stay.Results: Among 81,661 patients with invasive mechanical ventilation for longer than 24 h, 2727 patients receiving SD were matched with 2 727 receiving SOC. The ICU-acquired infection incidence was lower in the SD group as compared with the SOC group (Incidence Rate Ratio = 0.66 [0.60–0.73]; p < 0.001) although the ICU mortality was similar (31.9% vs 32.5%, respectively p = 0.689). Acquisition of MDRO was lower in the SD group than in the SOC group (40 (1.5%) patients vs. 139 (5.1%) patients p < 0.001).Conclusions These results showed that a strategy of SD was associated with reduced ICU-acquired infection incidence and decreased emergence of MDRO, while the mortality was not affected
Efficacy of Irbesartan in Celiprolol-Treated Patients With Vascular Ehlers-Danlos Syndrome
No full textInternational audienceBACKGROUND: Vascular Ehlers-Danlos syndrome is a rare genetic disorder characterized by defective type III collagen and a high risk of arterial morbidity and mortality. Several cardiovascular drugs are used for treatment, including celiprolol, but no controlled trial in this condition has been conducted to date. We hypothesized the benefit of the addition of an angiotensin II receptor blocker. METHODS: A multicenter, randomized, placebo-controlled trial was conducted to assess the efficacy and safety of the angiotensin II receptor blocker irbesartan in adults with vascular Ehlers-Danlos syndrome on stable background celiprolol therapy. Patients were randomized 1:1 to receive irbesartan (150 mg/day titrated to 300 mg/day) or placebo for 2 years. The composite primary outcome was defined as any vascular Ehlers-Danlos syndrome–related fatal or nonfatal arterial event or any new or worsening arterial lesions detected by systematic head-to-pelvis computed tomography angiography or peripheral arterial duplex ultrasound at different time points, using a time-to-first-event analysis. RESULTS: Twenty-nine participants (62% female; 40.3±11.3 years of age) were randomized to irbesartan, and 28 (64% female; 40.7±11.0 years of age) were randomized to placebo. The composite primary outcome occurred in 8 of 29 patients (27.6%) receiving irbesartan versus 15 of 28 patients (53.6%) receiving placebo (hazard ratio, 0.42 [95% CI, 0.17, 0.99]; P <0.05). The risk of recurrent symptomatic or nonsymptomatic arterial events was lower with irbesartan than with placebo (risk ratio, 0.37 [95% CI, 0.19, 0.68]; P =0.002). A reduction of progression of arterial lesions was observed at all sites. Irbesartan significantly reduced systolic blood pressure compared with placebo (baseline-adjusted difference of 5.4 mm Hg [ P <0.001]), but no relation was observed with the reduction of the primary composite outcome. Eleven episodes of irbesartan-related hypotension were recorded, leading to a downtitration in 4 patients. CONCLUSIONS: Compared with placebo, irbesartan reduced the risk of severe symptomatic and asymptomatic arterial events in patients with vascular Ehlers-Danlos syndrome on background celiprolol therapy. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02597361
High Mortality Due to Pneumococcal Meningitis in Children With Sickle Cell Disease: A French Multicenter Observational Study From 2001 to 2021
No full textInternational audienceBackground: Sickle cell disease (SCD) predisposes children to bacterial infections, particularly invasive pneumococcal disease. Pneumococcal immunization associated with antibiotic prophylaxis reduced the incidence of invasive pneumococcal disease in these patients. However, the risk remains higher than in the general population. Our main objective was to describe the features of pneumococcal meningitis and estimate the case-fatality rate in children with SCD. The secondary objective was to assess serotype distribution and resistance patterns and the proportion of cases related to vaccine failure. Methods: This nationwide multicenter observational study was conducted in France between 2001 and 2021. All cases of pneumococcal meningitis in children with SCD < 18 years old from the French National Registry of Pediatric Pneumococcal Meningitis were included. Results: Of 2145 pneumococcal meningitis, 25 cases (1.2%, 95% CI: 0.8–1.7) occurred in children with SCD [mean age = 4.6 years (±4)], with a high case-fatality rate (28%, n = 7, 95% CI: 10.4–45.6). Nonvaccine serotypes were predominant (n = 15, 65%, 95% CI: 45.8–84.7) over vaccine serotypes (n = 8, 35%, 95% CI: 15.3–54.3). One case of vaccine failure (4%, n = 1/23) and 2 breakthrough cases (n = 2/23, 9%) were observed. Penicillin-non-susceptible Streptococcus pneumoniae strains were identified in 39% (n = 7). Conclusions: The occurrence of pneumococcal meningitis in children with SCD during the pneumococcal conjugate vaccines era was associated with a high case-fatality rate and a predominance of nonvaccine serotypes. The implementation of new serotype-expanded PCV may have a potentially positive impact on this vulnerable population