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Association Between Surgeon Stress and Major Surgical Complications
No full textInternational audienceImportance. Surgeon stress can influence technical and nontechnical skills, but the consequences for patient outcomes remain unknown.Objective. To investigate whether surgeon physiological stress, as assessed by sympathovagal balance, is associated with postoperative complications.Design, Setting, and Participants. This multicenter prospective cohort study included 14 surgical departments involving 7 specialties within 4 university hospitals in Lyon, France. Exclusion criteria consisted of patient age younger than 18 years, palliative surgery, incomplete operative time-stamping data, procedures with a duration of less than 20 minutes, and invalid surgeon heart rate variability (HRV) data. Data were accrued between November 1, 2020, and December 31, 2021, with 30-day follow-up completed on May 8, 2022. Analyses were performed from January 1 to May 31, 2024.Exposure. Sympathovagal balance of the attending surgeon in the first 5 minutes of surgery.Main Outcomes and Measures. Major surgical complications, extended intensive care unit stay, and mortality within 30 days, after adjustment via mixed-effects multivariable logistic regression for surgeon age, professional status, the time of incision, the random effect of the surgeon, and a composite risk score incorporating patient comorbidities and surgery characteristics. Sympathovagal balance was quantified by the low frequency to high frequency (LF:HF) ratio derived from HRV data measured by chest monitors worn intraoperatively. The LF:HF ratio was normalized at the surgeon level to the median value observed for each surgeon during the study period to control for baseline differences.Results. A total of 793 surgical procedures performed by 38 attending surgeons were included in the analysis. Median patient age was 62 (IQR, 47-72) years, and 412 (52.0%) were female, with a median of 2 (IQR, 1-4) comorbidities. Median surgeon age was 46 (IQR, 39-52) years, 39 (78.9%) were male, and 22 (57.9%) were professors. Median surgeon heart rate was 88 (IQR, 77-99) beats per minute. Median surgeon LF:HF ratio was 7.16 (IQR, 4.52-10.72) before and 1.00 (IQR, 0.71-1.32) after normalization. Increased surgeon sympathovagal balance during the first 5 minutes of surgery was associated with significantly reduced major surgical complications (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.98; P = .04), though not with reduced intensive care unit stay (AOR, 0.34; 95% CI, 0.11-1.01; P = .05) or mortality (AOR, 0.18; 95% CI, 0.03-1.03; P = .05).Conclusions and Relevance. Increased surgeon stress at the beginning of a procedure was associated with improved clinical patient outcomes. The results are illustrative of the complex relationship between physiological stress and performance, identify a novel association between measurable surgeon human factors and patient outcomes, and may highlight opportunities to improve patient care
Development of a 50% (w/v) aluminium chloride hexahydrate solution as haemostatic agent
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Muscle composition is not a prognostic factor for muscle strength recovery after anterior cruciate ligament surgery by hamstring tendon autograft
No full textInternational audiencePurpose: For the athlete, anterior Cruciate Ligament (ACL) rupture and its surgical management are often aturning point in their career. Success and time to return to sport are essential parameters for athletes and theirsupport staff, so it is critical to understand the prognostic factors influencing return to sport after anteriorcruciate ligament reconstruction (ACLR). The aim of this study was to determine the influence of hamstringmuscle composition on muscle power following ACLR with autogenous hamstring grafts.Methods: 24 patients with chronic torn ACL were included at a single-center over a period of 17 months. Theyunderwent surgical repair and during this procedure grafts were harvested from the gracilis and the semitendinosus.Muscle composition was assessed on the remaining proximal part of the semitendinosus muscle, which isusually discarded, by immunostaining. Muscle power was defined by comparing the strength of the operated legand the healthy leg on an isokinetic dynamometer at 6 months according a standardized protocol after 6 monthsof outpatient rehabilitation. Various other intrinsic and extrinsic factors were also studied, such as body massindex (BMI), age, sex, smoking, or sport practiced, to determine factors influencing isokinetic strength test afterACLR.Results: No statistical relationship was identified between muscle composition and the muscle power between theoperated and healthy leg. Smoking and female gender were associated with worse muscle recovery. Age and BMIhad no influence on isokinetic performance at 6 months.Conclusion: Following ACLR muscle composition is not associated with difference in strength between the twolegs at 6 months. Determining muscle fiber composition of the patient does not inform the rehabilitation protocolor predict muscle strength recovery. Larger series data is required to understand the influence of gender or tobaccoon muscle fiber characteristic.Level of Evidence: : I; Prospective prognostic study
Spacers in two-stage strategy for periprosthetic infection
No full textInternational audienceIn two-stage revision of infected implants, the first stage involves removing the implant and implanting a joint spacer, and the second stage involves implanting a new prosthesis at least 6 weeks later. Spacers have two main functions: local administration of high-dose antibiotics, and preservation of the joint space by reducing soft tissue retraction and improving patient comfort until reimplantation. The present review aims to detail the necessary characteristics of antibiotics added to cement to achieve good joint diffusion, to describe the steps of two-stage revision, and to present the types of spacer available according to the joint and complications. The antibiotic used in the spacer must be heat-resistant, water-soluble and chemically stable in the cement. Gentamicin and vancomycin are generally preferred. We recommend at least 3 months’ systematic antibiotic therapy for periprosthetic joint infection. Reimplantation is performed either at 6 weeks without antibiotic washout or 3 months after 2 weeks’ washout Spacers may be static (non-articulating) or dynamic (articulating). Static spacers are mainly used in the knee or hip in cases of severe bone defect or risk of soft-tissue lesions. An articulating spacer enables some joint functions to be preserved in the knee, hip or shoulder. The most frequent complications are the dislocation of dynamic spacers and the breakage of static or dynamic spacers. To optimize efficacy and minimize complications, the biomechanical and bacteriological characteristics of spacers must be considered.Level of evidenceExpert opinion
Multi-modal refinement of the human heart atlas during the first gestational trimester
No full textUnderstanding human cardiac development is essential to improving the diagnosis and treatment of congenital heart defects. Here, we present a multi-modal atlas of the developing human fetal heart during the critical first trimester. Using single-nucleus RNA sequencing, we sampled nearly 50,000 cardiac nuclei from three human fetuses at 8.6, 9.0, and 10.7 post-conceptional weeks (pcw). This dataset enabled distinction of 21 cell types, including novel contractile, conductive, and stromal cells. Lymphatic endothelial, epicardial and autonomic neural and glial cells were among the new, smaller populations for which we established high-resolution transcriptional profiles. We further integrated the snRNAseq data with published single-cell RNAseq data from hearts between 5 to 7 pcw. Combined trajectory analysis allowed us to identify a new human cardiomyofibroblast progenitor, preceding the segregation and diversification of cardiomyocyte and many stromal lineages. To refine cell-type annotations, we turned to spatial transcriptomics. Analysis of six Visium sections from two additional hearts was aided by deconvolution of spots with our snRNAseq data. We further confirmed key markers using in situ hybridization or immunofluorescence on sectioned or whole hearts, followed by standard or light-sheet confocal microscopy. Altogether, these complementary approaches permitted us to add anatomical-positional features such as chamber specificities, innervation and conduction system components, or subdomains of the atrioventricular septation complex. Each translates cell identity into specialized cardiac functions. A total of forty first-trimester hearts were studied to discover and validate cellular characteristics across a wide range of scales, from the individual nucleus to the entire organ. Our results offer a comprehensive resource for understanding the cellular dynamics of human cardiac development and lay the groundwork for further studies into the molecular mechanisms underlying congenital heart malformations. This atlas adds unprecedented spatial and temporal resolution to the characterization of human-specific aspects of early human heart formation
Five and 10-year evolution of longitudinal melanonychia appearing before the age of 5: A multicenter prospective cohort study from the International Dermoscopy Society
No full textInternational audienc
Innovative approaches to organ preservation in heart transplantation: A comprehensive review by the French Society of Thoracic and Cardiovascular Surgery
No full textJ.G. received travel fees from TransMedics (Andover, USA). The other authors declare that they have no competing interest.International audienceImproved approaches for organ preservation have been recently applied in heart transplantation to prevent the risk of primary graft dysfunction. To review heart-graft preservation systems and to identify criteria for using innovative devices in each specific situation. A working group of the French Society of Thoracic and Cardiovascular Surgery performed a literature review focusing on organ preservation and post-transplant outcomes. Static cold storage is the most widely used method but involves cold ischaemia and is therefore limited for prolonged preservation. Optimizing this method by ensuring uniform and stable cooling (SherpaPak™) seems to be associated with favourable results, even with expanded-criteria grafts. Continuous normothermic organ perfusion (Organ Care System) shortens the cold ischaemia time, thus maintaining heart-graft viability despite long transportation times or long waits to achieve complex recipient-heart explantation. Moreover, this method can rehabilitate Maastricht III heart grafts. Continuous hypothermic oxygenated perfusion (XVivo™, not yet approved by regulatory authorities) has recently been associated with favourable outcomes, even in case of extended out-of-body preservation>8hours. The new devices for heart preservation can be expected to allow successful transplantation despite long transport times, lengthy explantation procedures and the use of grafts from expanded-criteria donors, including donors after controlled circulatory arrest. Further studies are needed to assess patient and graft outcomes, determine the optimal device for each situation and evaluate the cost-benefit ratio
Cardiac Amyloidosis Screening and Management in Patients With Heart Failure With Preserved Ejection Fraction: An International Survey
No full textInternational audienceCardiac amyloidosis (CA) is still an underdiagnosed cause of heart failure (HF) and early disease recognition and timely disease-modifying therapy (DMT) administration translate to better outcomes. We aimed to assess CA screening and management approaches for patients with HF preserved ejection fraction (HFpEF) among physicians worldwide. An independent academic web-based survey was distributed worldwide between May 2023 and July 2023. Overall, 1,460 physicians (61% were men, median age was 42 [34 to 49] years) from 95 countries completed the survey. A total of 2/3 of respondents had experience diagnosing CA and reported having 10% of patients with CA in patients with HFpEF. Systematic screening for CA of all patients with HFpEF was performed by 10% of responders, whereas 24% did not consider the screening. Most responders (39%) used left ventricular hypertrophy as a screening criterion. Serum protein electrophoresis with immunofixation of free light chain and urine protein electrophoresis or cardiac magnetic resonance were selected by half of the responders as a first-line diagnostic tool. The combination of serum protein electrophoresis with immunofixation free light chain, urine protein electrophoresis, and bone scintigraphy was considered by 32% of the participants. CA DMT was available for 48% of the physicians. About 82% of responders would administrate HF to patients with HFpEF with CA, with the most preferable drugs being diuretics, sodium-glucose cotransporter-2 inhibitors, and renin-angiotensin-aldosterone system inhibitors. In conclusion, the results reveal the uncertainties among physicians worldwide regarding the need for CA screening of patients with HFpEF. CA remains a disease with very heterogeneous management, particularly, in the screening and diagnostic workup. The HF community should aim to educate on CA and improve access to DMT
The definition of clinical obesity is changing!
No full textInternational audienceNo abstract availabl
Ms-Multi-Spine challenge proceedings
No full textInternational audienceThis proceedings book gathers the methodological papers accompanying pipelines submitted for the ms-multi-spine-challenge (https://portal.fli-iam.irisa.fr/MS-Multi-Spine/), that took place in the context of Miccai 2025 conference. This challenge results from the joint motivation of the OFSEP(https://www.ofsep.org/en) (French registry on multiple sclerosis aiming at gathering, for research purposes, imaging data, clinical data and biological samples from the French population of multiple sclerosis subjects), FLI(https://portal.fli-iam.irisa.fr/) (France Life Imaging, devoted to setup a national distributed e-infrastructure to manage and process medical imaging data) and Empenn research team. These particular efforts were directed towards bringing attention to the spinal cord multiple sclerosis lesion segmentation and to its specific methodological setting. Indeed, in clinical practice, it is highly recommended to acquire at least two sequences among a set of available ones for the detection of spinal cords, without specific guidelines to date. In practice, depending on the center and context, any combination of existing MR sequences can be provided. This challenge therefore represents a concrete and paradigmatic case of missing modalities setting where, depending on the case, some modalities may be missing both at inference or training time. To the best of our knowledge, such clinical datasets are still rarely available in medical imaging. More generally, to date, the medical imaging community concentrated its efforts toward the detection/segmentation of the lesions in brain MRI but spinal cord lesions remain a topic much less studied. In this challenge, we provided a set of 100 segmented cases with different combinations of sequences among sagittal T2w, sagittal PSIR, sagittal STIR and 3d MPRAGE to the participants, that were asked to propose a segmentation method being able to deal with any of the following combinations (sagittal T2w, sagittal PSIR), (sagittal T2w, sagittal STIR), (sagittal T2w, 3d MP2RAGE) and (sagittal T2w, sagittal STIR, 3D MP2RAGE). The performances of the methods were then assessed using a dedicated testing set. The training and testing data sets were manually annotated using a principled process involving 5 experts for each case. All pipelines were submitted in the form of a docker and integrated to the VIP platform (creatis.insa-lyon.fr/vip/) and participants were not involved in the evaluation on the test set data. The dataset can be requested at (https://shanoir.irisa.fr/shanoir-ng/welcome) and we hope it will contribute to unlock new solutions to improve spinal cord lesion segmentation methods