HAL-HCL
Not a member yet
19000 research outputs found
Sort by
Is bicortical femoral pin insertion safe for Image-based Robotic Knee Arthroplasty Surgery ? A comparative complications analysis in 970 Consecutive Cases
No full textInternational audienceOBJECTIVES: Limited data exists on complications associated with robotic image-based system in knee arthroplasty. This study aims to document complications in robotic arm-assisted knee arthroplasties, and evaluate the system's safety by comparing two femoral pin insertion methods: bicortical diaphyseal with additional stab wounds, and unicortical metaphyseal placement through the main incision.METHODS: All patients undergoing primary knee arthroplasty with the image-based robotic system (Mako, Stryker, Mako Surgical Corp., Fort Lauderdale, FL, USA) from 1st March 2021 to 31st January 2024 with a minimum follow-up of 2 months were included. Demographics, system and non-system-related complications, as well as outcomes were recorded. Complications were categorized as either major (requiring a second surgical intervention) or minor.RESULTS: A total of 970 consecutive cases (median age 69.3 years) were analyzed. The unicortical group comprised 651 cases, while the bicortical group 319. The incidence of non-system-related complications was 2.37%, with the most common being joint stiffness (10 cases; 1.03%), followed by lateral femoral condyle fracture (4;0.41%). The overall incidence of system-specific complications was 1.03%. Pin-related femoral fractures occurred in 0.2% of cases, all postoperatively and in the unicortical group. There was no statistically significant difference between the femoral pin insertion-related complication rates among the two groups (0.3% in the unicortical, compared to 0% in the bicortical group; p-value= 0.3). Complications included tibia fracture (0.1%), delayed wound healing (0.2%), superficial wound infection (0.1%), tibia osteomyelitis (0.1%), and "exostosis" (0.2%). The major complications rate was 0.3% and minor 0.7%.CONCLUSIONS: Minimal system-specific overall complications indicate that robotic arm-assisted surgery is safe. The bicortical diaphyseal femoral pin insertion method does not increase the complication rates compared to the unicortical metaphyseal method
Patient perceptions of artificial intelligence in dental imaging diagnostics: a multicenter survey
No full textInternational audienceAbstract Objectives To evaluate patients' perceptions of the use of artificial intelligence (AI) in dental imaging diagnostics across six centers worldwide, hereby named according to their respective cities: Ribeirão Preto (Brazil), Aarhus (Denmark), Lyon (France), Tromsø (Norway), Porto (Portugal), Louisville (USA). Methods A survey was administered at each center, focusing on patient attitudes and beliefs regarding AI in dental imaging diagnostics. The survey comprised 16 statements rated on a Likert scale, patient characteristics, and an optional comment section. Inter-center differences were analyzed using chi-square and Fisher's exact tests, and correlation analyses were performed between participant characteristics and their perceptions of AI. Results A total of 2,581 responses were collected. Most participants expressed positive perceptions of AI as a complementary diagnostic tool, rather than a replacement for human dentists. Key concerns included the need for human oversight, data privacy, and potential cost increases. Differences were observed between centers, with participants from Ribeirão Preto being more likely to accept AI replacing dentists, whereas those from Aarhus and Tromsø expressed greater skepticism about AI’s diagnostic capabilities. Higher levels of education and familiarity with AI were positively associated with more favorable views, provided that human supervision remained a key component. Conclusions Overall, patients favor the use of AI in dental imaging as an auxiliary diagnostic tool, with human supervision remaining essential. Cultural and demographic factors significantly influence perceptions. Advances in knowledge The findings highlight the need for tailored communication strategies to address patient concerns and facilitate the integration of AI into dental care
Regular-fat and low-fat dairy foods and cardiovascular diseases: Perspectives for future dietary recommendations
No full textInternational audienceMost current dietary guidelines for the prevention of cardiovascular diseases (CVD) recommend the consumption of low-fat dairy in place of regular-fat dairy foods, one of the main sources of dietary saturated fatty acids (SFAs). Here, we summarize the data presented and discussions held-relating to the validity of such recommendations-between a panel of international nutrition research experts at a high-level closed workshop on \"Saturated Fat in Dairy and Cardiovascular Diseases,\" which took place in Amsterdam on 15-16 April, 2024. The most recent evidence indicates that overall, consumption of milk, yogurt and cheese, irrespective of fat content, is neutrally associated with CVD risk. There is also no evidence yet from randomized controlled trials that consumption of regular-fat milk, yogurt, and cheese has different effects on a broad array of cardiometabolic risk factors when compared with consumption of low-fat milk, yogurt, and cheese. Thus, the body of evidence does not support differentiation between regular-fat and low-fat dairy foods in dietary guidelines for both adults and children. Strategies focusing primarily on reduction of energy-dense, nutrient-poor foods, the main source of SFAs in Western diets, rather than on the fat content of dairy foods, are more likely to benefit the population's cardiovascular health. Future research is needed to understand better the place of regular-fat and low-fat dairy foods within healthy eating patterns
Primary mediastinal B-cell lymphoma (PMBCL): The LYSA pragmatic guidelines
No full textInternational audiencePrimary mediastinal B-cell lymphoma (PMBCL) is a distinct subtype of large B-cell lymphoma with unique clinical, histopathological, and molecular characteristics. Despite its aggressive nature, PMBCL has a high cure rate when managed appropriately. Advances in the understanding of PMBCL biological characteristics, coupled with improvements in diagnostic tools and therapeutic approaches, have significantly improved patient outcomes in recent years. In this article, we present a set of pragmatic guidelines developed by the Lymphoma Study Association (LYSA) for the management of PMBCL. These guidelines address key aspects of diagnosis, staging, response evaluation, and treatment, integrating the latest evidence from clinical trials, expert consensus, and real-world practice. The aim of the guidelines is to provide clinicians with a clear, practical framework to optimize care for patients with PMBCL, ensuring that the best available evidence is translated into clinical practice
The role of nutritional vitamin D in chronic kidney disease–mineral and bone disorder in children and adults with chronic kidney disease, on dialysis, and after kidney transplantation—a European consensus statement
No full textInternational audienceABSTRACT Vitamin D deficiency is common in patients with chronic kidney disease (CKD) and associates with poor outcomes. Current clinical practice guidelines recommend supplementation with nutritional vitamin D as for the general population. However, recent large-scale clinical trials in the general population failed to demonstrate a benefit of vitamin D supplementation on skeletal or non-skeletal outcomes, fueling a debate on the rationale for screening for and correcting vitamin D deficiency, both in non-CKD and CKD populations. In a collaboration between the European Renal Osteodystrophy initiative of the European Renal Association (ERA) and the European Society for Paediatric Nephrology (ESPN), an expert panel performed an extensive literature review and formulated clinical practice points on vitamin D supplementation in children and adults with CKD and after kidney transplantation. These were reviewed by a Delphi panel of members from relevant working groups of the ERA and ESPN. Key clinical practice points include recommendations to monitor for, and correct, vitamin D deficiency in children and adults with CKD and after kidney transplantation, targeting 25-hydroxyvitamin D levels >75 nmol/l (>30 ng/ml). Although vitamin D supplementation appears well-tolerated and safe, it is recommended to avoid mega-doses (≥100 000 IU) and very high levels of 25 hydroxyvitamin D (>150–200 nmol/l, or 60–80 ng/ml) to reduce the risk of toxicity. Future clinical trials should investigate the benefit of vitamin D supplementation on patient-relevant outcomes in the setting of vitamin D deficiency across different stages of CKD
Type III interferon primes pDCs for TLR7 activation and antagonizes immune suppression mediated by TGF-β and PGE2
No full textInternational audienceConventional dendritic cell and plasmacytoid dendritic cell (pDC) subsets have specialized functions that can be modulated by the tumor microenvironment, and produce different interferons that are central to antitumor immune responses. While the function of type I interferons in tumor immunity is well characterized, that of type III interferons produced by type 1 conventional dendritic cells in the tumor microenvironment remains unclear. Here we demonstrate in vitro that type III interferons orchestrate pDC survival, activation and TLR7 expression in the blood, thereby enhancing pDC responses to a TLR7 ligand. Moreover, we show that tumor-associated pDCs express the highest level of IFNLR1, and that these immune cell subsets are the most responsive to IFN-III. Importantly, type III interferons prevent the inhibition of pDCs induced by TGF-β or PGE2 in tumor soluble milieu from patients to restores production of IFN-α in pDCs. With TGF-β or PGE2 having pleotropic functions in immune regulation, our results thus implicate IFN-III-mediated immune modulation to have broad impact on various pathological situations.pDCs can be distinguished from conventional dendritic cells (cDC) by their lack of CD11c and the surface expression of BDCA2/CD303 and IL-3 Receptor (CD123). Their main function is to produce high amounts of type I interferon (IFN-I) after TLR7 or TLR9 engagement by viral ssRNA and ODNs CpG, respectively 1,2 . IFN-I produced by pDCs was shown to induce antiviral and antitumor responses in epithelial cells and immune cells 3,4 , which has led to the approval of IFN-I derivatives, namely IFN-α2 A and IFN-α2B, as treatments for several malignancies 5 . In cancer, an IFN-I signature in the tumor microenvironment (TME) was correlated with "hot tumors", characterized by a strong immune infiltrate and a better response to immunotherapies 6 . Conversely, the downregulation of IFN-I receptor (IFNAR1) is associated with a poor clinical outcome and tumor progression in melanoma 7 , breast and colorectal cancers 8,9 .The precise role of pDCs within the TME remains unclear. While pDC infiltration within tumors was correlated with positive prognosis in colorectal and pancreatic cancers, pDCs were associated with a negative prognosis in ovarian cancer. In breast cancer, they were associated with a positive or negative prognosis 10 . In this context, we and others have demonstrated that pDCs are dysregulated in the TME, displaying a particularly poor capacity to secrete IFN-α 11-13 . This was</div
Estimation of the budget impact of the dual dispensing circuit of emicizumab in France: The HemiValue study
No full textInternational audienceHemophilia A is a rare bleeding disorder associated with an economic burden for patients and their caregivers. This study, called HemiValue, consists in a budget impact model to assess the benefits for patients and the budgetary impact of this shift to dual dispensing for all stakeholders involved, comparing the cost and time savings from the patients' perspective and from the pharmacies' perspective. Methodology: The impact of the dual dispensing circuit over one year was evaluated from the patients' perspective, the evaluation included costs, travel and waiting times related to obtaining the treatment, as well as associated income losses. The analysis also included perspectives from hospital pharmacies (HP), community pharmacies (CP), and ecological considerations. Results: On an individual level, the availability of emicizumab in CP reduced the time spent obtaining this treatment by the equivalent of 3 working days per year. The 322 euros difference in direct costs per year represents a reduction in the proportion of costs relative to the available income of families from 2.6% to 0.2%. This reduction was more pronounced for low-income households and those living more than 30 min from a HP. Discussion: The dual dispensing circuit reduces the financial and logistical burdens associated with obtaining emicizumab. These results highlight the importance of innovative dispensing models that aim to ease constraints for patients and their caregivers while working towards greater equity in accessibility
Outcome of high-grade B-cell lymphoma compared to other large B-cell lymphoma after CAR-T rescue. A DESCAR-T LYSA study
No full textInternational audienceHigh-grade-B-cell lymphoma (HGBL) with MYC and BCL2 and/or BCL6 rearrangements (double hit [HGBL-DH] or triple hit [HGBL-TH]), or not otherwise specified (HGBL-NOS), are considered to be more aggressive diseases among large B-cell lymphomas (LBCL). CD19-targeting Chimeric Antigen Receptor (CAR) T-cells have changed the prognosis of chemoresistant LBCL. Clinical and pathological data of patients treated for relapsed/refractory LBCL or HGBL in third line or more, all characterized by FISH, were collected from the French DESCAR-T registry. Between January 2018 and November 2022, 228 patients were included across 14 centers, 73 with HGBL (28 HGBL-DH MYC-BCL2, 14 HGBL-TH, 8 HGBL-DH MYC-BCL6, 23 HGBL-NOS) and 155 with non-HGBL. Median follow-up was 18.5 months [95% CI, 14.3-23.4] from the date of infusion. Progression-free survival (PFS) and overall survival (OS) were not significantly different between HGBL and non-HGBL, at respectively 3.2 months [95% CI, 2.8-6.0] vs 4.5 months [95% CI, 3.1-8.7] (p = 0.103) and 15.4 months [95% CI, 5.6-32.4] vs 18.3 months [95% CI, 8.5-NR]. From the date of eligibility, the median OS was inferior for patients with HGBL-TH/DH MYC-BCL2 at 6.6 months vs 18.5 months for HGBL-NOS vs 13.6 months for HGBL-DH MYC-BCL6 vs 11.8 months for LBCL (p = 0.037). However, infused patients presented the same outcome. CAR T-cell therapy used in third line or more seems to overcome the poor prognosis of HGBL subtypes, especially in HGBL-TH/DH MYC-BCL2. This observation supports considering the potential benefit of using CAR-T earlier in the course of the disease
