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Bromocriptine treatment and outcomes in peripartum cardiomyopathy: the EORP PPCM registry
No full textInternational audienceAbstract Background and Aims Peripartum cardiomyopathy (PPCM) remains a serious threat to maternal health around the world. While bromocriptine, in addition to standard treatment for heart failure, presents a promising pathophysiology-based disease-specific treatment option in PPCM, the evidence regarding its efficacy remains limited. This study aimed to determine whether bromocriptine treatment is associated with improved maternal outcomes in PPCM. Methods Peripartum cardiomyopathy patients from the EORP PPCM registry with available follow-up were included. The main exposure of this exploratory non-randomized analysis was bromocriptine treatment, and the main outcome was a composite endpoint of maternal outcome [death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction (left ventricular ejection fraction < 35%) at 6-month follow-up]. Inverse probability weighting was used to minimize the effects of confounding by indication. Multiple imputation was used to account for the missing data. Results Among the 552 patients with PPCM, 85 were treated with bromocriptine (15%). The primary endpoint was available in 491 patients (89%) and occurred in 18 out of 82 patients treated with bromocriptine in addition to standard of care (22%) and in 136 out of 409 patients treated with standard of care (33%) (P = .044). In complete case analysis, bromocriptine treatment was associated with reduced adverse maternal outcome [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.10–0.83, P = .021]. This association remained after applying multiple imputation and methods to correct for confounding by indication (inverse probability weighted model on imputed data: OR 0.47, 95% CI 0.31-0.70, P < 0.001). Thromboembolic events were observed in 6.0% of the patients in the bromocriptine group vs. 5.6% in the standard of care group (P = .900). Conclusions Among women with PPCM, bromocriptine treatment in addition to standard of care was associated with better maternal outcomes after 6 months
Why Molecular Subphenotyping Is Needed in Cardiogenic Shock and How to Accomplish This
No full textInternational audienceNo abstract availabl
Serial Lactate in Clinical Medicine – A Narrative Review
No full textInternational audienceAbstract Aims Cardiogenic shock (CS) is the deadliest manifestation of acute heart failure, with persistently high mortality rates and a lack of recent therapeutic breakthroughs. Accurate risk prediction is crucial in clinical decision‐making and the design of future clinical trials. We aimed to validate the CLIP score, a biomarker‐based risk score comprising cystatin C, lactate, interleukin‐6 and NT‐proBNP, for predicting mortality in acute coronary syndrome (ACS) related CS, and to compare its predictive value with the previously published CardShock risk score. Methods and results The study is a post hoc analysis of the CardShock Study, a prospective, observational European multicentre study on CS. The CLIP score was calculated 12 h after hospital admission, and its ability to predict 90‐day mortality was assessed using are under the curve (AUC) of the receiver‐operating characteristics (ROC) curve analysis. The discriminative ability of the CLIP score was compared with the CardShock risk score by comparing the AUC's. The cohort was dichotomized into low and high risk groups by the optimal cut‐off value derived from the ROC analysis of the CLIP score. Kaplan–Meier curves were constructed to evaluate risk stratification when combining the CLIP and CardShock risk scores. The cohort ( n = 121) comprised 77% ( n = 93) men and the median age was 67 years (IQR 61–76). A total of 21% ( n = 25) of the patients had non‐ACS related CS. The CLIP score demonstrated appropriate predictive accuracy for 90‐day mortality (AUC 0.84, 95% CI 0.77–0.91), comparable with the CardShock risk score (AUC 0.77 [95% CI 0.69–0.85]; P = 0.064 for comparison). A CLIP score cut‐off of 0.28 stratified patients into high risk (65% mortality) and low risk (16% mortality) groups. In addition, incorporating the CLIP score enhanced risk stratification in all CardShock risk score categories. Conclusions The CLIP score, calculated within 12 h of hospital admission, accurately predicted 90‐day mortality in CS and complemented the CardShock risk score. The biomarker‐based score has potential utility in dynamic mortality risk assessment and could inform clinical management and trial design
Socio‐economic status and the effect of guideline‐directed medical therapy in the STRONG‐HF study
No full textInternational audienceAbstract Aims Acute heart failure (AHF) impacts millions globally, with outcomes varying based on socio‐economic status (SES). Methods SES measured by annual household income, years of education and medical insurance coverage. Each patient's income and education level relative to the median or mean, respectively, in the country was calculated, and categorized into tertiles (0, 1 or 2 from lowest to highest). SES scores (0–5) were computed as the sum of these levels plus insurance coverage (0 = no or 1 = yes ). Patients' baseline characteristics, outcomes (HF readmission, death and their composite) and the effect of high‐intensity care (HIC) vs. usual care (UC) were examined by SES scores 0–2, 3 and 4–5. Results Lower SES patients, who were younger, predominantly female, Black and non‐European, had fewer comorbidities such as atrial fibrillation, diabetes and ischaemic heart disease and exhibited milder HF, indicated by a lower NYHA class, lower creatinine and higher cholesterol before discharge. Despite having milder HF and less comorbidities, after adjusting for baseline characteristics, patients with higher SES had numerically better outcomes, though differences were not statistically significant. 180‐day hazard ratios (HRs) for HF readmission or death were 0.75 (95% CI 0.48–1.16) for SES scores of 3 and 0.85 (95% CI 0.58–1.23) for scores of 4–5, compared to 0–2. Higher SES patients had numerically better treatment effect from HIC, with HRs of 0.69 for SES 0–2, 0.72 for SES 3 and 0.50 for SES 4–5. Conclusions In this post hoc analysis of the STRONG‐HF study, lower SES was associated with milder acute HF but similar 180‐day outcomes. Higher SES patients benefitted more from HIC
Rapid-sequence clinical research before and during a pandemic: Lessons learned and the way forward
No full textInternational audienceIn the aftermath of the COVID-19 pandemic, the structuring of a nationwide research network for preparation and response to emerging infectious diseases (EID) with epidemic or pandemic potential has become increasingly essential. A nationwide EID operational research network (OPEN-ReMIE),is funded for five years through the France 2030 program and run by the French national research agency (ANR). Its primary missions are to accelerate hospital-based clinical research under epidemic or pandemic conditions with academic or industrial sponsors, and to pursue this effort in international research networks. OPEN-ReMIE governance is geared to steering this network and to guaranteeing its operability in inter- as well as crisis modes. It will be the point of entry for key international trial platforms, academic and private sponsors, regulatory agencies, associations of citizens and patients, and think tanks committed to promoting scientific integrity. OPEN-ReMIE encompasses six work packages: (i) regulatory affairs, sponsoring, fast-track procedures and contracts; (ii) clinical site network management; (iii) methodology and management centers to provide methodological expertise (generic master protocols, sets of core and extended variable catalogs, electronic case reports form templates, data management and interoperability, monitoring…); (iv) laboratory and biological resource center management; (v) drug supply and pharmacovigilance supervisory board; (vi) training programs and communication plans for various stakeholders: research teams, healthcare professionals, students, associations of citizens and patients and, increasingly, civil society actors. All in all, OPEN-ReMIE is a nationwide \"preparedness task force\" embedded in a large-scale European consortium for EID clinical research and working with other international EID clinical research platforms
Towards a bottom-up and economical approach to grow nanocrystalline diamond film
No full textInternational audienceTowards a bottom-up and</div
Science de la durabilité : recherches participatives (volume 4)
No full textCe 4e volume consacré à la science de la durabilité continue d'approfondirla réflexion collective sur l'interdisciplinarité et l'ancrage territorial des acti-vités de recherche dans les Suds. Centré sur les recherches participatives,cet ouvrage présente à la fois un état des lieux et des retours d'expériences.L'IRD partage ici avec l'ensemble de la communauté scientifique la richessede ces recherches tout en abordant les questionnements épistémologiques,éthiques, de valeurs et les enjeux institutionnels qu'elles font émerger
Magnetite Nanoparticle Photothermal Therapy in a Pancreatic Tumor-on-Chip: A Dual-Action Approach Targeting Cancer Cells and their Microenvironment
No full textInternational audienceThe application of magnetite nanoparticles (MagNPs) for photothermal therapy (MagNP-PTT) has recently expanded to cancer treatment. This study introduces MagNP-PTT in a tumor-on-a-chip model to target highly aggressive pancreatic ductal adenocarcinoma (PDAC). A tumor-on-chip system was developed using PANC-1 PDAC cells embedded in a collagen type I extracellular matrix and cultured for 1 week to form tumor spheroids. This platform offers a framework for applying PTT in a model system that aims to mimic the native tumor microenvironment. MagNPs efficiently penetrate the tumor spheroids, achieving controlled heating via near-infrared (NIR) light. By adjusting nanoparticle concentration and laser power, temperature increments of 2 °C between 38-48 °C were established. Temperatures above 44 °C significantly increased cell death, while lower temperatures allowed partial recovery. Beyond inducing cancer cell death, MagNP-PTT altered the extracellular matrix and triggered a slight epithelial-mesenchymal transition marked by increased vimentin expression. These findings highlight MagNP-PTT as a dual-action therapy, targeting both tumor cells and their microenvironment, offering an alternative approach for overcoming stromal barriers in pancreatic cancer treatment
Is there a conservative case for abolishing passports?
No full textInternational audienceConservative philosophers argue that good policy is one that draws on history. In this guest lecture, I ask whether the abolition of passports and the desire to return to the pre-1914 regime of free movement can be supported as conservative policy
