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Direct genome sequencing of Leishmania tropica in tissues of Moroccan patients with cutaneous leishmaniasis reveals micro-focal transmission underlain by (pseudo-)clonal and sexual reproduction modes
No full textInternational audienceAbstract Leishmania tropica is causing cutaneous leishmaniasis (CL) from North Africa to India and in Ethiopia and is reported to be transmitted from humans to humans through sand fly bites. While this species is characterized by a high genomic diversity all over the area of endemicity, there is very little information on diversity at micro-epidemiological scale. Here, we zoomed on an epidemic Moroccan focus of CL and studied transmission patterns by comparative genomics of parasites in human patients. We used a culture-independent method of genome sequencing, applied directly on dermal scrapings. We identified 7 groups of nearly identical genotypes, as well as parasites with mixed ancestry. Our results reveal a micro-focal transmission among humans, underlain by (pseudo) clonal and sexual reproductive modes. This study demonstrates the power of direct genome sequencing for evolutionary genetics at a micro-epidemiological scale
Federated Learning for MRI-based BrainAGE: a multicenter study on post-stroke functional outcome prediction
No full textObjective: Brain-predicted age difference (BrainAGE) is a neuroimaging biomarker reflecting brain health. However, training robust BrainAGE models requires large datasets, often restricted by privacy concerns. This study evaluates the performance of federated learning (FL) for BrainAGE estimation in ischemic stroke patients treated with mechanical thrombectomy, and investigates its association with clinical phenotypes and functional outcomes.Methods: We used FLAIR brain images from 1674 stroke patients across 16 hospital centers. We implemented standard machine learning and deep learning models for BrainAGE estimates under three data management strategies: centralized learning (pooled data), FL (local training at each site), and single-site learning. We reported prediction errors and examined associations between BrainAGE and vascular risk factors (e.g., diabetes mellitus, hypertension, smoking), as well as functional outcomes at three months post-stroke. Logistic regression evaluated BrainAGE's predictive value for these outcomes, adjusting for age, sex, vascular risk factors, stroke severity, time between MRI and arterial puncture, prior intravenous thrombolysis, and recanalisation outcome.Results: While centralized learning yielded the most accurate predictions, FL consistently outperformed single-site models. BrainAGE was significantly higher in patients with diabetes mellitus across all models. Comparisons between patients with good and poor functional outcomes, and multivariate predictions of these outcomes showed the significance of the association between BrainAGE and post-stroke recovery.Conclusion: FL enables accurate age predictions without data centralization. The strong association between BrainAGE, vascular risk factors, and post-stroke recovery highlights its potential for prognostic modeling in stroke care
Is longer really better? Results of a retrospective real-life cohort study evaluating the benefit of adding a weekly educational session to a traditional 8-week home-based pulmonary rehabilitation programme in people with COPD.
No full textInternational audienceObjectives To evaluate the short-term and long-term benefits of adding a weekly educational session to a traditional 8-week home-based pulmonary rehabilitation (PR) programme in people with chronic obstructive pulmonary disease (COPD). Primary hypothesis was that 8 home-based supervised sessions will be equivalent to 16 home-based supervised sessions at both short- and long-term after PR.Design Retrospective cohort study conducted on prospectively collected real-life data, from January 2010 to December 2021.Setting FormAction Santé, Pérenchies France.Participants Eligible individuals were aged >18 years with a diagnosis of COPD and referred to the home-based PR programme by their respiratory physician. Participants were retrospectively divided into two groups (Gr 1, 8 PR sessions, n=759, and Gr 2, 8 PR sessions+8 educational sessions, n=262).Intervention All participants received an 8-week personalised home PR programme. A subgroup of participants received one additional supervised home session per week, including education and motivational support for daily physical activities and walking.Outcomes Health-related quality of life, dyspnoea, anxiety and depressive symptoms, fatigue and exercise tolerance were assessed at baseline (M0), at the end of PR (M2), and 14 months (M14) after M0.Results Baseline characteristics and assessments were similar between groups with an exception for long-term oxygen therapy (Gr1: 69.8% vs Gr2 53.0%, p<0.001) and noninvasive ventilation (Gr1: 38.6% vs Gr2: 29.8%, p=0.015). At M2 and M14, all the assessments were improved in both groups (p<0.01). At M2, the improvement in health status and exercise tolerance was higher in Gr 2 compared with Gr 1 (p<0.05). From M0 to M14, 90 (11.9%) participants and 29 (11.1%) participants died in Gr 1 and Gr 2, respectively (p=0.794).Conclusion People with COPD benefited, at short and long terms, from both 8 or 16 supervised home-based PR sessions. Once-weekly home-based supervised sessions during 8 weeks, combined with unsupervised physical training sessions and self-management plan for the other health behaviours, might be the best compromise between patients, health professionals and policy makers
RNA-based diagnostic studies in genetics: Review and guidance from a multidisciplinary French network
No full textInternational audienceThe widespread use of high-throughput sequencing for genetic diagnosis has led to considerable advances in patient care, but interpretation of the variants identified remains a challenge and geneticists routinely face the question of variants of uncertain significance. The clinical interpretation of genomic variants requires a high level of expertise to ensure appropriate genetic counseling. Assessing the impact of variants on splicing is a key issue in order to determine their pathogenicity as each variant can impact pre-mRNA splicing by disruption of the splicing code. It is for this reason that a diverse group of French molecular and clinical genetics experts from different diagnostic laboratories nationwide was established to discuss splicing issues and elaborate diagnostic recommendations. We describe an update of these recommendations with the aim of highlighting the importance of transcript characterization for variant interpretation and facilitating the diagnostic implementation of transcript studies, an important source of new diagnostics in human genetics
Integrating socio-ecosystemic factors in One Health approaches: A scoping review in zoonotic disease research
No full textSource Agritrop Cirad (https://agritrop.cirad.fr/613470/) * Autres projets (id;sigle;titre): ;;(FRA) Preacts Africam//International audienceIt is widely accepted that zoonoses pose an ever-growing threat which should be tackled using a One Health approach. Like One Health, the socio-ecosystemic framework is a powerful concept that has been used to study complex systems. The aim of this work is to identify the socio-ecosystemic factors influencing zoonotic risk, while assessing and highlighting the importance of using this framework from a One Health perspective. To do so, we conducted a scoping review following the PRISMA-ScR guidelines on articles written in English, published between 1986 and 2023, and extracted from three scientific databases (PubMed®, Scopus® and Web of Science™) in January 2023 or identified by snowball sampling. Eligibility criteria were applied to select relevant scientific articles from various disciplines, related to the epidemiology of zoonotic agents in a context of epidemic risk. Among the 1661 articles extracted from the databases, to which must be added articles identified by snowball sampling, a total of 195 articles that underwent full-text analyses were included in our work. We identified 47 socio-ecosystemic factors influencing the risk of zoonotic emergence: 15 were categorized as ecological, 15 as economic, and 17 as social. The social factor “hunting, poaching and wildlife trafficking” was the most referenced, with 24 citations. Only 15 % of the studies were considered truly “interdisciplinary” because they integrated all three dimensions of the socio-ecosystem, and their publication dates show that the issue has only recently been taken up. These results provide a relevant synthesis of knowledge on the subject, in an original way that underlines the equal importance of these three dimensions. The corpus of articles is covered with a good saturation of references, ensuring the representativeness of the results. This work could contribute to a more holistic and effective consideration of the risk of zoonotic emergence, by emphasising the importance of interdisciplinarity
Using the Q-method to explore pregnant and breastfeeding women's perceptions of antibiotic use in Mahajanga, Northwest Madagascar
No full textSource Agritrop Cirad (https://agritrop.cirad.fr/613398/)International audienceBackground: The Q-method is a research approach that combines quantitative and qualitative techniques to study people's subjectivity on a given theme. In Madagascar, antibiotic usage practices remain largely unstudied, particularly among pregnant and breastfeeding women. This study aims to use the Q-method to document the opinions of pregnant and breastfeeding women on antibiotic use practices in the Northwest region of Madagascar. Methods: The Q-method was applied to 115 pregnant and breastfeeding women from two districts, one urban and one rural, in Northwest Madagascar. The participants ranked 36 statements about antibiotic use on a 7-point scale ranging from − 3 (strong disagreement) to + 3 (strong agreement). Principal component analysis (PCA) was used to analyze the rankings and identify groups of women with differing or similar viewpoints. The Wilcoxon and Kruskal-Wallis rank sum tests were employed to assess significant differences among participants in each group and to evaluate the differences between these groups. Additionally, semistructured interviews were conducted to explore the participants' reasoning behind their rankings and to complement the quantitative findings. Results: Among the 115 women, 51% (59/115) resided in urban areas, while 49% (56/115) lived in rural regions. PCA identified two main groups of women with distinct viewpoints on antibiotic use. Group 1 comprised 55.6% (64/115) of the women and consisted of women who only complied with medical indications and instructions by being vigilant. Group 2 represented 35.6% (41/115) of the respondents and included women who believed in antibiotic usage based on receiving information first from multiple sources (medical staff or personal experience or other nonmedical relatives). 10 women (8.8%) could not be classified under either of the two groups. Differences in opinions were observed in Group 1 based on age (p = 0.004), marital status (p = 0.013), educational level (p = 0.007), gravidity (p = 0.062), and area of residence (p = 0.125), and in Group 2 based on educational level (p = 0.065) and gravidity (p = 0.127). Insights from the semistructured interviews enriched the interpretation of these groups' classification. Conclusions: Pregnant and breastfeeding women surveyed in Northwest Madagascar believe that the best approach to antibiotic use is to follow the recommendations of health care professionals. However, some rely on advice from others, whether medical or nonmedical. To improve adherence to antibiotic treatments based solely on medical prescriptions and ensure their proper use in Madagascar, the communication between health care providers and patients must be strengthened
Mise au point sur les compléments alimentaires
No full textInternational audienceThis article is the first in a series of articles on food supplements, written by a working group of the French Society of Nutrition (SFN) created in 2023. It introduces the subject by considering their official definition, characteristics, and potential benefits. It details the various risks associated with their consumption. These are often underestimated by consumers because dietary supplements are not intended to treat illnesses, but the risks are numerous and the consequences sometimes serious, justifying seeking the advice of a healthcare professional with proper training on the subject
Comparison between multimodal foundation models and radiologists for the diagnosis of challenging neuroradiology cases with text and images.
No full textInternational audiencePurposeThe purpose of this study was to compare the ability of two multimodal models (GPT-4o and Gemini 1.5 Pro) with that of radiologists to generate differential diagnoses from textual context alone, key images alone, or a combination of both using complex neuroradiology cases.Materials and methodsThis retrospective study included neuroradiology cases from the "Diagnosis Please" series published in the Radiology journal between January 2008 and September 2024. The two multimodal models were asked to provide three differential diagnoses from textual context alone, key images alone, or the complete case. Six board-certified neuroradiologists solved the cases in the same setting, randomly assigned to two groups: context alone first and images alone first. Three radiologists solved the cases without, and then with the assistance of Gemini 1.5 Pro. An independent radiologist evaluated the quality of the image descriptions provided by GPT-4o and Gemini for each case. Differences in correct answers between multimodal models and radiologists were analyzed using McNemar test.ResultsGPT-4o and Gemini 1.5 Pro outperformed radiologists using clinical context alone (mean accuracy, 34.0 % [18/53] and 44.7 % [23.7/53] vs. 16.4 % [8.7/53]; both P < 0.01). Radiologists outperformed GPT-4o and Gemini 1.5 Pro using images alone (mean accuracy, 42.0 % [22.3/53] vs. 3.8 % [2/53], and 7.5 % [4/53]; both P < 0.01) and the complete cases (48.0 % [25.6/53] vs. 34.0 % [18/53], and 38.7 % [20.3/53]; both P < 0.001). While radiologists improved their accuracy when combining multimodal information (from 42.1 % [22.3/53] for images alone to 50.3 % [26.7/53] for complete cases; P < 0.01), GPT-4o and Gemini 1.5 Pro did not benefit from the multimodal context (from 34.0 % [18/53] for text alone to 35.2 % [18.7/53] for complete cases for GPT-4o; P = 0.48, and from 44.7 % [23.7/53] to 42.8 % [22.7/53] for Gemini 1.5 Pro; P = 0.54). Radiologists benefited significantly from the suggestion of Gemini 1.5 Pro, increasing their accuracy from 47.2 % [25/53] to 56.0 % [27/53] (P < 0.01). Both GPT-4o and Gemini 1.5 Pro correctly identified the imaging modality in 53/53 (100 %) and 51/53 (96.2 %) cases, respectively, but frequently failed to identify key imaging findings (43/53 cases [81.1 %] with incorrect identification of key imaging findings for GPT-4o and 50/53 [94.3 %] for Gemini 1.5).ConclusionRadiologists show a specific ability to benefit from the integration of textual and visual information, whereas multimodal models mostly rely on the clinical context to suggest diagnoses
Sheep models in translational surgery.
No full textInternational audienceBackground: The selection of an animal model is tedious. One must consider several factors; one of these, of utmost importance, is the translational value of the animal model. The sheep, as a translational surgical model, possesses a multiple of advantages that makes it one of the preferred models in several research domains. Summary: Sheep are the state-of-the-art test models for cardiovascular research and safety studies required for approval of cardiovascular implantable devices; the sheep’s heart size, cardiac muscle, heart valves, and the mechanical, haemodynamic, and coagulation parameters are very similar to humans. Furthermore, the pregnant sheep/lamb are robust models for studying neonatal adaptation and placental physiology due to its physiological similarities with humans. Its placental structure supports efficient gas exchange, resembling human oxygen transfer mechanisms. The ovine model is mainly used in studies of adaptation at birth, foetal physiology during labour, and congenital diaphragmatic hernia. The sheep model is also used in several orthopaedic preclinical models, mainly in the study of critical bone defects, cancellous bone healing, osteomyelitis, and joint replacement surgeries. It is also a preferred model of bone healing in osteoporosis. Moreover, the sheep has gained popularity as a model of osteoarthritis (OA); it is a validated model of surgically induced OA. Several therapeutic modalities can be evaluated using validated outcome measures such as, kinetics, kinematics, imaging, repeated arthroscopic grading, synovial fluid analysis, and biomarkers. The ovine model, because of its size, is the closest to humans for the evaluation of spinal surgery techniques, devices, and spinal fusion biological enhancers/cancellous graft replacement. Finally, we will outline the different specificities of sheep analgesia and anaesthesia. Challenges encountered in ruminant anaesthesia are mainly in relation with their digestive physiology that creates a high risk of regurgitation during anaesthesia and a hindrance of diaphragm/respiratory movements due to rumen repletion and meteorism. Fasting regimen and management of recovery should encompass strategies that limit the starving sensation and allow for reduced social isolation. Clarification of the interactions between scientific objectives and anaesthesia-analgesia protocols prevents conflicts between the ethics and the purpose of the experiment while allowing for development of model-specific anaesthesia and pain management protocols. Key Messages: The sheep has become a popular model because of its size, availability, robustness, cost, and ease of handling. Furthermore, as a preclinical model, the same validated objective outcome measures used to measure success in humans can apply to sheep