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Design and evaluation of a surgical boot camp: a step-by-step guide to curriculum development and impact assessment
No full textInternational audienceBackgroundThe transition from medical school to surgical residency often leaves students underprepared for essential technical procedures, impacting their confidence and patient safety. Surgical boot camps can help address this skill gap, but few articles have described exactly how to organize a boot camp. We aimed to precisely describe the simulation stations and evaluate the effectiveness of the boot camp. MethodsWe conducted a prospective, monocentric, observational study at the University Hospital of Clermont-Ferrand (France) over a 3-year period, assessing technical skills and cognitive workload before and after boot camp using a validated questionnaire. We included sixty-five medical students (34 female, 31 male) who had been accepted into a general surgery residency program were included. We described precisely the 9 simulation stations. ResultsAfter the boot camp, participants reported increased confidence in basic surgical skills, with significant improvements in technical performance. Satisfaction scores were high, averaging 8.8 out of 10 for women and 9.0 for men. Segmenting the boot camp into multiple workshops made it easy to organize. ConclusionThis surgical boot camp significantly reduced the perceived cognitive workload and improved the confidence of incoming residents, addressing key challenges in pre-residency preparation. By providing a detailed description of our simulation workshops, we aim to facilitate the implementation of similar programs in other institutions.</div
Le syndrome des abcès aseptiques : mises à jour et nouvelles données de 2025
No full textInternational audienceAseptic abscess syndrome (AAS) is a rare systemic disorder characterized by sterile abscesses rich in neutrophils. It occurs isolated or associated with inflammatory bowel diseases (IBD). Clinically, AAS presents with fever, abdominal pain, and elevated inflammatory markers. Diagnosis is based on a combination of clinical, laboratory, and imaging findings (CT scan, PET scan), along with the exclusion of infectious and malignant causes. The French national registry currently includes 100 patients, with 44% women and a mean age at diagnosis of 33.7 f 16.5 years. The average diagnostic delay is 9.1 f 18.3 months, reflecting limited awareness of this entity. Abscesses most commonly affect the spleen (62%), lymph nodes (41%), liver (33%), skin (24%), and lungs (21%). An associated IBD is reported in 39% of cases. The clinical course is marked by a high relapse rate (57%), especially in patients with hepatic or cutaneous involvement at presentation. Conversely, colchicine treatment and coexisting IBD appear to be protective against relapse. Management relies primarily on corticosteroids and colchicine, often combined with immunosuppressants or biologic agents. Over recent years, there has been a trend toward fewer IBD associations and increased use of biologics. The ongoing multicenter translational study ABSCESSBIOT aims to further elucidate the pathophysiology of AAS and improve therapeutic strategies
Agreement of concomitant cardiac output measurement by thoracic bio‐impedance and inert gas rebreathing in healthy subjects
No full textInternational audiencePurpose Inasmuch as they are deemed valid, noninvasive measurement of cardiac output techniques present advantages of ease and safety for use in humans. Few studies have compared the use of thoracic bioimpedance and inert gas rebreathing techniques for cardiac output (CO) assessment at rest and exercise. This manuscript reports on differences between Physioflow® and Innocor® CO measurements at rest and during cycling in a population of healthy subjects. Methods Fifty healthy subjects (52 ± 16 years) underwent an incremental cycle exercise testing (IET) during which standardized Physioflow® and Innocor® CO assessments were achieved. Measurements were completed in a subgroup of twelve subjects during two constant‐load 10‐min cycling bouts at moderate and high intensities. Results Mean difference between Physioflow® and Innocor® was of 0.002 ± 0.98 l/min at rest and 0.38 ± 1.31 l/min during IET without statistical difference. Correlation coefficient values were higher for exercise ( r = 0.83) than resting ( r = 0.40) measurements. Good reproducibility of the two devices was observed on different graded exercises with intraindividual variability lower than 6%, except for rest Innocor® CO measurements (CV = 18%). Conclusion Physioflow® and Innocor® can be easily used concomitantly for noninvasive measurement of CO. Despite finding a strong agreement between techniques for exercise CO, results should not be interpreted as being interchangeable as values are derived from different flow measurements: systemic blood flow for Physioflow® and pulmonary blood flow for Innocor®. However, the concomitant use of both techniques could be of value in clinical setting for noninvasive intrathoracic shunt quantification
Scientific Opinion of the French Agency for Food, Environmental and Occupational Health & Safety on the establishment of dietary guidelines for people following a diet that excludes some or all foods of animal origin (vegetarians)
No full textInternational audienceThis document presents the opinion of the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), established from the work of its Working Group on Vegetarian diets and validated by its Expert Committee on Human Nutrition. ANSES issued an internal request to establish dietary guidelines for people who follow a diet that excludes some or all foods of animal origin. Firstly, ANSES conducted a systematic review of the scientific literature to identify epidemiological links between health and various types of vegetarian diets. This systematic review showed that the risk of developing type 2 diabetes is lower with vegetarian than with non‐vegetarian diets. With a lower level of evidence, vegetarians are less likely than non‐vegetarians to develop certain diseases, such as ischaemic heart disease, ovulation disorders, certain types of cancer (prostate, stomach, blood) and certain ophthalmological and gastro‐intestinal diseases. However, they are at greater risk of bone fractures and hypospadias (congenital malformation of the urethra). The epidemiological studies examined showed that vegetarians have a less favourable nutritional status in iron, iodine and vitamins B12 and D, and a poorer calcium and phosphorus balance than non‐vegetarians. Vegans also have a less favourable nutritional status in vitamin B2. ANSES then used dietary optimisation to identify combinations of food groups (state variables) enabling the set objectives to be met, i.e. to reduce nutritional and toxicological risks, while deviating as little as possible from current consumption habits. All the nutritional and toxicological constraints and the criteria (minimisations or maximisations) made it possible to take account of the risks associated with nutrient intakes or exposure to contaminants, as well as the expected nutritional benefits. The systematic review and establishment of dietary guidelines using an optimisation tool show that the lacto‐ovo‐vegetarian diet requires particular attention regarding certain nutrients for which requirements in terms of vitamin D and eicosapentaenoic and docosahexaenoic fatty acids may not be met. The risk of requirements not being met by the lacto‐ovo‐vegetarian diet is greater than that associated with the diet of non‐vegetarian populations. In addition, lacto‐ovo‐vegetarians limiting their intake of milk and fresh dairy products may not be able to cover their vitamin B12 requirements. Furthermore, with the vegan diet, which excludes all foods of animal origin, it is difficult to meet the dietary reference value for zinc in men
Multicenter performance evaluation of the "quanty TOXO (RH region)" kit (Clonit) for molecular diagnosis of toxoplasmosis
No full textInternational audienceThe diagnosis of congenital toxoplasmosis or disseminated toxoplasmosis in immunocompromised patients nowadays relies on molecular tools, in particular real-time PCR. There are many reagents on the market, and their evaluation by independent experts provides valuable information to medical biologists who are looking for a high-performance kit among the different references. Under the aegis of the French National Reference Center for Toxoplasmosis, we report here a multicenter evaluation of the analytical and clinical performances of the "quanty TOXO (RH region)" PCR assay manufactured by Clonit. The kit showed good analytical performance, as indicated by the results of serial dilution tests and external quality control samples. PCR efficiencies varied from 95% to 105%; linearity zone extended over four log units (R² >0.99), and limit of detection varied from <1 parasite/mL to between 1 and 5 parasites/mL, i.e., from <0.08 parasite/PCR to between 0.2 and 1 parasite/PCR, depending on the center. Based on 141 cryopreserved DNAs from a large range of clinical specimens, we determined a clinical sensitivity of 94.7% (71/75; 95% confidence interval [CI]: 87.1%-97.9%) and a clinical specificity of 100% (66/66; 95% CI: 94.5%-100%). Four false negative results were detected despite amplification carried out in duplicate. Overall, the "quanty TOXO (RH region)" PCR assay demonstrated satisfactory analytical and clinical performances for the diagnosis of toxoplasmosis, even using extraction and amplification techniques or biological matrices not validated by the manufacturer.IMPORTANCEDue to its speed and accuracy, PCR is now the gold standard for diagnosing congenital and disseminated toxoplasmosis. High-performance molecular testing is essential, especially for immunocompromised patients and congenital infections, to initiate early treatment. This diagnostic approach increasingly relies on commercial assays. However, commercially available kits do not guarantee performance. In this study, conducted by the French National Reference Center for Toxoplasmosis, we performed an independent multicenter evaluation of the "quanty TOXO (RH region)" PCR assay manufactured by Clonit. Our results showed that this kit delivered satisfactory results for routine diagnostic use. However, among the 141 clinical samples tested, four false negative results were noted, corresponding to specimens with low parasitic load
Successful Treatment of Secondary Hypersomnia Due to Complex Post-Traumatic Stress Disorder with Eye Movement Desensitization and Reprocessing: A Case Report
No full textInternational audienceHypersomnia may be classified as primary or secondary, with secondary hypersomnia arising from a variety of underlying causes. Thus, according to ICSD3-TR classification, the diagnosis of idiopathic hypersomnia (IH) is established based on (1) excessive daytime sleepiness (EDS); (2) electrophysiological findings including either a mean sleep latency of less than 8 min on the Multiple Sleep Latency Test (MSLT) or increased total sleep (≥11 h) on 24 h polysomnography; and (3) systematic elimination of other potential etiologies, including sleep deprivation, substances, and medical, psychiatric (notably mood disorders), or sleep disorders. Nevertheless, the clinical heterogeneity observed in IH fuels an ongoing debate, reflecting the limited understanding of its underlying pathophysiological mechanisms. This report describes the case of a patient presenting with a clinical and polysomnographic phenotype of IH (MSLT < 8 min). A comprehensive psychopathological evaluation was performed to explore the possibility of secondary hypersomnia, which revealed features consistent with complex post-traumatic stress disorder (c-PTSD). Psychotherapy focused on c-PTSD was administered with positive and objective results in hypersomnolence/EDS. This clinical improvement suggests a potential relationship between psychological trauma and hypersomnia, a connection that is rarely described in the literature and warrants further investigation. This case highlights the need for a comprehensive assessment of secondary factors, particularly complex trauma, even in the presence of a clinical and polysomnographic phenotype consistent with IH
The French 100% Santé Reform: impacts on dental care utilization
No full textInternational audienceIn 2019, France implemented a large-scale reform aimed at reducing out-of-pocket health care expenditures, with the objective of preventing the forgoing of dental care for financial reasons. The aim of this study was to assess the impacts of this reform on dental care utilization, with a particular focus on full dentures as prosthetic care, which was the main target of the reform. The study was based on analyses of large-volume administrative data from the French Social Health Insurance funds and comprised more than one billion dental treatments, encountered in the years 2014 to 2023. Drawing from a quasi-experimental research design and segmented negative binomial regression, Controlled Interrupted Time Series Analyses (CITSA) were conducted with a “control outcome” approach. CITSA compared utilization rates for various types of care whose coverage was differentially affected by the reform. Models were adjusted for COVID and seasonality covariates and stratified by socioeconomic status. Following the removal of out-of-pocket payments for resin-based full dentures, their utilization was 58.85% (95%-CI: 37.18-83.95) higher compared to the control scenario. The utilization of other types of dental care, largely unaffected by the reform, remained unchanged. Prophylactic care use only increased slightly during the study period. These findings suggest that the removal of out-of-pocket expenditures through the French 100% Santé reform led to higher utilization of full dentures. However, as the reform focuses on specific treatment items and mainly concerns patients with voluntary health insurances, the impacts of the reform should be carefully monitored in the future, particularly its effects on vulnerable populations
Enfants atteints de psoriasis de la cohorte Secu-Ped : les patients utilisant des anti-interleukines 17 dans la vie réelle sont-ils éligibles pour les études cliniques de phase III ?
No full textInternational audienceIntroductionLes essais cliniques de phase III des biothérapies pour les enfants souffrant de psoriasis modéré à sévère sont dessinés pour une population sélectionnée. Cette population peut différer des enfants vus dans notre pratique quotidienne.Notre objectif était d’évaluer la proportion d’enfants atteints de psoriasis ayant reçu un anti-interleukine 17, sécukinumab (SECU) ou ixékizumab (IXE), dans la cohorte internationale en vie courante « Secu-Ped » (anti-interleukin 17 in children with psoriasis), qui auraient pu être inclus dans les trois essais cliniques de phase III de ces traitements.Matériel et méthodesLes données au début de la 1re biothérapie des 152 enfants (âge moyen : 12,9 ± 3,4 ans ; filles : 54% ; psoriasis en plaques : 58 % ; rhumatisme psoriasique : 9,9 %) inclus dans 7 pays ont été analysées, 134 enfants avaient reçu du SECU et 24 de l’IXE.L’inéligibilité a été évaluée après application des critères d’inclusion (CI) et d’exclusion (CE) utilisés dans les essais de phase III du SECU et du l’IXE, après analyse des publications et du registre des essais thérapeutiques ClinicalTrials.gov. Une analyse pas-à-pas a été effectuée, en démarrant par l’âge, puis le type clinique, les scores de sévérité et les autres paramètres, quand disponibles.RésultatsPour les deux essais thérapeutiques du SECU, seuls quatre paramètres étaient identifiables (âge, forme clinique, PASI et PGA). Aucun autre CI et CE n’était pas disponible. Dans l’essai portant sur le psoriasis sévère (Bodemer C, et al.), 12 enfants (9,0 %) auraient pu être inclus. Dans l’étude sur le psoriasis modéré à sévère (Magnolo N, et al.), 43 (32,1 %) auraient pu être inclus.Pour l’essai sur l’IXE (Paller A, et al.) tous les critères étaient disponibles, notamment l’antériorité des traitements. Quatre enfants (11,2 %) auraient été éligibles à cet essai.DiscussionSur cette grande cohorte en vie courante, moins d’un tiers des enfants étudiés aurait été éligible aux essais thérapeutiques essentiellement du fait de leur forme clinique et de la sévérité du psoriasis à l’inclusion. Il est probable que nous ayons surévalué ce taux car pour le SECU de nombreux CI et CE n’étant pas disponibles, et donc n’ont pas pu être analysés. D’autre part, nous avons inclus les enfants pour lesquels le paramètre analysé (ex : PASI, PGA) n’était pas disponible (donnée manquante) et considéré comme incluables dans les essais.ConclusionCe type d’analyse souligne la nécessité de cohortes prospectives ou rétrospectives d’enfants psoriasiques sous biothérapie, en vie courante, tant la différence par rapport aux enfants inclus dans les essais est importante
Preventing neuropathy and improving anticancer chemotherapy with a carbazole-based compound
No full textInternational audienceWhile advances in cancer therapy have improved remission rates, chemotherapy-induced peripheral neuropathy (CIPN) remains a lasting and untreatable side effect. This study introduces Carba1, a bifunctional carbazole compound that protects against CIPN through two mechanisms. First, Carba1 interacts with tubulin, allowing for lower doses of taxanes, common chemotherapeutics known for causing CIPN, without reducing their anticancer effectiveness. Second, Carba1 activates nicotinamide phosphoribosyltransferase (NAMPT), enhancing NAD biosynthesis and boosting the metabolic resilience of neurons and Schwann cells against chemotherapy-induced damage. Carba1 shows strong neuroprotective effects in vitro against paclitaxel, cisplatin, and bortezomib toxicity and in vivo in a rat model of paclitaxel-induced neuropathy. Crucially, Carba1 does not interfere with paclitaxel’s tumor-fighting ability or promote tumor growth. Structure-activity analyses of Carba1 derivatives reveal the potential to develop compounds with dual or solely neuroprotective effects. These findings position Carba1 as a promising candidate to prevent CIPN, with potential to enhance both cancer treatment outcomes and patients’ quality of life
Altérations des cellules hôtes et multiplication des agents pathogènes dans un modèle d’épithélium intestinal in vitro de co-infection par la microsporidie Encephalitozoon intestinalis et l’entérovirus A71.
No full textInternational audienceLes agents pathogènes intracellulaires sont impliqués dans plusieurs infections intestinales symptomatiques et asymptomatiques. En réorganisant les compartiments de la cellule hôte, ils établissent un microenvironnement qui favorise leur survie et leur réplication. La plupart des études menées jusqu’à présent se sont concentrées sur des modèles de monoinfection, qui ne reflètent pas pleinement la réalité biologique dans laquelle plusieurs agents pathogènes peuvent coexister et interagir au sein de l’environnement intestinal. Cette étude visait à évaluer la pertinence d’un modèle in vitro de barrière intestinale constitué de cellules épithéliales Caco-2 différenciées pour examiner les effets d’une co-infection combinant le microsporidie Encephalitozoon intestinalis et l’entérovirus A71.Un modèle épithélial intestinal commun, permissif pour les deux agents pathogènes, a été développé afin d’optimiser les conditions d’infection. Les infections individuelles par l’un ou l’autre agent ont induit une relocalisation de la protéine des jonctions serrées ZO-1, ainsi qu’une désorganisation du réseau d’actine associée à l’extrusion des cellules infectées hors du monocouche, indiquant une perturbation de l’intégrité épithéliale. Dans des conditions de co-infection séquentielle, cette altération est survenue plus tôt, suggérant une perte synergique de l’intégrité de la barrière résultant de l’action combinée des deux agents.Une diminution du nombre de copies du génome d’EV a été observée lors de la co-infection, suggérant une possible compétition pour la niche intracellulaire. La réponse précoce de l’hôte, évaluée par la production d’interleukine-8, a été détectée pour chaque agent pathogène, sans effet significatif d’une infection microsporidienne préalable sur la réponse à l’infection virale.Dans l’ensemble, ces résultats mettent en évidence une possible compétition entre les deux agents pathogènes pour les ressources cellulaires de l’hôte, influençant en fin de compte la dynamique et l’intégrité de la barrière intestinale