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Role of interleukin-6 in migraine chronification and suggested Th17/Regulatory T cell imbalance in migraine pathophysiology
No full textInternational audienceThe pathogenesis of migraine remains unclear; however, substantial evidence supports the hypothesis that neuroinflammation plays a key role. Several studies have analysed the levels of peripheral cytokines in migraine patients; however, they are heterogeneous and provide conflicting results. Therefore, we aim to clarify the current state of knowledge regarding the role of cytokines in migraine and its chronification.Methods. We performed a systematic literature review in PubMed, Embase and Cochrane using systematic search algorithms. Animal studies, publications with less than 10 migraine subjects, reviews, letters, case reports, and publications written in other than English or French were not included in our analysis. Reviews and references were screened for extra publications. Results. We identified 1,999 publications, of which 71 were selected. Two extra publications were added via citation screening. A total of 73 publications were included in our review for qualitative and meta-analysis (Fig. 1). IL-6 levels were significantly increased in the peripheral blood of adults with chronic versus episodic migraine and in the peripheral blood and saliva of adults during versus outside an attack (qualitative and meta-analysis). Peripheral blood levels of Transforming Growth Factor- (TGF-) were also increased in adults with migraine versus controls (qualitative analysis); so were the levels of chemokines such as ADP, C-C motif Ligand (CCL) 2 and CCL3 (meta-analysis) (Fig. 2 and 3). Conclusions. Our literature review suggests that IL-6 may be involved in the chronification of migraine rather than its triggering. Increased levels of IL-6 and TGF- also suggest a Th17/Regulatory T cell imbalance in migraine pathophysiology
Retrospective case‐control study of nutritional and respiratory status in children with type III esophageal atresia
No full textInternational audienceObjectives: To evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests at school-age. Methods: Retrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history, and outcomes of patients with or without undernutrition (body mass index [BMI] z-score < -2 SD) at the age of 6-9 years were compared. Results: Of the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 ± 0.4. At birth, 13 (65%) of them were preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs. 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p = 0.002), and 60% of them required pulmonary treatments (vs. 32%, p = 0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio [OR] = 6.0), hernia/cryptorchidism surgery (OR = 5.2), a restrictive syndrome (OR = 3.3) and pulmonary crisis treatment use (OR = 2.7) as associated with undernutrition.ConclusionsIn contrast to intestinal and esophageal surgeries, respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA
Does the indocyanine green test reduce the risk of anastomotic dehiscence in colorectal surgery?
No full textInternational audienceIntroduction: In colorectal surgery, assessment of the vascularization of the intestinal segments to be anastomosed by injection of indocyanine green (ICG) is one of the intra-operative measures to decrease the risk of anastomotic leak (AL). The aim of this evidence-based review was to evaluate the effectiveness and utility of this measure.Method: We conducted a comprehensive literature review in electronic databases (PubMed, Scopus, Cochrane Library), coupled with a manual search. Only randomized trials and meta-analyses were included. The primary outcome measure was clinical AL (Grade B and C according to the International Study Group of Rectal Cancer) RESULTS: A total of eight randomized trials and three meta-analyses were included. The conclusions of the three meta-analyses consistently showed a reduction in the risk of AL (by one-third in the most recent meta-analyses). However, the conclusions of the eight trials (especially those with the larger sample sizes) were discordant regarding colonic surgery (excluding rectal resection). In subgroup analysis, recent trials showed no difference in AL in favor of ICG for right colectomy, and data on left colonic or rectal surgery, although discordant, suggested that the benefit of ICG, although not statistically significant, was clinically relevant in the majority of studies.Conclusion: According to currently available evidence, the use of ICG does not appear to be useful for right colectomies. However, the usefulness of ICG in left-sided colectomies and rectal resections is probable, although not formally proven
Diagnostic Reference Levels in pediatric interventional cardiology: A multicenter study by the French cohort in HARMONIC project: Multicenter DRLs for Pediatric Interventional Cardiology
No full textInternational audiencePediatric interventional cardiology (IC) is an important diagnostic and therapeutic approach for addressing congenital heart disease (CHD) in children. However, the associated ionizing radiation raises long-term health concerns, emphasizing the need for dose optimization.Methods: A retrospective analysis of radiation dose metrics was conducted on pediatric IC procedures performed across seven hospitals from 2018 to 2020. Data were stratified by five weight groups (<5, 5–<15, 15–<30, 30–<50, 50–<80 kg) and seven IC procedure categories. Median and 75th quantile values for dose-area product (DAP), DAP normalized to body-weight (DAP/BW) and fluoroscopy time (FT) were calculated to define typical values and DRLs, respectively. The DRL-weight curve approach was also used to determine the 50th quantile curve for each IC procedure category.Results: A total of 1815 pediatric IC procedures were analyzed, comprising 534 diagnostic and 1281 therapeutic procedures. Significant variations in DAP were observed across different procedure types and weight groups, while fluoroscopy time showed no significant variation. Typical-DRL values (median-75th percentile values) of DAP (Gy·cm²) ranged from 1.9-3.9 to 4.8-5.8 for coronarography, from 0.7-1.3 to 9.2-15.6 for angiography, from 0.3-0.6 to 0.8-1.5 for pulmonary valve dilatation, from 2.8-3.7 to 11.6-14.6 for pulmonary artery dilatation and stenting, from 0.6-1.3 to 2.8-6.0 for atrial septal defect closure and from 0.1-0.4 to 3.1-5.4 for patent ductus arteriosus closure in function of weight groups and 0.2-0.3 for Rashkind in patients <5kg.Conclusion: This study provides the first multicenter DRLs for pediatric IC procedures in France, offering valuable benchmarks for dose optimization. These findings lay a strong foundation for future national and international guidelines in pediatric IC care
Computed Tomography radiomic analysis of paraspinal muscles in the prognosis of advanced head and neck cancers
No full textInternational audienceBackground & aims: Sarcopenia is a well-recognized risk factor for adverse outcomes in neoplastic diseases, and body composition assessment using computed tomography is a standard method for its evaluation. Radiomics, an automated and quantitative image-analysis approach that has demonstrated prognostic value in various clinical contexts, has not yet been applied to the assessment of axial musculature for outcome prediction in head and neck cancers. The primary aim of this study was to investigate whether radiomic analysis of the paravertebral muscles on computed tomography imaging could improve survival prediction in patients with locally advanced head and neck cancer. Methods: We retrospectively included 71 patients with locally advanced head and neck cancer who received induction chemotherapy at our institution. Radiomic features were extracted following manual segmentation of the paravertebral muscles at the L1 level on computed tomography scan. Only features that were unaffected by the timing of contrast injection and demonstrated high intra-observer reproducibility were retained for analysis. Associations between these radiomic features and survival were assessed using univariate and multivariate Cox proportional hazards regression. Relationships with treatment toxicity and therapeutic response were evaluated using either Student's t-test or the Mann-Whitney test, as appropriate, and multivariate logistic regression. Results: A total of 21 radiomic parameters were retained for analysis. In the multivariate analysis, none of these parameters were significantly associated with survival. However, the ability to maintain oral feeding at diagnosis and one histogram-based radiomic feature -the sum of Hounsfield unit values after discretization -emerged as the most promising predictors. After binarization of this histogram feature, both variables were significantly associated with survival, stratifying the cohort into four groups with distinct survival outcomes (p < 0.001). None of the radiomic parameters demonstrated a significant association with treatment-related toxicity in the multivariate analysis. Nevertheless, the CT subcutaneous fat index and the second-order radiomic feature GLRLM SRE exhibited a trend toward being risk factors for toxicity
Impacts of a polyphenol mixture on hemostasis in rats under anticoagulant therapy
No full textOral CommunicationInternational audienceBackground: Rivaroxaban is one of the most common anticoagulant treatments used for preventing blood clots in conditions of cardiovascular risk such as atrial fibrillation and deep vein thrombosis. However, one of its drawbacks is an increased risk of bleeding, which can be problematic in clinical settings. Anticoagulant-related adverse events were responsible for 10% of emergency admissions due to adverse drug reactions [1]. Polyphenols are bioactive compounds exclusively found in plant foods and beverages known for their health benefits, mainly on cardiovascular health. Although still poorly documented at clinical level, compounds of the flavonoid class have been reported to exhibit a direct impact on primary haemostasis by inhibiting platelet aggregation, to be anti-coagulant due to an antifactor IIa and Xa activity [2-3]. Finally, flavonoids can modulate fibrin clot structure [4-5]. However, it is worth to note that main of these results have been obtained in vitro in nonphysiological conditions regarding the bioavailability and metabolism of flavonoids. Objective: On this base, we hypothesize that anti-coagulant properties of polyphenols may contribute to an increased risk of haemorrhage in patients under anti-coagulant therapy.Method: To demonstrate the contribution of polyphenols on haemostasis in physiological relevant conditions, Sprague-dawley male rats were fed 1/ a standard diet (SD), 2/ a standard diet with rivaroxaban (riva), 3/ a standard diet supplemented with a polyphenol mixture (0,3 % w/w) mimicking the daily polyphenol intake (qualitatively and quantitatively) of a diet rich in fruits and vegetables (PP) or 4/ a standard diet with rivaroxaban and the polyphenol mixture (riva+PP) for 6 weeks. At the end of this intervention, haemostasis was evaluated measuring the tail bleeding time and the volume of blood lost after a standardized cut. Classic clinical parameters of coagulation and haemostasis on plasma, such as thrombin generation and coagulation factor assays, were assessed. Vascular reactivity of aortic rings in response do phenylephrine and acetylcholine was assessed by myography.Results: Dietary intervention did not modify daily intake, weight gain, body composition, systolic and diastolic blood pressure, and heart rate. Anti-Xa activity was detected in rats supplemented with anticoagulant, but not in the other groups. Similarly, Endogenous Thrombin Potential (ETP) and peak thrombin levels, two parameters measured in thrombin generation assay, were significantly lower in rats supplemented with anticoagulant (Riva and Riva+PP) compared to the control and PP groups. Surprisingly, tail bleeding time in anticoagulant rats was not longer than in control rats, and it was significantly lower in the Riva+PP group compared to the PP group. In addition, vascular reactivity measured in aortas demonstrated that polyphenol supplementation contribute to reverse hyper-reactivity induced by rivaroxaban treatment. Conclusion:This study shed new light on vascular effect of anticoagulant therapy and on the impact of dietary polyphenols on haemostasis, potentially offering a novel approach to mitigating bleeding risks associated with anticoagulant therapy.</div
Real-world efficacy and safety outcomes of acalabrutinib in chronic lymphocytic leukemia: primary results of a French multicentre observational study (NAOS)
No full textInternational audienceAcalabrutinib is a second-generation BTK inhibitor approved for the treatment of chronic lymphocytic leukemia (CLL) after demonstrating efficacy and safety in clinical trials. NAOS, a real-world study, complements these trials with realworld (rw) acalabrutinib data generated from clinical practice. This retrospective, non-interventional, longitudinal study was conducted in 59 sites in France in adult patients initiating acalabrutinib for CLL in 2021-2022.The study assessed rw use (time to discontinuation, TTD) and effectiveness (rw progression free survival, rwPFS) in first line (L1) and relapsed/ refractory setting (L2+). At the time of the analysis, data were collected from routine medical records since the treatment start up to the end of 2022. Of the 485 enrolled patients, 58.8% were in L1 and 41.2% in L2+. Median age was 73 (L1) and 77 (L2+) years. Of them, 55.1% had a prior cardiovascular history, 25.1% del(17p)/TP53m, and 67.4% were uIGHV. Among 188 patients initiated in 2021 (119 L1; 69 L2+), 31.4% discontinued treatment, 14.9% of whom due to adverse event (AE). The 12-month rwPFS rate was 93.1% (88.5-97.7) in L1 and 87% (79.0-94.9) in L2 + patients with no significant difference based on del17p/TP53m (p = 0.21) and on IGHV status (p = 0.34). AEs leading to treatment changes occurred in 40 patients (21.3%), grade 3/4 AE in 9.6%, while cardiac disorders occurred in only 2.1% of patients. NAOS, one of the largest real-world cohorts of acalabrutinib-treated CLL patients in Europe, showed effectiveness and safety consistent with clinical trials, despite an older population with more cardiovascular comorbidities.</div
Distribution reappraisal of peripheral T‐ and NK‐cell lymphoma entities through the French Lymphopath network database
No full textInternational audienceNo abstract availabl
