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Automated segmentation of deep brain structures from Inversion-Recovery MRI
No full textInternational audienceMethods for the automated segmentation of brain structures are a major subject of medical research. The small structures of the deep brain have received scant attention, notably for lack of manual delineations by medical experts. In this study, we assessed an automated segmentation of a novel clinical dataset containing White Matter Attenuated Inversion-Recovery (WAIR) MRI images and five manually segmented structures (substantia nigra (SN), subthalamic nucleus (STN), red nucleus (RN), mammillary body (MB) and mammillothalamic fascicle (MT-fa)) in 53 patients with severe Parkinson’s disease. T1 and DTI images were additionally used. We also assessed the reorientation of DTI diffusion vectors with reference to the ACPC line. A state-of-the-art nnU-Net method was trained and tested on subsets of 38 and 15 image datasets respectively. We used Dice similarity coefficient (DSC), 95% Hausdorff distance (95HD), and volumetric similarity (VS) as metrics to evaluate network efficiency in reproducing manual contouring. Random-effects models statistically compared values according to structures, accounting for between- and within-participant variability. Results show that WAIR significantly outperformed T1 for DSC (0.739 ± 0.073), 95HD (1.739 ± 0.398), and VS (0.892 ± 0.044). The DSC values for automated segmentation of MB, RN, SN, STN, and MT-fa decreased in that order, in line with the increasing complexity observed in manual segmentation. Based on training results, the reorientation of DTI vectors improved the automated segmentation
Prevalence and risk factors for postpartum depression two months after cesarean delivery: a prospective multicenter study
No full textInternational audienceThe prevalence and risk factors of postpartum depression after cesarean delivery remain unclear. OBJECTIVE: To assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery. STUDY DESIGN: Prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery trial, conducted in 27 French hospitals in 2018 to 2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take non-respondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an Edinburgh Postnatal Depression Scale cutoff value of 11 or higher. RESULTS: The questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval, 14.9%-18.0%) with an Edinburgh Postnatal Depression Scale score of 13 or higher and 23.1% (95% confidence interval, 21.4%-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were prepregnancy characteristics such as young age (adjusted odds ratio 0.83, 95% confidence interval 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (adjusted odds ratio 2.58, 95% confidence interval 1.85-3.59 for North Africa; adjusted odds ratio 1.57, 95% confidence interval 1.09-2.26 for Sub-Saharan Africa and adjusted odds ratio 1.99, 95% confidence interval 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (adjusted odds ratio 1.70, 95% confidence interval 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (adjusted odds ratio 1.36, 95% confidence interval 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (adjusted odds ratio 1.73, 95% confidence interval 1.32-2.26) and bad memories of delivery on day 2 postpartum (adjusted odds ratio 1.67, 95% confidence interval 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (adjusted odds ratio 0.73, 95% confidence interval 0.53-0.97). CONCLUSION: Around one woman in 6 had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain, and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression.Perinatal professionals should pay particular attention to postoperative pain management
Organisation of clinical research in intensive care units: A scoping review
No full textInternational audienceBackground: Clinical research is essential for the development and progress of therapies and procedures. Intensive care units (ICUs) manage the sickest patients. Numerous clinical trials are organised in ICUs to evaluate new treatments or support techniques. Concomitantly, new professions involved in clinical research set-ups are emerging.Aim: The aim of this scoping review was to identify the nature and extent of research evidence on the organisation of clinical research in ICUs.Methods: This review focusses on observational and qualitative narrative studies dealing with clinical research organisation in ICUs, with a special interest in structures coordinating research, the roles of clinical research professionals, and the training required. Medline and Embase were analysed between January 2000 and June 2024. Assessment of the study quality was based on the Let Evidence Guide Every New Decision evaluation system and the Newcastle-Ottawa quality assessment scale.Results: Of the 14 studies reviewed, four were narrative and 10 observational descriptive. All were based on cross-sectional surveys. Most studies were carried out in North America, the United Kingdom, and Australia/New Zealand. ICU clinical research professionals were mostly female nurses aged between 31 and 50 years who had a wide diversity of training profiles and performed greatly varied tasks from data collection to publication of the article. Reported job satisfaction depended on the degree of autonomy, the workload, the extent of professional recognition, and opportunities for professional promotion.Conclusions: The organisation of ICU clinical research reflects considerable diversity in training, tasks, job organisation, and responsibilities
Validation of the FL/IL6 score, a new dynamic cytokine-based risk-model in adults with acute myeloid leukemia, a prospective multicentre filo study.
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Buprenorphine Substitution as a Tapering Strategy for Opioid Discontinuation in Patients with Chronic Pain: A Nonrandomized and Proof of Concept Study
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Treatment sequencing in inflammatory bowel disease: Towards clinical precision medicine
No full textInternational audienceInflammatory bowel diseases, including Crohn's disease and ulcerative colitis, raise ongoing challenges in clinical management due to their variable courses and impact on patient quality of life. The emergence of advanced therapies, from biologics to small molecules, has prompted the need for effective sequencing strategies to optimize patient outcomes. To this date, there is no algorithm for treatment sequencing and physicians must select the safest and most effective treatment according to each individual patient. This review aims to explore the latest insights in treatment sequencing according to multiple criteria, such as prior use of anti-TNF alpha agents, prior surgery, disease phenotype and location, but also patient characteristics, such as age or history of malignancy. Treatment sequencing in IBD should be part of a clinical medicine approach and be tailored to individual patient characteristics, disease severity, and therapeutic response history. Indeed, a personalized approach of therapeutic management in inflammatory bowel diseases can improve long-term outcomes and quality of life. Ongoing research is essential to refine sequencing strategies, and better incorporate these advances into clinical practice
Switching From Dupilumab to Tralokinumab or Janus Kinase Inhibitors in Cases of Ocular and/or Facial Adverse Events in Patients With Atopic Dermatitis: A Multicenter Retrospective Study
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Prognosis Associated with Complete Pathological Response Following Neoadjuvant Treatment for PancreaTic AdenOcarciNOma in the FOFLIRINOX Era: the Multicenter TONO Study
No full textInternational audienceBackground: The use of multiagent FOLFIRINOX chemotherapy for pancreatic adenocarcinoma in a neoadjuvant setting has been associated with an increased rate of complete pathological response (CPR) after surgery. This study investigated the long-term outcomes of patients with CPR in a multicenter setting to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS).Methods: This retrospective cohort study examined biopsy-proven pancreatic adenocarcinomas with CPR after neoadjuvant chemotherapy or chemoradiotherapy and surgery, between January 2006 and December 2023 across 22 French and 2 Belgian centers. Cox analyses were used to identify prognostic factors of OS and RFS.Results: There were 101 patients with CPR after chemotherapy (n = 58, 57.4%) and chemoradiotherapy (n = 43, 42.6%) followed by surgery. Neoadjuvant FOLFIRINOX was used in 90% of patients. The median OS after surgery was 177 months (95% confidence interval (CI) 58.9-177 months) with 1-, 3-, 5-, and 10-year OS rates of 93%, 75%, 63%, and 51%, respectively. The median RFS was 67.8 months (95% CI:34.4-NR) with 1-, 3-, 5-, and 10-year RFS rates of 83%, 58%, 54%, and 49%, respectively. The multivariate Cox analysis of OS and RFS showed that preoperative radiotherapy was an independent negative prognostic factor for OS (hazard ratio (HR) 2.51; 95% CI 1.00-6.30; p = 0.03) and RFS (HR 2.62; 95% CI 1.27-5.41; p = 0.009).Conclusions: Complete pathologic response after neoadjuvant treatment is associated with remarkable long-term survival that is usually not seen after the resection of pancreatic adenocarcinomas. One-third of the patients still experienced disease recurrence, which was more common in those receiving preoperative chemoradiotherapy
