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The great live and move challenge and the promotion of physical activity in children: results from a two-school-year cluster-randomized trial
No full textInternational audienceBackground Population surveys indicate that a large proportion of children worldwide do not meet the recommended 60 min of moderate-to-vigorous physical activity (PA) daily. This study aimed to assess the impact of the Great Live and Move Challenge (GLMC), a theory of planned behavior (TPB)-based intervention, on PA and TPB variables in French primary school children over two school years. Secondary objectives included assessing whether TPB variables mediated the GLMC's impact on PA and whether the GLMC impacted the strength of the link between TPB variables.Methods A cluster-randomized controlled trial was conducted over 16 months. One hundred primary schools were randomized into an intervention or control group. A total of 2723 children aged 7-11 years (mean age: 9.1; 49.7% boys) were included (n intervention = 1420, n control = 1303). The GLMC, based on TPB, comprised a motivational phase (targeting attitudes, subjective norms, and perceived behavioral control) and a volitional phase (notably focusing on the intentions-PA link). The intervention involved teachers, parents, and community stakeholders. The primary outcome was the change in the proportion of children meeting PA guidelines after 16 months. Secondary outcomes included changes in mean daily PA and TPB variables. Assessments occurred at baseline, 4, 12, and 16 months. Data were analyzed using mixed models and path analyses. ResultsThe "time × group" interaction indicated that, compared with the control group, the intervention group had a significantly higher proportion of children meeting international PA guidelines after 16 months (OR = 3.38, 95% CI = 2.50 to 4.56, P < 0.001). TPB variables did not significantly mediate the impact of the GLMC on mean daily PA at 16 months. The path coefficient between intentions and mean daily PA was significantly higher in the intervention group than in the control group at 4 (CR = 2.45; β = 0.22 vs. 0.13) and 16 months (CR = 2.87; β = 0.24 vs. 0.14).</div
La médecine périopératoire : les perspectives
No full textNational audiencePerioperative medicine, a natural extension of anesthesiology and critical care, is emerging as a pivotal specialty in response to an aging population, rising comorbidities, and the growth of minimally invasive and outpatient surgery. Its goal is to design individualized care pathways that integrate prehabilitation, post-hospital follow-up, and city-hospital coordination to ensure safe recovery, particularly for high-risk patients. The structuring of these pathways relies on multidisciplinary teams and the creation of dedicated \"care pathway team\" capable of anticipating patient needs, preparing discharge, and streamlining communication between hospital and community providers. Indicators, long viewed merely as quality control tools, are evolving into levers for anticipation, decision-making, and personalization of care, particularly through the integration of patient-reported outcome and experience measures (PROMs, PREMs). The rise of digital health and artificial intelligence opens major opportunities: early detection of complications, virtual patient modeling, clinical decision support, and connected follow-up. Their success, however, depends on interoperable information systems, high-quality data, and active medical oversight to mitigate bias. Over the next thirty years, anesthesiology, resuscitation, and perioperative medicine will need to combine pharmacological and technological innovation with environmental sustainability - reducing the carbon footprint of clinical practices - while also improving caregivers' quality of life. By positioning itself as both an interface specialty and a driver of innovation, perioperative medicine is set to become a cornerstone of sustainable, patient-centered healthcare.La médecine périopératoire (MPO), prolongement naturel de l’anesthésie-réanimation, s’impose comme une spécialité pivot face au vieillissement de la population, à l’augmentation des comorbidités et au développement de la chirurgie ambulatoire et mini-invasive. Elle vise à organiser des parcours de soins individualisés, intégrant préhabilitation, suivi post-hospitalier et coordination ville–hôpital, afin de sécuriser la récupération des patients, notamment les plus fragiles. La structuration des parcours repose sur des équipes pluridisciplinaires et la création de « cellules parcours », capables d’anticiper les besoins, de préparer le retour à domicile et de fluidifier les échanges entre acteurs hospitaliers et de ville. Les indicateurs de suivi, longtemps perçus comme outils de contrôle qualité, deviennent de véritables leviers d’anticipation, d’aide à la décision et de personnalisation des soins, notamment grâce à l’intégration de mesures rapportées par les patients (PROMs, PREMs). L’essor du numérique et de l’intelligence artificielle ouvre des perspectives majeures : détection précoce des complications, modélisation virtuelle du patient, aide documentaire et suivi connecté. Leur succès repose sur l’interopérabilité des systèmes d’information, la qualité des données et une supervision médicale active pour éviter les biais. Pour les trente prochaines années, l’ARMPO devra conjuguer innovation pharmacologique et technologique, durabilité environnementale (réduction de l’empreinte carbone des pratiques) et amélioration de la qualité de vie des soignants. En s’affirmant comme spécialité d’interface et moteur d’innovation, la MPO deviendra un pilier de la santé durable et centrée sur le patient
Effect of an adapted physical activity program in Parkinson's disease: A randomized controlled study (APA-Park)
No full textInternational audienceContext: Previous studies assessing adapted physical activity (APA) in Parkinson's disease (PD) have been very heterogeneous regarding methodology and intervention, and have generally not addressed the question of combining various types of physical activity with a long-term evaluation. Objectives: To evaluate the immediate and long-term effect of a 3-month APA program, combining endurance, resistance training and stretching on motor symptoms, body composition, cardiorespiratory function and metabolic profile in PD patients. Methods: In this controlled trial, we randomly assigned forty-four PD patients in a 1:1 ratio to receive a 3-month APA program (APA + group, n = 22), or freely practice physical activity (APA- group, n = 22). The patients were evaluated for parkinsonian symptoms (UPDRS-III), body composition, cardiorespiratory function and metabolic profile at baseline, immediately after the end of the program (M3) and six months later (M9). Results: Between baseline and M3, the mean UPDRS-III score decreased in PD patients from the APA + group whereas it increased in the APA- group (-1.2 +/- 6.6 vs. +1.9 +/- 8.9; p = 0.04), regardless of age, sex, disease duration, dopaminergic treatment, UPDRS-III and axial score at baseline, but these between group differences waned at M9. No between group difference was observed regarding the evolution of body composition, metabolic profile or cardiorespiratory function between baseline, M3 and M9. Conclusion: A 3-month APA program combining endurance and resistance training plus stretching is more efficient for improving motor symptoms in PD compared to an unstructured engagement in non-specific physical activities. However, the benefits fade away six months after discontinuation of the program. Statistical analysis conducted by: LAMBERT Celine, CHU Clermont-Ferrand, DRCI, Biostatistics Unit, ClermontFerrand, FRANCE. Registration number: clinicaltrials.gov number NCT02816619
Genetic Diagnoses Among Congenital Anomaly Cases in Europe: Data From the EUROCAT Network
No full textInternational audienceBackground: Surveillance of congenital anomaly prevalence over time can identify new teratogens. Anomalies with a genetic cause are excluded from the monitoring.Objectives: We examined temporal changes in the proportion of genetic diagnoses among cases with a congenital anomaly.Methods: Data was used from twenty EUROCAT congenital anomaly registries over the birth years 2013 and 2022. All pregnancy outcomes were included. Multilevel binomial regression models were fitted to estimate the annual change in the proportion of genetic diagnoses of all anomalies by registry. Results were additionally reported, excluding cases with trisomy 13, 18, or 21.Results: Overall, 20% of the 100,099 cases in the study had a genetic diagnosis, and this proportion increased annually by 1.4% (95% CI, 0.8%-1.9%); an absolute increase of approximately 3% from 2013 to 2022. After excluding the trisomies, the overall proportion was 10% with an annual increase of 1.2% (95% CI 0.4%-2.0%). There was considerable variation in the proportion of genetic cases per registry. An increasing proportion of genetic diagnoses was found for five congenital anomaly groups, after excluding the trisomies. We hypothesise that the increase in genetic diagnoses is due to increased access to clinical genetic services, more extensive genetic testing, and the identification of new genes as causes of congenital anomalies.Conclusions: The modest increase in genetic diagnoses among cases with a congenital anomaly is not expected to have a large impact on the surveillance of the non-genetic anomalies in the EUROCAT network. EUROCAT will continue to monitor the proportion of genetic diagnoses every five years
A clinical predictive score of high liver iron content in metabolic hyperferritinemia: a retrospective cohort pilot study
No full textInternational audienceBackground : In metabolic hyperferritinemia, most patients do not require bloodletting as the liver iron content is mildly increased. We aimed to develop a clinical predictive score of high liver iron content in metabolic hyperferritinemia to guide the prescription of magnetic resonance imaging of the liver.Methods : We conducted a single-center retrospective cohort study including consecutive patients with metabolic hyperferritinemia who underwent a liver iron content evaluation at diagnosis. Excessive alcohol consumption was an exclusion criterion. A multivariate analysis followed by a 1000 bootstrap replicate analysis with an expectationmaximization algorithm was used to identify the predictive factors of high liver iron content. A ROC curve analysis was built to study the performance of the score based on the odds-ratio provided by the multivariate analysis.Results : 217 patients (180 men, mean age 57 years old) were included. Fifty-five patients (25%) had high liver iron content (≥ 100 µmol/g). In univariate analysis, a family history of hyperferritinemia requiring phlebotomies was associated with high LIC, as well as an increase of transferrin saturation > 45% (p < 0.001). In multivariate regression, a family history of hyperferritinemia (OR 6.15, CI95 [2.11-17.92]), increased ferritin level ≥ 600 µg/L (OR 5.53, CI95 [1.43-21.42]) and increased transferrin saturation ≥ 45% (OR 2.63, CI95 [1.32-5.23]) were significantly associated with high liver iron content. A 15-point predictive score (area-under-the-curve 0.72, CI95 [0.64-0.79], p < 0.001) was built, providing an OR of 4.17 (CI95 [2.15-8.07], p < 0.001) for high liver iron content (sensitivity 60%, specificity 97%, negative predictive value 84%).Conclusion : in this pilot study, ferritin ≥ 600 µg/L, transferrin saturation ≥ 45% and a family history of hyperferritinemia requiring bloodletting provided a simple clinical score to predict high liver iron content in metabolic adult hyperferritinemia. The bootstrap analysis confirmed the robustness of our model
The influence of preoperative methylprednisolone bolus on edema in lower leg fractures: A prospective randomized controlled trial
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Effects of Resistance Training on Muscular Adaptations and Inflammatory Markers in Overweight and Obese Men
No full textInternational audiencePurpose Obesity may blunt exercise responsiveness to improve muscular adaptations. The effect of resistance training (RT) targeting different body regions on muscle and inflammatory markers is unclear. This study aimed to investigate the impact of upper (upper body exercises), lower (lower body exercises), or combined (upper body + lower body exercises) RT on muscle and inflammatory markers, body composition, and performance in overweight and obese men. Methods Sixty overweight and obese men (age, 31 ± 4 yr) were randomly assigned to one of four groups: upper-body RT (UB; n = 15), lower-body RT (LB; n = 15), combined RT (UB + LB; n = 15), or control (C; n = 15). The training protocol consisted of three exercise sessions per week for 12 wk. Blood samples for measuring serum markers (follistatin, myostatin, C-reactive protein (CRP), adiponectin, tumor necrosis factor α (TNF-α), and irisin) were obtained at baseline and 48 h after the final training session. Fat mass (FM), body fat percentage, skeletal muscle mass (SMM), and fat-free mass were measured using bioelectrical impedance analysis (InBody 720). Results SMM, fat-free mass, UB and LB strength and power, follistatin, follistatin/myostatin ratio, adiponectin, and irisin significantly increased, whereas FM, body fat percentage, myostatin, CRP, and TNF-α significantly reduced from pre- to post-training in all training groups ( P < 0.05). Changes in LB muscle power ( r = 0.558), both UB ( r = 0.518) and LB ( r = 0.419) muscle strength, and follistatin ( r = 0.545) had moderate positive relationships with ΔSMM, whereas changes in myostatin ( r = −0.585) had a moderate negative relationship with ΔSMM. Also, changes in myostatin ( r = 0.825) and CRP ( r = 0.715) had a strong positive relationship with ΔFM, whereas TNF-α ( r = 0.467) had a moderate positive relationship with ΔFM. Follistatin ( r = −0.789) and adiponectin ( r = −0.713) had a strong negative relationship with ΔFM, whereas irisin ( r = −0.426) had a moderate negative relationship with ΔFM. Conclusions Combined RT elicits the greatest increases in follistatin, follistatin/myostatin ratio, and adiponectin, and decreases in myostatin and CRP compared with other training groups in overweight and obese men. However, systemic improvements may be achieved through performing UB or LB RT alone
The Effects of Pomegranate Supplementation on Markers of Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis
No full textInternational audiencePomegranate supplementation has been shown to reduce oxidative stress and inflammation, with some evidence suggesting it may accelerate recovery from exercise-induced muscle damage (EIMD), including metabolic, mechanical, and neuromuscular recovery.ObjectivesThis systematic review and meta-analysis aimed to investigate the effects of pomegranate supplementation on markers of EIMD.MethodsA systematic search of Scopus, PubMed, and Web of Science up to January 2024 identified studies evaluating pomegranate supplementation and exercise recovery. Studies involving athletes and nonathletes aged 18–55 were included. Weighted mean differences (WMDs) were calculated for EIMD markers. Study quality was assessed using a modified physiotherapy evidence database scale. This review was registered with the International Prospective Register of Systematic Reviews (ID: CRD42024536905).ResultsTen studies were included in the meta-analysis. Pomegranate supplementation did not significantly affect markers of metabolic recovery, including myoglobin (WMD: –1.344 ng/mL; 95% confidence interval (CI): –4.11, 1.42 ng/mL, P = 0.342) and creatine kinase (WMD: –11.990 U/L; 95% CI: –28.64, 4.66 U/L, P = 0.158), or neuromuscular recovery, as indicated by lactate concentrations (WMD: –0.093 mmol/L; 95% CI: –0.39, 0.21 mmol/L, P = 0.546). Muscle soreness also remained unchanged (WMD: 0.999; 95% CI: –0.18, 2.17, P = 0.097). However, a significant reduction in lactate dehydrogenase amounts (WMD: –21.152 U/L; 95% CI: –39.29, –3.01 U/L, P = 0.022) immediately postexercise suggests a short-term protective effect against mechanical muscle damage.ConclusionsPomegranate supplementation does not appear to enhance overall recovery markers for EIMD but may offer short-term benefits for mechanical muscle damage. Standardizing supplementation regimens, dosages, and exercise protocols is crucial to better understand the potential benefits of pomegranate supplementation in EIMD recovery
Expert consensus‑based clinical practice guidelines for nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP)
No full textInternational audienceThe objective of this work was to develop guidelines for nutritional support in critically ill adults and children (excluding neonates and burn patients) unable to maintain an adequate oral intake. We aimed to provide up-to-date recommendations based on high-level evidence including the results of recent landmark randomized controlled trials. Experts from the French Intensive Care Society (SRLF), the French Society of Clinical Nutrition and Metabolism (SFNCM), and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP) used the GRADE methodology to develop the guidelines. Twenty-four Patient Intervention Comparator Outcome (PICO) questions were identified, resulting in 34 adult and 29 pediatric recommendations. Of the 34 recommendations for adults, three were based on high-level evidence, 12 on moderate-level evidence, and 19 on expert opinion. The corresponding numbers for the 29 pediatric recommendations were one, five, and 23. All recommendations achieved strong agreement among the experts. These guidelines emphasize the importance of individualized nutritional support strategies that incorporate recent high-quality evidence to optimize the outcomes of critically ill patients
Efficacy and safety of azacitidine for VEXAS syndrome: a large-scale retrospective study from the FRENVEX group
No full textInternational audienceVEXAS (Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic) syndrome is a severe monogenic disorder caused by somatic UBA1 mutations, characterized by inflammation, cytopenias and frequent association with myelodysplastic neoplasms (MDS). Steroid dependence is common, and targeted therapies have demonstrated limited efficacy. Azacitidine (AZA), a hypomethylating agent used in MDS, has shown potential in VEXAS but data remain limited. This multicenter retrospective study assessed AZA efficacy and safety in 88 genetically confirmed VEXAS patients from the FRENVEX (French VEXAS) group, 80% meeting WHO 2022 MDS criteria. Inflammatory response rates were 41% at 6 months and 54% at 12 months, regardless of MDS status. A total of 50 (61%) patients achieved inflammatory response, with 70% occurring at 6 months, suggesting a delayed median response. Among responders, relapse-free survival on AZA was 90% at 1 year and 85% at 5 years. Of the 12 responders who discontinued AZA, 9 relapsed after a median of 3.1 years (range: 0.4-5.6), with effective re-exposure in 4 of 5 patients. Hematological responses included red blood cell transfusion independence in 65% and platelet improvement in 77% of patients. Molecular response, defined as a ≥25% reduction in UBA1 variant allele frequency (VAF), was observed in 65% of patients, all of whom achieved inflammatory and hematological responses; and VAF dropped below 2% in 43% of cases. Infections (34%) and cytopenias (36%) were common, particularly during the first three cycles. This study establishes AZA as an effective therapy for VEXAS, improving inflammation, cytopenias, and UBA1 clonal burden, warranting larger prospective trials