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Subcutaneous Infliximab for Perianal Crohn's Disease: The BioLap-Rem Multicenter Study From the GETAID
No full textInternational audienceINTRODUCTION: Intravenous infliximab (IFX) is the cornerstone for treating patients with perianal Crohn's disease (pCD). Data on the recently launched subcutaneous (SC) IFX for pCD are limited. The aim of our study was to evaluate the effectiveness and safety of SC IFX in pCD. METHODS: We conducted a multicenter retrospective cohort study from the GETAID, including patients with either active (group 1) or inactive (group 2) pCD when they started SC IFX. Inclusion criteria were, for group 1: active pCD in the 6 months before initiation of SC IFX; for group 2: inactive pCD for >6 months at the time of IV to SC switch. The primary end points were clinical remission at 6 months in group 1 and pCD relapse in group 2. RESULTS: Of the 183 patients included in 24 centers, 66 were in group 1 and 117 in group 2. The median follow-up was 50.4 (27.0–64.6) and 53.4 (40.6–67) weeks, respectively. In group 1 at 6 months, clinical remission was observed in 44.6% of patients and clinical response in 87.7%. Clinical remission including seton removal occurred in 35.5% of patients. In multivariable analysis, high body mass index was the only independent predictor of remission (odds ratio 0.88, 95% confidence interval 0.77–0.99). In group 2, rates of relapse-free survival were 94.3% and 87.9% at 6 and 12 months, respectively. Sixteen cases (8.3%) of adverse events related to SC injection were observed. DISCUSSION: SC IFX was effective and safe for the treatment of active pCD and for maintaining remission after switching in this large multicenter cohort, thus supporting its use in routine practice in this indication
Hearing loss in French survivors of childhood and adolescent leukemia: impact on quality of life and schooling difficulties
No full textInternational audienceBACKGROUND: Hearing dysfunction following ototoxic or intensive cancer treatments is an underreported late effect among survivors of childhood and adolescent acute leukemia. The AUDandLEA project is the first study to examine, in a large cohort of childhood acute leukemia survivors: 1. the associated factors of hearing loss; 2. the association of hearing loss and the life of the individuals. METHODS: The AUDandLEA (AUDition and Leucémie Enfants et Adolescents) project was a cross-sectional study. The participants were included in the French LEA cohort which includes 18 French medical teams. The inclusion criteria of the patients were: childhood acute leukemia survivors, diagnosed before the age of 18 and after 1980, had a valid response (yes or no) regarding auditory sequela, and alive on December 31, 2022. The following data were collected: sociodemographics and clinical data, quality of life and schooling course. RESULTS: Among 6145 individuals, 1.45 % (95 % confidence interval [1.11-1.69 %]) persons were classified having a hearing loss. Compared to the individuals without hearing loss, those with hearing loss were significantly younger at the diagnosis and presented more often an acute myeloid disease. They also reported the worst level of quality of life and more often grade retention. CONCLUSION: Hearing loss should have consequences in the quality of life and the schooling course. It is essential to carry out systematic screening during and after the implicated treatments
Imatinib-Induced Reactive Angioendotheliomatosis: A Paradoxical Pro-Angiogenic Case.
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Local recurrence after R0 partial nephrectomy for RCC: insights from a large multicenter cohort (PREPARE study – UroCCR 140)
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Présence du tabac dans les films et consommation tabagique chez les jeunes.
No full textInternational audienceThe presence of tobacco in films and TV series remains widespread, despite its proven impact on the initiation of smoking among young people. In addition to films, platforms massively distribute these images, influencing adolescents, whose risk of starting to smoke is multiplied by two to three after exposure. Social media amplifies this phenomenon. In response to this observation, measures have been proposed: film classification, health warnings, and awareness-raising among film professionals and platforms. However, total censorship is contested in the name of artistic freedom. The challenge is to reconcile public health and creative freedom to achieve the goal of a tobacco-free generation by 2032.La représentation du tabac au cinéma et dans les séries reste très fréquente, en dépit de son impact prouvé sur l’initiation au tabagisme des jeunes. Outre les films, les plateformes diffusent massivement ces images, influençant les adolescents, dont le risque de commencer à fumer est multiplié par deux à trois après exposition. Les réseaux sociaux amplifient ce phénomène. Face à ce constat, des mesures sont proposées : classification des films, avertissements sanitaires, sensibilisation des professionnels du cinéma et des plateformes de diffusion. Cependant, la censure totale est contestée au nom de la liberté artistique. L’enjeu est de concilier santé publique et liberté créative pour atteindre l’objectif d’une génération sans tabac d’ici à 2032
Real life study of ivosidenib in either monotherapy or combined with azacytidine for first line mutant IDH1 AML: A study from the french AML intergroup ALFA/filo
No full textInternational audienceBackground: IDH1 mutations are found in 6-10% of acute myeloid leukemia (AML) cases. Ivosidenib (IVO), an oral mIDH1 inhibitor, is approved for newly diagnosed mIDH1 AML in patients (pts) aged ≥75 years or unfit for intensive chemotherapy as monotherapy (US), based on the results of the AG120-C-001 study (Roboz, Blood, 2020, median overall survival (mOS) 12.6 months) or with azacitidine (AZA) (US and Europe) based on the results of the AGILE study (Montesinos, NEJM, 2022, mOS 29.3 months). However, data available on IVO+/-AZA in real-life are limited. Method: This retrospective study (IVOOBS, NCT06377579)included pts treated in France between 01/2017 and 02/2024 through a compassionate use program with IVO+/-AZA for mIDH1 AML, front-line or at time of relapse or for a refractory disease. Here we focused only on newly diagnosed pts. The primary objective was OS and secondary objectives included response rate (ELN-2022 criteria) and toxicity. Results: 49 pts from 17 centers were included; 16 (33%) received IVO alone (IVO-mono cohort) and 33 (67%) the combination (IVO+AZA cohort). IVO-mono cohort (n=16) : The median age was 72 yo (IQR: 60 - 83.25), 62.5% were male. Most of the pts were unfit (PS > 2 in 92%) with high-risk disease (secondary AML n=14, including 8 pts who have already received AZA for prior hematologic disease; adverse (adv)-risk according to ELN-2022 classification n=7, 43%, intermediate (int)-risk n= 9, 57%). The median white blood count (WBC) was 2.67 Giga/L. The majority of pts started IVO at the recommended dose of 500 mg/day (d) (n=13, 81%), while 3 started at 250 mg/d (concomitant prescription of azole). Median duration of IVO treatment was short (3.25 months, IQR: 1.6-7.07) as 77% % (n=10) of IVO discontinuations occurred within 4 months (3 allo-HCT, 3 progressions, 2 differentiation syndrome (DS), 1 QT prolongation (QTp), 1 death). Any grades of DS and QTp were reported in 25% (n=4) and 7% (n=1) of pts, respectively, while grade 3-4 hepatic, infection and hematologic adverse events (AE) occurred in 0, 4 and 3 pts, respectively. Two deaths were linked to IVO (DS). Mortality at D30 and D60 was 6% and 25%, respectively. Composite complete remission (CCR) (CR/CRh/CRi) rate was 37% (31%/6%/0%), with no MLFS and 44% of non-responders (19% of pts not assessed (NA)). For pts receiving IVO at 500mg/d, CCR was 46% (38%/8%/0%). At 250mg/d, 2 pts did not respond and 1 was NA. Four pts (3 in CR, 1 in no response) received an allo-HCT after IVO. Among responders (n=6), 1 pt relapsed at 10.8 months. With a median follow-up (mFU) of 4.5 months, mOS was 4.5 months (95% CI: 2.07-not reached (NR)) and 2y OS 31.25% (95% CI: 15.11-64.64). IVO+AZA cohort (n=33): The median age was 78 yo (IQR: 75 – 80), 60% were male. The majority of pts were unfit (PS > 2 in 93%) and classified as int-risk (83%) according to ELN-2022 classification (adv-risk 17%). However, according to ELN-2024 classification, most pts had favourable-risk (n=22, 67%) (adv-risk n=2, NA n=9). The median WBC was 2.15 Giga/L. Nine pts (27%) had a secondary AML. The majority of pts started IVO at the dose of 500 mg/d (n=27, 82%), while 6 pts started at 250 mg/d (concomitant prescription of azole (n=5), previous cardiac history (n=1)). Median number of AZA cycles was 6 (range: 1; 28). Median duration of IVO treatment was 13.1 months (IQR: 8.4-18.4) and 26% (n=5) of IVO discontinuations occurred within 4 months (3 progressions, 2 deaths). Mortality at D30 and D60 was 3% and 9%, respectively. DS was reported in 3 pts (9%) and QTp in 2 (7%), any grades, while grade 3-4 hepatic, infection and hematologic AE occurred in 0, 5 and 8 pts, respectively. No death was linked to IVO. CCR was 73% (55%/12%/6%), 3% showed MLFS, 21% were non-responders and 3% NA. CCR was 78% (56%/15%/7%) and 50% (50%/0%/0%) for those receiving IVO at 500 mg/d and 250mg/d, respectively. Among responders (n=24), only 1 pt was consolidated with an allo-HCT and 8 (33%) relapsed at a median of 11.4 months. At relapse, 4 were treated with AZA+BCL2 inhibitor and 1 obtained CR. With a mFU of 16.6 months, mOS was NR (95% CI: 16.62-NR) and 2y OS 52% (95% CI: 35.55-76.56). Conclusion: This retrospective real-life study shows the reproducibility of the results of the AGILE study (IVO+AZA). Pts receiving IVO mono had poorer outcome compared to those of the AG120-C-001 study, likely because pts were at higher risk. The dose of 500 mg/d should also be preferred questioning the role of azole prophylaxis
Seizure-related biomarkers of sudden unexpected death in epilepsy (SUDEP) in drug-resistant focal epilepsy (REPO2MSE): a prospective, multicentre case–control study
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Association of prehospital vs. in-hospital intubation with mortality in hemorrhagic shock after severe trauma: a propensity-matched study
No full textInternational audienceObjective Hemorrhagic shock after severe trauma has a high mortality rate. Intubation may increase hemodynamic failure in shocked patients. Our aim was to assess the association of intubation timing with mortality and morbidity among patients with hemorrhagic shock after severe trauma. Methods This is a retrospective, multicenter study using data from the French Traumabase registry that includes severely injured trauma patients admitted to trauma centers. Patients were included if they were intubated, presented with hemorrhagic shock following severe trauma [≥four packed red blood cells (PRBCs) transfusions within the first 6 h of care], and underwent hemostasis surgery or interventional radiology procedure within 24 h of admission. Patients with severe trauma brain injury (abbreviated injury scale head ≥3) were excluded. The primary outcome was all-cause ICU mortality. Secondary outcomes were: time to hospital arrival, ICU and hospital lengths of stay, Simplified Acute Physiology Score II, prehospital norepinephrine use, and number of PRBCs transfusions within the first 24 h. Patients were categorized by intubation timing (prehospital intubation vs. in-hospital intubation) and matched by propensity score based on variables associated with the occurrence of prehospital intubation. Results Among the 840 patients included [mean age 41 (±18), 646 (74%) male], 455 (54%) had road traffic accidents, 153 (18%) falls, and 189 (23%) penetrating trauma. The median Injury Severity Score was 22 (16–34). After propensity score matching, 454 patients (227/group) were analyzed. Twenty-three patients (10%) died in the ICU in the prehospital intubation group vs. 18 (7.9%) in in-hospital intubation group [OR 1.28, 95% CI (0.69–2.37)]. Concerning secondary outcomes, prehospital intubation was associated with a higher need for norepinephrine support [130 (57%) vs. 83 (37%); OR 2.47, 95% CI (1.64–3.72)] and a longer time to hospital arrival [median within-pair absolute difference: 15 min; 95% CI (5–27)]. There was no significant difference for other secondary outcomes. Conclusion In this cohort of patients with hemorrhagic shock after severe trauma, prehospital intubation was not associated with a change in ICU-mortality
Exoskeletons as potential devices to support and enhance rescuers’ chest compression performance during out-of-hospital cardiac arrest
No full textInternational audienceExoskeletons are wearable structures that support and assist movement, or augment the capabilities of the human body. These functionalities could theoretically assist bystanders or rescuers performing manual chest compressions during out-of-hospital cardiac arrest, as this emergency procedure is prone to physical exhaustion. Compressions are an intense muscular effort involving a dynamic muscular pattern with conflicting postural constraints. Rescuer fatigue sets in rapidly, leading to postural instability and a lack of mechanical power delivered by the arms to the patient's torso, which affects hemodynamic efficiency. Physical augmentation and postural stabilization are two functions that could be provided by an exoskeleton during cardiopulmonary resuscitation. This device would combine the advantages of manual and mechanical chest compressions, bypassing anthropometric parameters such as the rescuer's aerobic capacity and muscle mass to maintain efficient chest compressions, and avoiding the negative issues associated with over-assistance through a servomotor function. This concept paper examines the specifications of an ideal theoretical device in this context, noting the potential technical difficulties and barriers to implementation.</div
Entre soin et éducation : quel rôle joue l’ergothérapeute dans les programmes éducatifs destinés aux patients borderline ?
No full textBorderline personality disorder, a complex and often misunderstood condition, which significantly affects patients’ quality of life. Therapeutic patient education and psychoeducation have emerged as effective strategies to support individuals with this disorder. This thesis aims to precisely identify the role of occupational therapists within these educational programs. To do so, a qualitative study was conducted through three semi-structured interviews. The data were transcribed and thematically analyzed. The investigator identified that the involvement of occupational therapists remains limited and often occurs late in the process. However, their contribution is considered relevant: they bring a concrete and engaging approach, particularly in emotional regulation and daily autonomy. To conclude, we can say that although their role is still only partially recognized, strengthening the involvement of occupational therapists from the early stages of program design could lead to more comprehensive and tailored care for individuals with BPD.Le trouble de la personnalité limite, complexe et souvent mal compris, altère fortement la qualité de vie des patients. L’éducation thérapeutique du patient et la psychoéducation apparaissent comme des stratégies efficaces. Ce mémoire vise à identifier précisément le rôle de l’ergothérapeute dans ces programmes éducatifs. Pour ce faire, une étude qualitative a été menée via trois entretiens semi-directifs. Les données ont été retranscrites et analysées par thématiques. L’investigatrice a identifié que l'intégration des ergothérapeutes reste limitée et tardive. Cependant, leur rôle est jugé pertinent : ils apportent une approche concrète et ludique, notamment dans la régulation émotionnelle et l’autonomie quotidienne.En conclusion, on peut dire que malgré une reconnaissance encore partielle, renforcer l’intégration des ergothérapeutes dès la conception des programmes permettrait une prise en charge plus complète et adaptée des patients borderline