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Improving the care pathway for people living with HIV aged 70 years and older: the impact of geriatric screening in an infectious diseases unit (AUTO-HIV 70)
No full textInternational audienceBackground With increased life expectancy of people living with HIV comes increased rates of multimorbidity and frailty, which services are not currently managing well. A geriatric day hospital (GDH) screening program was offered in our infectious disease department for all people living with HIV aged 70 years and older coming for follow-up, with the aim to provide more holistic ageing care. In order to evaluate our professional practice, we assessed the proportion of participants who had a planned change in their care pathway following this screening, and describe the population who benefited from this GDH.Methods From July 2021 up to January 2024, a cross-sectional study was performed. Demographic data was collected from participant's medical records along with various validated geriatric screening scores. Changes in the care pathway included referrals to a health professional and/or a change in treatment. Changes were indicated by the results of the screening program, planned by the clinician if the changes were considered relevant and if the participant agreed, and finally implemented or not at the next consultation. The percentage of participants with a change in their care pathway following the geriatric screening test is presented with a 95% confidence interval. The factors associated with it were studied using the Chi-squared test or the Fisher's exact test for categorical variables, and Student's t test or Mann-Whitney test for continuous variables.Results A total of 63 people living with HIV, aged 75.2 ± 4.6 years, were included, 57.1% of whom had at least three comorbidities. According to the geriatric screening evaluations, a change in the care pathway was indicated in 56/63 (88.9%; 95%CI: 78.4 to 95.4%) people living with HIV, and planned by the doctor with the participant's agreement in 34/63 (54.0%; 95%CI: 40.9 to 66.6%) participants. Factors associated with a planned change in the care pathway were Dat' AIDS mortality score (p=0.02), EPICES score (p=0.03), Fried frailty phenotype (p=0.007) and GFST (p=0.04). At least one planned change in the care pathway was implemented before the next consultation six months later in 30/63 (47.6%) people living with HIV.</div
Migration du 2,4 di-tert-butylphénol des dispositifs ophtalmiques multidoses vers les préparations à base de tacrolimus : influence de la formulation.
No full textInternational audienc
Intravenous administration of antibiotics by prolonged and continuous infusion
No full textInternational audienceHighlightsProlonged or continuous infusions may improve the ease of administration and/or clinical effectiveness in some situations.Antibiotics, in particular beta-lactam antibiotics, are unstable molecules, their infusion modes must be strictly controlled.These guidelines, based on a literature review, suggest practical methods of administration in hospitals and outpatient care.</ul
Adaptive thermogenesis in response to weight loss and weight regain: first evidence in adolescents with severe obesity
No full textInternational audienceWhile the effects of multidisciplinary weight loss (WL) on resting energy expenditure remain unclear in adolescents with obesity, the potential presence of adaptive thermogenesis (AT) has never been explored, which was the objective of the present work. Twenty-six adolescents (14·1 ( sd 1·5) years) with severe obesity completed a 9-month inpatient multidisciplinary intervention followed by a 4-month follow-up. Anthropometric measurements, body composition (dual X-ray absorptiometry) and resting energy expenditure (REE, indirect calorimetry) were assessed before (T0) and after 9 months of WL intervention (T1) and after a 4-month follow-up (T2). AT, at the level of REE, was defined as a significantly lower measured v . predicted (using regression models with baseline data) REE. Two pre-cited REE equations were used, using both fat mass and fat-free mass (FFM) (predicted REE using equation 1) or FFM only (predicted REE using equation 2). Measured and predicted REE significantly decreased between T0 and T1 ( P < 0·001) and remained lower at T2 compared with T0 (measured REE: P = 0·017; predicted REE: P < 0·001). Predicted REE using equation 2 was significantly higher than measured REE at T1 ( P = 0·012), suggesting the presence of AT. FFM at T0 was negatively correlated with ATp1T1 (Rho = –0·428; P = 0·033) and ATp2T1 (Rho = –0·485; P = 0·014). The variation of FFM between T0 and T1 was negatively correlated with AT at T1 and T2. These preliminary results suggest the existence of AT in response to WL in adolescents with obesity, independently of the degree of WL. AT was associated with subsequent body weight and fat regain, suggesting AT may represent a damper to WL attempts while increasing the adolescents’ risks for subsequent weight and adiposity rebounds
Comparative assessment of early neointimal formation: P8RI-coated Silk Vista versus Pipeline Vantage (Shield) in a rabbit model using optical coherence tomography
No full textInternational audienceBackground Several coating strategies have been recently introduced to reduce thrombogenicity of flow diverters (FDs), while the P8RI coating focuses on stimulating endothelial cells for faster arterial healing. This study aims to evaluate early neointimal growth over the FD struts by comparing these two strategies in an animal model. Methods Bare Silk Vista (bare-SV), P8RI Silk Vista (P8RI-SV), and Pipeline Vantage with Shield technology (Shield-PV) were implanted in rabbits to treat elastase-induced aneurysms (n=6, 10, and 7, respectively) and in the aorta (n=6, 7, and 4, respectively). At 5 and 28 days, the devices were imaged with optical coherence tomography (OCT) to evaluate the stent-coverage ratio. Conventional histology and multiphoton microscopy were also performed. Results The aneurysm occlusion rate was similar in all three groups (P=0.577). On OCT images, the stent-coverage ratio on day 5 and day 28 (overall and at each location) was significantly higher with P8RI-SV compared with both bare-SV and Shield-PV (Kruskal-Wallis P<0.0001, Dunn post-test P<0.001 for both timepoints). Histological and multiphoton microscopy evaluations confirmed that the struts of P8RI-SV were covered by well-organized neointima expressing a high rate of collagen at the aneurysm neck and in the aorta, compatible with an advanced stage of tissue remodeling and stabilized neointima. Conclusion P8RI-SV demonstrated higher rates of neointimal formation covering the FD struts compared with bare-SV and Shield-PV at day 5 and day 28 in rabbits. These results confirm faster and improved arterial healing with P8RI coating; however, further studies are needed to evaluate the clinical benefits in patients
Management of bone loss in revision total knee arthroplasty with tantalum cones: Primary aseptic revision versus multiple revisions
No full textInternational audienceBackgroundThe increasing number of revisions following total knee arthroplasty (TKA) has led to the appearance of new challenges, including the management of bone defects. The use of porous tantalum cones is one of the options to address this bone loss.PurposeWe carried out a retrospective study to compare the medium-term outcomes of single and multiple TKA revisions in the context of massive bone defects using tantalum cones. We analyzed: (1) the survival of the revision implants, (2) osseointegration of the cone, (3) the clinical and functional outcomes, (4) complications.MethodsBetween July 2011 and May 2019, 79 metaphyseal reconstructions (MRs) were performed in 58 patients (mean age 68 ± 11 (41–89)) who received tantalum cones during the procedure. Revisions for infection were excluded. The massive bone defects were classified as Anderson Orthopaedic Research Institute types 2B/3. The cone had to be removed in 12 patients (16 MRs). Implant survival free of all-cause revision and cone survival free of aseptic loosening were calculated. Osseointegration of the cones was determined on radiographs. A subset of patients (n = 46) underwent a clinical assessment including the OKS, KSS, KOOS, satisfaction level and knee flexion. All of the patients (n = 58) underwent a radiological assessment. Complications were documented during the follow up period.ResultsThe mean follow up was 73.1 months ± 29.8 (12–143). In all, 91 cones (48 at the femur and 43 in the tibia) had been implanted during 79 MR procedures: 40 in the primary revision group (R-primary) and 39 in the multiple revision group (R-multiple). Survivorship of the implant free of all-cause revision at 6 years was better in the R-primary group, 97.5 % (95 %CI: 93 % to 100 %) than in the R-multiple group, 70.5 % (95 %CI: 57 % to 87 %) (P < 0.01). Survivorship of the cone free of aseptic loosening at 6 years was comparable between the two groups: 100 % (95 %CI 100 % to 100 %) for R-primary and 96.8 % (95 %CI 91 % to 100 %) for R-multiple (P = 0.26). At the final assessment, 10 of 91 cones had no bone ingrowth; all of them were in the R-multiple group (P = 0.012). The functional outcomes were better in the R-primary group. The mean OKS was 31.5 ± 8.7 (16–45) vs. 25.7 ± 9.1 (9–41) in the R-multiple group (P = 0.014). The mean KSS global was 146.2 ± 32.3 (69–197) vs. 136.8 ± 20.9 (98–182) in the R-multiple group (P = 0.082). The KOOS global was 61.3 ± 17 (26–84) vs. 48.3 ± 15.7 (18–79) in the R-multiple group (P < 0.01). In the R-primary group, 78 % of patients (22/28) were satisfied or very satisfied with the outcome vs. 61 % (11/18) in the R-multiple group (P = 0.25). The mean knee flexion at the final assessment was 102.7 ± 24.2 (20–125) in the R-primary group vs. 98.3 ± 16.5 (70–120) in the R-multiple group (P = 0.36). A re-revision was needed in 16 of the 79 MRs (20 %). The most common cause of failure was a periprosthetic infection in almost half of these cases (eight of 16). Only one re-revision was needed in the R-primary group, while 15 were needed in the R-multiple group (P < 0.001).ConclusionsMR using porous tantalum biomaterials is a viable technique for managing massive bone defects during TKA revision. Multiple revisions were associated with worse implant survivorship and worse functional outcomes than primary (or first) revisions, along with having a higher likelihood of infection-related complications. The survivorship of the cones free of aseptic loosening was comparable between primary and repeat revisions. Loosening was more frequent on the femoral side than the tibial side
Satisfaction et prise en charge de la douleur chez les femmes incluses ou non dans un protocole de réhabilitation améliorée après césarienne
No full textInternational audienceUne étude transversale à visée étiologique a été conduite</div
Optimizing Sample Size and Statistical Methods for Probabilistic Sweet Spot Mapping in Deep Brain Stimulation
No full textInternational audienceDeep Brain Stimulation (DBS) for movement disorders can greatly benefit from the insights provided by probabilistic mapping. This consists in the application of statistical approaches to stimulation data of multiple patients. Such analysis is influenced by the input data and chosen statistical method, hindering the generalizability of the obtained results. This study aims at determining the minimum sample size yielding stable results, and the statistical approach providing higher results consistency. Intra-operative stimulation test data of 36 patients who underwent DBS surgery for Parkinson’s Disease (PD), were used to compute Probabilistic Sweet Spots (PSS). The PSS were calculated with sample sizes ranging from 4 to 36 (steps of 2) using Bayesian t-test, Wilcoxon test with False Discovery Rate correction and Wilcoxon test with nonparametric permutations correction. Calculations were repeated 10 times. Obtained PSS were compared in terms of size and position variability across sample sizes and between statistical methods. Only the PSS computed with the Bayesian t-test reached stability in all the three chosen metrics. Stability in size and centroid location was reached from a sample size of 14 patients, while the covered volume (Dice coefficient) stabilized from a sample size of 18 patients. The Bayesian t-test also provided higher results consistency with respect to the other approaches. The composition of the dataset in cohorts with <20 patients has a greater influence on the extent and location of computed PSS. Moreover, the Bayesian t-test demonstrated the highest suitability to extrapolate results from analyses involving small sample sizes.Clinical Relevance— Determining the minimum number of patients and most suitable method to calculate stable PSS is crucial for ensuring the reliability and clinical applicability of Probabilistic Mapping approaches. This ensures the generalizability of findings, allowing for a more accurate understanding of the underlying pathology. These insights can be used to refine diagnostic approaches and optimize clinical interventions, ultimately improving patient care