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Efficacy of erythroid‐stimulating agent and luspatercept in VEXAS syndrome: A multicenter retrospective study by the FRENVEX group
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A comparison of minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the management of tibial pilon fractures: A prospective randomized study
No full textInternational audienceIntroductionThe aim of this study was to compare two surgical procedures for the treatment of tibial pilon fractures, i.e. minimally invasive plate osteosynthesis (MIPO) vs. open reduction and internal fixation (ORIF), in terms of wound healing time, ankle swelling, change in pain, functional outcomes and complications.HypothesisWe hypothesized that MIPO treatment would induce a faster healing process and lower complications rates.Patients and methodsThis monocentric, comparative, prospective and randomized study was based on the enrollment of 54 patients between November 2017 and May 2023. Patients hospitalized for a tibial pilon fracture with closed or open fracture (Cauchoix or Gustilo type I) received randomly ORIF or MIPO treatment using distal tibial locking compression plates of 3.5 mm. Data collection included demographics, wound dressing wear time, ankle circumference ratio, pain scores, AOFAS, FADI and MAZUR functional scores, and complications. Data were monitored from the intervention day until 12 months of follow-up, with different intermediate follow-up visits. They were then compared between minimally invasive and open surgery groups.ResultsWe found similar dressing wear times in both groups with a mean of 21.55 ± 14.91 days in the ORIF group and 18.0 ± 6.44 days in the MIPO group (p = 0.312). VAS pain scores and ankle circumference ratio did not reveal a significant difference between the two techniques. The infection rate was identical in both groups (15.4%; 4/26). Wound complication rates in the ORIF group (11.5%; 3/26) and the MIPO group (7.7%; 2/26) were not statistically different (p = 0.334). The analysis of the functional scores showed ameliorated results in the ORIF group at 3 months follow-up with higher AOFAS, FADI and MAZUR scores, but at further monitoring visits there was no evidence of the superiority of one technique over another.ConclusionThe MIPO technique was not distinctively superior to ORIF method in the treatment of tibial pilon fractures
Validation and safety of AmbuLatory care for transient ischemic attack from emergency department (VALID study)
No full textInternational audienceBackground: Transient Ischemic Attacks (TIAs) are a common reason for Emergency Department (ED) visits and represent a significant public health issue. Patients experiencing TIAs often face significant delays in undergoing various tests due to ED overcrowding and limited availability of neurologists. Emergency physicians (EPs) and neurologists have identified several criteria for allowing outpatient management. We conducted this study to assess the safety of this approach.Methods: A reappointment pathway was established to oversee the management of TIAs following an ED visit. The primary objective was to evaluate the safety of this pathway by monitoring any events occurring between discharge from the ED and the neurology reappointment. We conducted a retrospective descriptive single-center study of patients who benefited from this pathway between September 2021 and September 2023. In the case of an event, we assessed sequalae using NIHSS and Modified Rankin Scale.Results: 186 patients were included, with a mean age of 64 years. 53.7 % were women. The median ABCD2 score was 3. The median time spent in the ED was 444 min. Eight patients experienced an event. The risk of post-TIA event was 2.7 % at 30 days, and 3.2 % at 90 days. None of the patients had sequala at the end of the follow-up. 12.9 % of MRI scans revealed recent established strokes.Conclusion: Our study demonstrates the safety of a systematic reappointment pathway for patients presenting with TIAs in the ED. Future research should validate our results with larger cohorts and explore strategies to optimize outpatient management of patients
Psychosocial well-being index and sick leave in the workplace: a structural equation modeling of Wittyfit data
No full textInternational audienceObjective: This study aims to build a structural equation model of a psychosocial well-being index based on 10 psychosocial factors and investigate its association with sick leave. Methods Data of workers using Wittyfit was collected in 2018. Psychosocial factors (job satisfaction, atmosphere, recognition, work-life balance, meaning, work organization, values, workload, autonomy, and stress) were self-assessed using health-related surveys, while sick leave records were provided by volunteer companies. Results: A total of 1,399 workers were included in the study (mean age: 39.4 ± 9.4, mean seniority: 9.2 ± 7.7, 49.8% of women, 12.0% managers). The prevalence of absenteeism was 34.5%, with an average of 8.48 ± 28.7 days of sick leave per worker. Structural equation modeling facilitated computation of workers’ psychosocial well-being index (AIC: 123,016.2, BIC: 123,231.2, RMSEA: 0.03). All factors, except workload ( p = 0.9), were influential, with meaning ( β = 0.72, 95% CI 0.69–0.74), values (0.69, 0.67–0.70) and job satisfaction (0.64, 0.61–0.66) being the main drivers ( p < 0.001). Overall, psychosocial well-being was found to be a protective factor for sick leave, with a 2% decreased risk (OR = 0.98, 95% CI 0.98–0.99, p < 0.001) and duration (IRR = 0.98, 95% CI 0.97–0.99, p < 0.001) per psychosocial well-being index point. Conclusion: The psychosocial well-being index provides a measure of psychosocial well-being and helps predict sick leave in the workplace. This new indicator could be used to analyze the association between psychosocial well-being and other health outcomes. Clinical trial registration Clinicaltrials.gov , identifier NCT02596737
Perioperative antimicrobial prophylaxis and surgical site infection prevention, what clinicians and researchers must know
No full textInternational audienceSurgical site infections (SSIs) are among the most common healthcare-associated infections, leading to increased morbidity, prolonged hospital stays, and significant healthcare costs. Surgical antimicrobial prophylaxis (SAP) is a critical strategy for SSI prevention, yet its effectiveness is threatened by antimicrobial resistance and variability in clinical practice.This narrative review provides an evidence-based update on the pathophysiology of SSIs, highlighting the interplay between endogenous microbiota, surgical stress, and perioperative factors such as hypoxia, immune modulation, and microbiome disruption. The current state-of-the-art in SAP is reviewed, including antibiotic selection, timing, dosing, intraoperative redosing, and the avoidance of unnecessary postoperative administration.Key intra- and postoperative measures to reduce the risk of SSI are covered, including glycaemic control, body temperature management, goal-directed fluid therapy, and skin antisepsis. A critical appraisal of the supporting evidence is included, with emphasis on areas of ongoing debate.The final section outlines future research priorities: optimizing dosing in obese patients, evaluating continuous infusion, tailoring prophylaxis to surgical site and microbiome, and addressing the management of patients colonized with multidrug-resistant organisms. Non-antibiotic strategies and rapid diagnostic tests are also discussed as promising avenues to enhance precision in infection prevention.By integrating current knowledge with emerging perspectives, this review aims to support the refinement of SSI prevention strategies and contribute to antimicrobial stewardship in modern surgical practice
Handiparentalité et ergothérapie
No full textBackground: only in 2020 did the policy to support parenthood begin to consider people with a disability. Occupational therapy, a discipline focused on autonomy and social participation, could play an important role in supporting these parents. This dissertation explored the way occupational therapist intervenes in the path of disabled parenting.Methods: a quantitative study was carried out, using an online questionnaire for disabled parents. 207 answers were kept for analysis.Results: only 10% of the parents had occupational therapy support, but their high level of satisfaction confirmed the relevance of this discipline in disabled parenting. For the other parents, the main cause of not having consulted an occupational therapist was lack of knowledge about this profession. More than half of them, however, thought it could have been useful.Conclusion: this research underlined the need to improve the visibility and accessibility of occupational therapy. In addition, a draft conceptual model of parenting was proposed, designed to support the occupational therapist's intervention strategy in the disability-parenting pathway. It remains to be developed.Contexte : depuis 2020 seulement, les politiques d'aide à la parentalité intègrent progressivement les personnes en situation de handicap. L'ergothérapie, discipline centrée sur l'autonomie et la participation sociale, pourrait jouer un rôle déterminant dans l'accompagnement de ces parents. Cette étude examine la place de l'ergothérapeute dans le parcours de handiparentalité.Méthode : une enquête quantitative a été menée via un questionnaire en ligne auprès de parents en situation de handicap. 207 réponses ont été retenues pour l'analyse.Résultats : seuls 10 % des répondants ont bénéficié d’un accompagnement ergothérapique, mais leur niveau élevé de satisfaction confirme la pertinence de cette discipline dans le parcours de handiparentalité. La majorité des autres parents n'y a pas eu recours par méconnaissance de la profession, bien que plus de la moitié estime qu'un tel accompagnement aurait pu leur être bénéfique.Conclusion : cette recherche souligne la nécessité d’améliorer la visibilité et l’accessibilité de l’ergothérapie. De plus, un projet de modèle conceptuel de la parentalité est proposé, visant à soutenir la stratégie d’intervention de l’ergothérapeute dans le parcours de handiparentalité. Il reste à développer
Correction: Clinical features, etiologies, and outcomes in adult patients with meningoencephalitis requiring intensive care (EURECA): an international prospective multicenter cohort study
No full textInternational audienceNo abstract availabl
Sex-specific axon initial segment plasticity underlies cortical hyperexcitability in trigeminal pain
No full textNeuropathic pain results from peripheral lesion, causing maladaptive plasticity and central sensitization. Clinical and preclinical studies demonstrate that modifications of primary sensory cortex (S1) activity are essential for neuropathic pain persistence. Rodent studies report heightened S1 pyramidal cell excitability in neuropathic pain model, the origins of which remain debated. The axon initial segment, the action potential trigger zone, is a major determinant of neuronal excitability and is known to undergo structural changes after neural perturbation but its role in chronic pain is poorly understood and no studies have explored its role in cortical hyperexcitability in chronic pain models. Besides, despite a higher prevalence of chronic pain in women, most of preclinical studies have been conducted in males. By integrating electrophysiology, immunohistochemistry, and computational modeling, this study demonstrates that in a trigeminal neuropathic pain rat model, sex-specific structural plasticity of the axon initial segment enhances the excitability of layer 5 pyramidal cells in the somatosensory cortex, potentially driving network-level hyperactivity
Non-motor Subtypes in Candidates for Subthalamic Deep Brain Stimulation for Parkinson’s Disease
No full textInternational audienceIntroduction: Patients with Parkinson’s Disease (PD) vary markedly in terms of non-motor symptoms (NMS) as the disease progresses. To improve PD management and clinical-trial assessment, we aimed to determine NMS endotypes in a cohort of patients with advanced PD.Methods: We conducted an ancillary cluster analysis of the 2013–2018 cohort (n=722) of PREDISTIM. In this French multicenter interventional cohort, consecutive candidates for subthalamic deep brain stimulation undergo thorough assessment of motor symptoms (MS) and NMS at the inclusion visit. The NMS data are based on the MDS-UPDRS, Montreal Cognitive Assessment (MoCA), and several psychiatric scales: Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and Lille Apathy Rating Scale (LARS). Cluster analysis with 17 NMS was conducted to identify groups with homogenous NMS profiles.Results: Three distinct NMS clusters were identified. The largest had mild MS. The smallest had moderate MS and the most severe NMS, including cognitive and psychiatric dysfunction. The middle-large group had moderate MS and NMS but was distinguished by having the worst sleeping problems. The clusters did not differ in onset age or patient age and may be underpinned by disparate patterns of anatomical brain damage.Conclusion: The mainly-motor (Cluster 1), mainly non-motor (Cluster 3), and intermediate (Cluster 2) NMS endophenotypes must be replicated in an independent cohort but may help stratify patients for management (pharmacological, deep-brain stimulation, and non-pharmacological treatments) and inclusion and assessment in clinical trials
[99mTc]Tc-NTP 15 − 5, a new proteoglycan tracer for functional imaging of joint cartilage: phase I (CARSPECT)
No full textInternational audienceBackground [ 99m Tc]Tc-NTP 15 -5 showed affinity for joint cartilage proteoglycans on preclinical studies but has not been tested in humans. This phase I trial (CARPECT: NCT04481230) aims to define the optimal of [ 99m Tc]Tc-NTP 15 -5 injected activity to obtain the best visual contrast of cartilage, without toxicity. Quantitative analyses of cartilage, periarticular uptakes, biodistribution, pharmacokinetic and dosimetry of this new tracer were also studied. ResultsBetween November 2020 and June 2022, five patients with unilateral knee osteoarthritis or breast cancer treated with hormonal therapy inducing cartilage disease were injected with [ 99m Tc]Tc-NTP 15 -5, at increasing activity levels: 5, 10 and 15 MBq/kg. No major toxicity was reported, according to NCICTC 4.0 scale. With an activity of 15 MBq/Kg, the median rate of joint uptakes higher than diaphysis' one on whole body planar scintigraphy was 80.6% (80.60-85.45) at 2 h p.i. and increased with time. S/N ratio with muscular background measured on SPECT-CT was superior to 3 from 2h30 p.i for cartilage. Uptake evolution depending on time from 1h00 to 6h30 p.i. permitted to discriminate cartilage and pooled proteoglycan structures from background and cartilage from ligaments + tendons for all examination times (p < 0.001), and cartilage from bursa at 1 h p.i. (p < 0.05). Pharmacokinetic, biodistribution and dosimetry were in line with preclinical studies. ConclusionsThis study confirms the usability and accuracy of [ 99m Tc]Tc-NTP 15 -5 for cartilage human functional imaging 2 h after injection, at 15 MBq/kg.</div