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Social media use and roles of self-objectification, self-compassion and body image concerns: a systematic review
No full textInternational audienc
Les poupées russes de l’antibiorésistance - cartographie hiérarchique des gènes et des vecteurs de résistance transférable
No full textNational audienceObjectifComprendre la dissémination des gènes de résistance antimicrobiens (ARGs) nécessite une lecture structurée de leur contexte génomique et d'une cartographie fine des vecteurs de résistance. Nous proposons une approche conceptuelle de représentation hiérarchique des génomes, situant chaque ARG dans son environnement génomique : élément génétique mobile (MGE), plasmide ou chromosome, jusqu’à la souche hôte. Cette vision offre un cadre pour explorer la diversité des vecteurs et mécanismes de résistance en France.Matériels et MéthodesCette approche a été appliqué à environ 1500 d’isolats d’Enterobacteriaceae, P. aeruginosa et A. baumannii, collectés par trois Centres Nationaux de référence de la Résistance (CNR) français. Ces génomes, séquencés en long et short reads, ont été assemblés et annotés dans une base de connaissances pour identifier les ARGs et leur environnement génomique. La structure hiérarchique des génomes est restituée sous forme de fichiers et rapports HTML automatisés, de visualisations type IGV et d’applications interactives Shiny, pour une lecture des emboîtements génomiques.RésultatsLe concept de structure hiérarchique des génomes et de visualisation de génomes BMR porteurs d’ARGs est présenté Figures 1-3.Sur l’ensemble des ARGs des génomes de bactéries multi-résistantes (BMR) des 3 CNR français, 65 % sont localisés sur le chromosome, 30 % sur des plasmides, et 4 % sur des réplicons non identifiés. Parmi les ARGs chromosomiques, 82 % ne sont associés à aucun MGE, 17 % sont sur des transposons, le reste sur des prophages ou ICE. 2 % sont imbriqués dans deux transposons. Sur les plasmides, 69 % des ARGs sont associés à des MGEs, dont 67 % à des transposons et 1,5 % à des prophages. 16 % sont imbriqués dans un MGE contenu dans un transposon, et 1 % dans un MGE contenu dans un prophage.ConclusionCette représentation permet d’explorer intuitivement la diversité des environnements des ARGs, d’identifier des synténies conservées de résistances au sein des génomes, des hotspots d’insertion, et de classifier les MGEs selon leur contenu ou typage plasmidique. Elle constitue un cadre pour des analyses ciblées sur des ARGs émergents et permet une meilleure compréhension des dynamiques génomiques associées à la résistance
Why should we stop implanting transobturator sling?
No full textInternational audienceSince the first FDA warning on pelvic mesh in 2008, the debate on the use of synthetic polypropylene slings for the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) has intensified. Despite the controversy, transvaginal tape (TVT) and transobturator tape (TOT) have revolutionized pelvic floor surgery. Systematic reviews and large trials confirm that synthetic slings, especially TVT, are safe and effective with low long-term complication and revision rates. Compared with older methods such as Burch colposuspension, slings offer similar efficacy but fewer voiding problems. While TOT is associated with a lower risk of bladder perforation and other intraoperative complications, it has a significantly higher incidence of chronic groin and pelvic pain. Emerging evidence links this pain to anatomical challenges, nerve entrapment and possible inflammatory responses, often making symptom resolution difficult even after mesh removal. In addition, the complete mesh removal is difficult in case of TOT, contributing to long-term patient morbidity. Given the higher re-operation rates, the prevalence of chronic pain, and the complex management associated with TOT, we argue for its discontinuation. TVT, despite its own risks, is more effective, reversible and manageable in the event of complications. Clinical focus should now shift to improving surgeon training, patient selection and postoperative care to optimise outcomes and minimise harm. LEVEL OF EVIDENCE: 3
Interim analysis of the IRMAA study: concordance between MRI and histopathological analysis of bladder cancer
No full textInternational audienceINTRODUCTION : Bladder cancer are common, and their management and prognosis depend on the stage of tumor infiltration, particularly the involvement of the muscular layer. MRI appears to be an effective tool for assessing this infiltration, but its role remains to be determined. The aim of our study was to evaluate the concordance between the VIRADS score established on MRI and the histopathological examination of TURBT samples to access the staging T of bladder cancer. METHODS : We conducted an interim analysis on patients enrolled in the prospective, single-center IRMAA study (NCT05464576). All patients underwent bladder MRI prior to surgery. The VIRADS score on MRI was blindly compared to the histopathological results of TURBT samples for tumor staging T. We secondarily evaluated the concordance between the VIRADS score and the histopathological analysis of cystectomy as well as the efficacy of neoadjuvant chemotherapy. RESULTS : A total of 85 patients were included. 109 lesions were jointly identified on MRI and TURBT, of which 11 were discordant lesions. The concordance rate is 89.91% with a Cohen's Kappa coefficient of 0.74. Sensitivity is 100%, specificity is 87.4%, positive predictive value is 66.7% and negative predictive value is 100%. CONCLUSION : MRI is a promising tool for discrimination between NMIBC and MIBC. This interim analysis allowed us to identify discordant cases in order to refine future MRI interpretations for the final analysis of the IRMAA study
New three‐dimensional nuclear morphometry tool quantifies impact of slow freezing on sperm hypercondensed chromatin
No full textInternational audienceBackground: Perm freezing compromises nuclear integrity. Standardized tools to assess three‐dimensional (3D) chromatin alterations are lacking. Objectives This study aimed to present a novel protocol for 3D nuclear morphometric analysis of human spermatozoa to measure slow freezing and thawing‐induced alterations.Materials and methods Human sperm cells were examined before and after freezing using a consistent 3D nuclear morphometric analysis protocol that distinguishes between live and dead spermatozoa. Morphometric assessments were performed by microscopy and image analysis with the NucleusJ2.0/NODeJ software, without introducing denaturing agents. The analysis included measurements of nuclear volume, elongation, flatness, and the volume of hypercondensed chromatin (Hc) regions, along with the relative fluorescence intensity of these zones (RHF intensity). Additional parameters evaluated comprised sperm vitality, motility, DNA fragmentation, and chromatin decondensation.Results: A quantitative analysis of 4919 sperm nuclei from 10 patients demonstrated significant modifications in the hypercondensed chromatin (Hc) zones, with a marked decrease in sperm vitality and motility ( p < 0.001) and a significant increase in DNA fragmentation ( p < 0.05). At the chromatin level, slow freezing induced a higher number of Hc zones per nucleus ( p < 0.01), a reduction in the average volume of these zones ( p < 0.0001), and a reduced relative fluorescence intensity ( p < 0.01). Notably, these chromatin alterations were most pronounced in viable spermatozoa.Discussion and conclusion: This study is the first to provide standardized 3D nuclear morphometry measurements for human sperm, offering a novel biomarker to assess male fertility and cryopreservation susceptibility, with potential clinical applications for improving patient care. Slow freeze–thaw cycle induced significant alterations in sperm chromatin, disrupting nuclear organization and forming several smaller, less compacted hypercondensed chromatin zones
Suivi à long terme des vascularites cryoglobulinémiques mixtes non infectieuses
No full textInternational audienceIntroductionLes vascularites cryoglobulinémiques représentent une cause de vascularite des petits vaisseaux. Les principales données épidémiologiques et thérapeutiques proviennent des formes asscociées à l’infection par le virus de l’hépatite C. Notre objectif était de décrire l’évolution à long terme et les facteurs de risque de rechute des vascularites cryoglobulinémiques non liées aux infections.Patients et méthodesNous avons mené une étude française multicentrique, rétrospective, incluant les patients avec une vascularite liée à une cryoglobulinémie de type II ou III, sans élément pour une cause infectieuse, notamment virus des hépatites B ou C. Les données ont été collectées dans les dossiers des patients. Les formes sévères étaient définies par une atteinte rénale et/ou digestive et/ou respiratoire et/ou neurologique centrale. La rémission clinique était définie par la disparition des signes d’activité de la vascularite et la rémission immunologique par la négativation des marqueurs immunologiques, disparition de la cryoglobulinémie, du facteur rhumatoïde et normalisation de la fraction C4 du complément.RésultatsNous avons inclus 304 patients dont 67 % de femmes avec une médiane d’âge de 64 [53–74] ans au moment du diagnostic de la vascularite. La vascularite cryoglobulinémique était essentielle dans 42 % des cas, associée à une connectivite dans 32 % des cas et secondaire à une hémopathie lymphoïde dans 26 % des cas. Dans le cadre de la première ligne thérapeutique, 112 (37 %) ont reçu un traitement par corticoïdes seuls ou en association avec du rituximab dans 93 (31 %) cas ou du cyclophosphamide chez 65 (21 %) patients. Après le traitement de première ligne, 132 (43 %) patients ont présenté une rechute, survenue dans un délai médian de 18 [5–49] mois. La rechute était sévère chez 41 (14 %) patients. En analyse multivariée, les vascularites secondaires à une connectivite (OR 1,80, IC95 % [1,05–3,09], p = 0,03) et l’absence de rémission immunologique (OR 0,45 IC95 % [0,24–0,83], p = 0,01) étaient indépendamment associées au risque de rechute. En comparant les 702 lignes thérapeutiques reçues par les patients, le rituximab était associé à une prévention des rechutes (OR 0,63 IC95 % [0,43–0,93], p = 0,002). Durant un suivi médian de 70 [34–144] mois, 70 (23 %) patients sont décédés. Au cours du suivi, 35 (16 %) qui n’avaient pas d’hémopathie au diagnostic ont développé un lymphome.ConclusionLes vascularites cryoglobulinémiques non infectieuses représentent une pathologie sévère avec des rechutes fréquentes. Les vascularites secondaires à une connectivite et l’absence de rémission immunologique sont associées au risque de rechute. Le rituximab prévient les rechutes
Baseline characteristics of the TRANSLATE2 cohort: a prospective study on rheumatoid arthritis-associated interstitial lung disease
No full textInternational audienceObjectives: To describe the baseline characteristics of patients enrolled in the TRANSLATE2 cohort (NCT04227535), a national, multicenter, prospective case-control study designed to investigate the genetic and non-genetic determinants of interstitial lung disease (ILD) in rheumatoid arthritis (RA).Methods: Cases with RA-ILD and RA controls without ILD were consecutively included in TRANSLATE2 with a 5-year prospective follow-up. All participants fulfilled the ACR/EULAR 2010 classification criteria for RA. ILD presence or absence was confirmed for every participant by chest high-resolution computed tomography (HRCT). Baseline demographic and clinical data were collected. Blood samples were collected at enrollment for centralized biobanking of DNA, RNA, and serum to support future genetic and biomarker studies. For ILD cases, chest HRCT scans were centrally reviewed to determine HRCT pattern. For the current study, associations with ILD were tested using univariable and multivariable logistic regression models.Results: Among the 506 patients included (275 RA-ILD, 231 RA-noILD), RA-ILD cases were more frequently male (48.4% vs. 29.9%), older at enrollment (66.6 [9.9] vs. 58.5 [13.2] years) and older at RA onset (52.2 [14.7] vs. 45.8 [14.3] years). ILD was independently associated with male sex (OR 1.82; 95% CI 1.06, 3.14) and older age at RA onset (OR per 10 years 1.28; 95% CI 1.10,1.50). For ILD cases, the most frequent HRCT patterns were definite for usual interstitial pneumonia (39.3%) and non-specific interstitial pneumonia (17.8%). At enrollment, respiratory symptoms were observed in 67.3% with a mean forced vital capacity % predicted of 87.6% (21.7) and a mean diffusing capacity of the lung for carbon monoxide % predicted of 58.4% (18.8).Conclusion: The TRANSLATE2 cohort provides a comprehensive and deeply phenotyped dataset that offers a unique opportunity to investigate the genetic architecture, risk factors, and natural history of RA-ILD. 287/300 words
The Healthcare Amyloidosis European Registry (HEAR): design of a national registry with a European extension strategy, and foundation of the F-CRIN GRACE network
No full textInternational audienceBackground: Cardiac amyloidosis (CA) is a rare disease that can lead to poor quality of life, conduction disorders, arrhythmia, heart failure, and even death. Fortunately, specific treatments that can modify the natural history of the disease and the disease outcomes are now available. However, data on the prevailing patient management procedures and long-term outcomes of CA are scarce.Objective: The Healthcare Amyloidosis European Registry (HEAR) is 34-centre registry initiated in France and structured for European expansion through the French Clinical Research Infrastructure Network's Group for Research on Amyloidosis and Care Excellence and the European Clinical Research Infrastructure Network. We expect to include 8500 patients between January 2021 and December 2027.Methods: The HEAR has been designed to capture detailed demographic, clinical, laboratory, imaging, and therapeutic data from both suspected and confirmed cases of all cardiac amyloidosis subtypes, including wildtype transthyretin amyloidosis, variant transthyretin amyloidosis, light-chain amyloidosis, and rarer forms. This comprehensive approach has been designed to (i) improve our understanding of real-world diagnostic pathways, treatment practices, and patient outcomes and (ii) incorporate patient-centred innovations. To enhance the patient-centred nature of the registry, patient-reported outcome measures (PROMs) will be systematically collected.Conclusions: By addressing diagnostic pathways, real-world management and PROMs and by applying technological innovations and European scalability, the next-generation HEAR is establishing itself as a valuable resource for clinical research, public health interventions, and better patient care in the field of CA
Prognosis of liver abscess in the intensive care unit (POLAIR), a multicentre observational study
No full textInternational audienceBackground: Liver abscess (LA) is a rare but potentially serious condition with a high mortality rate. Current epidemiological data of LA patients requiring intensive care unit (ICU) admission are limited.Methods: This multicentre retrospective study included adults admitted to 24 ICUs in France between January 2010 and December 2020. Risk factors for mortality were identified by multivariate analysis. A propensity score was used to adjust for confounders related to the presence of portal vein thrombosis.Results: 335 patients were enrolled. The median age was 66 years [53-73] and 68% were male. Commons comorbidities included diabetes (29.9%) and cancer or haematological disease. Septic shock was the main reason for admission (58%). The median SAPS2 score at ICU admission was 42 [31-53] and the SOFA score was 6 [3-9]. The putative origin of LA was biliary (31%), while 40% were cryptogenic. Most patients (60%) had a solitary LA, involving the right lobe (38.8%), with a median diameter of 67 mm [47-91]. Associated portal vein thrombosis (PVT) was present in 13.4% of cases. Microbiological documentation was obtained in 82% of patients, showing gram-negative bacilli (59.7%), mainly Escherichia coli (19.6%) and Klebsiella spp. (19.1%), and gram-positive cocci (29.6%), mainly Streptococcus spp. (17.1%). Drainage was performed in 62% of cases, 40% within 48 h. The median duration of antibiotic therapy was 35 days [21-42]. During hospitalisation, 62% of patients required vasopressors and 29% required mechanical ventilation. In-ICU mortality was 11.6%. Multivariate analysis showed that organ dysfunction illustrated by SOFA score (HR 3.45 [1.95-6.09], p < 0.001) and PVT (HR 3.14 [1.54-6.39], p = 0.001) were significant risk factors for mortality. Drainage was not associated with improved short-term survival (HR 1.22 [0.65-2.72], p = 0.52). In the population matched for PVT confounders, a higher sofa score was the only factor associated with mortality (HR 3.11 [1.76-5.49] IC95%, p = 0.001).Conclusions: This multicentre study illustrates the severity of LA in French intensive care units and identifies organ dysfunction (SOFA score) and portal vein thrombosis as major risk factors for mortality. Prospective studies are needed to improve management strategies, as the survival benefit of drainage is unclear