Portail HAL de l'Université Picardie Jules Verne
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Optimal patient care in advanced chronic kidney disease progressing to kidney failure
No full textInternational audienceThe transition from advanced chronic kidney disease (CKD) to kidney failure requires comprehensive management to optimize patient outcomes. This crucial period, in practical terms defined by CKD stages G4 and G5, involves complex decision-making regarding kidney replacement therapy, pre-emptive kidney transplantation and conservative kidney management. Patient preferences, quality of life, and comorbidities, especially cardiovascular disease, are essential considerations when making treatment decisions. Importantly, nephroprotective therapies should be continued even at advanced stages of CKD to stabilize kidney function and prevent cardiovascular events. Pre-emptive kidney transplantation, when feasible, offers the best outcomes and should be prioritized. Dialysis initiation should be based on clinical symptoms and shared decision-making with the patient, rather than laboratory values alone. For some, particularly older, patients with substantial comorbidities, conservative kidney management, emphasizing symptom management without kidney replacement therapy, might be preferred. Considerable disparities in access to care exist globally, especially in low- and middle-income countries, highlighting the need for tailored strategies. Registry and cohort studies have provided most of the scientific understanding in this area, but more randomized clinical trials are needed to guide advanced CKD management
77 Shades of Grey
No full textBruce Wayne contacted us to help him develop a new surveillance technology for dark environments such as caves, using a swarm of Unmanned Aerial Vehicles (UAVs), called Batdroids. A Batdroid has no chirality, limited visibility, and a perfect clock to synchronize with the others. A Batdroid can produce 77 shades of grey in dark mode and four colors in light mode.In this paper, we propose two algorithms using three Batdroids to perpetually explore a finite 3D grid modeling a cave. The first algorithm operates in darkness, uses 77 shades of grey, and requires visibility range one. The second operates in light, uses four colors and visibility range two. We also prove that three is the optimal number of Batdroids required to solve Bruce Wayne's challenge.</p
P1102 Impact of Disease Duration on Clinical and Endoscopic Responses at 1 Year in Patients with Crohn’s Disease Treated with Guselkumab: Pooled Analysis of the GALAXI 2 & 3 Studies
No full textInternational audienceBackground Shorter disease duration at biologic treatment initiation has been associated with improved therapeutic outcomes in Crohn’s disease (CD).1,2 Using pooled data from two randomized clinical trials, we evaluated whether disease duration impacts achievement of clinical and endoscopic outcomes in adults with active CD treated with guselkumab (GUS). Methods Post-hoc analyses used pooled data from the Phase 2/3 GALAXI 2 & 3 studies in adults with moderately to severely active CD randomized to intravenous GUS 200mg at week (W) 0, W4, W8, followed by subcutaneous GUS 100mg every 8W (Q8W) from W16-40 or GUS 200mg Q4W from W12-44. Analyses were stratified by baseline (BL) disease duration: ultrashort (USDD; ≤1 year), intermediate-short (ISDD; >1 to ≤ 2 years), intermediate-long (ILDD; >2 to ≤ 5 years), and long (LDD; >5 years) disease duration. Rates for clinical response (100-point decrease from BL in CD Activity Index [CDAI] or CDAI<150), clinical remission (CDAI<150), endoscopic response (≥50% improvement from BL in Simple Endoscopic Score for CD [SES-CD] or SES-CD≤2), endoscopic remission (SES-CD≤4, ≥2-point reduction from BL in SES-CD, and no SES-CD sub-score >1), and deep remission (clinical and endoscopic remission) were evaluated at W12 (placebo-controlled period) and W48. Results Despite numerical differences, BL characteristics were generally balanced across disease duration subgroups; as expected, increasingly higher proportions of patients with a history of inadequate response or intolerance to biologic therapies were observed with longer disease duration (Table 1). At W12, GUS induction therapy was effective irrespective of disease duration (data not shown). Achievement rates in the pooled GUS groups increased through W48, with rates of clinical response (range: 74% to 78%), clinical remission (range: 65% to 73%), and endoscopic response (range: 47% to 54%) being comparable across disease duration subgroups. A clinically relevant trend toward lower rates of endoscopic remission (USDD: 44%; ISDD: 41%; ILDD: 35%; LDD: 31%) and deep remission (USDD: 43%; ISDD: 37%; ILDD: 29%; LDD: 28%) was observed with longer disease duration (Figure 1). Conclusion Among adults with moderately to severely active CD from GALAXI 2 & 3, GUS demonstrated clinical and endoscopic benefits across disease duration subgroups with increasing rates through 1 year. A trend toward lower rates of endoscopic/deep remission at 1 year was observed in patients with longer disease duration, supporting earlier initiation of GUS treatment in the disease course. References: 1. Peyrin-Biroulet L, Colombel JF, Louis E, et al. Shorter Crohn’s Disease Duration Is Associated With Better Clinical and Endoscopic Outcomes With Risankizumab in Phase 3 Studies. Gastro Hep Adv. 2024;3(4):539-550. Published 2024 Mar 7. doi:10.1016/j.gastha.2024.02.008 2. Faleck DM, Winters A, Chablaney S, et al. Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn’s Disease But Not Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019;17(12):2497-2505.e1. doi:10.1016/j.cgh.2018.12.040 Conflict of interest: Ferrante, Marc: Research grants from AbbVie, EG Pharma, Celltrion, Janssen, Pfizer, Takeda and Viatris Consultancy fees from AbbVie, AgomAb Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, MRM Health, Merck Sharp and Dohme, Pfizer, Takeda and ThermoFisher Speakers’ fees from AbbVie, Biogen, Boehringer Ingelheim, Dr Falk Pharma, Ferring, Janssen-Cilag, Merck Sharp and Dohme, Pfizer, Takeda, Truvion Healthcare and Viatris Fumery, Mathurin: Grant: Pfizer Personal Fees: Abbvie, Janssen, Takeda, MSD, Biogen, Amgen, Sandoz, Fresenius, Gilead, Celgene, Galapagos, Mylan, Tillots, Ferring, Pfizer, Hospira, CTMA, Boehringer, Lilly, Arena Non-financial Support: Abbvie, Janssen, Takeda, MSD, Galapagos, Ferring, Pfizer Atreya, Raja: Served as a paid or unpaid consultant for or received honoraria from AbbVie, Amgen, Arena Pharmaceuticals, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion Healthcare, Dr. Falk Pharma, Ferring, Fresenius Kabi, Galapagos, Gilead, GlaxoSmithKline, InDex Pharmaceuticals, Johnson & Johnson, Kliniksa Pharmaceuticals, Merk Sharp & Dohme, Novartis, Pfizer, Roche, Samsung Bioepsis, Stelic, Sterna Biologicals, Takeda, and Tillotts. Van Rampelbergh, Rian: Employee of Johnson & Johnson Van Duijnhoven, Wilbert: Employee of Johnson & Johnson (and stock holder) Bravatà, Ivana: Johnson Johnson employee Nazar, Maciek: Employee of Johnson & Johnson Van Denderen, Jacqueline: Employee of Johnson & Johnson Mccaffrey, Victoria: Employee of Johnson & Johnson Armuzzi, Alessandro: Consulting fees from AbbVie, Abivax, Alfa Sigma, Astra Zeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celltrion, Eli-Lilly, Enthera, Ferring, Galapagos, Gilead, Giuliani, Janssen, Lionhealth, MSD, Nestlé, Pfizer, Protagonist Therapeutics, Roche, Samsung Bioepis, Sanofi, Sandoz, Takeda, Teva Pharmaceuticals, Tillots Pharma Speaker’s fees from AbbVie, Abivax, AG Pharma, Alfa Sigma, Biogen, Bristol-Myers Squibb, Celltrion, Eli-Lilly, Ferring, Galapagos, Gilead, Janssen, Lionhealth, MSD, Novartis, Pfizer, Roche, Samsung Bioepis, Sandoz, Takeda, Teva Pharmaceuticals Research support from Biogen, MSD, Takeda, and Pfizer Non-financial support from Abbvie, Janssen, MSD, Pfizer, Taked
Role of Cefiderocol in the Treatment of Carbapenem-Resistant Nonfermenting Gram-Negative Bacilli (Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia) Infections: An Expert Statement
No full textInternational audienceIntroduction: Infections caused by nonfermenting gram-negative bacilli (NF-GNB), particularly Acinetobacter baumannii, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa, are associated with high morbidity and mortality, especially among critically ill or immunocompromised patients. The rise of multidrug resistance has rendered many first-line antibiotics ineffective, highlighting the need for novel agents such as cefiderocol, a siderophore cephalosporin with unique pharmacokinetics and broad in vitro activity against resistant gram-negative pathogens.Methods: A multidisciplinary panel of French experts in infectious diseases, microbiology, pharmacology, and intensive care reviewed the available evidence and clinical experience of cefiderocol. Using a structured consensus process, the group developed pragmatic, expert-based recommendations for its use against A. baumannii, S. maltophilia, and P. aeruginosa, considering clinical scenarios, resistance mechanisms, pharmacokinetic/pharmacodynamic (PK/PD) optimization, and practical implementation.Results: Cefiderocol demonstrates potent in vitro activity against NF-GNB, including colistin- and imipenem-resistant isolates. Clinical success, however, depends on optimized PK/PD exposure, particularly in high-inoculum infections or patients with augmented renal clearance. Cohort studies and meta-analyses suggest lower mortality and markedly reduced nephrotoxicity compared with colistin-based regimens in A. baumannii infections. For S. maltophilia, cefiderocol shows consistently low minimum inhibitory concentration (MIC) and serves as a reliable alternative to trimethoprim-sulfamethoxazole or fluoroquinolones. Against P. aeruginosa, it retains high in vitro activity and should be considered after failure of newer β-lactams, with caution in New Delhi metallo-β-lactamase (NDM)-producing isolates. Continuous infusion and early therapeutic drug monitoring are encouraged to maximize efficacy.Conclusions: Cefiderocol is a valuable therapeutic option for severe NF-GNB infections when conventional agents fail. Its use should be guided by pathogen-specific MICs and PK/PD-based dosing. The expert panel underscores the importance of early microbiological diagnosis, susceptibility testing, and optimized administration to achieve maximal clinical benefit while preserving cefiderocol's role within antimicrobial stewardship
TAAGNet: A graph-based multi-agent reinforcement learning framework for integrated production and AGV scheduling in dynamic hybrid flow shop with uncertain sequencing
No full textInternational audienceThe integrated scheduling of production and transportation in dynamic hybrid flow shops (DHFSP) under sequencing uncertainty is a critical yet challenging NP-hard problem. Traditional methods often fail to provide high-quality solutions in real-time due to the tight coupling between manufacturing and logistics resources, such as Automated Guided Vehicles (AGVs). To address this challenge, this paper proposes Type-aware Attention-based Graph Network (TAAGNet), a novel multi-agent deep reinforcement learning (MARL) framework for the real-time, coordinated scheduling of machines and AGVs. We first model the dynamic workshop state as a unified heterogeneous graph, capturing the complex topological relationships among jobs, machines, and AGVs. Based on this representation, a decoupled multi-agent architecture is designed, comprising a Machine Agent (MA) and an AGV Agent (AA) that learn cooperative policies for production and transportation tasks, respectively. Both agents leverage a shared TAAGNet backbone to effectively extract relational features and inform decision-making. A contribution-based reward mechanism is also designed to facilitate effective collaboration. Extensive experiments demonstrate that TAAGNet significantly outperforms benchmark dispatching rules and achieves a superior balance between solution quality and computational efficiency compared to metaheuristic methods like Genetic Algorithms, highlighting its suitability for complex and dynamic industrial environments
Declining Semen Quality in North Africa: from 2019 to 2024: Retrospective Multicentric Study of 21,585 patients
No full textInternational audienceRecent evidence suggests a global decline in semen quality, raising significant concerns about male reproductive health. Data from North Africa is limited, the region faces unique environmental and lifestyle challenges. Additionally, the COVID-19 pandemic may have caused transient or lasting effects on male fertility. This retrospective study aimed to evaluate changes in semen quality among North African men between 2019 and 2024, in comparison with data from 2013 to 2018, and to assess the potential impact of the COVID-19 pandemic on sperm parameters. A total of 21,585 semen samples from men aged 19 to 74 years, originating from five North African countries (Tunisia, Algeria, Libya), were analyzed. Semen analyses were performed in a Tunisian andrology laboratory in accordance with WHO 5th and 6th edition criteria. Assessed parameters included sperm concentration, motility, morphology, vitality, and DNA integrity. Temporal and regional trends were evaluated and compared to a historical cohort from 2013 to 2018. Sperm concentration and progressive motility showed a marked decline in 2020, coinciding with the first COVID-19 wave (p<0.001). Although a gradual recovery was noted after 2021, the 2024 values remained lower than those of 2019. Sperm morphology exhibited a continuous decline throughout the study period. Libyan men had the highest median sperm concentration, while Algerians had the lowest. Compared to the 2013–2018 cohort, there was a 27.6% decrease in concentration, 20.5% reduction in motility, and a drop in normal morphology from 12.1% to 5%. Semen quality among North African men continued to deteriorate between 2019 and 2024, with a temporary accentuation during the COVID-19 pandemic. These findings underscore the multifactorial nature of male fertility decline in the region and highlight the need for preventive public health strategies. Lay summary Studies show that men’s sperm quality is getting worse around the world, which can affect their ability to have children. There isn’t much information about this in North Africa, a region with special environmental and lifestyle factors. The COVID-19 pandemic might have also influenced men’s fertility. This study looked at sperm samples from men in five North African countries between 2019 and 2024 and compared them to samples from 2013 to 2018. The goal was to see if sperm quality changed and if COVID-19 had any effect. The results showed that in 2020, when COVID-19 first appeared, sperm numbers and how well they moved dropped a lot. After 2021, there was some improvement, but sperm quality was still lower in 2024 than before the pandemic. The shape of sperm got worse steadily over the years. Men from Libya had the best sperm counts, while men from Algeria had the lowest. In short, sperm quality in North African men got worse over the years, especially during COVID-19. This shows that many things may be causing this problem, and it’s important to take steps to protect men’s reproductive health
Addictions : ce qui a changé en 2025
No full textInternational audienceThe field of addiction medicine is rapidly evolving due to shifting drug markets and emerging patterns of use. In Switzerland, the possible arrival of highly potent synthetic opioids highlights the need for interprofessional preparedness, particularly through wider training in naloxone use. At the same time, the rise in recreational ketamine use brings an underestimated urological complication: ketamine-induced cystitis, whose early detection is crucial. Growing digitalisation also fosters compulsive pornography use, where craving plays a key role; new tools such as the PCE-S scale help to better assess these mechanisms. Together, these trends call for strengthened monitoring, prevention, and adaptive clinical strategies.Le champ de l’addictologie évolue rapidement sous l’effet des nouveaux marchés des substances et des changements de consommation. En Suisse, la possible arrivée d’opioïdes de synthèse très puissants souligne la nécessité d’une préparation interprofessionnelle, notamment par la diffusion et l’apprentissage de la naloxone. Parallèlement, l’usage récréatif croissant de kétamine s’accompagne d’une complication urologique encore sous-estimée : la cystite induite par la kétamine, dont la détection précoce est essentielle. Enfin, la digitalisation favorise des usages compulsifs de la pornographie, où le craving joue un rôle central ; de nouveaux outils comme l’échelle PCE-S permettent de mieux évaluer ces mécanismes. Ces évolutions appellent à adapter surveillance, prévention et stratégies cliniques
Photometric Virtual Visual Servoing based on Gaussian Splatting
No full textInternational audienceWe present a novel approach that integrates pho-tometric Image-Based Virtual Visual Servoing (IBVVS) withGaussian Splatting (GS), a recent and efficient 3D representa-tion for photo-realistic view synthesis. In our framework, theservoing process is performed entirely in simulation using aGS model trained on a sparse set of images from a scenewheras unseen images serve as target views for photometricIBVVS. At each iteration a rendered image from the GS modelsimulate the camera’s current view, and the pixel-wise intensityerror between the rendered and target images is used tocompute control commands for camera pose optimization. Thisframework removes the need for externally acquired explicit 3Dgeometry or precomputed dense depth maps from traditionalsensors, since depth information is implicitly obtained from theGS representation and used directly in the control loop. Themethod enables virtual servoing toward novel views that werenot captured during training. Experimental results demonstrateaccurate and smooth convergence, highlighting the potentialof learned view synthesis for 3D camera tracking and visualservoing applications
ROSCAs and household welfare in rural Africa
No full textInternational audienceThis paper investigates how participation in local financial savings groups – specifically, Rotating Savings and Credit Associations (ROSCAs) – supports household livelihoods and well-being, using cross-sectional data from nationally representative WAEMU household surveys. To address potential endogeneity in ROSCA participation, we employ multiple identification strategies, including selection-on-observables, Entropy Balancing, and instrumental variables. The results suggest that ROSCA membership enhances well-being, primarily through increased consumption of food and non-food goods, with stronger effects observed in rural areas. Policy implications include the potential for targeted rural interventions to bridge gaps in financial services and for poverty reduction programs to partner with ROSCAs to deliver accessible, community-based financial tools. Such measures can strengthen household resilience, promote sustainable livelihoods, and foster inclusive economic development across Sub-Saharan Africa
Zero trust architecture for digital, sustainable, and resilient supply chains in the era of Industry 5.0/4.0
No full textInternational audiencePurpose As supply chains become increasingly digitalized and interconnected, they face growing challenges related to cybersecurity, operational resilience and environmental sustainability. These pressures are particularly intense in the automotive industry, where sustainable concerns, high levels of automation and third-party dependencies create a complex and vulnerable operational landscape. In this context, this paper aims to address the integration of zero trust architecture (ZTA) and artificial intelligence (AI) that emerge as a strategic imperative to secure and optimize supply chain systems. Design/methodology/approach This study explores the key factors for deploying ZTA and AI within automotive supply chains. It uses a hybrid methodological approach that combines expert-based evaluation using gray-decision-making trial and evaluation laboratory and interpretive structural modeling. Theoretically grounded within the dynamic capability lens, the study captures the organizational abilities to continuously adapt, integrate and realign digital, operational and strategic resources in response to evolving technological, regulatory and sustainability factors. Findings The findings reveal significant interdependencies among technological, organizational and sustainability-oriented factors, offering a structured framework for guiding ZTA-AI integration in support of Industry 5.0/4.0 objectives. Based on these findings, the authors propose a ZTA-resilient, intelligent and sustainable ecosystems framework that aligns operational resilience, regulatory compliance, secure technological integration and collaborative ecosystem intelligence. Originality/value To the best of the authors’ knowledge, this study is among the first to conceptually and methodologically explore the integration of ZTA in supply chain management. By linking ZTA with AI through dynamic capabilities, it fills a critical gap in the literature on secure, digital and resilient transformation. Furthermore, it offers a strategic roadmap for organizations navigating digital trust and sustainable transformation, contributing new theoretical and managerial insights to the fields of cybersecurity and operations management