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Antibioprophylaxie après rupture des membranes à terme avant travail : étude en population de l’administration par voie orale
No full textInternational audienceTerm prelabor rupture of membranes is one of the most frequent risk factors for early-onset neonatal sepsis (EONS). In 2017, the French Society of Neonatology updated its recommendations for EONS prophylaxis, validating only the intravenous route. Through a retrospective study, we sought to evaluate whether the use of the oral route before labor was associated with an increased incidence of EONS.La rupture des membranes à terme avant travail est un des facteurs de risque les plus fréquents d’infection néonatale bactérienne précoce (INBP). En 2017, la Société française de néonatalogie a mis à jour le champ des recommandations de la prophylaxie des INBP, ne validant que la voie intraveineuse. Une étude rétrospective a cherché à évaluer si l’usage de la voie orale avant travail était associé à une augmentation de l’incidence des INBP
Sedation–Analgesia Management in Neonates with Hypoxic–Ischemic Encephalopathy under Therapeutic Hypothermia: Feedback from a Local Study on 51 Patients
No full textInternational audienceThe objective of this study is to explore real-world practices in managing sedation–analgesia in a population of neonates with hypoxic–ischemic encephalopathy undergoing therapeutic hypothermia. Retrospective data from neonates admitted with hypoxic–ischemic encephalopathy to the neonatal intensive care unit of Lille University Hospital were collected, between December 31, 2018, and July 15, 2022. Drug and dosage of sedation–analgesia during the 96 hours following therapeutic hypothermia initiation were collected. Neonates were divided into four subgroups for principal component analysis, according to neurological examination at discharge: death, severe sequelae, moderate sequelae, no sequelae. Neonates with a favorable outcome were exposed to higher cumulative doses. They were more likely to be exposed to polypharmacy, midazolam, and dexmedetomidine, and increasing doses of these. Daily doses of opioids did not vary significantly. Newborns with acute renal failure had lower cumulative doses. There was no significant difference between newborns with and without hepatic cytolysis. Practice assessments highlight heterogeneity regarding sedation–analgesia, especially within patient groups. Findings indicate that sedation–analgesia is not reassessed as often as it should be to account for specific pharmacokinetic parameters and the physiologic course of recovery
Respiration Can Trigger Cerebrovascular Reactivity: A Novel Method to Quantify Cerebrovascular Resistance Dynamics Using Real-Time Phase-Contrast MRI.
No full textInternational audiencePurpose: To directly quantify respiration-driven cerebrovascular resistance dynamics (CRD) using a gas-free MRI framework based on the internal-to-external artery carotid flow ratio (ratio_Q).Theory and methods: Two independent datasets (n = 10 and n = 17) were used to evaluate repeatability and to compare breathing conditions. Real-time phase-contrast MRI (RT-PC) was performed at the C2-C3 level, and a dedicated in-house software was used to extract the respiratory-frequency components of internal and external carotid artery flow (Q_ICA and Q_ECA). The flow ratio (ratio_Q = Q_ICA/Q_ECA) was derived to attenuate cardiac-driven inflow effects. Its mean value (aver_ratio_Q) reflected baseline cerebrovascular resistance, while its pulsatility index (PI_ratio_Q = amplitude/mean) quantified respiration-driven CRD.Results: In Dataset 1, ratio_Q showed excellent within-session repeatability for its mean value (ICC(3,1) = 0.96) and good repeatability for its pulsatility index (ICC(3,1) = 0.79). In Dataset 2, sustained deep breathing increased mean cerebrovascular resistance, evidenced by a decrease in aver_ratio_Q from 2.5 ± 0.9 to 1.7 ± 0.9. Specifically, aver_Q_ICA decreased by 30% (p < 0.001), whereas aver_Q_ECA showed no significant change (a 5% increase, p = 0.094). Respiration-driven CRD was enhanced during sustained deep breathing, with PI_ratio_Q increasing by ≈69% compared with free breathing (from 13.6 ± 5.0 to 23.0 ± 7.3, p < 0.001).Conclusion: This gas-free RT-PC approach using the ICA-to-ECA flow ratio provides a stable and reproducible index of respiration-driven CRD, enabling isolation of cerebrovascular resistance modulation from cardiac effects and supporting its potential role in the development of faster and more accessible CVR assessment strategies
Respiratory Muscle Activity and Weaning from Mechanical Ventilation after Spinal Trauma: The ACCESSIT Study
No full textInternational audienceRationale Spinal trauma, especially when associated with spinal cord injury (SCI), can impair respiratory muscle function and complicate early weaning from mechanical ventilation (MV). Objectives In patients admitted for spinal trauma requiring MV, to prospectively assess and monitor the coordination, structure, and activity of non-invasively accessible respiratory muscles, in relation to weaning outcomes up to the first weaning attempt. Methods We enrolled adult patients with traumatic spine injury, requiring MV in the Trauma-Neuro intensive care unit (ICU) at St. Micheal’s Hospital in Toronto. Rib cage-abdomen synchrony was assessed with respiratory inductive plethysmography, while respiratory muscle thickness and activity were measured with ultrasound and surface electromyography. Patients not expected to survive the first 48 hours were not included. The relationship between muscle parameters and weaning outcome was assessed through logistic regression and time dependent Cox proportional hazards models. Results We enrolled 30 trauma patients: 67% male, median age 48 (35–64); half had confirmed SCI. Four (13.3%) died in ICU and 18 (60%) were weaned at first attempt, with no difference between SCI and non-SCI. Konno-Mead plots suggested strong association between paradoxical breathing and early weaning failure, with larger total and inspiratory loop area (normalized to tidal volume) in patients who failed weaning (Area Under the Curve = 0.95 [95%CI 0.80–1.00]), regardless of the SCI status. Paradoxical inward rib cage movement was observed in 70% of failure patients vs. 27% in success, P = .05). Failure patients had progressive reduced internal oblique thickness (4.0 ± 0.7 vs 5.2 ± 1.3 mm, P = .03) and increased parasternal intercostal thickness (3.2 ± 1.2 vs 2.3 ± 0.6 mm, P = .07), both being associated with probability of early weaning failure (OR = 0.88 and OR = 1.16, respectively). Conclusions Paradoxical breathing, inward thoracic inspiratory motion and changes in respiratory muscle thickness characterize early weaning failure after spinal trauma, independently of SCI presence. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT05207046. Primary Source of Funding St. Michael’s Hospital Medical Services Association (2022-23 Innovation Funds)
Ferroelectric nanodot reservoir for neuromorphic computing
No full textInternational audienceWe present a ferroelectric-based data reservoir designed for neuromorphic computing applications. The reservoir consists of an ensemble of nonlinear ferroelectric nanodots capable of storing information through their stable polarization states. These nanodots are confined between electrodes and form a network of parallel connected capacitive elements, which can either be addressed individually or integrated between common conducting plates. By leveraging the intrinsic nonlinearity and memory of ferroelectric polarization switching, the device maps incoming signals into a high-dimensional space of polarization configurations. This physical transformation enables efficient temporal information encoding and provides a rich dynamic representation for subsequent processing in a readout layer of a neuromorphic circuit
P0373 Factors Associated with a Complicated Behavior or Diagnostic Delay in Crohn’s Disease: A Prospective Multicenter French and Belgian Cohort of Newly Diagnosed Patients
No full textInternational audienceBackground Despite diagnostic advances, one-third of Crohn’s disease (CD) patients still present with complicated behavior at diagnosis. Delayed diagnosis, often related to nonspecific symptoms or socio-demographic factors, may contribute to this 1. We aimed to identify factors linked to delayed diagnosis or complicated CD. Methods We conducted a prospective multicenter observational study in France and Belgium (April 2024 - December 2025) including consecutive CD patients (≥18 years) diagnosed within the last 12 months. Patients and gastroenterologists completed questionnaires on clinical, socio-demographic, socio-economic deprivation assessed by the EPICES score (French individual index of deprivation), and healthcare pathway data. Late diagnosis was defined as > 12 months from symptom onset. Univariate analyses compared inflammatory (B1) vs complicated (Stricturing = B2/ Fistulizing = B3) behavior and delayed (>12 months) vs timely (<12 months) diagnosis. Multivariate analyses will follow. Results Across 61 centers, 743 patients were enrolled. We present findings from the first 316 included. Forty-nine percent were female; median age was 30 years [23–43]. Disease location was ileal (48%), colonic (18%), or ileocolonic (34%). At diagnosis, 63% had B1 and 37% B2/B3 behavior; 24% had a delayed diagnosis. Complicated CD was more frequent in male patients (61% vs 46%;p = 0.010), in case of ileal location (58% vs 42%; p = 0.010) and hospitalization at diagnosis (71% vs 44%;p<0.001). B1 behavior was more common in female patients (54% vs 39%; p = 0,010), patients having children (46% vs 33%;p = 0.033), family history of IBD (27% vs 16%; p = 0.037), and was associated with misdiagnosis (44% vs 32%;p = 0.,030), ≥3 General Practitioners (GP) consultations prior to diagnosis (45% vs 24%;p<0.,001), diarrhea (42% vs 12%;p<0.001) and presence of at least one red flag (nocturnal diarrhea, prolonged diarrhea, rectal bleeding, or weight loss) (93% vs 74%; p < 0.001). Diagnostic delay was associated with ≥3 GP consults (59% vs 31%;p<0.001), misdiagnosis (64% vs 32%;p<0.001), >4-week wait for gastroenterologist visit (58% vs 35%; p < 0.001), and use of complementary medicine (38% vs 21%;p<0.007). No association was found with gender, age, red flags, EPICES score and disease location or behavior. Conclusion In this large cohort of CD patients, B1 forms seemed to be initially misdiagnosed for irritable bowel syndrome-diarrhea, leading to a prolonged diagnostic journey before gastroenterology referral, whereas complicated forms (B2/B3) may have evolved silently before presenting with abrupt and severe manifestations prompting immediate evaluation. Diagnostic delays were mainly driven by factors related to the healthcare pathway rather than by deprivation or disease behavior. Reference: 1. Souaid C, Fares E, Primard P, Macaigne G, El Hajj W, Nahon S. A review investigating delays in Crohn’s disease diagnosis. Clin Res Hepatol Gastroenterol. 2025;49(1):102500. doi:10.1016/j.clinre.2024.102500 Conflict of interest: Dr. Souaid, Christophe: No conflict of interest Flamant, Mathurin: No conflict of interest Bozon, Anne: No conflict of interest Nancey, Stéphane: board membership and lecturing fees from Abbvie, Takeda, Celltrion Healthcare, Pfizer, Galapagos, Johnson & Jonshon, Lilly, Fresenius, Amgen, Medac, MSD. Caron, Bénédicte: No conflict of interest Blanc, Pierre: No conflict of interest Buisson, Anthony: Grant: Abbvie, Celltrion, Pfizer and Takeda Personal Fees: Abbvie, Amgen, Arena, Biogen, Celltrion, Ferring, Janssen, MSD, Pfizer, Roche, Sanofi-Aventis, Takeda, Tillotts, Vifor Pharma, Richard, Nicolas: Lecture/consultant fees from AbbVie, Amgen, Celltrion, Ferring, Janssen, Lilly, Sandoz and Takeda. Barrau, Mathilde: No conflict of interest Faure, Patrick: No conflict of interest Nachury, Maria: Abbvie, Alfa Sigma, Biosynex, Celltrion, Galapagos, Janssen, Lilly, MSD, Pfizer, Takeda Allez, Matthieu: Grant: Janssen, Genentech/Roche, Takeda Personal Fees: Abbvie, Amgen, Astra-Zeneca, Biogen, Boehringer-Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Ferring, Galapagos, Genentech, Gilead, IQVIA, Janssen, Novartis, Pfizer, Spyre therapeutics, Roche, Takeda, Tillots 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 Mathieu, Nicolas: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Abbvie, Alfa sigma,Biosynex, Celltrion, Janssen, Lilly, Pfizer, Takeda: Speakers fees payments Support for attending meetings and/or travel: Abbvie, Celltrion, Janssen, Lilly, Pfizer, Takeda Participation on a Data Safety Monitoring Board or Advisory Board: Abbvie, Alfa sigma, Celltrion, Janssen, Lilly, Medtronic, Pfizer, Takeda Clairet, Valentine: No conflict of interest Charkaoui, Maeva: No conflict of interest Caillo, Ludovic: Abbvie, Amgen, Celltrion, Ferring, Fresenius, Lilly, Jonhson&Jonhson, MSD, Pfizer, Takeda, Sandoz Laharie, David: Personal Fees: Board, consulting and lecture fees from Abbvie, Alfasigma, Amgen, Biocon, Celltrion, Ferring, Fresenius-Kabi, Johnson & Johnson, Lilly, MSD, Pfizer, Sandoz and Takeda Uzzan, Mathieu: Grant: ECCO-IOIBD, Fondation pour la Recherche Medicale (FRM), SNFGE Personal Fees: Abbvie, Takeda, Celltrion, Janssen, Amgen, Alfasigma, Pfizer Etienney, Isabelle: takeda Locher, Christophe: No conflict of interest Guillo, Lucas: No conflict of interest Reenaers, Catherine: Grant: Ferring, Janssen, Takeda, Fresenius, Biogen Personal Fees: Ferring, Janssen, Takeda, Fresenius, Abbvie, Galapagos, Pfizer, Celltrion, Thermofisher, BMS, Lilly, Thermofisher Nuzzo, Alexandre: No conflict of interest Vidon, Mathias: No conflict of interest Gouynou, Célia: No conflict of interest Kirchgesner, Julien: Lecture fees and/or consulting fees from from Abbvie, Amgen, Astrazeneca, Celltrion, Galapagos, Janssen, Lilly, MSD, Takeda, Tillots, Pfizer. Viennot, Stéphanie: No conflict of interest Pelletier, Anne-Laure: received lecture/consultant fees from Janssen,Pfizer and Novartis Liefferinckx, Claire: Consultancy/speaker fees: Takeda, Janssen, Abbvie, Alfasigma, Celltrion Le Gall, Guillaume: No conflict of interest Paupard, Thierry: No conflict of interest Cavicchi, Maryan Nicolas: M.C.: Consultant for JOHNSON & JOHNSON, ABBVIE, TAKEDA and MSD Honoraria for lectures, presentations, speakers for MSD, LILLY, ABBVIE, AMGEN, TAKEDA, PFIZER, MYLAN and TILLOTS Support for attending meetings from JOHNSON & JOHNSON, ABBVIE, FERRING, TAKEDA and MSD Board for JOHNSON & JOHNSON, ABBVIE, PFIZER and LILLY Receipt of equipment and materials from CELTRION and BIOSYNEX Fathallah, Nadia: Grant: A. Legrand AbbVie Amgen Biolitec Brothier FCare Systems Janssen Sandoz Takeda THD Lab Tillotts Pharma Favier, Laurie: No conflict of interest Skinazi, Florence: No conflict of interest Le Berre, Catherine: Abbvie, Amgen, Celltrion, Ferring, Fresenius Kabi, Galapagos, Gielad, Janssen, Lilly, MSD, Nordic Pharma, Pfizer, Sandoz, Takeda. Del Tedesco, Emilie: Abbvie, Sanofi, Ferring, Pfizer, Janssen, Takeda, Mylan, Viatris, Norgine, Lilly, Biogen, Mayoly,Gilead, Amgen et Celltrion Renaud, Laurence: No conflict of interest Nahon, Stéphane: No conflict of interes
P0955 Efficacy of Anti-TNF Agents for the Treatment of Anoperineal Fistulas Without Luminal Crohn’s Disease: A Multicenter Cohort Study
No full textInternational audienceBackground Isolated perianal Crohn’s Disease (CD) represent a diagnostic and therapeutic challenge. Evidence on the efficacy of anti-TNF agents in this context remains limited (1). The aim of this study was to evaluate the long-term effectiveness of anti-TNF among patients with perianal fistula without luminal CD. Methods All consecutive patients (i) with recurrent perianal fistulas, (ii) without evidence of luminal CD after upper endoscopy and ileocolonoscopy, and (iii) treated with anti-TNF (infliximab or adalimumab) in 10 French centers between January 2006 and December 2024 were included in this retrospective cohort. The TOPCLASS classification was used to characterize the type of perianal involvement (1). Clinical remission (disappearance of discharge and fistula openings), clinical response (decrease in fistula discharge according to the clinician), and MRI response/remission were evaluated. Discontinuation of anti-TNF therapy for reasons other than clinical remission, the need of antibiotic therapy, or for further anoperineal surgery were considered treatment failures. Results Sixty-five patients were included (median age 37 years [IQR]: 28-44), 37 (57%) men and 20 (33%) active smokers). All had undergone at least one perianal surgery prior to anti-TNF treatment (median number of procedures: 3 [2-4]). Almost all fistula tracts were complex (97%). According to the TOPCLASS consensus criteria (1), 26 patients (39%) met the definition of isolated anal CD. The median follow-up was 28 months [12-60] and the median duration of exposure to anti-TNF agent was 19 [12-36] months. At 12 and 36 months, clinical response was achieved in 32/63 (51%) and 10/35 (29%) patients, respectively, while clinical remission was achieved in 16/63 (25%) and 7/34 (21%) patients (Figure 1). At 12 months, MRI response was observed in 29/55 (52,3%) patients and remission in 6/55 (11%) patients. At 36 months, MRI response rate was 7/21 (21%) and the remission rate was 1/21 (5%). In univariate analysis, transsphincteric tracts and rectovaginal fistulae were the only caracteristics associated with clinical remission at 12 months (respective odds radios : 3.6 (1.1 – 11.8); p = 0.03 and 11.5 (1.5-151.2); p = 0.04). During follow-up, 21 of the 53 patients who had a seton in place at baseline (83% of the cohort, 53/65) underwent seton removal (39.3%). In addition, luminal CD were diagnosed in 10 patients (15%), including 4 who had met the TOPCLASS criteria for isolated anal CD at induction. Conclusion In this cohort of patients with anoperineal fistulas and no evidence of luminal CD, anti-TNF treatment resulted in clinical remission in a quarter of patients within one year. Over a median follow-up of two years, one-sixth of patient were diagnosed with luminal CD. Reference: 1. Hanna LN, Munster LJ, Joshi S, Wendelien van der Bilt JD, Buskens CJ, Hart A, et al. Isolated perianal Crohn’s disease: a systematic review and expert consensus proposing novel diagnostic criteria and management advice. Lancet Gastroenterol Hepatol. 2025;10(8):75768. Conflict of interest: Idrissi, Abla: No conflict of interest Fathallah, Nadia: Grant: A. Legrand AbbVie Amgen Biolitec Brothier FCare Systems Janssen Sandoz Takeda THD Lab Tillotts Pharma Altwegg, Romain: Advisory boards from Abbvie, Takeda, Johnson and Johnson, Lilly, Alphasigma, Celltrion, Pfizer, Amgen, Biogen, Sandoz, Ferring Savoye, Guillaume: No conflict of interest De Parades, Vincent: - Clinical research: Brothier, Sandoz, Takeda - Advisory boards: Abbvie - Courses, training, conferences: Abbvie, Amgen, Biolitec, FCare Systems, Janssen, Takeda, THD lab, Tillots Nachury, Maria: Abbvie, Alfa Sigma, Biosynex, Celltrion, Galapagos, Janssen, Lilly, MSD, Pfizer, Takeda Amiot, Aurelien: Personal Fees: Abbvie, Fresenius-Kabi, Adacyte, Tillotts pharma, Janssen, Pfizer, Biogen, AMgen, Sandoz, Takeda, Galapagos, Eli Lilly Abramowitz, Laurent: No conflict of interest Caillo, Ludovic: Abbvie, Amgen, Celltrion, Ferring, Fresenius, Lilly, Jonhson&Jonhson, MSD, Pfizer, Takeda, Sandoz Rouillon, Clea: Abbvie\Takeda\Galapagos\Biogen\Amgen\Lilly Laharie, David: Personal Fees: Board, consulting and lecture fees from Abbvie, Alfasigma, Amgen, Biocon, Celltrion, Ferring, Fresenius-Kabi, Johnson & Johnson, Lilly, MSD, Pfizer, Sandoz and Takeda 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 Dr. Richard, Nicolas: Lecture/consultant fees from AbbVie, Amgen, Celltrion, Ferring, Janssen, Lilly, Sandoz and Takeda
Science sans conscience n’est que pauvre justice - Limites actuelles et essentielles des algorithmes de résolution des différends
No full textInternational audienceThe emergence of artificial intelligence in arbitration law raises questions about its scope. Economic operators are already resolving disputes (professional-client relationships) using AI. This article, written in 2021, analyses the limits of the use of AI in arbitration, both intrinsic limits to the act of judging and normative limits in French law.L'irruption de l'intelligence artificielle dans le droit de l'arbitrage pose la question de sa portée. Déjà, des opérateurs économiques résolvent des litiges (rapport professionnel-client) par le biais de l'IA. Cet article, rédigé en 2021, analyse les limites de l'usage de l'IA en arbitrage, limites intrinsèques pour l'acte de juger, limites normatives dans la loi française
An O(D)-Round Snap-stabilizing Termination Detection in Arbitrary Rooted Networks
No full textIn this paper, we investigate the question of (asymptotic) time optimality for snap-stabilizing wave algorithms. Snap-stabilization is a refinement of self-stabilization guaranteeing that after a period of transient faults, any system achieving it immediately resumes a correct behavior. We consider here the atomic-state model under the distributed weakly fair daemon in the context of rooted connected networks. In these settings, we propose to augment a silent BFS spanning tree construction with efficient snap-stabilizing termination detection. This approach yields an asynchronous snap-stabilizing wave algorithm that both constructs a BFS spanning tree and detects the termination of its construction in O(D) rounds and using O(log ∆ + log D) bits per process, where ∆ is the maximum degree of the network and D is any upper bound on D. As a result, and to the best of our knowledge, we obtain the first asynchronous asymptotically round-optimal snap-stabilizing wave algorithm of the literature. We then generalize our approach to augment any silent algorithm with snap-stabilizing termination detection. This leads to a snap-stabilizing wave algorithm that both executes the silent task and detects its termination in O(F + D) rounds, where F is the stabilization time of the input silent algorithm; thereby incurring an asymptotically optimal additive overhead of O(D) rounds. The memory overhead also remains low, namely O(log ∆ + log D) additional bits per process
