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A New Superimposition Method Usable for Comparing the Shape of Several Maps
No full textInternational audienceBidimensional regression was developed by Waldo Tobler since the 1960s to evaluate the resemblance between two plans. This is the most used way in geography to highlight differences in shape between maps. However, bidimensional regression can only compare the shape of two background maps simultaneously. This article presents two ways of generalizing bidimensional regression in order to be able to compare more than two geographic maps using a geometric morphometric approach. For this purpose, we took inspiration from the generalization of the ordinary Procrustes algorithm. An example shows that the generalized bidimensional regression makes it possible to compare the shape, and therefore the structure of several cognitive maps thanks to the creation of a morphospace. More precisely, it makes it possible to produce a typology of maps based on their shape on the one hand, and to identify the main variations in shape of all the maps analyzed on the other
L’effet du cercle social sur les processus de la mémoire épisodique au cours du vieillissement
No full textInternational audienc
Endogenous endophthalmitis complicating infective endocarditis: a multicenter case series
No full textInternational audienceIntroduction Endogenous endophthalmitis (EE) is a rarely reported complication of infective endocarditis (IE). In an international series, we sought to determine the clinical and microbiological profile, treatment and outcome of patients presenting with IE-related EE. Methods Cases of EE recorded from 2014 to 2023 in 9 centers in Europe and the United States were collected. Results were compared to a matched control group. Results Sixty-six patients with EE were reported, mean age 65.2± 14.9 years, 71% (n=47) male. Blood cultures were positive in 90% (60 cases) of patients, with a predominance of streptococci (46%, n=30). As compared with the control group (n=264), the EE group presented with more frequent diabetes (34vs 20%, p=0.02), history of cirrhosis (9 vs 3%, p=0.04), glomerulonephritis (15 vs 0.3%, p<0.001), embolism before admission (92 vs 55%, p<0.001), and Janeway lesions (9 vs 1%, p=0.002). Streptococcal infection (46 vs 26%, p= 0.003) was more frequent and enterococcal infection (0 vs 18%, p< 0.001) less frequent in the EE group. The main ocular symptoms were a decrease in visual acuity (96%), red eye (55%) and ocular pain (55%). Treatment of EE consisted of intravitreal antibiotic injection in 55 (83%) patients and vitrectomy in 17 (26%). Improvement of visual acuity was observed in 36 (55%) patients but 43 (65%) still experienced severe impairment at one-year with 20 (30%) patients classified as legally blind. Conclusion EE is a serious complication of IE with severe residual vision impairment. Patients with IE should be evaluated for ocular complications, since early detection of EE is crucial to prevent delays in management and to preserve visual function.Severe endogenous endophthalmitis Endophthalmitis versus control grou
Les variations hémodynamiques d'un tilt test peuvent-elles prédire une réponse à l'expansion volémique chez les patients en réanimation ?
No full textObjective : To assess whether hemodynamic variations induced by a 30° tilt test can predict fluid responsiveness (≥10% increase in cardiac output) in critically ill patients. Methods : This prospective, observational, multicenter study was conducted in two ICUs (Amiens University Hospital and Beauvais Hospital) and included 30 patients. All had hypotension or signs of hypoperfusion requiring fluid resuscitation. Each patient underwent baseline clinical, biological, and echocardiographic assessment, followed by a passive leg raising maneuver, a 30° tilt test, and a standardized 500 mL fluid challenge. Hemodynamic and echocardiographic parameters (aortic velocity-time integral, stroke volume, cardiac output, inferior vena cava maximal diameter, collapsibility and distensibility) were measured at each step. Results: Thirty patients were included (mean age 67 ± 14 years; 50% male). Thirteen patients (43%) were fluid responders. At baseline, no significant differences were observed. In spontaneously breathing patients, heart rate variation during the tilt test significantly correlated with cardiac output increase after fluid expansion (r = 0.73; p = 0.001). A ≥4% increase in heart rate during the tilt test predicted fluid responsiveness with 80% sensitivity and 71% specificity. Conclusion : In spontaneously breathing ICU patients, the 30° tilt test may represent a simple, non-invasive, and reproducible tool to predict fluid responsiveness.Objectif : Évaluer si les variations hémodynamiques induites par un tilt test à 30° permettent de prédire la réponse à l’expansion volémique (augmentation ≥ 10 % du débit cardiaque) chez des patients hospitalisés en réanimation. Méthodes : Étude prospective, observationnelle, multicentrique, menée au CHU Amiens et au CH Beauvais, incluant 30 patients en réanimation. Tous présentaient une hypotension ou des signes d’hypoperfusion justifiant un remplissage vasculaire. Chaque patient a bénéficié d’une analyse clinique, biologique et échocardiographique à l’état basal, d’un lever de jambes passif, d’un tilt test à 30°, puis d’un remplissage standardisé par 500 mL de soluté. Les paramètres hémodynamiques et échocardiographiques (intégrale temps-vitesse aortique, volume d’éjection systolique, débit cardiaque, étude du diamètre maximale, de la collapsibilité, distensibilité de la veine cave inférieure) ont été mesurés à chaque étape. Résultats : Trente patients ont été inclus (âge moyen 67 ± 14 ans ; 50 % d’hommes). Treize patients (43 %) étaient répondeurs au remplissage. À l’état basal, aucune différence significative n’a été observée. En ventilation spontanée, la variation de la fréquence cardiaque lors du tilt test était significativement corrélée à la variation du débit cardiaque après remplissage (r = 0,73 ; p = 0,001). Une augmentation ≥ 4 % de la fréquence cardiaque lors du tilt test prédisait une réponse favorable au remplissage avec une sensibilité de 80 % et une spécificité de 71 %. Conclusion : Chez les patients en ventilation spontanée, le tilt test à 30° apparaît comme un outil simple, non invasif et reproductible pour prédire la réponse au remplissage vasculaire en réanimation
Évaluation de l'impact des stages de découverte en médecine et santé au travail sur les représentations des internes de médecine générale de premier semestre en Picardie
No full textIntroduction: Occupational medicine is often subject to numerous prejudices (perceived as overly administrative, disconnected from patient care, etc.), yet this discipline is essential because it plays a key role in preventing occupational risks and supporting job retention. This study aimed to assess the impact of a work placement in occupational medicine on the prejudices of general practice interns enrolled in the first semester of 2023–2024. Materials and Methods: This comparative observational study was conducted using questionnaires administered before and after the placement to 46 interns, in order to evaluate their preconceptions, their knowledge of the specialty, the perceived usefulness of the placement, and their potential interest in retraining in this field. Results: 10% of the interns had a positive view of occupational medicine before the placement, compared with more than 50% afterward. Around 75% of the interns considered the placement useful for their future professional practice (compared with around 95% before). The perception of the relationship between general practitioners and occupational physicians remained unchanged after the placement. No difference was observed between interns considering a career change (15.2%) and the others, except that the former believed they had been better trained in occupational medicine during their studies and placed less importance on collaboration between the two disciplines. Conclusion: These results suggest that this placement is a relevant tool for combating prejudices and that its integration into the general practice curriculum helps to promote occupational health while providing concrete field experience.Introduction : la médecine du travail est victime de nombreux préjugés (perçue comme trop administrative, déconnectée du soin…) pourtant cette discipline est essentielle en jouant un rôle dans la prévention des risques professionnels et le maintien en emploi. Cette étude a été menée afin d’évaluer l’impact d’un stage de découverte en médecine du travail sur les préjugés des internes de médecine générale inscrits en 1er semestre 2023–2024. Matériel et méthode : cette étude observationnelle comparative a été réalisée via des questionnaires diffusés, avant et après le stage, auprès de 46 internes afin d’évaluer les préjugés, la connaissance de la spécialité, l’utilité perçue du stage, ainsi que l’intérêt potentiel pour une reconversion. Résultats: 10% des internes avaient une bonne image de la médecine du travail avant le stage, contre plus de 50% après. Environ 75% des internes ont estimé que ce stage était utile pour leur futur professionnel (contre environ 95% avant). La perception de la relation entre médecins généralistes et médecins du travail est demeurée inchangée au terme du stage. Aucune différence n’a été observée entre les internes envisageant une reconversion (15,2%) et les autres hormis que ces premiers considéraient avoir été mieux formés à la médecine du travail durant leurs études et accordaient moins d’importance à la collaboration entre les deux disciplines. Conclusion : Ces résultats montrent que ce stage constitue un outil pertinent pour lutter contre les préjugés et que son intégration dans la maquette de médecine générale contribue à valoriser la santé au travail tout en permettant une expérience concrète du terrain
En quoi l’apport de René Laennec a-t-il contribué à faire évoluer la pratique médicale au XIXe siècle vers une forme plus proche de la médecine moderne ?
No full textSUMMARY : In the eighteenth century, medicine remained bound by ancient doctrines lacking scientific foundations. Diagnosis relied primarily on questioning and observation, while treatments were of uncertain efficacy. The absence of reliable tools and an overly theoretical training hindered progress. The Enlightenment movement and pioneers such as Morgagni initiated a decisive shift by establishing the anatomo-clinical method, based on the systematic correlation between semiology and anatomical lesions identified at autopsy. In this context, René Laennec made a decisive contribution. Through a historical analysis, this thesis demonstrates how Laennec transformed nineteenth-century medicine with the invention of the stethoscope in 1816, paving the way for a more scientific practice. It retraces his biography, his research in pathological anatomy, and the circumstances surrounding this innovation. His seminal work De l’auscultation médiate is examined as an unprecedented codification of a method linking sounds to anatomical lesions. Although mediate auscultation initially faced ideological and practical resistance, its dissemination was ensured through hospital teaching, medical publications, and international translations. Its gradual integration into medical education, together with the technical evolution of the stethoscope, consolidated its worldwide adoption. Beyond the instrument itself, Laennec’s legacy lies in the enduring establishment of the anatomo-clinical method and bedside teaching. Even today, the stethoscope remains a universal symbol, combining scientific rigor with human proximity, and stands as testimony to the way in which Laennec truly revolutionized medicine.RÉSUMÉ : Au XVIIIe siècle, la médecine reste prisonnière de doctrines antiques sans base scientifique. Le diagnostic repose sur l’interrogatoire et l’observation, tandis que les traitements demeurent d’efficacité incertaine. L’absence d’outils fiables et une formation trop théorique freinent les progrès. Le mouvement des Lumières et des pionniers comme Morgagni initient alors une rupture en instaurant la méthode anatomo-clinique, fondée sur la corrélation entre la sémiologie et lésions anatomiques identifiées à l’autopsie. Dans ce contexte, René Laennec apporte une contribution décisive. À travers une analyse historique, cette thèse montre comment Laennec transforme la médecine du XIXe siècle par l’invention du stéthoscope en 1816, ouvrant la voie à une pratique scientifique. Elle retrace sa biographie, ses recherches en anatomopathologie et les circonstances de cette innovation. L’ouvrage fondateur De l’auscultation médiate est analysé comme une codification inédite d’une méthode reliant les sons aux lésions anatomiques. Bien que l’auscultation médiate rencontre initialement des résistances idéologiques et pratiques, sa diffusion s’impose grâce à l’enseignement hospitalier, aux publications médicales et aux traductions internationales. Son intégration progressive dans la formation, ainsi que l’évolution technique du stéthoscope, consolident son adoption mondiale. Au-delà de l’instrument, l’héritage de Laennec réside dans l’ancrage durable de la méthode anatomo-clinique et de l’enseignement au chevet du malade. Aujourd’hui encore, le stéthoscope demeure un symbole universel, alliant rigueur scientifique et proximité humaine, et témoigne de la manière dont Laennec a véritablement bouleversé la médecine
Isolated and Combined Effects of Cold, Heat and Hypoxia Therapies on Muscle Recovery Following Exercise-Induced Muscle Damage
No full textInternational audienceThe optimisation of muscle recovery from exercise-induced muscle damage (EIMD) is a major issue in sports medicine. This comprehensive review examines the effects of four environmental stressors, including cold (cold therapy), heat (heat therapy), hot–cold alternation (contrast therapy) and reduced oxygen availability (hypoxia therapy), on muscle recovery following EIMD. The analysis of related randomised controlled trials assessed the influences of these stressors on five markers of recovery (muscular performance, joint amplitude, muscle pain, swelling and blood biomarkers). Although cold therapy has been widely studied, the lack of consensus on its application modalities leads to controversial debates regarding its effectiveness for muscle recovery. Heat therapy, particularly hot water immersion, appears to be the most effective method for restoring muscle function. However, the use of local heating techniques is less well understood. Moreover, contrast therapy seems to be promising for reducing swelling post-EIMD; however, the lack of studies and the variety of utilised techniques involving contrast therapy limit conclusions. Finally, local hypoxia, which is elicited by intermittent blood flow restriction, demonstrates potential for reducing inflammation and improving the recovery of muscle function, based on the appropriate application of protocols. By synthesising existing data, this comprehensive review shows that most environmental stress-based therapies can be effective, if the modalities of application—such as dose or frequency—are appropriate. It offers practical recommendations for optimising muscle recovery. This review also highlights the need for further research to refine protocols and better understand the potential synergistic effects of these environmental stress-based interventions
Avis émis en ligne par les usagers de soins au sujet des médecins généralistes : quels impacts sur le choix des patients
No full textIntroduction : In the digital age, patients are becoming active players in their care pathways. In this context, online reviews of GPs are attracting growing interest, to guide the choice of practitioner. However, the place of online reviews in the decision-making process remains unclear. Method : Qualitative study using grounded theory and purposive sampling. Semi-structured interviews were conducted with 15 patients in the former Picardie region who had already consulted online reviews of general practitioners. Results : The influence of online reviews is ambivalent: they play a part in the choice of doctor, but are not the only decision-making criterion. Patients see them as just one tool among others, with recommendations from family and friends still playing an important role. Although they are considered useful, their reliability is questioned, as is their suitability for the medical world, with fears of a dehumanization of care. They can have an impact on the doctor-patient relationship. Expectations vary according to patient profile, but the relational dimension remains paramount. In the current context of medical shortages, the availability of the practitioner becomes a decisive criterion in the choice. Conclusion : Online reviews are becoming an increasingly popular decision-support tool, especially if the range of medical services on offer improves, enabling patients to choose more freely. Their relevance could be enhanced by better regulation.Introduction : à l’ère du numérique, les patients deviennent des acteurs de leur parcours de soins. Dans ce contexte, les avis en ligne sur les médecins généralistes suscitent un intérêt croissant, pour guider leur choix de praticien. Cependant, la place des avis en ligne dans le processus décisionnel reste encore mal définie. Méthode : étude qualitative menée par théorisation ancrée avec échantillonnage raisonné. Il a été réalisé des entretiens semi-dirigés auprès de 15 patients de l’ex-région Picardie ayant déjà consulté des avis en ligne concernant des médecins généralistes. Résultats : les avis en ligne exercent une influence ambivalente : ils participent au choix du médecin, mais ne constituent pas le seul critère décisionnel. Les patients les considèrent comme un outil parmi d’autres, les recommandations de proches conservant une place importante. S’ils les jugent utiles, leur fiabilité est remise en doute, tout comme leur adéquation au monde médical, redoutant une forme de déshumanisation du soin : ils peuvent avoir un impact sur la relation médecin-patient. Les attentes varient selon le profil des patients, mais la dimension relationnelle reste primordiale. Dans le contexte actuel de pénurie médicale, la disponibilité du praticien devient un critère déterminant dans le choix. Conclusion : les avis en ligne sont perçus par les patients comme un outil d’aide à la décision, d’autant plus utilisables, que l’offre médicale s’étoffera. Ils estiment qu’une meilleure régulation renforcerait leur pertinence, ce qui les rendrait plus exploitables
The phosphatase activity of soluble epoxide hydrolase regulates vascular calcification through the metabolism of pyrophosphate anions
No full textInternational audienceWhile the hydrolase activity of soluble epoxide hydrolase (sEH) reduces vascular calcification, it is not known whether the phosphatase activity of sEH (sEH-P) is also involved. Pharmacological and genetic inhibition of sEH-P reduced the increased calcium deposition in rat aortic rings cultured under high-phosphate conditions. This was associated with decreased mRNA expression of the osteochondrogenic markers Msx2 and Sox9 . Deendothelialization of the aortic rings abolished this anticalcifying effect, while the calcification of human aortic smooth muscle cells was unaffected by sEH-P inhibition, suggesting a predominant role of the endothelium. Endothelial NO release did not appear to contribute, but an increased level of the calcification inhibitor pyrophosphate anions (PPi) was observed in the culture supernatant of aortic rings when sEH-P was inhibited. In vitro experiments demonstrated that PPi is a substrate of sEH-P, and that inhibiting sEH-P prevented the high-phosphate induced decrease of PPi in human aortic endothelial cells. Furthermore, the aortic calcification related to chronic kidney disease induced by subtotal nephrectomy was reduced in sEH-P-deficient rats compared to wild-type rats. This was associated with an improvement in flow-induced isolated mesenteric artery dilatation and a reduction of cardiac hypertrophy and fibrosis. Vascular calcification is regulated by sEH-P through the metabolism of endothelial PPi. The prevention of vascular calcification, together with the reduction in vascular dysfunction and cardiac remodeling, suggests that inhibiting sEH-P may help to prevent the cardiovascular complications associated with chronic kidney disease
Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in mechanically ventilated patients with low tidal volume in ICU: a systematic review and meta-analysis
No full textInternational audienceBackground: Pulse pressure variation (PPV) is limited in low tidal volume mechanical ventilation. We conducted this systematic review and meta-analysis to evaluate whether passive leg raising (PLR)-induced changes in PPV can reliably predict preload/fluid responsiveness in mechanically ventilated patients with low tidal volume in the intensive care unit.Methods: PubMed, Embase, and Cochrane databases were screened for diagnostic research relevant to the predictability of PPV change after PLR in low-tidal volume mechanically ventilated patients. The QUADAS-2 scale was used to assess the risk of bias of the included studies. In-between study heterogeneity was assessed through the I2 indicator. Publication bias was assessed by the Deeks' funnel plot asymmetry test. Summary receiving operating characteristic curve (SROC), pooled sensitivity, and specificity were calculated.Results: Five studies with a total of 474 patients were included in this meta-analysis. The SROC of the absolute PPV change resulted in an area under the curve of 0.91 (95% CI 0.88-0.93), with overall pooled sensitivity and specificity of 0.88 (95% CI 0.82-0.91) and 0.83 (95% CI 0.76-0.89), respectively. The diagnostic odds ratio was 35 (95% CI 19-67). The mean and median cutoff values of PLR-induced absolute change in absolute PPV were both -2 points and ranged from -2.5 to -1 points. Overall, there was no significant heterogeneity with I2 = 0%. There was no significant publication bias. Fagan's nomogram showed that with a pre-test probability of 50%, the post-test probability reached 84% and 17% for the positive and negative tests, respectively.Conclusions: PLR-induced change in absolute PPV has good diagnostic performance in predicting preload/fluid responsiveness in ICU patients on mechanical ventilation with low tidal volume