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Attentes des internes de médecine générale en première année à Amiens, concernant la 4ème année d'internat pour la promotion 2023-2024
No full textIntroduction : The fourth year of general medicine residency, designed to enhance outpatient experience and encourage territorial anchoring, raises concerns among residents. This study examines their expectations regarding this reform. Method : A qualitative study was conducted with first-year general medicine residents in Amiens. Interviews were analyzed using the N'Vivo® software following a thematic analysis approach. Results : Residents perceive the additional year in a private practice as an opportunity to progressively develop autonomy and ensure continuous patient follow-up. However, they express concerns about the availability and pedagogical engagement of their supervising doctor. Practical training on financial management and practice administration is deemed a priority. The mixed compensation model is divisive because some see it as a financial improvement, while others fear rigid income caps and a lack of professional recognition. Discussion : Recent proposals, such as voluntary participation in outpatient emergency services and a daily cap of 25 consultations, address some initial concerns. However, the effectiveness of these measures will depend on clear regulatory guidelines and the involvement of supervising physicians. The actual impact of this fourth year on private practice establishment remains to be assessed. Conclusion : Residents interviewed consider the fourth year an opportunity for professionalization, provided that supervision is clearly defined and practical training is reinforced. Their acceptance of the reform will depend on its ability to balance educational objectives with adequate recognition of their status.Introduction : la quatrième année d'internat de médecine générale, visant à renforcer l'expérience ambulatoire et encourager l'ancrage territorial, soulève des interrogations chez les internes. Nous avons étudié leurs attentes concernant cette réforme. Méthode : une étude qualitative a été menée auprès d'internes de première année à Amiens. Les entretiens ont été traités via le logiciel N'Vivo® selon la méthode d'analyse thématique. Résultats : les internes perçoivent l'ajout d'un an en cabinet comme l'opportunité de développer une autonomie progressive et un suivi continu des patients. En revanche, ils redoutent un manque de garanties quant à la disponibilité pédagogique du maître de stage. Le besoin de formations pratiques sur la fiscalité et la gestion du cabinet apparaît prioritaire. La rémunération mixte divise car certains y voient une revalorisation, tandis que d'autres craignent un plafonnement rigide et peu de reconnaissance. Discussion : les propositions récentes comme la participation volontaire à la permanence des soins et la limitation à 25 actes par jour répondent en partie aux inquiétudes initiales. Cependant, l'appropriation de ces mesures dépendra de la clarté des textes et de l'implication des maîtres de stage. L'impact concret de cette quatrième année sur l'installation en libéral reste à évaluer. Conclusion : les internes interrogés considèrent la quatrième année comme une opportunité de professionnalisation, à condition de préciser la supervision et de renforcer la formation pratique. Leur adhésion dépendra de la capacité à concilier objectifs pédagogiques et reconnaissance de leur statut
Facteurs prédictifs à long terme de mortalité et de progression vers l'insuffisance rénale terminale chez les patients atteints de glomérulonéphrite extramembraneuse primitive et secondaire : une étude multicentrique rétrospective française, la cohorte GEMO
No full textBackground: Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. Its clinical presentation is heterogeneous, and long-term prognostic data remain limited despite recent advances in the understanding of this disease. The objective of our study was to identify long-term prognostic factors in a large cohort of patients with primary or secondary MN. Methods: We conducted a multicenter, retrospective study including 565 patients (367 primary MN, 198 secondary MN) diagnosed between 1990 and 2020. The primary outcome was a composite of death or need for renal replacement therapy. Predictive factors were analyzed using univariate logistic regression, and event-free survival was assessed using adjusted Cox models. Results: In multivariate analysis, patients with secondary MN had an increased risk of adverse outcomes compared to those with primary MN (HR = 1.56, 95% CI [1.06–2.30], p = 0.02). In primary MN, estimated glomerular filtration rate (eGFR) at diagnosis was a major prognostic factor (HR = 2.69, 95% CI [1.53–4.74] for eGFR between 30–60, and HR = 14.1, 95% CI [6.45–30.9] for eGFR < 30 ml/min/1.73 m², both p < 0.001), compared to patients with normal renal function. Proteinuria (UPCR) > 8 g/g at diagnosis was also associated with increased risk (HR = 2.26, 95% CI [1.04–4.91], p = 0.04) compared to UPCR < 3 g/g. High anti-PLA2R antibody titers were not associated with long-term prognosis. Rituximab, used as first-line therapy, was associated with a more favorable initial clinical response than other immunosuppressive treatments (HR = 0.30, 95% CI [0.11–0.81], p = 0.02), although it did not significantly improve long-term outcomes compared to alkylating agents. Conclusion: Renal function and proteinuria at diagnosis remain the key prognostic factors for death or renal replacement therapy in primary MN. Anti-PLA2R antibodies do not represent an independent prognostic marker. Rituximab appears to be emerging as a preferred first-line treatment for primary MN. These findings highlight the need to redefine and develop new tools for long-term risk stratification and personalized management.Contexte : la glomérulonéphrite extra-membraneuse (GEM) est une cause fréquente de syndrome néphrotique chez l'adulte. La présentation clinique est hétérogène et les données sur son pronostic à long terme restent limitées en dépits des progrès récent dans la compréhension des mécanismes de cette maladie. L'objectif de notre étude était d'identifier les facteurs pronostiques à long terme au sein d'une large cohorte de patients atteints de GEM primitive ou secondaire. Méthodes : il s'agit d'une étude multicentrique, rétrospective, incluant 565 patients (367 GEM primitives, 198 GEM secondaires) diagnostiquées entre 1990 et 2020. Le critère de jugement principal était composite associant le risque de décès ou de suppléance rénale. Les facteurs prédictifs d'évolution ont été analysés en régression logistique univariée et la survie sans événement selon un modèle de Cox ajusté. Résultats : en analyse multivariée, les patients avec une GEM secondaire présentaient un sur-risque d'événement par rapport aux patients avec une GEM primitive (HR= 1,56 IC 95% [1,06–2,30], p=0,02). Dans la GEM primitive, le débit de filtration glomérulaire estimé (DFGe) au diagnostic était un facteur pronostic majeur HR = 2,69 IC 95% [1,53–4,74] et HR = 14,1 IC 95% [6,45–30,9] respectivement pour un DFGe entre 30 et 60 ou < 30 ml/min/1,73 m² en comparaison aux patients avec une fonction rénale normale (tous p<0,001). Une protéinurie (UPCR) > 8 g/g au diagnostic était également associée à un sur-risque d'événement (HR = 2,26 IC 95% [1,04–4,91], p=0,04) par rapport aux patients avec un UPCR < 3g/g. Un titre élevé d'anti-PLA2R n'était pas associé au pronostic à long terme. Le rituximab utilisé en première ligne apportait une réponse clinique plus favorable que les autres immunosuppresseurs, (HR 0,30 [0,11–0,81], p=0,02), cependant son impact à long terme n'était pas significatif en comparaison aux agents alkylants. Conclusion : la fonction rénale et la protéinurie au diagnostic ont un rôle central dans la stratification du risque de décès et de suppléance rénale des patients avec une GEM primitive. Les anticorps anti-PLA2R ne constituent pas un facteur pronostique indépendant. Le rituximab semble s'imposer en pratique courante comme le traitement de première ligne de la GEM primitive. Ces résultats confirment la nécessité de redéfinir et de développer de nouveaux outils de stratification du risque à long terme pour une prise en charge personnalisée
L’erreur médicale en anatomopathologie : étude qualitative du vécu de 18 anatomopathologistes des Hauts-de-France
No full textInternational audienceIntroduction: The study aimed to investigate the experience of pathologists facing medical errors.Materials and methods: A qualitative study conducted with 18 pathologists in the Hauts-de-France region. Data were collected through semi-structured interviews and analyzed using grounded theory method.Results: Pathologists experienced three main stages after a diagnostic error: initial shock, re-mobilization, and enrichment. Most symptoms dissipated in the short term. Professional adjustments to prevent new errors were common. The term "second victim," referring to healthcare professionals affected by an error, was unfamiliar to participants. Most did not identify as "second victims," questioning the relevance of the term and emphasizing their responsibility in the error. To minimize errors, participants underlined the importance of communication, collaboration, and better working conditions. They called for ongoing training and improvement in managing medical errors, as well as increased recognition of the psychological impacts of such errors on healthcare professionals.Discussion: The results align with existing literature on other healthcare professionals. Currently, the term "second victim" is being questioned by some physicians and patient associations.Conclusion: The study sheds light on pathologists' experience with medical errors, emphasizing the importance of prevention, communication, and support for affected healthcare professionals. Further quantitative research is needed to confirm these findings
Current advances in magnetoelectric composites with various interphase connectivity types
No full textInternational audienceMagnetoelectric composites integrate the coupling between magnetic and piezoelectric materials to create new functionalities for potential technological applications. This coupling is typically achieved through the exchange of magnetic, electric, or elastic energy across the interfaces between the different constituent materials. Tailoring the strength of the magnetoelectric effect is primarily accomplished by selecting suitable materials for each constituent and by optimizing geometrical and microstructural designs. Various composite architectures, such as (0-3), (2-2), (1-3) and core-shell connectivities, have been studied to enhance magnetoelectric coupling and other required physical properties in composites. This review examines the latest advancements in magnetoelectric materials, focusing on the impact of different interphase connectivity types on their properties and performance. Before exploring magnetic-electric coupling, a brief overview of the historical background of multiferroic magnetoelectric composites is provided. Fundamental concepts underlying the magnetoelectric effect, piezoelectricity, and the magnetostrictive effect are explained, including their origins and examples of these materials' properties. So far, five types of magnetoelectric composite connectivities have been investigated experimentally: particulate composites (0-3), laminated and thin films (2-2), sticks embedded in a matrix, core-shell particles, and coaxial fibers. An outlook on the prospects and scientific challenges in the field of multiferroic magnetoelectric composites is given at the end of this review
Corrélation radio-clinique dans la maladie de Ménière
No full textIntroduction: Ménière's disease is a disabling condition that presents a significant public health challenge due to its diagnostic and therapeutic complexity. The diagnosis is solely based on clinical criteria. MRI may provide valuable assistance in diagnosis and overall patient management. The objective of this study was to investigate a radio-clinical correlation in Ménière's disease. Materials and Methods: A total of 77 patients with "definite" or "probable" Meniere's disease were included in this study. Each patient underwent labyrinthine MRI three hours after intravenous gadolinium injection. The average pure-tone hearing threshold and vestibular hypovalence were assessed. The severity stage of cochleo-vestibular hydrops was estimated using the Bernaerts classification. The presence of contralateral hydrops and disease duration were also analyzed. A correlation between the grade of endolymphatic hydrops, clinical symptoms, and disease duration was investigated. Results: The average pure-tone hearing threshold and vestibular hypovalence were positively correlated with the severity of cochleo-vestibular hydrops. Endolymphatic hydrops was detected in 84.42% of patients. Contralateral endolymphatic hydrops was identified in 23.08% of cases. The saccule was the first site of endolymphatic hydrops occurrence and was found in isolation in 21.54% of cases. The duration of Ménière's disease was correlated with the severity stage of endolymphatic hydrops. Cochleo-vestibular hydrops was consistently present in patients with Ménière's disease who had an average hearing loss greater than 45dB. Conclusion: The discovery of a radio-clinical correlation in Ménière's disease helps reinforce the diagnosis for patients, improves treatment adherence, and aids in the selection of therapeutic options during patient follow-up.Introduction : la maladie de Ménière est une pathologie invalidante qui soulève un véritable problème de santé publique de par sa difficulté diagnostique et thérapeutique. Le diagnostic repose sur des critères uniquement cliniques. L'IRM pourrait apporter une aide pour le diagnostic et dans la prise en charge globale du patient. Le but de cette étude était de rechercher une corrélation radio-clinique dans la maladie de Ménière. Matériel et méthodes : 77 patients ayant une maladie de Ménière « définie » ou « probable » ont été inclus dans cette étude. Une IRM labyrinthique a été réalisée 3h après l'injection intraveineuse de gadolinium chez chaque patient. Le seuil auditif tonal moyen ainsi que l'hypovalence vestibulaire ont été évalués. Le stade de sévérité de l'hydrops cochléo-vestibulaire a été estimé à l'aide de la classification de Bernaerts. La présence d'un hydrops controlatéral et la durée d'évolution de la maladie ont également été analysés. La corrélation entre le grade d'hydrops endolymphatique, les symptômes cliniques et la durée d'évolution de la maladie a été recherchée. Résultats : le seuil auditif tonal moyen et l'hypovalence vestibulaire sont corrélés positivement à la sévérité de l'hydrops cochléo-vestibulaire. L'hydrops endolymphatique a été mis en évidence chez 84,42% de nos patients. Un hydrops endolymphatique controlatéral a été mis en évidence dans 23,08% des cas. Le saccule est le premier lieu d'apparition de l'hydrops endolymphatique et a été retrouvé de manière isolée dans 21,54% des cas. La durée d'évolution de la maladie de Ménière est corrélée au stade de sévérité de l'hydrops endolymphatique. L'hydrops cochléo-vestibulaire est systématiquement présent chez les patients ayant une maladie de Ménière avec une perte auditive moyenne supérieure à 45dB. Conclusion : la découverte d'une corrélation radio-clinique dans la maladie de Ménière aide à conforter les patients dans leur diagnostic, améliore la compliance au traitement et apporte une aide dans le choix des thérapeutiques au cours du suivi du patient
Combining non-conventional enzymes and ozone to extract polysaccharidic hemicelluloses from bleached pulp for hydrogen production
No full textInternational audienc
5G Radiofrequency Exposure Reduces PRDM16 and C/EBP β mRNA Expression, Two Key Biomarkers for Brown Adipogenesis
No full textInternational audienceThe widespread use of wireless technologies has raised public health concerns about the biological effects of radiofrequency (RF) exposure. Children have a higher specific absorption rate (SAR) of radiation energy compared to adults. Furthermore, brown adipose tissue (BAT) is more prevalent in infants and tends to decrease with age. Previous animal studies demonstrated a cold sensation in rats exposed to 900 MHz (second generation, 2G). UCP1-dependent thermogenesis and BAT hyperplasia are two fundamental adaptive mechanisms initiated in response to cold. This study investigated the impact of short-term exposure to 2G and fifth generation (5G) on key thermogenic and adipogenic markers related to these mechanisms while considering age and exposure duration. Juvenile and young adult Wistar rats were randomized into three subgroups: a 5G group (3.5 GHz), 2G group (900 MHz), and a control group (SHAM). They were exposed to their respective continuous-wave RF signals for 1 or 2 weeks at an intensity of 1.5 V/m, with two exposure sessions of 1 h per day. After the exposure period, a RT-qPCR was carried out to evaluate the genetic markers involved in BAT thermogenesis and adipogenesis. Two adipogenic biomarkers were affected; a fold change reduction of 49% and 32% was detected for PRDM16 (p = 0.016) and C/EBP β (p = 0.0002), respectively, after 5G exposure, regardless of age and exposure duration. No significant RF effect was found on UCP1-dependent thermogenesis at a transcriptional level. These findings suggest that exposure to a 5G radiofrequency may partially disrupt brown adipocyte differentiation and thermogenic function by downregulating PRDM16 and C/EBP β, possibly leading to higher cold sensitivity
NASICON As-doped and glass additive dual strategy for novel NASICON-glass composite with superior ionic conductivity
No full textInternational audienceDue to their desirable properties, NASICON-type LATP materials are considered strong candidates for use as solid-state electrolytes in lithium batteries. However, their ionic conductivity, essential for optimal battery performance, remains lower than liquid electrolytes. This study highlights the effectiveness of a dual-strategy approach to improve LATP NASICON materials' ionic conductivity. By substituting titanium with arsenic, we developed a high-ion-conducting phase, Li1.5Al0.3As0.2Ti1.5(PO4)3, which showed significant advancements, achieving a high relative density of 89 % and an average grain size of 51 nm, which contributes to its improved performance. These modifications led to a significant boost in the ionic conductivity of the arsenic-doped LATP phase, which rose from 5.34 × 10−5 S.cm−1 for LATP to 8.57 × 10−4 S.cm−1 for the Li1.5Al0.3As0.2Ti1.5(PO4)3 phase at room temperature with an activation energy of 0.30 eV and a transference number close to 1. To address remaining porosity and grain boundary resistance, we developed a novel glass-ceramic composition by incorporating a high-ion-conducting glass additive (45Li2O-10Li2WO4-45P2O5) into the new elaborated Li1.5Al0.3As0.2Ti1.5(PO4)3 matrix. The addition of 3 wt% glass content notably enhanced the density and compactness of the material, increasing its ionic conductivity to 4.6 × 10−3 S. cm−1 at 25 °C with an activation energy of 0.25 eV, representing the highest ionic conductivity reported for NASICON and NASICON-composite materials. This work provides a cost-effective and efficient method for producing novel NASICON ceramics and glass-ceramic composites with superior ionic conductivity, setting a new benchmark for NASICON-composite materials and advancing the development of high-performance solid-state electrolytes for lithium batteries
10-years’ experience of endovascular reconstruction of aorto-iliac occlusive lesions: HERAB technic
No full textInternational audienceIntroduction: Hybrid endovascular reconstruction of the aortic bifurcation (HERAB) is an alternative technique to CERAB developed in our tertiary center for complex (TASC C-D) aorto-iliac occlusive lesions (AIOD). The purpose of this study was to report our results at 10 years and to try to identify factors influencing patency.Methods: From 2012 to 2023, all consecutive cases requiring endovascular aortic bifurcation reconstruction with HERAB technique for AIOD were collected at our tertiary center. Baseline data, procedural data, their 30-days complications and overall survival were recorded. Patency and freedom from TLR were analysed. Univariate analysis was performed to identify predictors of patency loss.Results: 92 patients were included in the study. The AIOD was classified TASC II D in 97% of cases, and indication for revascularization was intermittent claudication in 63 cases (68.5%). Technical success rate was 93.5% and the 30-day mortality rate was 1.1%. Respective 5-years primary, primary assisted and secondary patency rate were 68.8%, 80.7% and 89.5%, with freedom from target lesion revascularization rate of 83.7%. The collateral network patent before the surgery was preserved in 97% of cases. Only use of a Lifestream stent for iliac kissing stent was associated with loss of patency. In case of patency loss, clinical presentation was the same as the onset event in 52% of cases. Overall limb salvage rate was 98%.Conclusion: HERAB represents a safe and effective long-term alternative to CERAB. This procedure offers advantage of preserving the collateral network, allowing the use of lower-profile devices, and less expensive procedure
Ovarian Torsion in Prepubertal Girls: Clinical Characteristics, Biological and Radiological Features, Reccurency Rate
No full textInternational audienceIntroduction: The diagnosis of ovarian torsion is made with delay among pre-pubertal girls and the management after the surgical detorsion is poorly codified. We interested in the French experience during the last two decades.Methods: Retrospective study in French pediatric surgery centers from January 2000 to December 2022 concerning girls who presented with at least 1 episode of ovarian torsion in the prepubertal period. Data collected included patient history, symptomatology, biological and imaging assessment at first episode, emergency surgery, follow-up including recurrence.Results: Thirty centers participated and we included 502 girls diagnosed with ovarian torsion during a surgical procedure performed due to abdominal pain (with or without ovarian mass). The girls had a mean age of 7.9 years (± 2.8) and a median age of 8.3 years (Q1 5.97; Q3 10.12) at the time of the first episode of torsion. Nausea or vomiting was present in 71% of cases. Fever was present in 23% of cases and was more displayed 24 hours after the onset of abdominal pain (p < 0.0001). Mean follow-up was 2.1 (± 2.61) years. Only 42 out of 142 (30%) girls with enlarged ovaries (> 97th percentile) were referred to the endocrinologist to assess the existence of hormonal anomalies. Of the 482 girls without oophoropexy after the first episode of torsion, 71 (14.7 %) experienced at least one recurrence. Among them: 10 (7.5%) had an ovarian mass and 42 (55%) enlarged ovaries.Conclusion: Symptoms of ovarian torsion in pre-pubertal girls are not specific and clinicians should be aware of this insidious presentation in this group. These girls should be systematically referred to endocrinologists