Université de Rouen Normandie

Objectives The objective is to compare the learning curves between two pioneer and three second‐generation surgeons for RAPN in terms of WIT, CD and positive surgical margins. Materials and methods The charts of consecutive RAPNs of three centres were reviewed from the UroCCR prospective database. The experience was assessed by a regression model for each group. There was a univariate analysis on three consecutive sequences of 15 procedures. The learning speed for WIT was explored graphically by polynomial regression after cubic splines. Finally, CUSUM charts were obtained. Results There were 1203 RAPN in the pioneer group and 119 performed by second‐generation surgeons. There was a significant difference in the distribution of tumour size (p < 0.001) and the RENAL score (p < 0.001). The operative time was longer in the first group (p > 0.001). Independent factors for a higher WIT were the second group (p < 0.001), higher experience (p < 0.001) the collinearity between the group and experience (p < 0.001), the RENAL score (p < 0.001) and blood loss (p < 0.001). Adjusted Loess regressions showed a plateau of WIT at 400 procedures for the pioneers and a significant decrease at 20 procedures for the second generation. CUSUM chart analysis showed a ‘staircase’ pattern of the learning process, with three major steps at 150, 200 and 300 procedures. The major limitation is the difference in sample size between the two arms. Conclusions Learning curve patterns would reflect a transfer of knowledge to the second‐generation, as opposed to the establishment of standards by the pioneers.

Background The external carotid artery (ECA) branching pattern has been extensively studied in the current literature. However, its topographical variability has been barely reported. The aim of the current study was to assess the ECA in relationship with the styloid process (SP) and the mandible. Materials 100 computed tomography angiograms were randomly selected and retrospectively investigated on the neck region for the ECA course in relation to the SP and the mandible. Results A retrostyloid course of the ECA was identified on 18 sides (9%). Six patients had a bilateral retrostyloid ECA, and six patients had a unilateral variant. The side and sexes did not affect the prevalence of this variant. The elongated SP or variable ossification of the stylohyoid chain did not affect the retrostyloid course. The ECA retromandibular course of type 1 (straight course deep to the ramus of the mandible) was identified in 30.5%, type 2 (lateral retromandibular loop) in 20%, and type 3 (lateral retromandibular loop behind the ramus of the mandible) in 45.5%. The side and sexes did not affect the prevalence of this variant. Conclusions Our study enhances the current knowledge on the ECA topography. Both variants investigated in the current study, displace the ECA into the parapharyngeal space. Knowledge of these anatomic variations are of importance preoperatively to avoid iatrogenic injuries.

In this paper, we study optimality conditions for a class of control problems driven by a cylindrical Wiener process, resulting in a stochastic maximum principle in differential form. The control acts on both the drift and volatility, potentially as unbounded operators, allowing for SPDEs with boundary control and/or noise. Through the factorization method, we establish a regularity property for the state equation, which, by duality, extends to the backward costate equation, understood in the transposition sense. Finally, we show that the cost functional is Gâteaux differentiable, with its derivative represented by the costate. The optimality condition is derived using results from set-valued analysis.

Purpose The current meta-analysis aimed to investigate the extensor digitorum brevis manus (EDBM) muscle variability by calculating the pooled prevalence of all published variants. After considering the pooled prevalence, these variants were classified based on their insertion and relationship with the extensor indicis (EI) muscle and/or tendon. The origin of the variants, neural and arterial supply, and the terminology of the EDBM variants were further investigated. Materials The systematic review was conducted according to the guidelines proposed by the Evidence-Based Anatomy Workgroup and PRISMA 2020. Four databases were searched using several keyword combinations. The included studies were statistically meta-analyzed using the R programming language. The EDBM pooled prevalence was calculated, as were subgroup analyses of a few parameters. Results Thirty-one studies met our inclusion criteria, with a total sample of 9686 hands. The EDBM pooled prevalence was estimated at 1.96% (95%CI 1.42–2.58). The EDBM's most common insertion was via a distinct tendon to the index finger, coexisting with the typical EI tendon (0.38% pooled prevalence). The origin, innervation, and arterial supply of EDBM have not been studied systematically. Conclusions The EDBM variant can be considered infrequent, with a pooled prevalence of 1.96%. Particular attention should be given to the muscle’s insertion and relationship with the EI muscle and tendon. Knowledge of the EDBM morphological variability is adequate for hand and reconstructive surgeons to avoid confusion intraoperatively and misdiagnosis preoperatively.

Objectives Videofluoroscopic swallowing studies (VFSS) remain the gold standard for the instrumental assessment of oropharyngeal swallowing disorders alongside flexible endoscopic evaluation of swallowing (FEES), requiring a high standard of quality and correct implementation. The current best practice position statements aim to guide the clinical practice of VFSS in individuals experiencing swallowing disorders. Materials and methods An international expert consensus panel with expertise in oropharyngeal dysphagia, comprised of radiologists, speech-language therapists, otolaryngologists, and other professionals in the field, convened by the European Society of Swallowing Disorders (ESSD) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), developed best practice position statements. They were established using an online Delphi methodology involving an online panel discussion and item preparation and three consecutive rounds. Consensus was reached when ≥ 80% of the participants agreed on a specific recommendation. Results Eighteen best practice position statements were formulated, thereby establishing standard recommendations on the technical performance of VFSS. They cover VFSS planning, correct implementation, documentation, radiation protection, equipment and maintenance, and education and training. Conclusion These position statements summarise the panel’s deliberations and recommendations in performing VFSS, representing the agreed consensus of experts from ESSD and ESGAR. They provide a structured framework for optimising and standardising the performance of VFSS in patients with swallowing disorders. Key Points Question Significant regional and national differences in clinical practice when performing VFSS highlight the need for interdisciplinary recommendations to optimise patient care . Findings Eighteen statements were developed by representatives of the ESSD and the ESGAR . Clinical relevance These best practice position statements on the technical performance of VFSS may serve as a basis for standardising the procedure and ensuring high-quality service .

Objectives To assess the real‐world efficacy and safety of recombinant factor IX albumin fusion protein (rIX‐FP) in patients with hemophilia B (HB) in France. Methods Data on dosing frequency, weekly consumption, and bleeds before‐and‐after switching to rIX‐FP, were collected from December 2021 to February 2024. Annualized (spontaneous) bleeding rates [A(s)BRs] were calculated only in patients on prophylaxis with a follow‐up ≥ 6 months. Results This interim analysis focused on 77 patients ≥ 12 years; 62 (81%) had severe HB. After switching to rIX‐FP, the infusion interval was 14 (7–14) days. Weekly consumption was 43 (35.5–53) IU/kg. ABRs and AsBRs were 0.5 (0–1.9) and 0 (0–0.7) (n = 63) at 18.2 (12.3–21.9) months of follow‐up. Prophylactic efficacy of rIX‐FP was considered ‘Excellent’/‘Good’ in 65/68 (95%) patients. Among the 43 patients previously treated with rFIXFc, 21 increased the infusion interval from 7 (7–11) days with rFIXFc to 14 (7–14) days with rIX‐FP; 33/43 (77%) reduced weekly factor IX (FIX) consumption from 59.95 (46.35–77.93) to 42.5 (35.88–50.25) IU/kg. Patients maintained good protection against bleeds. Conclusion This analysis confirmed that switching to rIX‐FP allows for reducing injection frequency and FIX consumption while maintaining good bleed protection.

The internal jugular vein (IJV) is considered one of the prominent veins of the neck. It corresponds to the continuation of the sigmoid sinus and joins the subclavian vein to form the brachiocephalic vein. A retrospective study of 200 computed tomography angiographies was performed at the Larissa University Hospital Radiology Department, where the IJV variant morphology was investigated. Three unilateral cases of IJV duplication were observed (0.75%) in three patients (2 on the left and 1 on the right side). One case of IJV fenestration was identified (0.25%) in one patient on the left side. IJV duplication and fenestration are rare aberrations reported in several case reports, while their incidence has been barely reported. Knowledge of IJV variant anatomy (common and uncommon morphological variants) is paramount for head and neck surgeons and anesthesiologists to avoid iatrogenic injury.

Purpose of the Review Peripartum depression (PPD), including both depression during pregnancy and postpartum, is the most frequent health disorder during the perinatal period. It is a significant public health issue in many countries due to its prevalence and its impact on women, as well as on their partners and offspring. Here, we will attempt to untangle the most recent studies and publications, considering what it is essential to know in 2024 about PPD as a specific perinatal issue. Recent Findings PPD appears to be a very heterogeneous disorder in which a complex interplay between different factors contributes to its pathophysiology. Thus, the need to enhance diagnosis and referral through a better understanding of its severity and co-morbidities has emerged as a major public health issue. Indeed, research has consistently shown that PPD negatively impacts parent-infant interactions and infants’ cognitive, social, and emotional development. Evidence underlining its global risk has accumulated over the past three decades, but many questions remain, including how these vulnerable offspring developmental trajectories unfold. Summary

Objective Binge‐eating disorder is characterized by recurrent episodes of consumption of large amounts of food within a short period of time, without compensatory purging behaviors. This disease is a major public health issue and is associated with numerous comorbidities, encompassing anxiety and depression. The gut microbiota has been proposed to be an important player in the onset or maintenance of eating disorders. Here, we aim to better delineate the potential role of the gut microbiota in binge‐eating disorder. Method We used a model of intermittent limited access to palatable food where eight‐week‐old C57Bl/6 female mice had access during 2 h, every 2 days over a 10‐day period, to a high‐fat/high‐sucrose diet. Half of the animals received antibiotics to deplete their gut microbiota. Eating behavior and other behavioral parameters were compared between groups. Results We observed an increase in food intake as well as tachyphagia during the intermittent access to high‐fat/high‐sucrose diet. We demonstrate that gut microbiota depletion further increases food intake during these episodes and promotes binge‐eating behavior. No impact on anxiety or depressive‐like behavior was observed in animals. Discussion These results show that the gut microbiota is involved in the control of food intake during episodes of binge‐eating. This strengthens the potential role of the gut bacteria in binge‐eating disorder and the interest in therapeutic strategies aiming at modulating the patients' gut microbiota to treat this eating disorder.

Although the interest in autonomous vehicles and advanced driver assistance systems (ADAS) is significantly increasing, they won’t be viable until their system outperforms human drivers and can adapt to face unpredictable scenarios. Over the years, several testing methods have been developed, allowing vehicles to evaluate models and algorithms. However, these methods face many challenges, including the differences between conditions in simulation and in real world during the transfer of models. In response to these challenges, mixed-reality technology has shown some great potential in ensuring safer experiments. It enables vehicles to interact simultaneously with physical and virtual objects, thereby, duplicating critical scenarios to help the vehicle to learn how to adapt. In this paper, we present a comprehensive literature review of the use of mixed-reality techniques for self-driving systems and ADAS. We explore various applications and limitations of this approach. Additionally, we discuss possible directions for future work, highlighting the necessity of ongoing progress in this developing field.

The COVID‐19 pandemic, driven by SARS‐CoV‐2, led authorities to recommend halting assisted reproductive technology programs, focusing instead on fertility preservation, for cancer patients. The presence of SARS‐CoV‐2 in semen remains controversial. This multicentric prospective cohort study, conducted across 12 university medical centers, aimed to determine if SARS‐CoV‐2 is present in spermatozoa/seminal plasma in cancer patients by RT‐PCR and to assess its impact on standard semen parameters. The levels of cytokines and TNF‐α were measured in seminal fluid by ELISA. We enrolled 129 men who underwent sperm cryopreservation between July 7, 2020, and June 30, 2021. The 63 were included and tested for COVID‐19 in nasal swab samples by RT‐PCR and/or by serology. All patients were asymptomatic on the day of semen collection: 50 were uninfected, 8 had a positive nasal swab (PCR+) and 5 were seropositive. SARS‐CoV‐2 RNA was not detected in the seminal fluid or spermatozoa. Ejaculate volume was significantly lower in the PCR+ group compared to the uninfected group (median [IQR]: 2.6 mL [1.6–3.4] vs. 4.6 mL [2.6–5.2] p < 0.05). Total and progressive motility were lower in the PCR+ group compared to the seropositive group (32.5% [25.0–45.0] vs. 50% [49.0–55.0] p < 0.05, and 22.5% [10.0; 32.5] vs. 44.5% [40–49] p < 0.05). Higher TNF‐α level was observed in the PCR+ group (1.9 pg/mL [0–3.9]) compared to the uninfected group (0 pg/mL [0–0.4]) p < 0.05. Although SARS‐CoV‐2 was not detected in the sperm samples of cancer patients who were PCR+, the infection appears to impact sperm parameters, likely due to inflammation.

Background Poor sleep is a major concern in intensive care units (ICUs), particularly in mechanically ventilated patients, because it is associated with longer duration of the weaning phase and higher mortality. High noise levels in ICUs are frequently reported by patients as one of the most disturbing sleep-disrupting factors but would be responsible for less than 20% of arousals. This suggests major inter-individual variability in noise sensitivity. Our objectives were to define and assess noise sensitivity in mechanically ventilated patients and to explore its association with sleep duration, sleep quality and weaning duration. Methods We retrospectively re-analyzed polysomnographies (PSGs) recorded in 29 non-sedated patients, mechanically ventilated for at least 24 h and difficult to wean (i.e. ≥ 1 spontaneous breathing trial failure). All the arousals were identified on all the PSGs. We calculated mean noise level and identified all noise peaks (an abrupt increase of noise intensity of more than 10 decibels (dBA)) preceding each arousal. Each 21-second period preceding each arousal was divided into seven 3-second bins. We built a pre-event time histogram for each PSG by counting the total number of noise peaks in each bin. If the total number of noise peaks in one bin exceeded the average of the seven bins plus 2 SD, we considered that there was a significant relationship between the number of noise peaks in this bin and the arousal. The patient was then considered as noise-sensitive. Presence of atypical sleep, proportion of sleep stages, and weaning duration were assessed. Results Nineteen out of 29 patients (66%) were noise-sensitive. Duration of weaning from ventilator was significantly longer in noise-insensitive patients (median [interquartile range] 2 [1–2] versus 5 [2–8] days; p < 0.01). Proportion of N1, N2, N3 sleep stages and rapid eye movement sleep were similar in noise-sensitive and noise-insensitive patients. In contrast, the proportion of patients displaying atypical sleep was higher in noise-insensitive patients. Conclusion Our results report for the first time that most ICU patients were noise-sensitive. Lower noise sensitivity was associated with atypical sleep and could reflect lower brain reactivity to environment.

Background It is unknown which maintenance therapy is the most effective option for patients admitted for an acute severe ulcerative colitis (ASUC) episode responding to intravenous steroids. Methods We conducted a multicentre, parallel-group, open-label randomised controlled trial among 23 French centres in thiopurine and biologics-naïve adults admitted for ASUC responding to intravenous steroids. Eligible patients were randomly assigned to receive infliximab (IFX) and azathioprine (AZA) with a 7-day steroid tapering scheme (IFX+AZA arm) or AZA and conventional standardised steroid tapering regimen (AZA arm). The primary composite endpoint was treatment failure at week 52, defined as the absence of steroid-free clinical remission, the absence of endoscopic response, the use of a prohibited treatment for relapse, severe adverse event leading to treatment interruption, colectomy or death. Multiple imputation for missing data was performed. Findings Among the 64 patients randomised (Lichtiger score 13.5±2.0; median age of 34.5 (P25–P75 26.3–50.3) years, median C reactive protein of 29.0 (12.8–96.8) mg/L at baseline): 32 were assigned to the IFX+AZA arm and 32 to the AZA arm. In the ITT population, treatment failure at week 52 was observed in 22/27 (81.5%) in the AZA arm and 16/30 (53.3%) in the IFX+AZA arm (risk ratio 3.85, 95% CI (1.15 to 12.88), p=0.03). 29 adverse events were severe, including 13 disease exacerbations, 6 severe infections without any difference between both arms. Interpretation Combination therapy with IFX+AZA was more effective at 1 year than AZA alone to avoid treatment failure in patients with ASUC responding to intravenous steroids. Trial registration number NCT02425852 .

Purpose Few data are available in the literature in Europe on the possible impact of social health inequalities on the therapeutic management of idiopathic scoliosis. This study aimed to determine whether the adolescent’s care pathway in the French health system, affected by idiopathic scoliosis, from the stage of diagnosis to the postoperative stage, could be influenced by socio-economic deprivation. Methods This retrospective, multicenter study analyzed 883 patients with surgery for adolescent idiopathic scoliosis between 2009 and 2019. The main clinical outcomes were the Cobb angle at first specialist consultation, brace compliance, the Cobb angle at surgery indication, the time to surgery, postoperative correction, and complications. A multiple linear regression model and multiple logistic regression model were performed to analyze the main outcomes according to the European Deprivation Index (EDI) and Scale Index. Results With the exception of Cobb’s angle at the first consultation (OR = 1.03 [1.01–1.04]) and on postoperative correction (OR = 0.997 [0.995–0.999]) socio-economic deprivation did not significantly influence the course of care of the adolescent operated on with idiopathic scoliosis. Conclusion This study suggested the restricted influence of social deprivation on the management of surgical adolescent idiopathic scoliosis in the French health system. It seems that deprivation occurs only before special therapeutic management, strengthening the importance of systematic screening. Further studies are needed to assess the impact of different socioeconomic factors on this pathology.

INTRODUCTION Genetics of cerebral amyloid angiopathy (CAA) remains understudied. METHODS We assessed variants in Alzheimer's disease (AD) risk factor genes and differential diagnosis genes by performing exome sequencing among 78 patients with early‐onset definite or probable CAA, after negative screening for APP mutation or duplication. RESULTS Among 14 genes involved in non‐Aβ CAA, or vascular leukoencephalopathies, we detected pathogenic NOTCH3 variants in two patients, who exhibited lobar hematomas at the ages of 58 and 65, leading to a diagnosis redirection toward CADASIL. Of the remaining 76 patients, 23.1% carried at least one apolipoprotein E (APOE) ε2 allele and 43.6% carried at least one APOE ε4 allele, known as CAA risk factors. A total of 15 out of 76 (19.7%) carried either a loss‐of‐function or a rare predicted damaging missense or known AD risk variant in SORL1, TREM2, ABCA7, ABCA1, and ATP8B4. DISCUSSION Exome sequencing allowed the redirection toward CADASIL in two patients and suggested shared genetic factors between AD and CAA, beyond the APOE gene. Highlights The genetic component of cerebral amyloid angiopathy (CAA) remains understudied. Rare differential diagnoses such as CADASIL should be considered, even in cases of cerebral hemorrhage. Our study suggests shared genetic factors between AD and CAA, beyond the APOE gene. Rare variants in SORL1, TREM2, ABCA7, ABCA1 and ATP8B4 might be susceptibility factors in early‐onset CAA.