Factors associated with decreased ovarian reserve in Crohn's disease: A systematic review and meta‐analysis

International audienceIntroduction It is still unclear whether Crohn's disease (CD) might be associated with diminished ovarian reserve (OvR) and factors influencing anti‐Mullerian hormone (AMH) levels in CD are poorly known. Material and Methods We conducted a comprehensive literature search of multiple electronic databases from inception to June 2022 to identify all studies reporting AMH levels or factors associated with diminished OvR in patients with CD. Results Of the 48 studies identified in our search, eight (including 418 patients with CD) were finally included. The mean difference (95% confidence interval [CI]) in the AMH level between pooled CD patients and controls was −0.56 (−1.14 to 0.03) ( p = 0.06). A history of CD‐related surgery was not associated with a lower OvR (odds ratio, OR [95% CI] 1.34, [0.66–2.7]; p = 0.4). While disease activity and perianal disease seems associated with a low OvR, disease location (L2 vs. L1, OR [95% CI] = 95% CI [0.47–7.4]; p = 0.4) and L3 vs. L1 (OR [95% CI] = 1.44 [0.67–3.12]; p = 0.3), CD medication, and disease behavior were not. Conclusions Our systematic review and meta‐analysis did not identify a significantly low OvR in patients with CD. Contrary to CD‐related surgery risk factor, active disease was associated lower AMH levels

Traduction et republication de : « Maladie thromboembolique veineuse récidivante chez les patients cancéreux anticoagulés : diagnostic et traitement »

International audiencePatients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drug–drug interactions) and cancer progression.Les patients atteints de cancer présentent un risque significativement accru de maladie thromboembolique veineuse (MTEV), en raison à la fois de l’impact de la maladie maligne elle-même et de l’impact de certains médicaments anticancéreux sur l’hémostase. Cela est vrai à la fois pour le premier épisode de MTEV et pour sa récidive. Le diagnostic et la prise en charge de la récidive de la MTEV chez les patients atteints de cancer posent des problèmes particuliers, qui sont examinés dans le présent article, sur la base d’une revue systématique de la littérature publiée au cours de la dernière décennie. Il n’est pas certain que les algorithmes de diagnostic de la MTEV, validés principalement chez les patients sans cancer et ne recevant pas d’anticoagulant, soient également valables chez les patients cancéreux sous traitement anticoagulant. Les données disponibles suggèrent que dans ce contexte clinique, les algorithmes diagnostiques utilisant la probabilité clinique et le dosage des D-dimères seraient moins performants. Chez les patients atteints de cancer, l’angioscanner pulmonaire et l’échographie veineuse semblent être les outils les plus fiables pour le diagnostic de l’embolie pulmonaire et de la thrombose veineuse profonde, respectivement. Les options de traitement de la MTEV récidivante sous anticoagulant comprennent les héparines de bas poids moléculaire (à une dose thérapeutique ou à une dose plus élevée), le fondaparinux ou les inhibiteurs directs du facteur Xa par voie orale. Le choix du traitement doit tenir compte de la nature (embolie pulmonaire ou thrombose veineuse profonde) et de la gravité de l’événement récurrent, du risque hémorragique associé, du traitement anticoagulant en cours (type, dose, observance et interactions médicamenteuses éventuelles) et de l’évolution du cancer

The impact of cirrhosis on short and long postoperative outcomes after distal pancreatectomy

International audienceBackground: The impact of cirrhosis on the postoperative outcomes of distal pancreatectomy is yet to be reported. We aimed to evaluate the outcomes of distal pancreatectomy in patients with cirrhosis.Methods: We conducted a retrospective, multicentric study patients with cirrhosis who underwent planned distal pancreatectomy between 2008 and 2020 in French high volume centers. Patients with cirrhosis were matched 1:4 for demographic, surgical, and histologic criteria with patients without cirrhosis. The primary endpoint was severe morbidity (Clavien-Dindo grade ≥III). The secondary endpoints were postoperative complications, specifically related to cirrhosis and pancreatic surgery, and survival for patients with pancreatic adenocarcinoma.Results: Overall, 32 patients with cirrhosis were matched with 128 patients without cirrhosis. Most patients (93.5%) had Child-Pugh A cirrhosis. The severe morbidity rate after distal pancreatectomy was higher in patients with cirrhosis than in those without cirrhosis (28.13% vs 25.75%, P = .11. The operative time was significantly longer in the cirrhotic group compared with controls (P = .01). However, patients with and without cirrhosis had comparable blood loss and conversion rates. Postoperatively, the two groups had similar rates of pancreatic fistula, hemorrhage, reoperation, postoperative mortality, and survival rates at 1, 3, and 5 years.Conclusion: The current study suggests that distal pancreatectomy in high-volume centers is feasible for patients with compensated cirrhosis

Human intraparietal sulcal morphology relates to individual differences in language and memory performance

International audienceThe sulco-gyral pattern is a qualitative feature of the cortical anatomy that is determined in utero, stable throughout lifespan and linked to brain function. The intraparietal sulcus (IPS) is a nodal associative brain area, but the relation between its morphology and cognition is largely unknown. By labelling the left and right IPS of 390 healthy participants into two patterns, according to the presence or absence of a sulcus interruption, here we demonstrate a strong association between the morphology of the right IPS and performance on memory and language tasks. We interpret the results as a morphological advantage of a sulcus interruption, probably due to the underlying white matter organization. The right-hemisphere specificity of this effect emphasizes the neurodevelopmental and plastic role of sulcus morphology in cognition prior to lateralisation processes. The results highlight a promising area of investigation on the relationship between cognitive performance, sulco-gyral pattern and white matter bundles

Focused ultrasounds: What is their future in epileptology? A critical review

International audienceHigh intensity focused ultrasounds (HIFU) are being increasingly advocated as a useful tool in the management of focal drug-resistant epilepsy. Our aim was to review current literature on the topic and perform an inventory of open trials assessing HIFU effectiveness and safety in epilepsy management. To do so, a review was conducted and yielded one prospective clinical trials, two case reports and one safety study were retrieved, indicating that HIFU is still in its infancy when it comes to focal drug-resistant epilepsy therapy. Efforts should be made to develop this technology using multicentric prospective data with larger cohorts and prolonged follow-up

Effect of long-term deficit irrigation on tomato and goji berry quality: from fruit composition to in vitro bioaccessibility of carotenoids

International audienceDrought is a persistent challenge for horticulture, affecting various aspects of fruit development and ultimately fruit quality, but the effect on nutritional value has been under-investigated. Here, fruit quality was studied on six tomato genotypes and one goji cultivar under deficit irrigation (DI), from fruit composition to in vitro bioaccessibility of carotenoids. For both species, DI concentrated most health-related metabolites in fresh fruit. On a dry mass basis, DI increased total phenolic and sugar concentration, but had a negative or insignificant impact on fruit ascorbic acid, organic acid, and alcohol-insoluble matter contents. DI also reduced total carotenoids content in tomato (−18.7% on average), especially β-carotene (−32%), but not in goji berry DW (+15.5% and +19.6%, respectively). DI reduced the overall in vitro bioaccessibility of carotenoids to varying degrees depending on the compound and plant species. Consequently, mixed micelles produced by digestion of fruits subjected to DI contained either the same or lesser quantities of carotenoids, even though fresh fruits could contain similar or higher quantities. Thus, DI effects on fruit composition were species and genotype dependent, but an increase in the metabolite concentration did not necessarily translate into greater bioaccessibility potentially due to interactions with the fruit matri

Evaluating speech-in-speech perception via a humanoid robot

International audienceIntroduction: Underlying mechanisms of speech perception masked by background speakers, a common daily listening condition, are often investigated using various and lengthy psychophysical tests. The presence of a social agent, such as an interactive humanoid NAO robot, may help maintain engagement and attention. However, such robots potentially have limited sound quality or processing speed.Methods: As a first step toward the use of NAO in psychophysical testing of speech- in-speech perception, we compared normal-hearing young adults’ performance when using the standard computer interface to that when using a NAO robot to introduce the test and present all corresponding stimuli. Target sentences were presented with colour and number keywords in the presence of competing masker speech at varying target-to-masker ratios. Sentences were produced by the same speaker, but voice differences between the target and masker were introduced using speech synthesis methods. To assess test performance, speech intelligibility and data collection duration were compared between the computer and NAO setups. Human-robot interaction was assessed using the Negative Attitude Toward Robot Scale (NARS) and quantification of behavioural cues (backchannels).Results: Speech intelligibility results showed functional similarity between the computer and NAO setups. Data collection durations were longer when using NAO. NARS results showed participants had a relatively positive attitude toward “situations of interactions” with robots prior to the experiment, but otherwise showed neutral attitudes toward the “social influence” of and “emotions in interaction” with robots. The presence of more positive backchannels when using NAO suggest higher engagement with the robot in comparison to the computer.Discussion: Overall, the study presents the potential of the NAO for presenting speech materials and collecting psychophysical measurements for speech-in-speech perception

Farmers'perceptions about the risk of suicide and the available help schemes: a qualitative study in France

International audienceIntroduction: Farming communities are marked by high suicide rates, and this is characterised by multiple factors (working environment, use of lethal means, low use of health care). In France, help schemes have been implemented. The aim of this study was to analyse the perceptions of farmers in Brittany, France about suicide and the help offered to farmers at risk of suicide.Methods: For this qualitative study, semi-structured interviews were carried out and analysed according to a reflexive thematic analysis in the framework of an inductive approach. Results: Twenty-six farmers were interviewed. All had experienced the suicide of a relative or another farmer they knew. Interviewed farmers had a good knowledge of suicide, its risk factors and the signs that precede the suicidal act. Paradoxically, while some interviewed farmers had suicidal thoughts, they did not feel at risk of suicide because they did not have a ‘suicidal temperament’. When experiencing difficulties, farmers first sought support from those around them, particularly their spouse. An improvement in a farm's financial situation was an important factor to boost their mental health. Participation in groups or training courses was also an important help. Sometimes, they thought about seeing a healthcare professional, particularly their GP, but not everyone saw the usefulness of this approach. Mental health professionals (psychologists and psychiatrists) often had a bad reputation among farmers, despite the help they could offer. They all spoke of the need to offer proactive help to farmers, being aware of the low spontaneous help-seeking by colleagues in difficulty.Discussion: The interviewed farmers perceived that suicide was something that concerned others and represented a form of weakness. These specific features in the description of psychological pain by farmers may partly explain the low prevalence of depressive symptoms. Experiencing the suicide of a colleague was a traumatic experience with psychological consequences and negative health consequences. It can serve as a basis for preventive actions. A targeted and systematic screening of mental health problems in this population by GPs might improve the identification of farmers at high risk of suicide.Conclusion: These findings suggest that, given the low spontaneous help-seeking by farmers experiencing difficulties, proactive support could be an option to be developed

The importance of preoperative imaging in living-donor hepatectomy

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Diverse genetic causes of amenorrhea in an ethnically homogeneous cohort and an evolving approach to diagnosis

International audienceRESEARCH QUESTION: Premature ovarian insufficiency (POI) is characterised by amenorrhea associated with elevated follicle stimulating hormone (FSH) under the age of 40 years and affects 1-3.7% women. Genetic factors explain 20-30% of POI cases, but most causes remain unknown despite genomic advancements. DESIGN: We used whole exome sequencing (WES) in four Iranian families, validated variants via Sanger sequencing, and conducted the Acyl-cLIP assay to measure HHAT enzyme activity. RESULTS: Despite ethnic homogeneity, WES revealed diverse genetic causes, including a novel homozygous nonsense variant in SYCP2L, impacting synaptonemal complex (SC) assembly, in the first family. Interestingly, the second family had two independent causes for amenorrhea - the mother had POI due to a novel homozygous loss-of-function variant in FANCM (required for chromosomal stability) and her daughter had primary amenorrhea due to a novel homozygous GNRHR (required for gonadotropic signalling) frameshift variant. WES analysis also provided cytogenetic insights. WES revealed one individual was in fact 46, XY and had a novel homozygous missense variant of uncertain significance in HHAT, potentially responsible for complete sex reversal although functional assays did not support impaired HHAT activity. In the remaining individual, WES indicated likely mosaic Turners with the majority of X chromosome variants having an allelic balance of ∼85% or ∼15%. Microarray validated the individual had 90% 45,XO. CONCLUSIONS: This study demonstrates the diverse causes of amenorrhea in a small, isolated ethnic cohort highlighting how a genetic cause in one individual may not clarify familial cases. We propose that, in time, genomic sequencing may become a single universal test required for the diagnosis of infertility conditions such as POI