Hemorrhagic transformation during inter-hospital transfer for thrombectomy: Incidence, associated factors, and relationship with outcome

International audienceBackground: Patients with acute ischemic stroke with a large vessel occlusion (AIS-LVO) admitted to primary stroke centers (PSC) often require inter-hospital transfer to a comprehensive stroke center (CSC) for endovascular therapy (EVT). We aimed to determine the incidence of hemorrhagic transformation (HT) occurring during transfer, the factors associated with HT, and its relationship with 3-month outcome. Methods: We retrospectively analyzed data from two cohorts of AIS-LVO patients transferred from a PSC to a CSC for consideration of EVT. Patients were included if they had evidence of an anterior circulation AIS-LVO at the PSC and had a standard-of-care control brain imaging upon CSC arrival. HT was defined as any new hemorrhagic lesion within brain parenchyma visible on CSC admission imaging. Among HT patients, HT expansion was defined as an absolute volume increase of ⩾6 mL and a relative growth of ⩾33% between admission imaging and 24-h follow-up. Results: Overall, 566 patients were included, of whom 31 (5.5%) experienced HT during transfer. Inter-hospital HT was independently associated with inter-hospital arterial recanalization (adjusted odds ratio (aOR) = 6.95, 95%CI 2.94–16.39), higher pre-transfer NIHSS score (aOR = 1.08, 95%CI 1.02–1.14), and longer time from symptom onset to CSC arrival (aOR = 1.09, 95%CI 1.04–1.13). HT expansion between CSC arrival and 24 h occurred in 24% of HT cases. Inter-hospital HT was independently associated with modified Rankin scale ⩾3 at 3-month (aOR = 3.54, 95%CI 1.08–11.67, p = 0.038). Conclusion: HT during inter-hospital transfer for EVT is an uncommon event, yet is associated with a high rate of subsequent expansion and poor 3-month functional outcome. Treatments to reduce HT risk may be considered

In-host evolution of Yersinia enterocolitica during a chronic human infection

International audienceBacteria exhibit remarkable adaptability in response to selective pressures encountered during infection and antibiotic treatment. We characterize four Yersinia enterocolitica clonal isolates from successive bacteremia episodes that evolved within an elderly patient over 14 years. Their common evolution is characterized by a genome size reduction resulting in the loss of about a hundred genes and a so far undescribed deletion in the DNA gyrase gene gyrA conferring quinolone resistance. Third-generation cephalosporin resistance of the last isolate correlates with a truncation of OmpF in synergy with an increased production of BlaA and AmpC β-lactamases. A strong proteome remodeling of the isolates reveals a perturbed stringent response, as well as impaired metabolism which substantiate their severe growth defects in vitro, accounting for antibiotics tolerance and possibly therapeutic failure. This study documents previously unreported genetic and phenotypic changes associated with in-host adaptation of a pathogenic Yersinia species under antibiotic pressure

Inter-facility transfer for thrombectomy: a promising therapeutic window

International audienceCurrently, most acute ischemic stroke patients presenting with a large vessel occlusion are first evaluated at a nonthrombectomy-capable center before transfer to a comprehensive stroke center that performs thrombectomy. Interfacility transfer is a complex process that requires extensive coordination between the referring, transporting, and receiving facilities. As a result, long delays are common, contributing to poor clinical outcomes. In this review, we summarize the accumulating literature about the clinical as well as radiological-infarct growth, collateral change, arterial recanalization, and hemorrhagic transformation-changes during interfacility transfer for thrombectomy. Recent evidence shows that clinical/radiological changes during transfer are heterogeneous across patients and impact long-term functional outcomes, highlighting the urgent need to optimize care during this time window. We review some of the most promising therapeutic strategies-for example, penumbral protection to reduce infarct growth-that may improve clinical outcome in patients being transferred to thrombectomy-capable centers. Finally, we discuss key methodological considerations for designing clinical trials aimed at reducing infarct growth during transfer

Prevalence of term prelabor rupture of membranes and factors associated with a longer interval of rupture: data from the 2021 French national perinatal survey

International audienceObjectives: Term prelabor rupture of membranes (term PROM) increases maternal and neonatal morbidity, but its current prevalence is unknown. This study aimed to estimate the prevalence of term PROM and to identify factors associated with a longer interval of rupture of membranes using recent national population-based data.Study design: Women with singleton pregnancies and term deliveries from the 2021 French National Perinatal Survey were selected. The prevalence of term PROM, defined as the rupture of membranes from 37 weeks before spontaneous labor, and its 95 % confidence interval (CI) were estimated. The median interval of rupture, defined as the time between the rupture of membranes and the onset of spontaneous labor, induction or prelabor caesarean (whichever occurred first) was calculated. Sociodemographic and pregnancy factors related to a longer interval of rupture of membranes were analyzed using a survival analysis, adjusting for competitive risks of a spontaneous labor: induction of labor and prelabor cesarean. Adjusted Hazard Ratios (aHR) were calculated using multivariate analysis.Results: Among 10,810 eligible women, 3,052 had a term PROM, yielding a prevalence of 28.2 % (95 %CI 27.4-29.1). The median interval of rupture was 8.3 h (Interquartile 25-75[3.5-21.3]). Within the first 24 h following PROM, 90 % of women with a spontaneous labor were in labor. Factors associated with a longer interval of rupture included maternal age ≥35 (aHR = 0.82 95 %CI 0.72-0.93), primiparity (aHR = 0.73 95 %CI 0.66-0.81), Body-mass Index ≥25 (aHR = 0.87 95 %CI 0.77-0.97) or ≥30 (aHR = 0.73 95 %CI 0.62-0.85), being single (aHR = 0.66 95 %CI 0.48-0.90) and lower education (aHR = 0.82 95 %CI 0.69-0.97).Conclusions: Term PROM affects more than one in four women. Sociodemographic factors and parity are associated with a longer interval of rupture

Artificial Intelligence Applied to ElectroEncephaloGraphy in Epilepsy

International audienceArtificial Intelligence (AI) is progressively transforming all fields of medicine, promising substantial changes in clinical practice. In the context of epilepsy, Electroencephalography (EEG), a technique used for over a century, has historically been resistant to automated analysis due to the complexity of the signals and the challenges posed by artifact management. While the human eye excels at recognizing patterns, algorithms have demonstrated superior capabilities in detecting and characterizing specific features, such as long-term dynamics and synchrony. Furthermore, the advent of wearable EEG devices has led to an exponential increase in data volume, surpassing the limits of visual interpretation. Artificial Intelligence (AI) algorithms are now being developed to address these limitations, offering enhanced efficiency in both identifying subtle signal features and managing massive datasets. This review explores the fundamental principles of AI and its transformative potential in the field of EEG. It discusses the implications and the current limits, including improvements limited to aggregation of already known knowledge, for epilepsy diagnosis, medical and surgical treatment, and innovative approaches to patient monitoring, including seizure forecasting, highlighting how AI is poised to redefine the management of epilepsy.</div

Efficacy of Irbesartan in Celiprolol-Treated Patients With Vascular Ehlers-Danlos Syndrome

International audienceBACKGROUND: Vascular Ehlers-Danlos syndrome is a rare genetic disorder characterized by defective type III collagen and a high risk of arterial morbidity and mortality. Several cardiovascular drugs are used for treatment, including celiprolol, but no controlled trial in this condition has been conducted to date. We hypothesized the benefit of the addition of an angiotensin II receptor blocker. METHODS: A multicenter, randomized, placebo-controlled trial was conducted to assess the efficacy and safety of the angiotensin II receptor blocker irbesartan in adults with vascular Ehlers-Danlos syndrome on stable background celiprolol therapy. Patients were randomized 1:1 to receive irbesartan (150 mg/day titrated to 300 mg/day) or placebo for 2 years. The composite primary outcome was defined as any vascular Ehlers-Danlos syndrome–related fatal or nonfatal arterial event or any new or worsening arterial lesions detected by systematic head-to-pelvis computed tomography angiography or peripheral arterial duplex ultrasound at different time points, using a time-to-first-event analysis. RESULTS: Twenty-nine participants (62% female; 40.3±11.3 years of age) were randomized to irbesartan, and 28 (64% female; 40.7±11.0 years of age) were randomized to placebo. The composite primary outcome occurred in 8 of 29 patients (27.6%) receiving irbesartan versus 15 of 28 patients (53.6%) receiving placebo (hazard ratio, 0.42 [95% CI, 0.17, 0.99]; P &lt;0.05). The risk of recurrent symptomatic or nonsymptomatic arterial events was lower with irbesartan than with placebo (risk ratio, 0.37 [95% CI, 0.19, 0.68]; P =0.002). A reduction of progression of arterial lesions was observed at all sites. Irbesartan significantly reduced systolic blood pressure compared with placebo (baseline-adjusted difference of 5.4 mm Hg [ P &lt;0.001]), but no relation was observed with the reduction of the primary composite outcome. Eleven episodes of irbesartan-related hypotension were recorded, leading to a downtitration in 4 patients. CONCLUSIONS: Compared with placebo, irbesartan reduced the risk of severe symptomatic and asymptomatic arterial events in patients with vascular Ehlers-Danlos syndrome on background celiprolol therapy. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02597361

Exploring the boundaries between neoplastic and reactive lymphoproliferations: lymphoid neoplasms with indolent behavior and clonal lymphoproliferations—a report of the 2024 EA4HP/SH lymphoma workshop

International audienceThe boundaries between neoplastic and reactive lymphoproliferations were discussed during the 2024 European Association for Haematopathology/Society for Hematopathology workshop in Dubrovnik, Croatia. Session 5 focused on indolent lymphoid neoplasms and clonal lymphoproliferations. Seventy-two cases were submitted, representing good examples of indolent lymphomas and lymphoproliferative disorders (LPD) and their diagnostic challenges. The morphologic spectrum of primary cutaneous marginal zone lymphoma/lymphoproliferation (PC-MZL/PC-MZLPD) was discussed. PC-MZL/PC-MZLPD is divided in the immunoglobulin heavy chain switched-type and non-switched-type with some clinicopathological differences. The overlapping features between PC-MZL/PC-MZLPD and PC-CD4 + T-cell LPD were highlighted. The criteria for the diagnosis of indolent T-lymphoblastic proliferation (iT-LBP) were reviewed. Indolent T-cell lymphoproliferation of the gastrointestinal tract (iT-LPD-GI) is a rare clonal, non-destructive, and non-epitheliotropic T-cell LPD occurring in adults with a male predominance. The cases submitted to the workshop revealed clinicopathological heterogeneity. Unusual features like infiltration of the complete intestinal wall, mesenteric lymph node involvement, and splenomegaly were observed. A novel group of PD1 + /CD4 + indolent cases with intestinal tropism and dissemination to blood, bone marrow, lymph node, and skin was identified. Other indolent clonal B-and T-cell LPDs were discussed including transient, clonal CD8 + T-cell proliferations, usually the result of immune-mediated cytotoxic T-cell response to virus or neoantigens, and the recently described follicle center lymphoma (FLC) of the lower female genital tract. The increasing awareness of the existence of indolent LPDs should avoid unnecessary treatments. In this report, novel findings, recommendations for diagnosis, open questions, and diagnostic challenges raised by the cases submitted to the workshop will be discussed.</div

Deep Learning for the Early Diagnosis of Candidemia

International audienceIntroduction: Candidemia carries a heavy burden in terms of mortality, especially when presenting as septic shock, and its early diagnosis remains crucial.Methods: We assessed the performance of a deep learning model for the early differential diagnosis between candidemia and bacteremia. The model was trained on a large dataset of automatically extracted laboratory features.Results: A total of 12,483 episodes of candidemia (1275; 10%) or bacteremia (11,208; 90%) were included. For recognizing candidemia, a deep learning model showed sensitivity 0.80, specificity 0.59, positive predictive value (PPV) 0.18, weighted PPV (wPPV) 0.88, and negative predictive value (NPV) 0.96 on the training set (area under the curve [AUC] 0.69), and sensitivity 0.70, specificity 0.58, PPV 0.16, wPPV 0.87, and NPV 0.95 on the test set (AUC 0.64). Then, the learned discriminatory ability was tested in the subgroup of patients with available serum β-D-glucan (BDG) and procalcitonin (PCT) values to explore additive or synergistic effects with these more specific markers. Both feature selection and transfer learning did not improve the diagnostic performance of a model based on BDG and PCT only.Conclusions: A deep learning model trained on nonspecific laboratory features showed some discriminatory ability to differentiate candidemia from bacteremia, highlighting the ability of deep learning to exploit complex patterns within nonspecific laboratory data. However, the learned patterns did not improve the diagnostic performance of more specific markers. Further exploration of candidemia prediction using laboratory features through machine learning techniques remains a promising area of research, serving as a valuable complement to the development of large-scale models that also incorporate clinical features

Obesity: A Modulator in Acne Management

International audienceAcne vulgaris is an inflammatory and multifactorial skin disease involving the sebaceous gland and the skin microbiome. Different exposome factors, including hormonal and family factors, have been suggested to influence acne. Obesity is an increasingly observed condition worldwide, and is considered as a public health problem by the World Health Organization. Recently, a high body mass index has been identified as an acne severity risk factor in adolescents. A group of 5 dermatologists from different institutions and private practices from France involved in the research and clinical fields of acne -analysed recent literature on “obesity and acne” focusing on epidemiology, the pathogenesis of acne and obesity, as well as the management of acne in obese patients. The authors selected, prior to their discussion in November and December 2024 and again in March 2025, and discussed 52 articles concerning acne and obesity published since 2000 and available from the PubMed database. The authors agreed that, considering these common metabolic features, managing both acne and obesity in parallel and helping patients through a global approach including dermatological, endocrinal, psychological and nutrition, as well as lifestyle support is mandatory, and may allow for the improvement of both acne and obesity. Moreover, in order to allow dermatologists to manage acne in obese patients in the most efficient way, the authors developed and propose a decision tree. The authors consider that acne in obese patients is not a fatality, and taking care of acne should not be considered an isolated task in this specific patient population

The impact of the new WHO classification of renal cell carcinoma on the diagnosis of hereditary leiomyomatosis and renal cell carcinoma

International audienceABSTRACT Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is caused by heterozygous germline variants in the fumarate hydratase (FH) gene. Inheritance follows an autosomal dominant pattern. Loss of FH confers a predisposition for various benign and malignant neoplasms, including cutaneous leiomyomas, uterine fibroids and FH-deficient renal cell carcinoma. While benign, cutaneous and uterine manifestations have a relevant impact on quality of life and risk for complications, the vast majority of FH-deficient RCCs exhibit an aggressive behaviour with invasive growth and the potential for early metastatic spread. Additionally, pathogenic germline FH variants have been associated with other neoplasms, such as adrenal gland and Leydig cell tumours. The aggressive behaviour of FH-deficient RCC challenges nephron-sparing resection strategies, as a wide margin is recommended. Even after early nephrectomy for surgical removal of FH-deficient renal cell carcinomas, there is a relevant risk for distant metastasis as well as the remaining predisposition for de novo primary renal tumours in the other kidney. Active screening is central to HLRCC care since no preventative HLRCC-specific treatment exists. Vascular endothelial growth factor/epidermal growth factor receptor–directed treatment regimes, such as erlotinib/bevacizumab, demonstrate efficacy against HLRCC-associated RCC. This emphasizes the importance of establishing the correct diagnosis in HLRCC early on to guide therapeutic decisions. Morphologic criteria as well as specific immunohistochemical staining and molecular genetics allow the identification of FH-deficient RCC. Changes made in the recent 2022 World Health Organization classification impact the diagnosis of HLRCC in multiple ways. This commentary aims to discuss this impact and raise awareness among pathologists as well as clinicians involved in the care of patients with HLRCC