La transition écologique du système de santé et des établissements

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Understanding dopaminergic dose reduction following STN-DBS: mediation analysis

International audienceBackground Levodopa equivalent dopaminergic dose (LEDD) reduction after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease varies widely. Identifying predictors may guide patient selection and programming. Our objectives were to identify predictors of LEDD reduction and to test whether motor improvement mediates this association. Methods Data from 144 patients treated by STN-DBS were analysed. Predictors of LEDD reduction were selected using the Boruta algorithm, a machine-learning method comparing variable importance to randomised features and then tested in a structural equation model for direct and motor-mediated effects. Results Mean LEDD reduction was 41.7% (±38.2%) and motor improvement was 48.6% (±26.7%) at 1 year. Among the four predictors identified by Boruta, lower baseline LEDD (β=0.39, p=0.001), greater axial impairment (β=−0.25, p=0.003) and higher total volume of tissue activated (β=−0.17, p=0.031) were directly associated with lower LEDD reduction, independent of motor improvement. Sensorimotor STN overlap was not directly linked to LEDD reduction but was positively associated with motor improvement (β=0.34, p=0.001), which showed a trend-level effect on LEDD reduction (β=0.16, p=0.065). The total effect of sensorimotor STN overlap on LEDD reduction was not significant. Discussion Dopaminergic dose reduction after STN-DBS is constrained by preoperative axial symptoms and stimulation spread, independently of motor improvement, while sensorimotor STN overlap improves motor symptoms but not dose reduction. Integrating motor phenotype with anatomical guidance may enhance medication management post DBS

Effects of deep brain stimulation on non motor fluctuations in Parkinson’s disease (assessed with the NMF severity scale)

International audienceBackground: Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) is a well-established treatment for motor fluctuations (MF) in Parkinson's disease (PD), but its impact on non-motor fluctuations (NMF) remains unclear. As NMFs are frequent, disabling, and affect quality of life, understanding their response to DBS is critical.Objectives: To assess the presence of NMF after STN-DBS, identify preoperative factors of improvement, and compare NMF responses to DBS and levodopa.Methods: This project is an ancillary study of the French multicenter PREDISTIM cohort. We used the validated Non-Motor Fluctuation Severity Scale (NMF2S) to evaluate NMFs one year after STN-DBS and before surgery when data were available. Evaluations were performed under standardized conditions (OFF-Dopa/OFF-Stim vs. OFF-Dopa/ON-Stim).Results: We included 284 PD patients assessed one year after STN-DBS using the NMF2S scale. Preoperative data were available for 153 patients. Evaluations were performed under standardized stimulation conditions (OFF-Dopa/OFF-Stim vs. OFF-Dopa/ON-Stim).STN-DBS led to a 41.1% reduction in NMF severity, with anxiety, concentration difficulties, and pain showing the most improvement. However, DBS effects were less pronounced than those of levodopa, especially for psychiatric symptoms. NMF improvement did not correlate with motor improvement. Among all preoperative variables, only the levodopa response in the cognitive domain was associated with post-DBS NMF benefit.Conclusions: STN-DBS significantly improves NMFs, although to a lesser extent than levodopa. The dissociation between motor and non-motor responses underscores the need for specific markers to predict NMF outcomes. These findings support the integration of NMF assessment into DBS indications and patient selection

A nationwide 12‐month observatory of automated insulin delivery shows improved glucose control, sustained adoption, and reduced acute severe events

International audienceAims: A nationwide observational study was conducted to assess the 12-month effectiveness of AID systems in the routine care of people with Type 1 diabetes (PwT1D).Methods: All PwT1D, adults, and children, who initiated AID between January 1, 2022, and December 31, 2022, were included across 79 centres. Clinical data, continuous glucose monitoring (CGM) parameters, acute severe events in the last year, and HbA1c levels were collected at AID initiation, and after 3, 6, and 12 months of AID treatment. Median values [interquartile range, IQR] and % PwT1D with acute severe events were reported. The primary outcome was the change in time in range (TIR; 3.9-10 mmol/L) after 1 year with AID.Results: A total of 2741 PwT1D were included: 44.4% male, age 38 years [29], BMI 24.5 kg/m2 [6.7], diabetes duration 19 years [20]. AID systems were MiniMed 780G in 49.7%, Tandem Control-IQ in 49.3%, others in 1%. After 12 months, TIR increased from 58.0 [21] to 70.1% [14] while HbA1c levels decreased from 7.6 [1.2] to 7.0% [0.8]. Percent PwT1D experiencing severe hypoglycaemia (SH) decreased from 4.1 to 0.9%, and ketoacidosis from 1.2 to 0.6%. All improvements were observed after 3 months, sustained through 12 months, and statistically significant (p < 0.05). Only 2.8% of PwT1D discontinued AID.Conclusions: Twelve months of AID use in routine care improved glucose control in PwT1D, among whom there was less experienced SH and a minor discontinuation

Reconstructing a Sphere and the Camera Focal Length from a Single View by Fitting Planes

International audienceWe address two problems. First, reconstructing a sphere of a prescribed radius from a single calibrated view of its occluding contour. Second, reconstructing simultaneously a sphere of a prescribed radius and the camera focal length from a single view of the sphere's occluding contour. A sphere's occluding contour generally appears as an ellipse and existing reconstruction methods use ellipse fitting, thus requiring ≥ 5 contour points. The calibrated minimal solution requires 3 points, and a few methods can deal with it. The minimal solution with an unknown focal length requires 4 points, and there exists no method to deal with it. All existing methods share two shortcomings: (i) they fail for non-elliptic occluding contours, including parabola and hyperbola, and (ii) they use the point-to-ellipse distance, whose computation is not closed-form. On the first problem, we make the observation that the spherically-normalised contour points form a circle in space, which we reconstruct by plane fitting. This handles minimal 3-point and redundant > 3 point fitting, copes with elliptic and non-elliptic contours, and benefits from the simple point-to-plane distance. The reconstructed circle then leads to a one-parameter sphere family from which the actual sphere of prescribed radius is uniquely retrieved. We name our method SpherO, where letter 'O' depicts a circle. We robustify SpherO using random sampling at the 3-point plane fitting stage. Experimental comparisons show that SpherO outperforms the current-best 3-point method. On the second problem, we make the observation that the sphericallynormalised contour points generally form a non-circular spatial elliptic curve for wrong camera parameters. The calibration constraint is thus that the sphericallynormalised points must be cocircular, which implies coplanarity. The coplanarity constraint allows us to solve the minimal 4-point case. We solve redundant > 4 point case by fitting planes. This simultaneously reconstructs a circle and the camera focal length from a non-circular spatial elliptic curve. Finally the reconstructed circle and the camera focal length allow us to retrieve the sphere of prescribed radius. We name our method SpherOf, where letter 'f' is for the focal length. We robustify SpherOf using random sampling at the 4-point coplanarity constraint formation and 3-point plane fitting stages. Experiments show that SpherOf has comparable performance to SpherO

Comparaison du dosage de la tryptasémie entre deux automates : NOVEOS Flex® vs Phadia® 250

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Bacterial translocation and intestinal permeability in early axial spondyloarthritis association with 5-year outcomes: insights from the DESIR cohort

International audienceAbstract Objectives To evaluate the association between initial serological markers of intestinal permeability (IP) and bacterial translocation (BT), and the development of extra-musculoskeletal manifestations (EMM) and radiographic progression in axial spondyloarthritis (axSpA). Methods Serum samples from axSpA patients included in the DESIR cohort with clinical data available at 5 years were analyzed. Gut permeability was assessed by zonulin levels and BT was assessed by lipopolysaccharide (LPS)-derived 3-hydroxymyristate and phospholipid transferase protein (PLTP) levels. The associations of baseline serological markers with the presence of EMM and imaging sacroiliac scores were analyzed both at baseline and as primary outcomes of disease progression after 5 years follow-up. Associations were tested using univariate and multivariate logistic regression analyses. Results A total of 297 patients were included (mean age 31.5 ± 7.4 years; 48.5% female; 88.9% HLA-B27 positive). Baseline levels of 3-hydroxymyristate, PLTP activity, and zonulin showed no association with the presence or incidence of EMM. Baseline zonulin levels were lower in patients with baseline radiographic sacroiliitis (88.1 ng/ml vs. 140.6 ng/ml, p < 0.001), though this was not confirmed in multivariate linear regression. PLTP activity was positively correlated with the baseline SPARCC sacroiliac joint score (β = 0.61, p = 0.02), and this association remained significant after adjusting for age, sex, and CRP (β = 0.58, p = 0.03). Moreover, PLTP activity was significantly higher in patients with radiographic sacroiliitis progression (6.1 vs. 5.2 nmol/h/ml, p = 0.02), an effect maintained after adjustment (β = 0.27, p = 0.02). Conclusion PLTP activity is a promising biomarker associated with sacroiliac joint inflammation and radiographic progression over 5 years in recent axSpA

Craving in eating disorders: Mapping the concept through a systematic review

International audiencePurpose: Craving, long considered a hallmark of addictive disorders, has increasingly been recognized as a clinically significant phenomenon in eating disorders (ED). Yet, its conceptualization, measurement, and role in ED pathology remain inconsistent and fragmented. This review aimed to map existing knowledge through a systematic review. Methods: Searches were conducted in July 2025 in Embase, PsycInfo, and Web of Science. Eligible records were peer-reviewed studies including adults clinically diagnosed with ED. Fifty studies and fifteen reviews met the inclusion criteria. Results: Most studies examined bulimia nervosa (BN) and binge-eating disorder (BED), while anorexia nervosa (AN) and non-food-related cravings (e.g., exercise, vomiting, purging) were rarely addressed. Definitions of craving varied, sometimes conflating strong desire with loss of control or subsequent behaviors. Theoretical models were inconsistent, often borrowed from addiction research, and rarely integrated neurobiological findings. Craving assessment relied mainly on visual analogue scales (VAS) and the Food Cravings Questionnaire (FCQ), with limited use of qualitative, psychophysiological, or neurocognitive methods. Interventions specifically targeting craving were scarce. Cue exposure therapy (including virtual reality), neurofeedback, and noninvasive brain stimulation-repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)-showed encouraging but mixed effects. Across ED, craving was consistently associated with binge eating, with trait craving emerging as a stronger predictor than state craving. Conclusions: Craving is central yet conceptually elusive in ED. Establishing a consensual definition, developing theory-driven and transdiagnostic assessment tools, and expanding research beyond food and binge-related disorders are priorities to advance understanding and improve interventions.</div

How Statistical Methods, Hemispheric Data and Masking Approaches Shape Probabilistic Sweet Spots in Deep Brain Stimulation

ACLInternational audienceObjective: Probabilistic mapping is increasingly used to identify optimal stimulation regions (Probabilistic Sweet Spots, PSS) in Deep Brain Stimulation (DBS). Outcomes, however, depend on workflow parameters. This study examined how methodological and data-handling choices affect PSS stability and spatial consistency across varying sample sizes. Methods: Intraoperative stimulation test data from 36 Parkinson's Disease patients were analyzed. PSS were computed across increasing sample sizes using four statistical approaches: Bayesian t-test (BAYES), Logistic Regression Model (LRM), Wilcoxon test with FDR correction (WFDR), and Wilcoxon test with permutation correction (WPERM). We assessed the effects of statistical tests, hemispheric data handling, and masking parameters (i.e., minimum number of patients and stimulations per voxel) on PSS stability and consistency, evaluated in terms of size and spatial location. Results: BAYES was more robust at small to intermediate sample sizes, while WFDR and LRM stabilized only in larger cohorts (∼25–30 patients). WPERM consistently underperformed. Stability was higher in the left hemisphere. Combining hemispheres did not improve stability, suggesting asymmetries in stimulation effects. Masking parameters mainly affected PSS volume, with stricter thresholds reducing absolute size, but did not alter stability patterns. Conclusion: Statistical test choice, hemispheric analysis, and masking parameters strongly influence PSS outcomes. The Bayesian t-test is recommended for small to intermediate cohorts, and hemispheres should be analyzed separately to avoid masking clinically relevant asymmetries. Significance: By highlighting the interplay between sample size, statistical methods, hemispheric data, and masking strategies, this work contributes to standardizing probabilistic mapping practices and improving their reliability for clinical translation

Obtention de la vue critique de sécurité (VCS) lors d’une cholécystectomie par voie cœlioscopique pour lithiase vésiculaire symptomatique

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