Cancers des glandes salivaires : nouvelles approches thérapeutiques [Salivary gland cancer: new therapeutic approaches]

Salivary gland carcinomas are rare, characterized by a diversity of histological subtypes associated with variable clinical behavior and prognosis with usually a poor response to chemotherapy. In this context, molecular alterations have been identified and represent potential therapeutic targets: overexpression of human epidermal growth factor receptor 2 (HER2) and androgen receptors in salivary duct cancer, NOTCH mutations in adenoid cystic carcinoma, NTRK gene fusion in secretory carcinoma. Screening for these molecular alterations is mandatory in all patients with recurrent or metastatic salivary gland cancer as it may allow an individualized treatment

Shunt dysfunction patterns after transjugular intrahepatic portosystemic shunt creation using a combination of a generic stent-graft and bare-stents.

Even though transjugular intrahepatic portosystemic shunt (TIPS) using Fluency Stent-grafts provides good shunt patency rates, shunt dysfunction is a great concern after TIPS creation, occurring in up to 20% of cases within one year. The objective of this study was to describe shunt dysfunction patterns after TIPS creation using a combination of generic stent-grafts/bare-stents. Single-center retrospective study of all TIPS revisions between January 2005 and December 2020. TIPS revision angiograms were analyzed for stents' positions, stenoses' diameters, and stenoses' locations. Out of 99 TIPS, a total of 33 TIPS revisions were included. The median time to TIPS revision was 10.4 months. Angiograms showed four patterns of TIPS dysfunction-associated features (DAF), defined as follows: Type 1 was defined as stenosis located after the stent end in the hepatic vein (HV), type 2 as intra-stent stenosis located in the hepatic vein, type 3 as intra-stent stenosis or a kink in the parenchymal tract or the portal vein end of the TIPS, and type 4 as a complete TIPS occlusion. Types 1, 2, 3, and 4 were seen in 23 (69.7%), 5 (15.2%), 2 (6.1%), and 3 (9.1%) TIPS respectively. TIPS revision was successful in 30 (90.1%) patients with median pre- and post-TIPS revision PSG of 18.5 mmHg and 8 mmHg respectively (p < .001). Our results illustrate the four angiographic patterns of TIPS DAF after TIPS creation using a combination of generic stent-grafts/bare-stents and emphasize the need for appropriate stent length extending to the HV/inferior vena cava junction

Phagothérapie pour traiter les infections respiratoires [Phage therapy for respiratory infections]

The crisis of antibiotic resistance represents a global public health challenge, affecting particularly patients with respiratory infections. The use of (bacterio)phages for the treatment of bacterial infections (phage therapy) seems safe but its effectiveness has not yet been proven by controlled clinical trials. Nevertheless, phage therapy is regaining interest, encouraged by published cases treated successfully with personalized phage combinations as well as significant advances at a preclinical level. Standardized approaches in phage production and treatment administration, as well as future translational studies, are needed to improve our understanding and explore the potential of phage therapy

Ataxie cérébelleuse subaiguë : une atteinte atypique par le SARS-CoV-2 chez la personne âgée [Subacute cerebellar ataxia, an uncommon SARS-CoV-2 complication infection in older adults]

Cerebellar ataxia can be caused by neoplasia, toxics (drugs, heavy metals, alcohol), infection, vascular lesions or auto-immune and paraneoplastic pathologies. Neuroimaging must be performed urgently in case of sudden onset and serologies as well as a lumbar puncture should be performed. Several case reports of ataxia associated with COVID-19 have been published, however the underlying pathogenic mechanisms remain unclear. This is a diagnosis of exclusion when other causes are ruled out and when the ataxia appears simultaneously to COVID-19 infection. We lack data on best management, but the prognosis appears mostly favorable with good functional recovery without any specific treatment. This paper describes the case of a patient who developed a cerebellar ataxia as the only neurological manifestation of a SARS-CoV-2 infection

Polysémie de l’agitation chez le sujet dément [Polysemy of agitation in dementia]

Agitation is a common feature in people with dementia. Agitation can be the clinical expression of a medical condition comorbid with dementia or a behavioural and psychological symptom of dementia. In both cases, it is a clinical manifestation and not a disease in itself. This polysemy of agitation invites us to think of a global care of the demented subject taking into account the subject in his environment and their history. Reducing the treatment of agitation to sedating it amounts to a reification of the demented subject

5 minutes pour apprendre. Hallucination ne rime pas avec halopéridol [Haloperidol is not the first choice for every case of delirium]

Haloperidol is frequently used as first-line treatment for delirium. The Swiss Smarter medicine campaign recommends to favor non-pharmacological interventions and treatment of the underlying causes, in order to limit the use of haloperidol. When antipsychotics are necessary, they should be prescribed cautiously, taking into account contraindications and potential side effects. This article emphasizes the importance of history taking in patient with delirium before prescribing haloperidol

Tail Risks and Private Equity Performance

We examine the drivers of private equity in response to the fully exogenous Covid-19 shock, employing listed private equity as a proxy for traditional non-listed private equity. This approach enables us to reliably measure firm characteristics and performance in real-time. Listed private equity firms, on average, underperformed significantly during the crisis, with a performance drop ranging from 9.2% to 43.6%, depending on the model used. However, there is substantial crosssectional variation driven by unique firm-level attributes including access to capital, liquidity, transparency, and ownership structure. Listed private equity with better access to capital and higher transparency shows resilience during the crisis, while higher illiquidity and opacity exacerbate the negative effects. This study offers early evidence on Covid-19's impact on private equity firms, highlighting value drivers and performance dynamics of this alternative asset class during a period of extreme tail risk

Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit.

To review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs. Twenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution. The patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined-open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement. LTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach