Correction to: Extreme rainfall in Mediterranean France during the fall: added value of the CNRM-AROME Convection-Permitting Regional Climate Model

International audienceUnfortunately, the article "Extreme rainfall in Mediterranean France during the fall: added value of the CNRM-AROME Convection-Permitting Regional Climate Model", written by Quentin Fumière was originally published electronically on the publisher's internet portal (currently SpringerLink) on 24 July 2019 without open access with incorrect copyright holder as "Springer-Verlag GmbH Germany, part of Springer Nature 2019"

Extreme rainfall in Mediterranean France during the fall: added value of the CNRM-AROME Convection-Permitting Regional Climate Model

International audienceSouth-East France is a region often affected by heavy precipitating events the characteristics of which are likely to be significantly impacted in the future climate. In this study, uc(cnrm-arome), a Convection-Permitting Regional Climate Model with a 2.5 km horizontal resolution is compared to its forcing model, the Regional Climate Model uc(aladin-c)limate at a horizontal resolution of 12.5 km, self-driven by the uc(era-i)nterim reanalysis. An hourly observation dataset with a resolution of 1 km, uc(comephore), is used in order to assess simulated surface precipitation from a seasonal to hourly scale. The representation of the spatial pattern of fall precipitation climatology is improved by uc(cnrm-arome). It also shows a clear added value with respect to uc(aladin-c)limate through the improvement of the localization and intensity of extreme rainfall on a daily and hourly time scale on both fine and coarse spatial scales (2.5, 12.5 and 50 km). uc(cnrm-arome) in particular is able to simulate intense rainfall on lowlands and makes sub-daily rainfall events more intense than uc(aladin-c)limate. uc(cnrm-arome) still underestimates very extreme precipitation from above 30 mm/h or 230 mm/day

Modelling Mediterranean heavy precipitation events at climate scale: an object-oriented evaluation of the CNRM-AROME convection-permitting regional climate model

International audienceModelling the rare but high-impact Mediterranean Heavy Precipitation Events (HPEs) at climate scale remains a largely open scientific challenge. The issue is adressed here by running a 38-year-long continuous simulation of the CNRM-AROME Convection-Permitting Regional Climate Model (CP-RCM) at a 2.5 km horizontal resolution and over a large pan-Alpine domain. First, the simulation is evaluated through a basic Eulerian statistical approach via a comparison with selected high spatial and temporal resolution observational datasets. Northwestern Mediterranean fall extreme precipitation is correctly represented by CNRM-AROME at a daily scale and even better at an hourly scale, in terms of location, intensity, frequency and interannual variability, despite an underestimation of daily and hourly highest intensities above 200 mm/day and 40 mm/h, respectively. A comparison of the CP-RCM with its forcing convection-parameterised 12.5 km Regional Climate Model (RCM) demonstrates a clear added value for the CP-RCM, confirming previous studies. Secondly, an object-oriented Lagrangian approach is proposed with the implementation of a precipitating system detection and tracking algorithm, applied to the model and the reference COMEPHORE precipitation dataset for twenty fall seasons. Using French Mediterranean HPEs as objects, CNRM-AROME's ability to represent the main characteristics of fall convective systems and tracks is highlighted in terms of number, intensity, area, duration, velocity and severity. Further, the model is able to simulate long-lasting and severe extreme fall events similar to observations. However, it fails to reproduce the precipitating systems and tracks with the highest intensities (maximum intensities above 40 mm/h) well, and the model's tendency to overestimate the cell size increases with intensity

Correction to: Modelling Mediterranean heavy precipitation events at climate scale: an object-oriented evaluation of the CNRM-AROME convection-permitting regional climate model

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Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study

International audienceBackground: Technical improvements in devices, changes in angiographic grading scales and various confounding factors have made difficult the detection of the temporal evolution of angiographic and clinical results after endovascular treatment (EVT) for acute ischemic Stroke (AIS). We analyzed this evolution in time using the Endovascular Treatment in Ischemic Stroke (ETIS) registry. Materials and Methods: We analyzed the efficacy outcomes of EVT performed from January 2015 to January 2022, and modelized the temporal trends using mixed logistic regression models, further adjusted for age, intravenous thrombolysis prior to EVT, general anesthesia, occlusion site, balloon catheter use and the type of first-line EVT strategy. We assessed heterogeneity in temporal trends according to occlusion site, balloon catheter use, cardio embolic etiology, age (3 EVT device passes (43.1%–17.5%) and favorable outcome (35.8%–28.9%) decrease significantly over time. A significant heterogeneity in temporal trends in successful reperfusion according to the first-line EVT strategy was found (p-het = 0.018). The temporal trend of increasing successful reperfusion rate was only significant in patients treated with contact aspiration in first-line (adjusted overall effect p = 0.010). Conclusion: In this 7-year-old large registry of ischemic stroke cases treated with EVT, we observed a significant increase with time in the rate of recanalization whereas there was a tendency toward a decrease in the rate of favorable outcome over the same period

Acute surgical management of children with ruptured brain arteriovenous malformation

International audienceObjective: Rupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM.Methods: This study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King's Outcome Scale for Childhood Head Injury.Results: A total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71-0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13-26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3-10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I-II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently.Conclusions: HE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management

Etiology of intracerebral hemorrhage in children: cohort study, systematic review, and meta-analysis

International audienceOBJECTIVEUnderstanding the etiological spectrum of nontraumatic pediatric intracerebral hemorrhage (pICH) is key to the diagnostic workup and care pathway. The authors aimed to evaluate the etiological spectrum of diseases underlying pICH.METHODSChildren treated at the authors’ institution for a pICH were included in an inception cohort initiated in 2008 and retrospectively inclusive to 2000, which was analyzed in October 2019. They then conducted a systematic review of relevant articles in PubMed published between 1990 and 2019, identifying cohorts with pICH. Identified populations and patients from the authors’ cohort were pooled in a multicategory meta-analysis.RESULTSA total of 243 children with pICH were analyzed in the cohort study. The final primary diagnosis was an intracranial vascular lesion in 190 patients (78.2%), a complication of a cardiac disease in 17 (7.0%), and a coagulation disorder in 14 (5.8%). Hematological and cardiological etiologies were disproportionately more frequent in children younger than 2 years (p < 0.001). The systematic review identified 1309 children in 23 relevant records pooled in the meta-analysis. Overall, there was significant heterogeneity. The dominant etiology was vascular lesion, with an aggregate prevalence of 0.59 (95% CI 0.45–0.64; p < 0.001, Q = 302.8, I2 = 92%). In 18 studies reporting a detailed etiological spectrum, arteriovenous malformation was the dominant etiology (68.3% [95% CI 64.2%–70.9%] of all vascular causes), followed by cavernoma (15.7% [95% CI 13.0%–18.2%]).CONCLUSIONSThe most frequent etiology of pICH is brain arteriovenous malformation. The probability of an underlying vascular etiology increases with age, and, conversely, hematological and cardiac causes are dominant causes in children younger than 2 years

Etiology of intracerebral hemorrhage in children: cohort study, systematic review, and meta-analysis

International audienceOBJECTIVEUnderstanding the etiological spectrum of nontraumatic pediatric intracerebral hemorrhage (pICH) is key to the diagnostic workup and care pathway. The authors aimed to evaluate the etiological spectrum of diseases underlying pICH.METHODSChildren treated at the authors’ institution for a pICH were included in an inception cohort initiated in 2008 and retrospectively inclusive to 2000, which was analyzed in October 2019. They then conducted a systematic review of relevant articles in PubMed published between 1990 and 2019, identifying cohorts with pICH. Identified populations and patients from the authors’ cohort were pooled in a multicategory meta-analysis.RESULTSA total of 243 children with pICH were analyzed in the cohort study. The final primary diagnosis was an intracranial vascular lesion in 190 patients (78.2%), a complication of a cardiac disease in 17 (7.0%), and a coagulation disorder in 14 (5.8%). Hematological and cardiological etiologies were disproportionately more frequent in children younger than 2 years (p < 0.001). The systematic review identified 1309 children in 23 relevant records pooled in the meta-analysis. Overall, there was significant heterogeneity. The dominant etiology was vascular lesion, with an aggregate prevalence of 0.59 (95% CI 0.45–0.64; p < 0.001, Q = 302.8, I2 = 92%). In 18 studies reporting a detailed etiological spectrum, arteriovenous malformation was the dominant etiology (68.3% [95% CI 64.2%–70.9%] of all vascular causes), followed by cavernoma (15.7% [95% CI 13.0%–18.2%]).CONCLUSIONSThe most frequent etiology of pICH is brain arteriovenous malformation. The probability of an underlying vascular etiology increases with age, and, conversely, hematological and cardiac causes are dominant causes in children younger than 2 years

Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core

International audienceBackground: Emergent stenting in tandem occlusions and mechanical thrombectomy (MT) of acute ischemic stroke related to large vessel occlusion (LVO-AIS) with a large core are tested independently. We aim to assess the impact of reperfusion with MT in patients with LVO-AIS with a large core and a tandem occlusion and to compare the safety of reperfusion between large core with tandem and nontandem occlusions in current practice. Methods: We analyzed data of all consecutive patients included in the prospective Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and March 2023 who presented with a pretreatment ASPECTS (Alberta Stroke Program Early CT Score) of 0–5 and angiographically proven tandem occlusion. The primary end point was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0–3 at 90 days. Results: Among 262 included patients with a tandem occlusion and ASPECTS 0–5, 203 patients (77.5%) had a successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b-3). Reperfused patients had a favorable shift in the overall mRS score distribution (adjusted odds ratio [aOR], 1.57 [1.22–2.03]; P < 0.001), higher rates of mRS score 0–3 (aOR, 7.03 [2.60–19.01]; P < 0.001) and mRS score 0–2 at 90 days (aOR, 3.85 [1.39–10.68]; P = 0.009) compared with nonreperfused. There was a trend between the occurrence of successful reperfusion and a decreased rate of symptomatic intracranial hemorrhage (aOR, 0.5 [0.22–1.13]; P = 0.096). Similar safety outcomes were observed after large core reperfusion in tandem and nontandem occlusions. Conclusions: Successful reperfusion was associated with a higher rate of favorable outcome in large core LVO-AIS with a tandem occlusion, with a safety profile similar to nontandem occlusion