La sculpture romaine en Occident

Cet ouvrage réunit les résultats de deux manifestations complémentaires  : d’une part, la table ronde intitulée «  Rendre à César  », organisée le mercredi 20 juin 2012, à Paris, au Musée du Louvre et, d’autre part, les «  Rencontres autour de la sculpture romaine conservée en France  » qui ont eu lieu du 18 au 20 octobre 2012 au Musée départemental Arles antique. La richesse des interventions lors de ces deux manifestations permet de restituer un ouvrage composé de trente-huit articles, répartis en trois parties et une conclusion. La première partie, en écho et en développement de la table ronde du Louvre, porte sur le portrait du «  César du Rhône  », aussi bien que sur «  Le portrait romain en Gaule  ». La deuxième partie publie cinq études autour des «  nouvelles techniques d’investigations scientifiques  » et présente l’analyse des matériaux des sculptures en pierre et en bronze, découvertes dans le Rhône à Arles, ainsi qu’une étude ethnoarchéologique sur les techniques de production du portrait. Enfin une troisième partie présente les «  découvertes récentes et les nouvelles recherches  », déclinées en seize études qui sont consacrées à des études de cas (Autun, Vaison-la-Romaine, Nîmes, Metz-Divodurum, Apt), ainsi qu’à des relectures novatrices de sculptures méconnues (Plouarzel, Langres, Avignonet-Lauragais, Vernègues, vallée de l’Ubaye, Besançon, Lyon). Robert Turcan signe la conclusion. Ainsi, «  La sculpture romaine en Occident. Nouveaux regards   » reflète la variété et l’intérêt des questionnements actuels dans ce domaine

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Charateristics of severe asthmatic patients followed in the pulmonology department of Bordeaux university hospital center between 2016 and 2018

L’asthme sévère est considéré comme un problème de santé publique. Les études menées chez ces patients ont permis de mieux comprendre l’hétérogénéité de cette maladie et ont conduit au développement de biothérapies. Il persiste cependant une part d’ombre, car même si ces nouvelles thérapeutiques représentent un réel progrès dans la prise en charge de l’asthme sévère, ils n’ont pas la même efficacité chez tous les patients. A l’ère de la médecine personnalisée, la mise en route du traitement susceptible d’être efficace pour un patient donné, passe par une meilleure compréhension des phénotypes et endotypes. C’est dans ce contexte que s’inscrit notre étude dont l’objectif est de décrire les caractéristiques des patients asthmatiques sévères suivis au CHU de Bordeaux. Il s’agit d’une étude observationnelle, rétrospective, monocentrique ayant concerné les patients asthmatiques sévères, suivis en pneumologie de 2016 à 2018. Les données de 299 patients asthmatiques sévères ont pu être analysées. Cette population avait un âge moyen de 55 ans, était composée en majorité de femmes, de personnes en surpoids. Plus de la moitié des patients avait une maladie ayant débuté à l’âge adulte et présentaient une atopie. L’atteinte ORL n’était pas rare avec dans la majorité des cas, une rhinite. La comorbidité la plus fréquente était le RGO. La majorité de la population avait une inflammation de type Th-2. La fonction respiratoire de ces patients était modérément altérée avec un VEMS moyen de 71,42% de la théorique. L’anomalie scannographique thoracique la plus décrite était l’épaississement des parois bronchiques. 22% des patients prenaient une CSO au long cours avec une dose annuelle moyenne de plus de 1 g. Les trois biothérapies les plus prescrites étaient : l’Omalizumab, le Mepolizumab et le Dupilumab. Une meilleure compréhension des phénotypes de ces patients conduira à terme à une prise en charge optimale de leur pathologie.Severe asthma is considered as a serious public health problem. Studies conduct on severe asthma patients have permitted to better understand the heterogeneity of this disease and lead to the development of new targeted therapies. Even though these new treatments represent a significant progress in the management of severe asthma patients, there are still unmet needs because a number of patients don’t respond to these therapeutics. On this new era of personalized medicine, the initiation of a treatment that has a best chance of being effective relies on a better understanding of phenotypes and endotypes. It is in this context that our work fit, its objective is to describe the characteristics of severe asthmatics treated at the university hospital center of Bordeaux. This is an observational, retrospective, single-center study concerning severe asthma patients followed in the pulmonology department from 2016 to 2018. The data of 299 severe asthmatics patients were analyzed. This population had a mean age of 55 years, was composed mostly of women, of people who are overweight. More than half of these patients had a disease that started in adulthood and were atopic. An ENT injury was not rare, and rhinitis was the most commonly seen. The most frequent comorbidity was GERD. The majority of the population has a TH-2 inflammation based on the results of their biomarkers. The respiratory function of these patients was moderately altered. The most frequent abnormality seen on thoracic CT-scan was the thickening of bronchial walls. 22% of these patients took long term oral corticoids at a mean annual dose of more the one gram. The three biotherapies mostly prescribed were: Omalizumab, Mepolizumab and Dupilumab. A better comprehension of the phenotypes of these patients will conduct at term to an optimal management of their disease

Rapid Improvement after Starting Elexacaftor–Tezacaftor–Ivacaftor in Patients with Cystic Fibrosis and Advanced Pulmonary Disease

International audienceRationale: Elexacaftor-tezacaftor-ivacaftor is a CFTR (cystic fibrosis [CF] transmembrane conductance regulator) modulator combination, developed for patients with CF with at least one Phe508del mutation. Objectives: To evaluate the effects of elexacaftor-tezacaftor- ivacaftor in patients with CF and advanced respiratory disease. Methods: A prospective observational study, including all patients aged ⩾12 years and with a percent-predicted FEV1 (ppFEV1) <40 who initiated elexacaftor-tezacaftor-ivacaftor from December 2019 to August 2020 in France was conducted. Clinical characteristics were collected at initiation and at 1 and 3 months. Safety and effectiveness were evaluated by September 2020. National-level transplantation and mortality figures for 2020 were obtained from the French CF and transplant centers and registries. Measurements and Main Results: Elexacaftor-tezacaftor- ivacaftor was initiated in 245 patients with a median (interquartile range) ppFEV1 = 29 (24-34). The mean (95% confidence interval) absolute increase in the ppFEV1 was +15.1 (+13.8 to +16.4; P < 0.0001), and the mean (95% confidence interval) in weight was +4.2 kg (+3.9 to +4.6; P < 0.0001). The number of patients requiring long-term oxygen, noninvasive ventilation, and/or enteral tube feeding decreased by 50%, 30%, and 50%, respectively (P < 0.01). Although 16 patients were on the transplant waiting list and 37 were undergoing transplantation evaluation at treatment initiation, only 2 received a transplant, and 1 died. By September 2020, only five patients were still on the transplantation path. Compared with the previous 2 years, a twofold decrease in the number of lung transplantations in patients with CF was observed in 2020, whereas the number of deaths without transplantation remained stable. Conclusions: In patients with advanced disease, elexacaftor-tezacaftor-ivacaftor is associated with rapid clinical improvement, often leading to the indication for lung transplantation being suspended