Usefulness of multislice computerized tomography angiography in preoperative diagnosis of ruptured cerebral aneurysms.

International audienceOBJECTIVE: Non-invasive imaging methods have become primordial in subarachnoid hemorrhage. The aim of our study was to evaluate the sensitivity and specificity of multislice computed tomographic angiography (MSCTA) for the diagnosis of cerebral aneurysm. METHODS: The 28 included consecutive patients with SAH underwent both MSCTA and digital subtraction angiography (DSA). The MSCTA studies were interpreted by two independent readers (A and B) for the presence, the location and size of the aneurysm comparatively to the DSA as reference examination. RESULTS: In 20 patients, 38 aneurysms were diagnosed and in eight no aneurysm was found. Per patient basis, the diagnostic sensitivity and specificity were excellent. Per aneurysm basis, the diagnostic sensitivity and specificity of MSCTA were, respectively, 97.4 and 100% for reader A, 100 and 100% for reader B. For aneurysms less than 3mm, sensitivity was 100% for both readers. Interobserver agreement was excellent for the detection of aneurysm (kappa=0.98, 95% CI [0.96-1]). Intertechnique and interobserver agreements were excellent for the measurement of aneurysms (slope=0.86, r=0.91 p=3.1x10(-7) and slope=1.04, r=0.99, p<10(-6), respectively). CONCLUSION: MSCTA was an accurate and reproducible non-invasive imaging technique for preoperative diagnosis of ruptured cerebral aneurysm. The MSCTA may be proposed in first intention after the diagnosis of SAH was established, with special care regarding injection procedure and a strict reading method using native images and thin MPR

#AIDS Analyse Information Dangers Sexualité : caractériser les discours à propos du VIH dans les forums de santé

National audienceContexte : Les forums de discussion consacrés au VIH remplissent trois fonctions. Tout d'abord, ils sont utilisés par les internautes comme sources d'information pour se renseigner sur les traitements, les risques d'infection liés au sida ou le « vivre avec » la maladie ou le virus. Ensuite, ils servent de média pour les institutions de santé ou les associations afin de communiquer des informations de prévention sur le VIH. Enfin, ils apparaissent comme sources de connaissances pour les professionnels de santé (médecins, soignants) pour comprendre les comportements liés au VIH, et pour les professionnels de la prévention, pour modérer les forums et adapter les campagnes de prévention aux différents publics. Objectif : Notre objectif dans cet article est de proposer un processus d'ingénierie des connaissances com-plet, permettant : 1) de collecter des messages dans des médias sociaux ; 2) de classifier ces messages de manière semi-automatique selon le genre, le niveau d'expertise, le niveau informationnel, le type de risque ainsi que les émotions exprimées ; 3) de visualiser ces nouvelles connaissances dans une représentation ori-ginale prenant en compte la temporalité et la hiérarchie sous-jacente à la classification. Cette visualisation pourrait permettre aux gestionnaires de sites de forums et aux professionnels de santé de naviguer dans le flot de messages pour suivre l'évolution de l'importance de ces thématiques. Méthodes : Notre approche combine une démarche qualitative et quantitative. Nous avons travaillé sur plus de 226 252 messages issus du forum Sida Info Service. Deux chercheurs en sciences de l'information et de la communication ont élaboré une grille d'analyse, puis ont annoté 4 481 messages selon cette grille. Ces données ont été utilisées pour apprendre des classifieurs qui ont permis d'étiqueter l'ensemble des messages du site à notre disposition. Afin de définir les meilleurs classifieurs, nous avons comparé l'efficacité des mé-thodes de classification traditionnelles statistiques et plusieurs architectures d'apprentissage profond. Une fois les messages étiquetés, nous avons utilisé une visualisation de type streamgraph, combinée avec un outil de navigation hiérarchique, pour visualiser l'évolution de ces annotations dans le temps. Résultats : Les résultats sont prometteurs et montrent l'efficacité des méthodes d'apprentissage profond pour caractériser les messages des forums de manière automatique. La méthode de visualisation mise en place permet d'explorer les résultats de ces méthodes et ainsi faciliter l'accès aux connaissances

Adjuvant I-131 Lipiodol After Resection or Radiofrequency Ablation for Hepatocellular Carcinoma.

International audienceHigh rates of recurrence have been observed after curative treatment for hepatocellular carcinoma (HCC). The main aim of this study was to establish the influence of adjuvant transarterial radioembolization-based I-131 lipiodol on survival and recurrence

Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients

International audienc

Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysm : neuropsychological assessment.

International audienc

Side-Channel Analysis of SM2: A Late-Stage Featurization Case Study

SM2 is a public key cryptography suite originating from Chinese standards, including digital signatures and public key encryption. Ahead of schedule, code for this functionality was recently mainlined in OpenSSL, marked for the upcoming 1.1.1 release. We perform a security review of this implementation, uncovering various deficiencies ranging from traditional software quality issues to side-channel risks. To assess the latter, we carry out a side-channel security evaluation and discover that the implementation hits every pitfall seen for OpenSSL's ECDSA code in the past decade. We carry out remote timings, cache timings, and EM analysis, with accompanying empirical data to demonstrate secret information leakage during execution of both digital signature generation and public key decryption. Finally, we propose, implement, and empirically evaluate countermeasures.publishedVersionPeer reviewe

Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

International audienceBackground Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality. Methods For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France. Results Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79–1.26], p = 0.986). Conclusions In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020)

Veno-Arterial Extracorporeal Membrane Oxygenation for Circulatory Failure in COVID-19 Patients: Insights from the ECMOSARS Registry

International audienceObjectives: The clinical profile and outcomes of patients with Covid-19 who require veno-arterial or veno-venous-arterial extracorporeal membrane oxygenation (VA-ECMO - VAV-ECMO) are poorly understood. We aimed to describe the characteristics and outcomes of these patients and to identify predictors of both favorable and unfavorable outcomes.Methods: ECMOSARS is a multicenter, prospective, nationwide French registry enrolling patients who require VV/VA-ECMO in the context of Covid-19 infection (652 patients at 41 centers). We focused on 47 patients supported with VA- or VAV-ECMO for refractory cardiogenic shock.Results: Median age was 49. 14% of patients had a prior diagnosis of heart failure. The most common etiologies of cardiogenic shock were acute pulmonary embolism (30%), myocarditis (28%), and acute coronary syndrome (4%). E-CPR (Extracorporeal Cardiopulmonary Resuscitation) occurred in 38%. In-hospital survival was 28% in the whole cohort, and 43% when E-CPR patients were excluded. ECMO cannulation was associated with significant improvements in pH and FiO2 on day one, but non-survivors showed significantly more severe acidosis and higher FiO2 than survivors at this point (p = 0.030 and p = 0.006). Other factors associated with death were greater age (p = 0.02), higher BMI (p = 0.03), E-CPR (p = 0.001), non-myocarditis etiology (p = 0.02), higher serum lactates (p = 0.004), epinephrine (but not noradrenaline) use before initiation of ECMO (p = 0.003), hemorrhagic complications (p = 0.001), greater transfusion requirements (p = 0.001), and more severe SAVE and SAFE scores (p = 0.01 and p = 0.03).Conclusions: We report the largest focused analysis of VA- and VAV-ECMO recipients in Covid-19. Although relatively rare, the need for temporary mechanical circulatory support in these patients is associated with poor prognosis. However, VA-ECMO remains a viable solution to rescue carefully selected patients. We identified factors associated with poor prognosis and suggest that E-CPR is not a reasonable indication for VA-ECMO in this population