Compositional and mechanical properties of growing cortical bone tissue: a study of the human fibula

International audienc

Compositional and mechanical properties of growing cortical bone tissue: a study of the human fibula

International audienc

Endoscopic mucosal resection with anchoring of the snare tip: multicenter retrospective evaluation of effectiveness and safety

International audienc

A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program

International audienceIntroduction and study aims Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool.Methods A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 – 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones.Results A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively (P < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M (P < 0.001).Conclusion The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp

Gender Differences in Immune Reconstitution: A Multicentric Cohort Analysis in Sub-Saharan Africa

In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution

Neurology

The question of the long-term safety of pregnancy is a major concern in patients with multiple sclerosis (MS), but its study is biased by reverse causation (women with higher disability are less likely to experience pregnancy). Using a causal inference approach, we aimed to estimate the unbiased long-term effects of pregnancy on disability and relapse risk in patients with MS and secondarily the short-term effects (during the perpartum and postpartum years) and delayed effects (occurring beyond 1 year after delivery). We conducted an observational cohort study with data from patients with MS followed in the Observatoire Français de la Sclérose en Plaques registry between 1990 and 2020. We included female patients with MS aged 18-45 years at MS onset, clinically followed up for more than 2 years, and with ≥3 Expanded Disease Status Scale (EDSS) measurements. Outcomes were the mean EDSS score at the end of follow-up and the annual probability of relapse during follow-up. Counterfactual outcomes were predicted using the longitudinal targeted maximum likelihood estimator in the entire study population. The patients exposed to at least 1 pregnancy during their follow-up were compared with the counterfactual situation in which, contrary to what was observed, they would not have been exposed to any pregnancy. Short-term and delayed effects were analyzed from the first pregnancy of early-exposed patients (who experienced it during their first 3 years of follow-up). We included 9,100 patients, with a median follow-up duration of 7.8 years, of whom 2,125 (23.4%) patients were exposed to at least 1 pregnancy. Pregnancy had no significant long-term causal effect on the mean EDSS score at 9 years (causal mean difference [95% CI] = 0.00 [-0.16 to 0.15]) or on the annual probability of relapse (causal risk ratio [95% CI] = 0.95 [0.93-1.38]). For the 1,253 early-exposed patients, pregnancy significantly decreased the probability of relapse during the perpartum year and significantly increased it during the postpartum year, but no significant delayed effect was found on the EDSS and relapse rate. Using a causal inference approach, we found no evidence of significantly deleterious or beneficial long-term effects of pregnancy on disability. The beneficial effects found in other studies were probably related to a reverse causation bias.Observatoire Français de la Sclérose en Plaque

Methodology for the use of longitudinal quantitative biomarkers in medical decision making

Lorsqu'un biomarqueur est mesuré de façon répétée au cours du suivi de patients, il est d'abord nécessaire d'établir un critère, issu du profil d'évolution longitudinal du marqueur, afin de détecter la survenue d'un événement, ou d'en prédire la gravité. Nous avons développé une méthode de modélisation robuste de données longitudinales, afin de calculer les différents critères pour les patients, et d'en comparer les performances diagnostiques ou pronostiques. Dans un second temps, il faut déterminer un seuil de ce critère quantitatif au dessus ou en dessous duquel le test diagnostique est considéré comme positif. Une méthode Bayésienne d'estimation de ce seuil et de son intervalle de crédibilité a été développée. Ce travail a été appliqué au diagnostic de persistance locale de cellules cancéreuses après traitement par ultrasons d'un cancer de la prostate. Ce diagnostic est effectué à partir des mesures répétées d'antigène spécifique de la prostate (PSA), dont le nadir a été retenu, avec différents seuils, comme meilleur critère diagnostique. Ceci permet de n'effectuer des biopsies que lorsqu'il y a de fortes chances qu'elles soient positives.For the early diagnosis or prognosis of an event in presence of repeated measurements of a biomarker over time, it is necessary to define a criterion, stemming from the longitudinal profiles of that marker. A method was developed for a robust modelling of marker measurements, to calculate the various criteria for the patients, and compare their diagnostic or prognostic accuracies. Using the continuous criterion as a diagnostic test requires the specification of a threshold. A Bayesian method was developed to estimate this threshold and its credible interval. This method was applied to the diagnosis of local prostate cancer persistence after an ultrasound treatment. The diagnosis relies on serial measurements of prostate specific antigen (PSA), whose nadir (along with several thresholds) was found to be the best diagnostic criterion. This allows to trigger biopsy only when this biopsy is likely to be positive

Méthodologie de l’utilisation des biomarqueurs quantitatifs longitudinaux pour l’aide à la décision en médecine. Application aux PSA dans le cancer de la prostate

For the early diagnosis or prognosis of an event in presence of repeated measurements of a biomarker over time, it is necessary to define a criterion, stemming from the longitudinal profiles of that marker. A method was developed for a robust modelling of marker measurements, to calculate the various criteria for the patients, and compare their diagnostic or prognostic accuracies. Using the continuous criterion as a diagnostic test requires the specification of a threshold. A Bayesian method was developed to estimate this threshold and its credible interval. This method was applied to the diagnosis of local prostate cancer persistence after an ultrasound treatment. The diagnosis relies on serial measurements of prostate specific antigen (PSA), whose nadir (along with several thresholds) was found to be the best diagnostic criterion. This allows to trigger biopsy only when this biopsy is likely to be positive.Lorsqu'un biomarqueur est mesuré de façon répétée au cours du suivi de patients, il est d'abord nécessaire d'établir un critère, issu du profil d'évolution longitudinal du marqueur, afin de détecter la survenue d'un événement, ou d'en prédire la gravité. Nous avons développé une méthode de modélisation robuste de données longitudinales, afin de calculer les différents critères pour les patients, et d'en comparer les performances diagnostiques ou pronostiques. Dans un second temps, il faut déterminer un seuil de ce critère quantitatif au dessus ou en dessous duquel le test diagnostique est considéré comme positif. Une méthode Bayésienne d'estimation de ce seuil et de son intervalle de crédibilité a été développée. Ce travail a été appliqué au diagnostic de persistance locale de cellules cancéreuses après traitement par ultrasons d'un cancer de la prostate. Ce diagnostic est effectué à partir des mesures répétées d'antigène spécifique de la prostate (PSA), dont le nadir a été retenu, avec différents seuils, comme meilleur critère diagnostique. Ceci permet de n'effectuer des biopsies que lorsqu'il y a de fortes chances qu'elles soient positives