[Senile systemic amyloidosis: definition, diagnosis, why thinking about?].

International audienceSenile systemic amyloidosis (SSA) is characterized by infiltration of amyloid transthyretin fibrils in the myocardium. SSA occurs mainly (but not always) in elderly men. SSA leads to hypertrophic and/or restrictive cardiomyopathy complicated by conduction disturbances, atrial arrhythmia and systemic embolization (stroke...). That is why SSA needs a special care and to be diagnosed. Cardiac SSA diagnosis needs to exclude two other forms of cardiac amyloidosis: AL amyloidosis (light chain) and hereditary transthyretin amyloidosis (genetic testing). Scintigraphic 99mTc-DPD heart retention is observed in cardiac amyloidosis. DPD heart retention is more frequent in cardiac transthyretin amyloidosis than in cardiac AL amyloidosis. Specific treatments of cardiac TTR amyloidosis are in development

Lenalidomide in combination with melphalan and dexamethasone in patients with newly-diagnosed AL amyloidosis: a multicenter phase 1/2 dose escalation study.

International audienceNew treatment options are required for primary systemic AL amyloidosis (AL). This phase 1 / 2 dose-escalation study aimed to determine the maximum tolerated dose (MTD) of lenalidomide in combination with melphalan and dexamethasone (M-dex), and to assess the efficacy and tolerability of this therapy for patients with de novo AL. Twenty-six patients were enrolled across 4 cohorts: M-dex plus lenalidomide 5, 10, 15 and 20 mg once daily on days 1-21 in a 28-day cycle. No DLT was observed in cohort n degrees 1, 2 and 3. Four patients / 7 in cohort n degrees 4, M-dex + lenalidomide 20 mg/day, experienced dose-limiting toxicity. 15 mg lenalidomide was defined as MTD. A complete hematologic response was achieved in 42% at the dose of 15 mg of lenalidomide / day. After a median follow-up of 19 months, estimated 2-year overall survival and event-free survival (EFS) were 80.8% and 53.8%, respectively. Hematologic and organ responses were both associated with superior EFS rates (P = .0001). A higher EFS was also observed in patients whose free light chains decreased by more than 50% during therapy (P = .019). Lenalidomide 15 mg/day plus M-dex is a new effective combination therapy in patients with newly diagnosed AL. This study is registered at http://clinicaltrials.gov as NCT00621400

Unlocking the Smartphone's Sensors for Smart City Parking

An early version of this work appeared in the Proc. of IEEE ICC 2016 (Krieg et al., 2016)International audienceStudies have shown that drivers often spend over 20 min cruising for parking in city centers, accounting for as much as 30% of the traffic congestion. In response, cities like San Francisco have deployed systems capable of providing drivers real-time parking availability information. However, such systems rely on specialized infrastructure whose installation and maintenance costs in the tens of millions of dollars, unaffordable for many cities. We present SmartPark, a system for real-time parking information that relaxes the requirement for specialized infrastructure, relying instead on the smartphone’s sensors and the ubiquitous Wi-Fi and cellular infrastructure. To accomplish this, SmartPark addresses two major challenges, under the constraint of minimum impact on battery life: transportation mode detection and location matching. To minimize initial deployment cost and risk, SmartPark introduces an analytical approach for estimating parking availability even when only a small fraction of users adopt the application. We evaluate SmartPark using simulations and in the wild. Simulation results show that SmartPark, benefiting from as little as 20% adoption rate, can estimate parking availability with accuracy above 90%. Experimental results with the help of 12 volunteers show that SmartPark detects unparking events 97% of the time while triggering zero false positives

A GEIL flow cytometry consensus proposal for quantification of plasma cells: application to differential diagnosis between MGUS and myeloma.

This standardized multiparameter flow cytometric approach allows for the detection and quantification of bone marrow tumor plasma-cell infiltration in nearly all cases of MGUS and myeloma, independently of debris and hemodilution. This approach may also prove useful for the detection of minimal residual disease

Risk stratification for hospital-acquired venous thromboembolism in medical patients (RISE): Protocol for a prospective cohort study

Background: Hospital-acquired venous thromboembolism (VTE) is one of the leading preventable causes of in-hospital mortality. However, its risk assessment in medically ill inpatients is complicated due to the patients' heterogeneity and complexity of currently available risk assessment models (RAMs). The simplified Geneva score provides simplicity but has not yet been prospectively validated. Immobility is an important predictor for VTE in RAMs, but its definition is inconsistent and based on subjective assessment by nurses or physicians. In this study, we aim to prospectively validate the simplified Geneva score and to examine the predictive performance of a novel and objective definition of in-hospital immobilization using accelerometry. Methods and analysis: RISE is a multicenter prospective cohort study. The goal is to recruit 1350 adult inpatients admitted for medical illness in three Swiss tertiary care hospitals. We collect data on demographics, comorbidities, VTE risk and thromboprophylaxis. Mobility from admission to discharge is objectively measured using a wrist-worn accelerometer. Participants are followed for 90 days for the occurrence of symptomatic VTE (primary outcome). Secondary outcomes are the occurrence of clinically relevant bleeding, and mortality. The evolution of autonomy in the activities of daily living, the length of stay, and the occurrence of readmission are also recorded. Time-dependent area under the curve, sensitivity, specificity, and positive and negative predictive values are calculated for each RAM (i.e. the simplified and original Geneva score, Padua, and IMPROVE score) with and without the objective mobility measures to assess their accuracy in predicting hospital-acquired VTE at 90 days. Ethics and expected impact: The ethics committee approved the protocol and the study was registered on ClinicalTrials.gov as NCT04439383. RISE has the potential to optimize VTE risk stratification, and thus to improve the quality of care of medically hospitalized patients.</p