Traitements endovasculaires d'exclusion des anévrysmes du système vertébro-basilaire (à propos de 23 observations)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge radiologique et suivi des hémoptysies (à propos de 69 cas)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les fistules durales artério-veineuses intracrâniennes (à propos de 16 cas)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

OTELHO : Vers une horticulture connectée, suivi des macroorganismes pour réduire les pesticides

L’acceptabilité environnementale des cultures horticoles est questionnée aujourd’hui notamment au regard de l’usage des pesticides. Le projet OTELHO a développé un outil d’aide à la décision nommé S@M, utile au suivi des cultures et à la connaissance des épidémies, étape indispensable à la prise de décision d’intervention. Pour répondre aux enjeux environnementaux et de santé, les partenaires de ce projet DEPHY EXPE ont construit à la fois un réseau expérimental et une méthode de travail centrée sur la co-conception. Ils ont éprouvé l’outil S@M et caractérisé une combinaison de solutions techniques viables permettant de réduire significativement l’usage des pesticides en horticulture. Les travaux ont été conduits à la fois en station expérimentale et en exploitation sur trois systèmes, les plantes en pots, le gerbera fleurs coupées, le rosier fleurs coupées. A l’issue de six années de prototypage de l’OAD S@M divers modules sont aujourd’hui stabilisés et utilisés par les expérimentateurs et les conseillers en entreprise. Les essais sur les différents systèmes de culture ont permis de valider dans certaines conditions des combinaisons de leviers pour réduire l’usage des pesticides de plus de 50%.The environmental acceptability of horticultural crops is questioned today, particularly with regard to the use of pesticides. The OTELHO project has developed a S@M decision support tool, useful for crop monitoring and knowledge of epidemics, an essential step in decision making. To meet the environmental and health challenges, DEPHY EXPE project partners have built both an experimental network and a co-design-centered work method to test the S@M tool and characterize a combination of technical viable solutions to significantly reduce the use of pesticides in horticulture. The work was conducted both in experimental station and in farms on three systems, potted plants, gerbera cut flowers, rose cut flowers. After six years of prototyping the OAD S@M various decision support modules are now stabilized and used by the experimenters and business consultants. Trials on different cropping systems made it possible to validate combinations of levers under certain conditions to reduce the use of pesticides by more than 50%

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons