VASAO: visible all sky adaptive optics: a new adaptive optics concept for CFHT

International audienceVASAO is an ambitious project that explores new conceptual direction in the field of astronomical adaptive optics. In the era of 8 meter and larger telescopes, and their instrument costs and telescope time pressure, there is a natural niche for such ground-breaking conceptual development in the 4 meter class telescope. The aim of VASAO is to provide diffraction limited imaging in the visible with 100% sky coverage; the challenge (but potential rewards) arises from the simultaneity of these requirements. To this end, CFHT is conducting a feasibility study based on the polychromatic guide star concept (Foy et al., 1995 [4]) coupled with a high order curvature AO system, presented in this paper. A number of experiments have been started (or carried out) to study the challenges and limits of the techniques involved in an operational setting; these include the FlyEyes detector, and a polychromatic tip-tilt test on natural stars. Because such a project straddles such a fine line between facility instrument and experimental facility, careful thought has to be given to the balance between modes of operations and potential astrophysical targets

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Management of knee and hip osteoarthritis; public health aspects

L’arthrose est la maladie articulaire la plus fréquente pouvant être responsable d’une perte d’autonomie et d’un handicap fonctionnel majeur. Du fait du vieillissement de la population et de la prévalence de l’obésité, le nombre de personnes ayant une arthrose des membres inférieurs va augmenter dans les années à venir et entrainer une explosion des dépenses de santé. La cohorte « Knee and Hip OsteoArthritis Long-term Assessment » (KHOALA) est une cohorte française multicentrique représentative de patients atteints d’arthrose symptomatique de hanche et/ou de genou.Les objectifs de ce projet étaient d’établir une revue de la littérature sur les conséquences économiques de l'arthrose de hanche et/ou du genou. Puis à partir de la cohorte KHOALA, nous avons décrit la consommation de soins ; identifié les facteurs associés aux trajectoires d'utilisation des ressources de santé et estimé les coûts annuels totaux. Enfin nous avons réalisé une analyse systématique de la littérature sur les analyses coût-efficacité des anti-arthrosiques d’action lente et de l’acide hyaluronique intra articulaire dans l’arthrose de genoux.La revue systématique a objectivé une hétérogénéité des couts totaux par patient (de 0,7 à 12 k€/an). Les données de KHOALA ont démontré que la majorité des patients consultait son médecin généraliste et une minorité de patients consultait un spécialiste. Le seul facteur clinique indépendant prédictif des consultations des professionnels de la santé était l'état de santé mentale. Le coût total annuel moyen par patient sur la période d'étude de 5 ans était de 2180 ± 5 305 €. En France, les coûts médians pourraient atteindre 2 milliards € / an (IQR 0,7–4,3).Osteoarthritis is the most common joint disease that can be responsible for a loss of autonomy and a major functional disability. With the aging of the population and the prevalence of obesity, the number of people with lower limb osteoarthritis will increase in the coming years and lead to an explosion of health spending. The "Knee and Hip OsteoArthritis Long-term Assessment" cohort (KHOALA) is a representative French multicenter cohort of patients with symptomatic hip and / or knee osteoarthritis.The aims of this thesis were to provide an overview of the economic consequences of hip and knee osteoarthritis worldwide. Then from the KHOALA cohort, we described health care resources use in the KHOALA cohort, we identified factors associated with trajectories of healthcare use and we estimated the annual total costs. Finally, we conducted a systematic review of the literature on the cost effectiveness of intra-articular hyaluronic acid and disease-modifying osteoarthritis drugs used in the treatment of knee OA.The systematic review showed a heterogeneity of the total costs per patient (from 0.7 to 12 k € / year). KHOALA data showed that primary care physicians have a central role in osteoarthritis care, mental health state was the only independent predictive factor of healthcare professional consultations. The mean annual total cost per patient over 5 years was 2180 ± 5,305 €. In France, median annual total costs would be approximately 2 billion €/year (IQR 0.7-4.3)

Facteurs de risque prédictifs d'infections sévères chez les patients atteints de polyarthrite rhumatoïde traités par abatacept : données du registre ORA ("Orencia and Rheumatoid Arthritis")

REIMS-BU Santé (514542104) / SudocSudocFranceF

Cost Effectiveness of Intra-Articular Hyaluronic Acid and Disease-Modifying Drugs in Knee Osteoarthritis

International audienceBackground: The place of disease modifying osteoarthritis drugs and intra-articular hyaluronic acid in the therapeutic arsenal of knee osteoarthritis remains uncertain. Indeed, these treatments have demonstrated symptomatic efficacy but no efficacy for disease modification.Objective: This report reviews the cost effectiveness of intra-articular hyaluronic acid (IAHA) and disease modifying osteoarthritis drugs (DMOADs) used in the treatment of knee osteoarthritis. Methods: A systematic literature search of MEDLINE, Scopus, EMBASE and Cochrane databases for articles was performed independently by 2 rheumatologists who used the same predefined eligible criteria. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were annualized and converted to 2015 euros (€) by using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average.Results: A total of 95 abstracts were selected, and 13 articles were considered for the review. Nine articles were on IAHA and 4 articles on DMOADs. Only one article directly compared different IAHA compound. Articles showed substantial heterogeneity in methodological approaches. The incremental cost-effectiveness ratios (ICER) ranged from 4,000 to 57,550€ and from 240 to 53,225€ per QALY gained for DMOADs and IAHA respectively.Conclusions: This review highlights substantial heterogeneity between studies, ranging from cost saving (or dominating) position to very high ICERs, far above the acceptability threshold of 50,000 €/QALY. Additional research is needed to display reliable and robust ICER estimates for knee OA therapies

Diagnostic accuracy of electromyogram for myositis

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Prognostic Factors Related to Clinical Response in 210 Knees Treated by Platelet-Rich Plasma for Osteoarthritis

Many studies have shown the effectiveness of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. We aimed to determine the factors associated with good or poor response to PRP injections in knee osteoarthritis. This was a prospective observational study. Patients with knee osteoarthritis were recruited from a university hospital. PRP was injected twice at a one-month interval. Pain was assessed on a visual analog scale (VAS) and function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic stage was collected and defined according to the Kellgren–Lawrence classification. Patients were classified as responders if they met the OMERACT-OARSI criteria at 7 months. We included 210 knees. At 7 months, 43.8% were classified as responders. Total WOMAC and VAS were significantly improved between M0 and M7. Physical therapy and a heel–buttock distance >35 cm were the two criteria associated with poor response at M7 by multivariate analysis. Pain VAS at M7 appeared to be lower in patients with osteoarthritis for less than 24 months. No adverse effects were reported. PRP treatment in knee osteoarthritis appears to be well-tolerated and effective, even in patients who reacted poorly to hyaluronic acid. Response was not associated with radiographic stage

Severe Attack of Henoch-Schönlein Purpura With Neurological Involvement During Adalimumab Treatment for Crohn’s Disease

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Evolution of Health Care Consumption in the Knee and Hip Osteoarthritis Long Term Assessment Cohort, a French Population Based Cohort of Symptomatic Knee and/or Hip OA Patients

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