Spina bifida, continence et qualité de vie (étude multicentrique)

[Résumé en français] La Qualité de Vie Liée à la Santé (QVLS) est de plus en plus considérée pour apprécier les résultats des thérapeutiques. C'est un indicateur particulièrement adapté chez les personnes souffrant de handicap. L'incontinence urinaire et fécale est fréquente dans le Spina Bifida (SB) et les indications thérapeutiques sont controversées. L'hypothèse de notre étude est qu'une meilleure continence est liée à une meilleure QVLS chez les patients atteints de SB. Dans une étude multicentrique, la continence et la prise en charge ont été décrites. La QVLS a été précisée par le questionnaire MOS-SF36 (Medical Outcome Study-Short Form) chez les adultes et par le questionnaire VSP (Vécu Santé Perçu) chez les adolescents. Les relations entre le sexe, l'âge, les capacités de marche, le niveau de continence urinaire et fécale, les méthodes de prise en charge et la QVLS ont été étudiées dans une analyse univariée puis multivariée. Un entretien a été réalisé chez 460 patients, 300 adultes d'un âge moyen de 27,1 ans et 160 adolescents d'un âge moyen de 14,4 ans. Le traitement de l'incontinence urinaire a comporté dans 55% des cas une stratégie chirurgicale. Les techniques à l'origine d'un meilleur niveau de continence ont été précisées. Le traitement de l'incontinence fécale a comporté essentiellement des thérapeutiques médicales. Le traitement chirurgical selon Malone a été pratiqué dans 9,7% des cas. Nous n'avons pas retrouvé de forte relation entre la QVLS, le niveau de continence et les stratégies thérapeutiques. Une étude prospective de la QVLS avant et après une intervention est essentielle pour déterminer l'impact des traitements de l'incontinence sur la QVLS.[Résumé en anglais] Quality of life is increasingly seen as a key out come in determining the success of rehabilitation programmes. Bowel and bladder incontinence is frequently encountered in patients with Spina Bifida (SB). We have assumed that incontinence control, achieved through rigorous medical or surgical management, may lead to better health related quality of life (HRQoL). It was hypothesized that better continence might predict better HRQoL in people with SB. ln a multicenter study, urinary and faecal continence was assessed and urological and intestinal management was retrospectively reviewed. HRQoL in adult patients was assessed using the MOS-SF36 (Medical Outcome Study-Short Form). HRQoL in adolescents was scored using the VSP (Vécu Santé Perçu). Univariate and multivariate analysis were used to examine the relationships between sex, age, walking ability, urinary/faecal continence, methods of urinary/faecal management and HRQoL. Interviews were conducted in 460 patients. 300 were adults (mean age at 27.1 +- 6.9 years) and 160 were adolescents (mean age at 14.4 +- 1.8 years). ln 55% of patients, bladder management was based on surgical treatments. Surgical techniques providing better urinary continence were detailed. Treatment of faecal incontinence was mainly conservative. Malone's procedure was performed in 9.7% of patients. The present study failed to demonstrate strong relationships between continence, treatments, and HRQoL in patients with SB. A prospective survey of HRQoL, particularly before and after an operation, is essential if we are to determine the effects of various continence management strategies on HRQoL among people with SB.NANCY1-SCD Medecine (545472101) / SudocSudocFranceF

L' observance thérapeutique des patients infectés par le VIH (mise en place d'une prise en charge pluridisciplinaire au CHU de Nîmes)

MONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF

Risk Factors of Early Mortality and Morbidity in Esophageal Atresia with Distal Tracheoesophageal Fistula: A Population-Based Cohort Study

OBJECTIVE: To identify the risk factors for early mortality and morbidity in a population with distal esophageal atresia (EA)-tracheoesophageal fistula. STUDY DESIGN: Cohort study from a national register. Main outcomes and measures included early mortality, hospital length of stay (LoS), need for nutritional support at 1 year of age as a proxy measure of morbidity, and complications during the first year of life. RESULTS: In total, 1008 patients with a lower esophageal fistula were included from January 1, 2008, to December 31, 2014. The survival rate at 3 months was 94.9%. The cumulative hospital LoS was 31.0 (17.0-64.0) days. Multivariate analysis showed that intrahospital mortality at 3 months was associated with low birth weight (OR 0.52, 95% CI [0.38-0.72], P < .001), associated cardiac abnormalities (OR 6.09 [1.96-18.89], P = .002), and prenatal diagnosis (OR 2.96 [1.08-8.08], P = .034). LoS was associated with low birth weight (-0.225 ± 0.035, P < .001), associated malformations (0.082 ± 0.118, P < .001), surgical difficulties (0.270 ± 0.107, P < .001), and complications (0.535 ± 0.099, P < .001) during the first year of life. Predictive factors for dependency on nutrition support at 1 year of age were complications before 1 year (OR 3.28 [1.23-8.76], P < .02) and initial hospital LoS (OR 1.96 [1.15-3.33], P < .01). CONCLUSIONS: EA has a low rate of early mortality, but morbidity is high during the first year of life. Identifying factors associated with morbidity may help to improve neonatal care of this population

Coordinated Studies of Pristine Concordia Micrometeorites

International audienceWe have set up a consortium of French scientists specialized in the microanalysis of extraterrestrial matter. We have tested our ability to generate reliable data, using a great diversity of techniques on submillimeter-sized samples within one month

Results from the French National Esophageal Atresia register: one-year outcome

International audienceBACKGROUND: The aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA).METHODS: All 38 multidisciplinary French centers that care for patients with EA returned a specific questionnaire about the 1-year outcome for each patient. This information was centralized, checked, and entered into a database.RESULTS: From the total population of 307 EA patients born in 2008 and 2009, data about the 1-year outcome were obtained from 301 (98%) patients, of whom 4% were lost to follow-up and 5% died. Medical complications occurred in 34% of the patients: anastomotic leaks (8%), recurrent tracheoesophageal fistula (4%), and anastomotic stenosis (22%); all of the latter group needed dilation (median, 2 dilations/patient). A new hospitalization was required for 59% of patients (2.5 hospitalizations/patient) for digestive (52%) or respiratory (48%) reasons. Twelve percent of patients required antireflux surgery at a median age of 164 days (range, 33-398 days), and 1% underwent an aortopexy for severe tracheomalacia. The weight/age Z-score was -0.8 (range, -5.5 to 3.7 months) at 12 months. Fifteen percent of patients were undernourished at 12 months of age, whereas 37% presented with respiratory symptoms and 15% had dysphagia at the last follow-up. Significant independent factors associated with medical complications were anastomotic esophageal tension (p = .0009) and presence of a gastrostomy (p = .0002); exclusive oral feeding at discharge was associated with a decreased risk of complications (p = .007).CONCLUSIONS: Digestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding.</p

Long-Term Functional Outcomes of an Anorectal Malformation French National Cohort

International audienceThe present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France

Esophageal Atresia and Respiratory Morbidity

BACKGROUND AND OBJECTIVES: Respiratory diseases are common in children with esophageal atresia (EA), leading to increased morbidity and mortality in the first year. The primary study objective was to identify the factors associated with readmissions for respiratory causes in the first year in EA children. METHODS: A population-based study. We included all children born between 2008 and 2016 with available data and analyzed factors at birth and 1 year follow-up. Factors with a P value 50% of readmissions. Identifying high risk groups of EA patients (ie, those with chronic aspiration, anomalies of the respiratory tract, and need for tube feeding) may guide follow-up strategies

Comparison of machine perfusion versus cold storage in kidney transplant recipients from expanded criteria donors: a cohort-based study

International audienceBackground Most studies comparing the efficacy of hypothermic machine perfusion (HMP) versus static cold storage (SCS) are based on short-term outcomes. We aimed to better evaluate the mid-term impact of HMP in patients receiving expanded criteria donor (ECD) kidneys. Methods The analyses were based on the French Données Informatisées et VAlidées en Transplantation (DIVAT) observational cohort. Patients aged ≥45 years transplanted for the first or second times from an ECD donor since 2010 were studied. Our study reported the graft and/or patient survivals and the incidence of acute rejection episode. The Cox models and the Kaplan–Meier estimators, weighted on the propensity score, were used to study the times-to-events. Results Among the 2019 included patients, 1073 were in the SCS group versus 946 in the HMP group. The mean life expectancy with functioning graft was 5.7 years [95% confidence interval (CI) 5.4–6.1] for the HMP cohort followed-up for 8 years post-transplantation versus 6.0 years (95% CI 5.7–6.2) for the SCS group. These mid-term results were comparable in the patients receiving grafts from donors aged ≥70 years and in the transplantations with cold ischaemia time ≥18 h. Conclusions Our study challenges the utility of using HMP to improve mid-term patient and graft survival. Nevertheless, the improvement of the short-term outcomes is indisputable. It is necessary to continue technological innovations to obtain long-term results

The EKiTE network (epidemiology in kidney transplantation - a European validated database): an initiative epidemiological and translational European collaborative research

BACKGROUND: Kidney transplantation is considered to be the treatment of choice for people with end-stage renal disease (ESRD). However, due to the shortage of available organs and the increase in the ESRD prevalence in Europe, it is essential to improve transplantation outcomes by studying the related prognostic factors. Today, there is no European registry collecting data to perform such clinical epidemiology studies. MAIN BODY: Entitled EKiTE, for European cohort for Kidney Transplantation Epidemiology, this prospective and multicentric cohort includes patients from Spanish (Barcelona), Belgian (Leuven), Norwegian (Oslo) and French (Paris Necker, Lyon, Nantes, Nancy, Montpellier, Nice and Paris Saint Louis) transplantation centers and currently contains 13,394 adult recipients of kidney (only) transplantation from 2005 and updated annually. A large set of parameters collected from transplantation until graft failure or death with numbers of post-transplantation outcomes. The long-term follow-up and the collected data enable a wide range of possible survival and longitudinal analyses. CONCLUSION: EKiTE is a multicentric cohort aiming to better assess the natural history of the ESRD in European kidney transplant recipients and perform benchmarking of clinical practices. The data are available for clinical epidemiology studies and open for external investigators upon request to the scientific council. Short-term perspectives are to extend EKITE network to other European countries and collect additional parameters in respect of the common thesaurus.status: publishe