Évaluation du pronostic materno-fœtal chez des femmes avec un antécédent de chirurgie bariatrique comparativement à celui de femmes obèses non opérées

Introduction : le nombre de chirurgies bariatriques, notamment chez la femme en âge de procréer est en constante augmentation. La grossesse après chirurgie bariatrique maternelle est donc une situation clinique à laquelle les praticiens sont de plus en plus confrontés. La littérature actuelle est inconstante sur les risques qui peuvent y être associés et s’est peu intéressée à l’implication du statut nutritionnel de ces patientes dans la survenue de complications maternelles ou fœtales. Objectifs : évaluer le pronostic materno-fœtal des grossesses après chirurgie bariatrique comparativement à celui de grossesses chez des femmes obèses non-opérées. Établir un état des lieux du statut nutritionnel et du suivi pendant la grossesse de ces patientes aux antécédents de chirurgie bariatrique. Matériels et méthodes : nous avons conduit une étude observationnelle rétrospective basée sur les données de grossesse obtenues à partir du dossier médical informatisé de femmes ayant accouché entre Décembre 2017 et Juillet 2019 au CHU de La Conception. Résultats : 19 femmes avec un antécédent de chirurgie bariatrique et 254 femmes obèses non-opérées étaient incluses dans cette étude. La chirurgie bariatrique comparativement à l’obésité sans chirurgie préalable était associée de façon significative à un poids de naissance plus faible (3068,6 ± 504,2 g vs 3386,1 ± 660,9 g ; p=0,006) et à cinq fois plus de malformations congénitales chez les nouveaux nés (21,1% vs 4,1% ; p=0,013). Il existait dans les grossesses après chirurgie bariatrique une tendance à la diminution du taux de complications cardio-métaboliques (diabète gestationnel et hypertension gravidique) ainsi que du taux de macrosomie et de nouveaux nés ayant un gros poids pour l’âge gestationnel (LGA). Le statut nutritionnel pendant la grossesse des femmes opérées était marqué par de nombreuses carences et une insuffisance d’apports en macro et micronutriments. Le suivi nutritionnel de ces patientes était largement perfectible. Conclusion : la chirurgie de l’obésité entraine des carences nutritionnelles pouvant être responsables d’un sur risque de complications périnatales telles que des malformations congénitales ou une diminution du poids de naissance pouvant conduire à un petit poids pour l’âge gestationnel (SGA). Une prise en charge pluridisciplinaire, guidée par de nouvelles recommandations de bonne pratique permettrait de limiter ce risque

Considering the measurement noise for a nonlinear system identification with evolutionary algorithms.

International audienceThis paper deals with the identi cation of a nonlinear system modelled by a nonlinear output error (NOE) model when the system output is disturbed by an additive zero-mean white Gaussian noise. In that case, standard on-line or off-line least squares methods may lead to poor results. Here, our approach is based on evolutionary algorithms. Although their computational cost can be higher than the above methods, these algorithms present some advantages, which often lead to an effortless optimisation. Indeed, they do not need an elaborate formalisation of the problem. When their parameters are correctly tuned, they avoid to get stuck at a local optimum. To take into account the in uence of the additive noise, we investigate different approaches and we suggest a whole protocol including the selection of a tness function and a stop rule. Without loss of generality, simulations are provided for two nonlinear systems and various signal-to-noise ratios

New insights into the pathogenicity of TMEM165 variants using structural modeling based on AlphaFold 2 predictions

TMEM165 is a Golgi protein playing a crucial role in Mn2+ transport, and whose mutations in patients are known to cause Congenital Disorders of Glycosylation. Some of those mutations affect the highly-conserved consensus motifs E-φ-G-D-[KR]-[TS] characterizing the CaCA2/UPF0016 family, presumably important for the transport of Mn2+ which is essential for the function of many Golgi glycosylation enzymes. Others, like the G>R304 mutation, are far away from these motifs in the sequence. Until recently, the classical membrane protein topology prediction methods were unable to provide a clear picture of the organization of TMEM165 inside the cell membrane, or to explain in a convincing manner the impact of patient and experimentally-generated mutations on the transporter function of TMEM165. In this study, AlphaFold 2 was used to build a TMEM165 model that was then refined by molecular dynamics simulation with membrane lipids and water. This model provides a realistic picture of the 3D protein scaffold formed from a two-fold repeat of three transmembrane helices/domains where the consensus motifs face each other to form a putative acidic cation-binding site at the cytosolic side of the protein. It sheds new light on the impact of mutations on the transporter function of TMEM165, found in patients and studied experimentally in vitro, formerly and within this study. More particularly and very interestingly, this model explains the impact of the G>R304 mutation on TMEM165’s function. These findings provide great confidence in the predicted TMEM165 model whose structural features are discussed in the study and compared to other structural and functional TMEM165 homologs from the CaCA2/UPF0016 family and the LysE superfamily

Incertitude médicale, prise de décision et accompagnement en fin de vie

Ce numéro thématique sur l’incertitude médicale, la prise de décision et l’accompagnement en fin de vie relève quelques-uns des enjeux que comportent les décisions complexes et plurielles autour de la mort. La technologie et la biotechnologie réduisant les morts spontanées en milieu hospitalier, les professionnels du soin, les personnes malades et leurs proches doivent désormais composer avec des situations jadis exceptionnelles. Les articles réunis dans ce numéro s’appuient sur des corpus diversifiés, recueillis dans différents contextes nationaux (France, Italie, Suisse, Québec), ancrés dans un éventail de perspectives (les maladies génétiques, le cancer, la néonatalogie ou les soins intensifs), dans différents lieux (l’hôpital, les maisons et les unités de soins palliatifs ou encore le domicile) et à différents moments de la fin de vie (la palliation, la phase terminale, la sédation). In this special issue about medical uncertainty, decision-making and end-of-life accompaniment, the authors identify some of the various stakes of complex and plural decisions related to death. Technology and biotechnology reduce spontaneous deaths in hospitals. Thus, healthcare professionals, sick individuals and their relatives must now deal with situations once exceptional. The articles presented in this issue draw on corpuses of data that were collected in several national contexts (France, Italy, Switzerland, and Quebec) and diverse locations (hospital, palliative care unit, home). They broach end of life from manifold perspectives (genetic disorders, cancer, neonatal care, intensive care) and at various moments of it (palliation, terminal moments, and sedation)

Efficacy of oral manganese and D-galactose therapy in a patient bearing a novel TMEM165 variant

International audienc

Early Cardiac Toxicity Associated With Post-Transplant Cyclophosphamide in Allogeneic Stem Cell Transplantation

International audienceBackgroundPost-transplant cyclophosphamide (PT-Cy) has become a standard of care in haploidentical hematopoietic stem cell transplantation (HSCT) to reduce the risk of graft-versus-host disease. However, data on cardiac events associated with PT-Cy are scarce.ObjectivesThis study sought to assess the incidence and clinical features of cardiac events associated with PT-Cy.MethodsThe study compared clinical outcomes between patients who received PT-Cy (n = 136) and patients who did not (n = 195), with a focus on early cardiac events (ECE) occurring within the first 100 days after HSCT. All patients had the same systematic cardiac monitoring.ResultsThe cumulative incidence of ECE was 19% in the PT-Cy group and 6% in the no–PT-Cy group (p < 0.001). The main ECE occurring after PT-Cy were left ventricular systolic dysfunction (13%), acute pulmonary edema (7%), pericarditis (4%), arrhythmia (3%), and acute coronary syndrome (2%). Cardiovascular risk factors were not associated with ECE. In multivariable analysis, the use of PT-Cy was associated with ECE (hazard ratio: 2.7; 95% confidence interval: 1.4 to 4.9; p = 0.002]. Older age, sequential conditioning regimen, and Cy exposure before HSCT were also associated with a higher incidence of ECE. Finally, a history of cardiac events before HSCT and ECE had a detrimental impact on overall survival.ConclusionsPT-Cy is associated with a higher incidence of ECE occurring within the first 100 days after HSCT. Patients who have a cardiac event after HSCT have lower overall survival. These results may help to improve the selection of patients who are eligible to undergo HSCT with PT-Cy, especially older adult patients and patients with previous exposure to Cy