Time to treatment with bridging intravenous alteplase before endovascular treatment:subanalysis of the randomized controlled SWIFT-DIRECT trial.

BACKGROUND We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT). METHODS We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours. RESULTS We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64-81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall, there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short. CONCLUSIONS We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials. TRIAL REGISTRATION NUMBER URL: https://www. CLINICALTRIALS gov ; Unique identifier: NCT03192332

The BLLAST field experiment: Boundary-Layer late afternoon and sunset turbulence

Due to the major role of the sun in heating the earth's surface, the atmospheric planetary boundary layer over land is inherently marked by a diurnal cycle. The afternoon transition, the period of the day that connects the daytime dry convective boundary layer to the night-time stable boundary layer, still has a number of unanswered scientific questions. This phase of the diurnal cycle is challenging from both modelling and observational perspectives: it is transitory, most of the forcings are small or null and the turbulence regime changes from fully convective, close to homogeneous and isotropic, toward a more heterogeneous and intermittent state. These issues motivated the BLLAST (Boundary-Layer Late Afternoon and Sunset Turbulence) field campaign that was conducted from 14 June to 8 July 2011 in southern France, in an area of complex and heterogeneous terrain. A wide range of instrumented platforms including full-size aircraft, remotely piloted aircraft systems, remote-sensing instruments, radiosoundings, tethered balloons, surface flux stations and various meteorological towers were deployed over different surface types. The boundary layer, from the earth's surface to the free troposphere, was probed during the entire day, with a focus and intense observation periods that were conducted from midday until sunset. The BLLAST field campaign also provided an opportunity to test innovative measurement systems, such as new miniaturized sensors, and a new technique for frequent radiosoundings of the low troposphere. Twelve fair weather days displaying various meteorological conditions were extensively documented during the field experiment. The boundary-layer growth varied from one day to another depending on many contributions including stability, advection, subsidence, the state of the previous day's residual layer, as well as local, meso- or synoptic scale conditions. Ground-based measurements combined with tethered-balloon and airborne observations captured the turbulence decay from the surface throughout the whole boundary layer and documented the evolution of the turbulence characteristic length scales during the transition period. Closely integrated with the field experiment, numerical studies are now underway with a complete hierarchy of models to support the data interpretation and improve the model representations.publishedVersio

Aging Alters Functionally Human Dermal Papillary Fibroblasts but Not Reticular Fibroblasts: A New View of Skin Morphogenesis and Aging

Understanding the contribution of the dermis in skin aging is a key question, since this tissue is particularly important for skin integrity, and because its properties can affect the epidermis. Characteristics of matched pairs of dermal papillary and reticular fibroblasts (Fp and Fr) were investigated throughout aging, comparing morphology, secretion of cytokines, MMPs/TIMPs, growth potential, and interaction with epidermal keratinocytes. We observed that Fp populations were characterized by a higher proportion of small cells with low granularity and a higher growth potential than Fr populations. However, these differences became less marked with increasing age of donors. Aging was also associated with changes in the secretion activity of both Fp and Fr. Using a reconstructed skin model, we evidenced that Fp and Fr cells do not possess equivalent capacities to sustain keratinopoiesis. Comparing Fp and Fr from young donors, we noticed that dermal equivalents containing Fp were more potent to promote epidermal morphogenesis than those containing Fr. These data emphasize the complexity of dermal fibroblast biology and document the specific functional properties of Fp and Fr. Our results suggest a new model of skin aging in which marked alterations of Fp may affect the histological characteristics of skin

Neurology

The question of the long-term safety of pregnancy is a major concern in patients with multiple sclerosis (MS), but its study is biased by reverse causation (women with higher disability are less likely to experience pregnancy). Using a causal inference approach, we aimed to estimate the unbiased long-term effects of pregnancy on disability and relapse risk in patients with MS and secondarily the short-term effects (during the perpartum and postpartum years) and delayed effects (occurring beyond 1 year after delivery). We conducted an observational cohort study with data from patients with MS followed in the Observatoire Français de la Sclérose en Plaques registry between 1990 and 2020. We included female patients with MS aged 18-45 years at MS onset, clinically followed up for more than 2 years, and with ≥3 Expanded Disease Status Scale (EDSS) measurements. Outcomes were the mean EDSS score at the end of follow-up and the annual probability of relapse during follow-up. Counterfactual outcomes were predicted using the longitudinal targeted maximum likelihood estimator in the entire study population. The patients exposed to at least 1 pregnancy during their follow-up were compared with the counterfactual situation in which, contrary to what was observed, they would not have been exposed to any pregnancy. Short-term and delayed effects were analyzed from the first pregnancy of early-exposed patients (who experienced it during their first 3 years of follow-up). We included 9,100 patients, with a median follow-up duration of 7.8 years, of whom 2,125 (23.4%) patients were exposed to at least 1 pregnancy. Pregnancy had no significant long-term causal effect on the mean EDSS score at 9 years (causal mean difference [95% CI] = 0.00 [-0.16 to 0.15]) or on the annual probability of relapse (causal risk ratio [95% CI] = 0.95 [0.93-1.38]). For the 1,253 early-exposed patients, pregnancy significantly decreased the probability of relapse during the perpartum year and significantly increased it during the postpartum year, but no significant delayed effect was found on the EDSS and relapse rate. Using a causal inference approach, we found no evidence of significantly deleterious or beneficial long-term effects of pregnancy on disability. The beneficial effects found in other studies were probably related to a reverse causation bias.Observatoire Français de la Sclérose en Plaque

Long term prognosis of intracerebral haemorrhage

Contexte : Les hémorragies intracérébrales spontanées (HIC) sont grevées d’une mortalité élevée et d’un pronostic fonctionnel sombre. Les données concernant le pronostic à long terme des HIC sont rares. L’objectif principal de ce travail était d’étudier le pronostic au long cours des HIC en les abordant par le prisme de leur histoire naturelle.Méthodes : Nos populations d’étude sont issues de la cohorte prospective PITCH (Prognosis of IntraCerebral Haemorrhage) qui est une cohorte observationnelle ayant inclus de façon consécutive tous les patients admis au CHU de Lille pour une HIC spontanée entre 2004 et 2009. Nous avons étudié (i) l’incidence de la démence de novo post HIC ainsi que les facteurs prédictifs cliniques et neuroradiologiques associés à sa survenue ; (ii) la prévalence de la sidérose superficielle corticale (SSc) et les facteurs cliniques et radiologiques associés ; (iii) les facteurs prédictifs de récidive hémorragiques.Résultats : Nous avons mis en évidence qu’il existait un risque majeur de démence de novo chez les patients survivant à une HIC. Les facteurs prédictifs de démence identifiés tels que la localisation lobaire ou la SSc suggèrent une implication directe de l’angiopathie amyloïde cérébrale. Nous avons également montré qu’au sein de notre cohorte, un patient sur cinq avait de la SSc sur l’IRM cérébrale réalisée à l’admission. La SSc apparaissait être un facteur neuroradiologique prédictif majeur de récidive hémorragique.Conclusion : Les résultats de ce travail ont un impact important dans la prise en charge des patients ayant eu une HIC spontanée et permettront d’informer de façon adéquate les patients et leurs aidants. Ils apportent des informations nouvelles sur l’évaluation du risque de récidive hémorragique et sur d’éventuelles futures cibles thérapeutiques.Background: The low frequency of spontaneous intracerebral haemorrhage (ICH) and its high mortality rate may explain the paucity of data in long term outcomes. The main objective was to study long term prognosis of ICH through the prism of their natural history.Methods: Our study populations were based on the PITCH (Prognosis of IntraCerebral Haemorrhage) cohort which is an observational study that included consecutively adults admitted at the Lille University Hospital for spontaneous ICH between 2004 and 2009. We aimed to determine (i) the incidence of new onset dementia and its clinical and radiological predictive factors; (ii) the prevalence of cortical superficial siderosis (cSS) and its associated factors; (iii) predictive factors of recurrent ICH.Results: We showed that the risk of new onset dementia is substantial after spontaneous ICH. Predictive factors of new onset dementia such as ICH lobar location and cSS suggest the implication of underlying cerebral amyloid angiopathy. We found that one out of five patients had cSS on baseline MRI. cSS was a strong predictive factor of recurrent ICH. Conclusion: These findings are of immediate clinical relevance in the management of ICH patients and will allow to adequately inform patients and caregivers. These results may provide additional information on ICH recurrence risk assessment and may contribute to the development of future therapeutic strategies

Pronostic à long terme des hémorragies intra-cérébrales

Background: The low frequency of spontaneous intracerebral haemorrhage (ICH) and its high mortality rate may explain the paucity of data in long term outcomes. The main objective was to study long term prognosis of ICH through the prism of their natural history.Methods: Our study populations were based on the PITCH (Prognosis of IntraCerebral Haemorrhage) cohort which is an observational study that included consecutively adults admitted at the Lille University Hospital for spontaneous ICH between 2004 and 2009. We aimed to determine (i) the incidence of new onset dementia and its clinical and radiological predictive factors; (ii) the prevalence of cortical superficial siderosis (cSS) and its associated factors; (iii) predictive factors of recurrent ICH.Results: We showed that the risk of new onset dementia is substantial after spontaneous ICH. Predictive factors of new onset dementia such as ICH lobar location and cSS suggest the implication of underlying cerebral amyloid angiopathy. We found that one out of five patients had cSS on baseline MRI. cSS was a strong predictive factor of recurrent ICH. Conclusion: These findings are of immediate clinical relevance in the management of ICH patients and will allow to adequately inform patients and caregivers. These results may provide additional information on ICH recurrence risk assessment and may contribute to the development of future therapeutic strategies.Contexte : Les hémorragies intracérébrales spontanées (HIC) sont grevées d’une mortalité élevée et d’un pronostic fonctionnel sombre. Les données concernant le pronostic à long terme des HIC sont rares. L’objectif principal de ce travail était d’étudier le pronostic au long cours des HIC en les abordant par le prisme de leur histoire naturelle.Méthodes : Nos populations d’étude sont issues de la cohorte prospective PITCH (Prognosis of IntraCerebral Haemorrhage) qui est une cohorte observationnelle ayant inclus de façon consécutive tous les patients admis au CHU de Lille pour une HIC spontanée entre 2004 et 2009. Nous avons étudié (i) l’incidence de la démence de novo post HIC ainsi que les facteurs prédictifs cliniques et neuroradiologiques associés à sa survenue ; (ii) la prévalence de la sidérose superficielle corticale (SSc) et les facteurs cliniques et radiologiques associés ; (iii) les facteurs prédictifs de récidive hémorragiques.Résultats : Nous avons mis en évidence qu’il existait un risque majeur de démence de novo chez les patients survivant à une HIC. Les facteurs prédictifs de démence identifiés tels que la localisation lobaire ou la SSc suggèrent une implication directe de l’angiopathie amyloïde cérébrale. Nous avons également montré qu’au sein de notre cohorte, un patient sur cinq avait de la SSc sur l’IRM cérébrale réalisée à l’admission. La SSc apparaissait être un facteur neuroradiologique prédictif majeur de récidive hémorragique.Conclusion : Les résultats de ce travail ont un impact important dans la prise en charge des patients ayant eu une HIC spontanée et permettront d’informer de façon adéquate les patients et leurs aidants. Ils apportent des informations nouvelles sur l’évaluation du risque de récidive hémorragique et sur d’éventuelles futures cibles thérapeutiques

Peptide b amyloïdes plasmatiques en phase aiguë des accidents vasculaires cérébraux, impact de l'état cognitif préexistant

Introduction et objectifs : Des troubles cognitifs préexistants sont fréquents chez les patients présentant un accident vasculaire cérébral (AVC), et parfois dus à une maladie d Alzheimer (MA). Les peptides amyloïdes beta (Ab) plasmatiques sont de potentiels biomarqueurs de MA, et pourraient favoriser une dysrégulation vasculaire. L objectif de ce travail était d analyser les variations plasmatiques de l Ab40 et de l Ab42 au cours des AVC et de vérifier les hypothèses selon lesquelles (i) la concentration plasmatique d Ab40 diminue en phase aiguë de l ischémie cérébrale sans être influencée par l état cognitif préexistant et (ii) la concentration plasmatique de l Ab42 diminue avec le déclin cognitif préexistant sans influence de l AVC. Patients et Méthodes : L étude a été menée à partir des données collectées dans le cadre de l étude Biostroke (ClinicalTrials.gov Identifier: NCT00763217) chez des patients ayant une ischémie ou une hémorragie sus-tentorielle inclus prospectivement dans les 48 heures suivant le début des symptômes. Les éléments de l analyse incluaient les facteurs de risque vasculaires, des données de neuroimagerie et des paramètres biologiques dont les dosages plasmatiques des peptides Ab40 et Ab42. L évaluation systématique du déclin cognitif préexistant reposait sur la version longue de l Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) et a permis la constitution de 3 groupes : le groupe démence , le groupe troubles cognitifs sans démence (CIND) et le groupe cognition normale . Résultats : Nous avons inclus 403 patients dont 371 avec ischémie cérébrale. Vingt-cinq répondaient aux critères de démence, 142 aux critères de CIND. Il n y avait pas de différence significative des concentrations plasmatiques d Ab40, d Ab42 et du ratio Ab42/Ab40 entre les 3 groupes de patients. Après ajustement, la baisse de concentration plasmatique d Ab42 était toutefois indépendamment associée à la présence d un déclin cognitif préexistant (OR 0,973; IC 95%: 0,950-0,996; p=0,024). Les facteurs associés à une concentration élevée d Ab40 étaient l âge, le tabac et le diabète. Chez les patients avec ischémie cérébrale, ces résultats étaient inchangés excepté qu un prélèvement dans les 12 heures suivant le début des symptômes était indépendamment associé à la baisse de la concentration d Ab40 plasmatique. Conclusion: Chez les patients présentant un AVC, la concentration plasmatique d Ab40 dépendait principalement des caractéristiques de l AVC et plus particulièrement des délais de prélèvements, des facteurs de risque vasculaires et du type ischémique mais ne semblait pas influencée par le déclin cognitif. La concentration plasmatique d Ab42 ne semblait pas influencée par l AVC mais par le déclin cognitif préexistant.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Stroke occurring in patients with cognitive impairment or dementia

ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i) A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii) Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii) Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv) Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others