Première année de fonctionnement du parcours accès spécifique santé (PASS) de l’Université de Bordeaux : caractérisation et identification des facteurs de réussite pour la validation du PASS et l’entrée dans la filière médecine

Contexte : La réforme de la première année des études de santé définie dans le décret du 4 novembre 2019 a mis fin à la première année commune aux études de santé (PACES) pour introduire un nouveau système ayant pour objectif de diversifier l’accès aux formations de médecine, maïeutique, odontologie, pharmacie et kinésithérapie (MMOP-K) par différents parcours de formation antérieurs. À l’Université de Bordeaux a été mis en place un double système avec un parcours accès spécifique santé (PASS) et des licences accès santé (L.AS). La voie L.AS étant minoritaire en cette première année de mise en place de la réforme, nous avons centré notre analyse sur les étudiant·es en PASS en 2020–2021 et l’accès à la filière médecine. Méthodes : Cette première année de PASS a été évaluée au regard des résultats académiques aux épreuves écrites des deux semestres (nombre d’UE validées, validation/échec du PASS, admissibilité dans la filière médecine) et aux épreuves orales (réussite aux mini entretiens multiples, admission dans la filière médecine). Résultats et conclusion : Nous avons identifié le niveau scolaire à l’entrée à l’Université, mesuré par la mention au bac, comme étant le principal facteur de réussite pour la validation du PASS et la réussite à l’admission dans la filière médecine. Le déterminant social est également associé à la validation du PASS, indépendamment du niveau scolaire. Les résultats montrent également que l’hétérogénéité des résultats en fonction de l’option disciplinaire et du site géographique est essentiellement liée à des disparités de niveaux scolaires à l’entrée en PASS

Conditional FKBP12.6 Overexpression in Mouse Cardiac Myocytes Prevents Triggered Ventricular Tachycardia Through Specific Alterations in Excitation- Contraction Coupling

International audienceBackground— Ca 2+ release from the sarcoplasmic reticulum via the ryanodine receptor (RyR2) activates cardiac myocyte contraction. An important regulator of RyR2 function is FKBP12.6, which stabilizes RyR2 in the closed state during diastole. β-Adrenergic stimulation has been suggested to dissociate FKBP12.6 from RyR2, leading to diastolic sarcoplasmic reticulum Ca 2+ leakage and ventricular tachycardia (VT). We tested the hypothesis that FKBP12.6 overexpression in cardiac myocytes can reduce susceptibility to VT in stress conditions. Methods and Results— We developed a mouse model with conditional cardiac-specific overexpression of FKBP12.6. Transgenic mouse hearts showed a marked increase in FKBP12.6 binding to RyR2 compared with controls both at baseline and on isoproterenol stimulation (0.2 mg/kg IP). After pretreatment with isoproterenol, burst pacing induced VT in 10 of 23 control mice but in only 1 of 14 transgenic mice ( P <0.05). In isolated transgenic myocytes, Ca 2+ spark frequency was reduced by 50% ( P <0.01), a reduction that persisted under isoproterenol stimulation, whereas the sarcoplasmic reticulum Ca 2+ load remained unchanged. In parallel, peak I Ca,L density decreased by 15% ( P <0.01), and the Ca 2+ transient peak amplitude decreased by 30% ( P <0.001). A 33.5% prolongation of the caffeine-evoked Ca 2+ transient decay was associated with an 18% reduction in the Na + -Ca 2+ exchanger protein level ( P <0.05). Conclusions— Increased FKBP12.6 binding to RyR2 prevents triggered VT in normal hearts in stress conditions, probably by reducing diastolic sarcoplasmic reticulum Ca 2+ leak. This indicates that the FKBP12.6-RyR2 complex is an important candidate target for pharmacological prevention of VT

Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study

International audienceObjective: To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19.Methods: From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21).Results: A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity.Conclusion: This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality

Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals

International audienceBackgroundThe observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis.MethodThe primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results.ResultsBetween 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index &lt;18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks.ConclusionThe present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis