Trials

BACKGROUND: Postoperative upper gastrointestinal fistula (PUGIF) is a devastating complication, leading to high mortality (reaching up to 80%), increased length of hospital stay, reduced health-related quality of life and increased health costs. Nutritional support is a key component of therapy in such cases, which is related to the high prevalence of malnutrition. In the prophylactic setting, enteral nutrition (EN) is associated with a shorter hospital stay, a lower incidence of severe infectious complications, lower severity of complications and decreased cost compared to total parenteral nutrition (TPN) following major upper gastrointestinal (GI) surgery. There is little evidence available for the curative setting after fistula occurrence. We hypothesize that EN increases the 30-day fistula closure rate in PUGIF, allowing better health-related quality of life without increasing the morbidity or mortality. METHODS/DESIGN: The NUTRILEAK trial is a multicenter, randomized, parallel-group, open-label phase III trial to assess the efficacy of EN (the experimental group) compared with TPN (the control group) in patients with PUGIF. The primary objective of the study is to compare EN versus TPN in the treatment of PUGIF (after esophagogastric resection including bariatric surgery, duodenojejunal resection or pancreatic resection with digestive tract violation) in terms of the 30-day fistula closure rate. Secondary objectives are to evaluate the 6-month postrandomization fistula closure rate, time of first fistula closure (in days), the medical- and surgical treatment-related complication rate at 6 months after randomization, the fistula-related complication rate at 6 months after randomization, the type and severity of early (30 days after randomization) and late fistula-related complications (over 30 days after randomization), 30-day and 6-month postrandomization mortality rate, nutritional status at day 30, day 60, day 90 and day 180 postrandomization, the mean length of hospital stay, the patient's health-related quality of life (by self-assessment questionnaire), oral feeding time and direct costs of treatment. A total of 321 patients will be enrolled. DISCUSSION: The two nutritional supports are already used in daily practice, but most surgeons are reluctant to use the enteral route in case of PUGIF. This study will be the first randomized trial testing the role of EN versus TPN in PUGIF. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03742752. Registered on 14 November 2018.This research program is funded by the French Ministry of Health through Programme Hospitalier de Recherche Clinique 2016

Comment améliorer la vitesse de prise en charge des déficits neurologiques focaux (évaluation de l'utilisation d'une "fiche-réflexe" d'aide à la régulation aux SAMU 33 et SAMU 64 de Pau)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Analyse d'une situation de détection et de localisation

The influence of the frequency of stimulus and the nature of the preceding stimulus have been analyzed in a detection-localisation situation consisting in detecting the position of the lacuna of a Landolt ring presented in short time vision. In the four cases considered, ranging from an uniform distribution of stimulus to an unimodal and little dispersed distribution, effects of positive recency were found. Two mathematical adaptation models have been devised in an attempt to give an account of the overall results. Both imply the existence of a preparatory state varying from trial to trial and assume an all-or-nothing detection mechanism (an assumption compatible with the observations, at least as a first approximation). They essentially differ in that one of them assumes that the detection probability is independant from the preparatory state whereas the other assumes a higher detection probability when the stimulus is very close to the preparatory state than when it is far away. Both models include the same number of parameters. Confronted to observations, the second model is far more satisfactory : it predicts — with a generally great accuracy — the amplitude of the recency and frequency effects wherever they are to be found. time vision. In the four cases considered, ranging from an uniform distribution of stimulus to an unimodal and little dispersed distribution, effects of positive recency were found. Two mathematical adaptation models have been devised in an attempt to give an account of the overall results. Both imply the existence of a preparatory state varying from trial to trial and assume an all-or-nothing detection mechanism (an assumption compatible with the observations, at least as a first approximation). They essentially differ in that one of them assumes that the detection probability is independant from the preparatory state whereas the other assumes a higher detection probability when the stimulus is very close to the preparatory state than when it is far away. Both models include the same number of parameters. Confronted to observations, the second model is far more satisfactory : it predicts — with a generally great accuracy — the amplitude of the recency and frequency effects wherever they are to be found.L'influence de la fréquence des stimulus et de la nature du stimulus précédent a été analysée dans une situation de détection-localisation consistant à détecter la position de la lacune d'un anneau de Landolt présenté en vision brève. Dans les quatre conditions étudiées allant d'une distribution uniforme des stimulus à une distribution unimodale peu dispersée, des effets de récence positifs ont été constatés (erreurs de localisation moins importantes lorsque le stimulus précédent était proche). Par contre des effets de fréquence (erreurs moindres pour les stimulus plus fréquents) apparaissent dans certains cas seulement : ils sont d'autant plus marqués que la distribution des stimulus est moins dispersée et que la capacité de détection propre au sujet est moins bonne. Deux modèles mathématiques d'adaptation ont été élaborés pour tenter de rendre compte de l'ensemble de ces résultats. Tous deux supposent l'existence d'un état de préparation évoluant d'essai à essai et font l'hypothèse d'un mécanisme de détection par tout ou rien (hypothèse qui s'avère compatible avec les observations, au moins à titre de première approximation). Ils diffèrent essentiellement en ce que l'un d'eux suppose la probabilité de détection indépendante de l'état de préparation, tandis que l'autre suppose la probabilité de détection plus élevée quand le stimulus est voisin de l'état de préparation que lorsqu'il en est éloigné. Les deux modèles comportent le même nombre de paramètres. Confronté aux observations, le deuxième modèle est de beaucoup le plus satisfaisant : il prédit avec une précision généralement bonne mais assez variable selon les conditions l'amplitude des effets de récence et des effets de fréquence là où ils existent.Richard Jean-François, Rouanet H. Analyse d'une situation de détection et de localisation. In: L'année psychologique. 1968 vol. 68, n°1. pp. 37-68

Evaluation de la prise en charge de l'AVC ischemique en phase aigüe (<3 heures) par thrombolyse intraveineuse par alteplase ( au CHU de Bordeaux - Pellegrin)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Supprimer la graisse et l'eau en IRM mammaire (la séquence SPIR FLAIR)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pharmacy-Based Opportunistic Atrial Fibrillation Screening at a Community Level: A Real-Life Study

Purpose: Opportunistic pharmacy-based screening of atrial fibrillation (AF) appears effective, but the proportion of detected citizens is unknown. The aim of our real-life study was to determine rates of screening in a community population according to age group and gender. Methods: We conducted four community campaigns of pharmacy-based single-time point AF screening that involved individuals ≥65 years. We used a single-lead and hand-held device MyDiagnostick (6229 EV Maastricht, The Netherlands) that generates a 60-s ECG trace. All pharmacies of the communities (n = 54) were involved. Rates of screening were assessed on the base of the French National Institute for Statistics and Economic Studies data and were expressed as percentage and 95% Confidence interval (CI). Results: We screened 4208 individuals (Mean age, 74.2 ± 6.6 years; females, 60.2%). The screening rate in citizens aged ≥65 years was 17.2% (16.6–17.7), and higher in females than in males (17.9% [17.3–18.6] versus 16.0 [15.3–16.8], p p = 0.04), male sex (OR: 4.30 [2.33–7.92], p p = 0.0008) were independent predictors of unknown AF. Conclusion: Single-lead AF detection performed in community pharmacies result in screening one in six elderly citizens. Although male sex and elderly predicted unknown AF diagnosis, they were less involved in such designed campaigns

Quantile regression for incomplete longitudinal data with selection by death

International audienceQuantile regressions are increasingly used to provide population norms for quantitative variables. Indeed, they do not require any Gaussian assumption for the response and allow to characterize its entire distribution through different quantiles. Quantile regressions are especially useful to provide norms of cognitive scores in the elderly that may help general practitioners to identify subjects with unexpectedly low cognitive level in routine examinations. These norms may be estimated from cohorts of elderly using quantile regression for longitudinal data, but this requires to properly account for selection by death, dropout and intermittent missing data. In this work, we extend the weighted estimating equation approach to estimate conditional quantiles in the population currently alive from mortal cohorts with dropout and intermittent missing data. Suitable weight estimation procedures are provided for both monotone and intermittent missing data and under two missing-at-random assumptions, when the observation probability given that the subject is alive depends on the survival time (p-MAR assumption) or not (u-MAR assumption). Inference is performed through subject-level bootstrap. The method is validated in a simulation study and applied to the French cohort Paquid to estimate quantiles of a cognitive test in the elderly population currently alive. On one hand, the simulations show that the u-MAR analysis is quite robust when the true missingness mechanism is p-MAR. This is a useful result because computation of suitable weights for intermittent missing data under the p-MAR assumption is untractable. On the other hand, the simulations highlight, along with the real data analysis, the usefulness of suitable weights for intermittent missing data. This method is implemented in the R package weightQuant

Lidar vent UV avec une architecture robuste comprenant un interféromètre Quadri Mach-Zehnder pour la calibration/validation et la future génération d'Aeolus

International audienceWind speed measurement with on-board system has many applications in aeronautics (Gust Load alleviation, Haps, etc.) and space (Weather forecast). The molecular wind lidar is developed for those purposes as it sent laser pulses into the atmosphere to determine, with a spectral analyzer, the wind speed from the Doppler shift induced by the molecules of the atmosphere. In this paper we present the lidar architecture developed at ONERA, that uses a Quadri Mach-Zehnder (QMZ) as a spectral analyzer and a UV fiber laser, designed for gust load alleviation application. We discuss about the advantages of such architecture for wind measurement from space. Simulations of the performances have been performed in the case of Calibration/Validation (Cal/Val) of Aeolus, showing standard deviation on wind speed measurement less than 2 m/s up to 17 km of altitude for the optimized hybrid fiber laser of 10 W laser average power and a pulse repetition frequency (PRF) of 5 kHz. Simulations that evaluates the performances for Aeolus measurement with minor changes in the lidar architecture have been computed, with results showing that requirements are fulfilled up to 22.5 km of altitude with the optimized hybrid fiber laser of 10 W and 3 kHz PRF.La mesure de la vitesse du vent avec système embarqué a de nombreuses applications en aéronautique (atténuation des charges de rafales, Haps, etc.) et spatial (Prévisions météorologiques). Le lidar vent moléculaire est développé dans ce but car il envoie des impulsions laser dans l'atmosphère pour déterminer, avec un analyseur spectral, la vitesse du vent à partir du décalage Doppler induite par les molécules de l’atmosphère. Dans cet article nous présentons l'architecture lidar développée à l'ONERA, qui utilise un Quadri Mach-Zehnder (QMZ) comme analyseur spectral et un laser à fibre UV, conçu pour l'allègement des charges de rafales. Nous discutons des avantages d’une telle architecture pour la mesure du vent depuis l’espace. Des simulations des performances ont été réalisées dans le cas de Calibration/Validation (Cal/Val) d'Aeolus, montrant un écart type sur la mesure de la vitesse du vent inférieur à 2 m/s jusqu'à 17 km d'altitude pour l'optimisation laser à fibre hybride d'une puissance moyenne laser de 10 W et d'une fréquence de répétition d'impulsions de 5 kHz. Des simulations qui évaluent les performances de la mesure d'Aeolus avec des changements mineurs dans l'architecture lidar ont été réalisées, avec des résultats montrant que les exigences sont remplies jusqu'à 22,5 km d'altitude avec le laser à fibre hybride de 10 W et 3 kHz PRF

Exploitation des ressources halieutiques par la pêche artisanale dans et autour des aires marines protégées : socio-écosystème, conservation et gouvernance

International audienc