Clinical and prognostic implications of phenomapping in patients with heart failure receiving cardiac resynchronization therapy

Despite having an indication for cardiac resynchronization therapy according to current guidelines, patients with heart failure with reduced ejection fraction who receive cardiac resynchronization therapy do not consistently derive benefit from it.; To determine whether unsupervised clustering analysis (phenomapping) can identify distinct phenogroups of patients with differential outcomes among cardiac resynchronization therapy recipients from routine clinical practice.; We used unsupervised hierarchical cluster analysis of phenotypic data after data reduction (55 clinical, biological and echocardiographic variables) to define new phenogroups among 328 patients with heart failure with reduced ejection fraction from routine clinical practice enrolled before cardiac resynchronization therapy. Clinical outcomes and cardiac resynchronization therapy response rate were studied according to phenogroups.; Although all patients met the recommended criteria for cardiac resynchronization therapy implantation, phenomapping analysis classified study participants into four phenogroups that differed distinctively in clinical, biological, electrocardiographic and echocardiographic characteristics and outcomes. Patients from phenogroups 1 and 2 had the most improved outcome in terms of mortality, associated with cardiac resynchronization therapy response rates of 81% and 78%, respectively. In contrast, patients from phenogroups 3 and 4 had cardiac resynchronization therapy response rates of 39% and 59%, respectively, and the worst outcome, with a considerably increased risk of mortality compared with patients from phenogroup 1 (hazard ratio 3.23, 95% confidence interval 1.9-5.5 and hazard ratio 2.49, 95% confidence interval 1.38-4.50, respectively).; Among patients with heart failure with reduced ejection fraction with an indication for cardiac resynchronization therapy from routine clinical practice, phenomapping identifies subgroups of patients with differential clinical, biological and echocardiographic features strongly linked to divergent outcomes and responses to cardiac resynchronization therapy. This approach may help to identify patients who will derive most benefit from cardiac resynchronization therapy in "individualized" clinical practice

Classification en référence à une matrice stochastique

International audienceEtant donné un tableau de données X portant sur un ensemble de n objets, et une matrice stochastique S qui peut être assimilée à une matrice de transition d'une chaîne de Markov, nous proposons une méthode de partitionnement consistant à appliquer la matrice S sur X de manière itérative jusqu'à convergence. Les classes formant la partition sont déterminées à partir des états stationnaires de la matrice stochastique. Cette matrice stochastique peut être issue d'une matrice de similarité entre les objets, similarité qui peut être déterminée à partir du tableau X ou bien à partir de données externes. La matrice stochastique peut également refléter la densité de points autour des objets considérés. Différentes similarités et fonctions de densité sont étudiées et comparées (plus proches voisins, noyaux de densité...). La démarche sera illustrée sur la base de données simulées et de données réelles

Discrimination et Classification supervisée en référence à des prototypes

International audienceL'objectif de la classification supervisée est d'affecter des individus à des groupes définis a priori à partir des mesures effectuées sur des variables. Dans ce contexte, les analyses discriminantes linéaire et quadratique sont parmi les méthodes les plus populaires. Elles sont fondées sur des hypothèses de multinormalité. Dans certaines situations, cette règle s'avère inappropriée en particulier dans le cas d'un groupe multimodal ou en présence d'éléments atypiques. Pour pallier ce problème, la méthode proposée consiste à pondérer les individus de manière à déterminer des statistiques robustes. Dans une communication précédente, nous avons introduit une méthode de classification (non supervisée) basée sur la détermination d'une matrice stochastique. Un des intérêts de cette approche est d'exhiber des barycentres pondérés (appelés prototypes) au sein des différents groupes. Cette démarche est étendue au cadre de la classification supervisée et au cadre de la discrimination. Pour la classification supervisée, nous adoptons une démarche similaire à celle préconisée dans le cadre des réseaux de neurones probabilistes. Pour l'analyse factorielle discriminante, nous utilisons le système de pondération pour l'estimation des paramètres de localisation des matrices de variance covariance à l'intérieur de chaque groupe, ainsi que de la matrice de variance covariance totale

Mise en œuvre d’un programme d’activité physique adaptée chez les patients atteints de cancer : amélioration de leur qualité de vie, de leur fatigue et de leur capacité physique

Introduction : Les bénéfices de l’activité physique dans la prise en charge globale en cancérologie sont maintenant reconnus. Malheureusement, l’offre de soin reste encore trop limitée et peu standardisée. Objectif : Cette étude vise à évaluer le programme d’activité physique adaptée (APA) développé au sein de notre institut en comparant les niveaux de qualité de vie, de fatigue, d’activité physique et de sédentarité ainsi que des capacités physiques à l’entrée et à la sortie du séjour de réadaptation. Méthode : Étude rétrospective sur les patients (n = 72) ayant suivi le programme d’APA entre août 2019 et avril 2021. La fatigue ressentie était déterminée par l’échelle FSS (Fatigue Severity Scale), la qualité de vie par le questionnaire MOS-SF36 (santé physique et mentale), et les capacités physiques par le TM6 (test de marche des 6 minutes). L’analyse statistique de l’évolution des paramètres étudiés a été réalisée par un test de Student apparié en cas de normalité des données ou par un test de Wilcoxon dans le cas contraire. Résultats : À la suite des 24 demi-journées du programme de réadaptation, on observait une diminution significative de la fatigue ressentie (4,3 ± 1,6 vs. 3,3 ± 1,4 ; p < 0,0001***), une amélioration de la qualité de vie évaluée par le questionnaire MOS-SF36 (score physique, mentale et santé perçue) ainsi que des capacités physiques (432 ± 115,3 vs. 490,8 ± 100,5 m ; p < 0,0001***) des patients. Conclusion : Cette expérience pilote permet de valider les bénéfices globaux de notre programme d’APA chez les patients atteints de différent type de tumeur maligne

Comparison of three hypothesis testing approaches for the selection of the appropriate number of clusters of variables

Clustering of variables, Number of clusters, Hypothesis testing approach, Gap statistic, CLV, 62H15, 62H30, 62P99,

Yoga in the Rehabilitation of Post-Stroke Sequelae: A Non-Inferiority Randomized Controlled Trial.

International audienceIntroduction: Stroke survivors can experience various consequences that affect their physical and psychological balance. Yoga seems to be relevant for this population as it allows to work on both the body and the mind. The first objective of this study was to investigate the non-inferiority of yoga compared with conventional physical activity in improving physical function in patients with chronic post-stroke sequelae. The secondary objective was to investigate the superiority of yoga in improving the mental health of these patients.Methods: A randomized controlled trial was conducted. Thirty-six patients were randomized into two groups to practice a yoga program (YOG'AVC) or the Fitness and Mobility Exercise (FAME) program. Patients were assessed in a blinding mode pre- (T0) and post-program (T1) and 3–4 months after completion (T2). The physical assessments were the Berg Balance Scale, timed up and go test, 6-minute walk test, and quadriceps strength measured by hand-held dynamometer. Questionnaire assessments were: Activities-specific Balance Confidence Scale–Simplified, State-Trait Anxiety Inventory, Beck's Depression Inventory, and the Reintegration to Normal Living Index.Results: The YOG'AVC program was not inferior to the FAME program in improving balance, functional mobility and muscle strength. Both groups showed significant improvement (p < 0.05) between T0 and T1 in their anxiety, depression, and reintegration to normal life scores, with no significant difference between groups.Discussion: Both programs seem to be valuable in improving the physical abilities and psychological well-being of chronic post-stroke patients. However, further studies are required to confirm the difference between these programs

Do high-dose progestins impair sexual function in women treated for endometriosis? A prospective observational longitudinal study

International audienceIntroduction: High-dose progestins are used as an effective therapy for painful symptoms of endometriosis but their impact on sexual function has been poorly studied. The study aims to assess the impact of high-dose progestin on sexual function among women treated for endometriosis. Material and methods: In this bicenter prospective observational study, women with endometriosis who received medical or surgical treatment for endometriosis and who were sexually active were included. They completed the Sexual Activity Questionnaire (SAQ, a validated tool) before (T0) and 12 months after (T1) endometriosis treatment. We classified patients into two groups according to whether they were using high-dose progestins at T1: a high-dose progestin group and a control group. The main outcome was sexual function measured by the SAQ score (from 0 to 30) at T1. The secondary outcomes were each individual SAQ item, the dyspareunia 100-mm visual analog scale (VAS) and the quality of life assessed with EuroQoL Group 5D Index (EQ-5D) at T1. We also assessed the change in dyspareunia VAS and quality of life between T0 and T1. The Ethics Committee of Ile-de-France (Act 2004-806, 9 August 2004) approved the study. Results: Among 214 women included, 25 (12%) were exposed to high-dose progestins at T1. The SAQ score of women exposed to high-dose progestins was significantly lower compared with the control group, with or without adjustment for covariates (15.5 ± 6.3 vs 18.3 ± 6.2, P =.03, adjusted effect size −0.44 [95% CI −0.86 to −0.02], P =.04). High-dose progestin intake at T1 was associated with a lower subscore on two SAQ items: pleasure (1.8 ± 0.8 vs 2.2 ± 0.9, P =.02), and satisfaction with frequency of intercourse (1.2 ± 1.2 vs 1.8 ± 1.1, P =.02). In the overall population, dyspareunia VAS and quality of life assessed by EQ-5D improved between T0 and T1 (45 ± 29 at T0 vs 28 ± 29 at T1, P <.001; 0.78 ± 0.14 at T0 vs 0.86 ± 0.14 at T1, P <.001, respectively). At T1, the groups did not differ significantly for dyspareunia VAS (effect size 0.36 [95% CI −0.06 to 0.78], P =.10) and quality of life (EQ-5D, effect size 0.02 [95% CI −0.40 to 0.44], P =.91). Conclusion: In this observational study, high-dose progestins impair the sexual function of women treated for endometriosis even though they improved dyspareunia

Projet de multi-instrumentation géophysique en région Pays de la Loire

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Does accelerometry reflect hand function in infants at risk of unilateral cerebral palsy? A secondary analysis of BB-Bim results

Background: Infants at high-risk of unilateral Cerebral Palsy (UCP) may have asymmetry in upper extremity movement and function, which should be identified as soon as possible for management.AimsTo explore the feasibility of using two AX3 Axivity monitors in wrist-worn bracelets to quantify movements, and to identify whether accelerometry parameters are consistent with hand function.Methods and procedures6 infants at high risk of UCP (aged 3 to ?12 months) were included in a Single-Case Experimental Design to explore the impact of an 8-week bimanual stimulation home program.OutcomesEach week of the baseline (randomized duration 4-7 weeks) and 8-week program, the Hand Assessment for Infants (HAI) was performed and accelerometry parameters were collected during HAI and also during spontaneous activity, several times a week.ResultsActimetry was analyzed during HAI and 238 spontaneous activity sessions (mean 42±21min). Actimetry ratios distribution and evolution show a high variability, especially for spontaneous activity. No strong correlation was found between HAI scores and accelerometry parameters, either collected during HAI, or during spontaneous activity times.Conclusion and implicationsDespite its feasibility, using accelerometry bracelets looks unreliable for detecting and monitoring hand function in infants under one year