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Background Few central nervous systems (CNS) cases of actinomycetoma have been recorded in the literature, and most were reported in tropical and subtropical regions. The management of this invasive infection is difficult, especially when it affects the spine and the cranio-cervical regions. Case We report an unusual case of a cranio-cervical junction actinomycetoma, in a patient presenting a cerebellar syndrome from brainstem compression. The CT scan showed a compressive solid osteolytic lesion in the cranio-cervical junction. The patient underwent cranio-cervical decompression and lesion resection. The diagnosis of actinomycetoma was confirmed on immune-histochemistry and molecular analysis. At 4 months' follow-up, the patient presented a fatal recurrence disseminating within the cerebellum and the spine. Conclusion The surgical treatment of CNS actinomycetoma presented poor prognosis and a disseminating recurrence. We believe that clinicians and surgeons must be informed about these "new" infectious pathologies that are so difficult to treat, especially with the arrival of migrant patients from endemic countries in conflict.

Purpose The coronavirus 2019 (COVID-19) pandemic led to a compulsory lockdown of 3 months with strict restrictions. The impact of the COVID-19 pandemic has shown broad repercussions on patients with chronic pain; especially for conditions that present a significant emotional participation such as chronic low back pain (cLBP). Methods We performed a prospective study on 50 patients. Pre- and 1-month post-lockdown questionnaires such as: the Impact of Event Scale (IES), the Oswestry Disability Index (ODI), the Roland–Morris questionnaire (RMQ) and the visual analogue scale (VAS) for back and leg pain intensity were collected. Results The mean time of the evolution of cLBP was 33.04 months (range 5–120 months). Eighteen (36%) patients improved their cLBP (i-cLBP), whereas for 14 (28%) it was worse (w-cLBP). Cox multivariate proportional hazard model identified that MODIC 1 disc disease [OR 19.93, IC95% (2.81–102.13), p = 0.015] and at-home workouts [OR 18.854, IC95% (1.151–204.9), p = 0.040] were good prognosis factors of the improvement of cLBP while subclinical/mild Covid-19 anxiety (IES score 26) significantly improved their cLBP [OR 0.58, IC95% (0.025–0.834), p = 0.01]. Conclusion Lockdown affected the somatic component of cLBP by decreasing activities and physical measures, whereas the SARS-CoV-2 pandemic spectrum paradoxically improved the psychic and emotional component of cLBP.

OBJECTIVE Survival scoring systems for spine metastasis (SPM) were designed to help surgical practice. The authors sought to validate the prognostic accuracy of the main preoperative scoring systems for SPM. METHODS It was hypothesized that true patient survival in SPM was better than that predicted using prognosis scores. To investigate this hypothesis, the authors designed a French national retrospective study of a prospectively collected multicenter database involving 739 patients treated for SPM between 2014 and 2017. RESULTS In this series, the median survival time for all patients from an SPM diagnosis was 17.03 ± 1.5 months. Sensitivity and specificity were estimated using the area under the curve (AUC). The AUC of Tomita’s prognosis score was the lowest and poorest (0.4 ± 0.023, range 0.35–0.44), whereas the AUC of the Tokuhashi score was the highest (0.825). The Lei score presented an AUC of 0.686 ± 0.022 (range 0.64–0.7), and the Rades score showed a weaker AUC (0.583 ± 0.020, range 0.54–0.63). Differences among AUCs were all statistically significant (p < 0.001). The modified Bauer score and the Rades score had the highest rate of agreement in predicting survival, with a weighted Cohen’s kappa of 0.54 and 0.41, respectively, indicating a moderate agreement. The revised Tokuhashi and Lei scores had a fair rate of agreement (weighted Cohen’s kappa = 0.24 and 0.22, respectively). The van der Linden and Tomita scores demonstrated the worst performance, with only a “slight” rate of agreement (weighted Cohen’s kappa = 0.19 and 0.16, respectively) between what was predicted and the actual survival. CONCLUSIONS The use of prognostic scoring systems in the estimation of survival in patients with SPM has become obsolete and therefore underestimates survival. Surgical treatment decisions should no longer be based on survival estimations alone but must also take into account patient symptoms, spinal instability, and quality of life.

BACKGROUND Patients presenting spine metastasis (SpM) from prostate cancer (PC) form a heterogeneous population, through this study, we aimed to clarify and update their prognostic assessment. METHODS The patient data used in this study was obtained from a French national multicenter database of patients treated for PC with SpM between 2014 and 2017. A total of 72 patients and 365 SpM cases were diagnosed. RESULTS The median overall survival time for all patients following the event of SpM was 28.8 months. First, we identified three significant survival prognostic factors of PC patients with SpM: good Eastern Cooperative Oncology Group/World Health Organization personnel status (Status 0 hazard ratio [HR]: 0.031, 95% confidence interval [CI]: 0.008-0.127; p

There is currently no evidence of the possible benefit of plasma cell-targeting therapies (PCTT) in immunoglobulin A (IgA) monoclonal gammopathy (MG) associated with IgA vasculitis (IgAV). We report the outcome of different PCTT regimens in a cohort of MG-IgAV.We used a French network to retrospectively describe the outcome of MG-IgAV patients treated with PCTT.Five patients were included (mean age 65 years). All patients had severe baseline presentation including extensive necrotic purpura (n = 5), gastrointestinal involvement (n = 2), peripheral neuropathies (n = 2), and glomerulonephritis (n = 1). Two patients had IgA indolent multiple myeloma and three had IgA "MG of undetermined significance." Monotypic IgA deposition in the skin vessels wall was highlighted using an immunofluorescence assay. Cases of vasculitis in three patients (n = 3) were refractory to multiple line therapies, including cyclophosphamide (n = 3) or rituximab. Finally, PCTT including bortezomib plus cyclophosphamide and dexamethasone, bortezomib plus melphalan and prednisone, or bortezomib plus lenalidomide and dexamethasone were proposed, allowing complete remission in 4/5 patients without major adverse drug events.This study suggests that the MG-IgAV phenotype might be distinctive of usual IgAV (severe and refractory to conventional immunosuppressive regimens) and supports the benefit of PCTT. This study sheds new light on the overall biology of IgAV, strengthening the pathogenic role of the monoclonal IgA component in IgAV.

Objective We aimed to investigate whether anakinra, an interleukin-1receptor inhibitor, could improve outcome in moderate COVID-19 patients. Methods In this controlled, open-label trial, we enrolled adults with COVID-19 requiring oxygen. We randomly assigned patients to receive intravenous anakinra plus optimized standard of care (oSOC) vs. oSOC alone. The primary outcome was treatment success at day 14 defined as patient alive and not requiring mechanical ventilation or extracorporeal membrane oxygenation. Results Between 27th April and 6th October 2020, we enrolled 71 patients (240 patients planned to been enrolled): 37 were assigned to the anakinra group and 34 to oSOC group. The study ended prematurely by recommendation of the data and safety monitoring board due to safety concerns. On day 14, the proportion of treatment success was significantly lower in the anakinra group 70% (n = 26) vs. 91% (n = 31) in the oSOC group: risk difference—21 percentage points (95% CI, -39 to -2), odds ratio 0.23 (95% CI, 0.06 to 0.91), p = 0.027. After a 28-day follow-up, 9 patients in the anakinra group and 3 in the oSOC group had died. Overall survival at day 28 was 75% (95% CI, 62% to 91%) in the anakinra group versus 91% (95% CI, 82% to 100%) (p = 0.06) in the oSOC group. Serious adverse events occurred in 19 (51%) patients in the anakinra group and 18 (53%) in the oSOC group (p = 0·89). Conclusion This trial did not show efficacy of anakinra in patients with COVID-19. Furthermore, contrary to our hypothesis, we found that anakinra was inferior to oSOC in patients with moderate COVID-19 pneumonia.

To investigate the long-term effect of unilateral idiopathic epiretinal membrane (uiERM) removal on monocular and binocular visual function, and on vision-related quality of life (VR-QoL). Prospective, single-center study. The following data were collected before and after surgery: distance monocular and binocular best-corrected visual acuity (BCVA), horizontal and vertical metamorphopsia, horizontal and vertical aniseikonia, stereoacuity and National Eye Institute Visual Function Questionnaire-25 item (NEI VFQ-25). Forty-two patients (mean age: 72.7 ± 7.4 years; 24 men) were included. At 6 months postoperatively, distance monocular BCVA (p p = 0.001) and the composite score of NEI VFQ-25 (p p p = 0.01) BCVA, horizontal (p p = 0.02) metamorphopsia, vertical aniseikonia (p = 0.01), stereoacuity (p p

STUDY DESIGN A prospective patient' database operated on a cauda equina syndrome (CES). OBJECTIVE The aim of our study was to identify prognosis factors for favorable functional recovery after CES. SUMMARY OF BACKGROUND CES is a neurologic impairment of variable symptoms associating urinary, bowel, and sexual dysfunctions with or without motor or sensitive deficits caused by nerve root compression of the cauda equina. The definition of CES remains debated, as well as the prognosis factors for favorable functional recovery and the benefit of early surgery. METHODS One hundred and forty patients were included between January 2010 and 2019. Univariate and Multivariate cox proportional hazard regression models were conducted. RESULTS The patients were young with a median age of 46.8 years (range 18-86 years). At presentation, 60% were affected by a motor deficit, 42.8% a sensitive deficit, 70% urinary dysfunctions and 44% bowel dysfunctions. The mean FU was 15.5 months. Bilateral motor deficit (p = 0.017) and an initial deficit severity of 0-2 (p = 0.001) represented prognosis factors of poor motor recovery. Initial anal incontinence (p = 0.007) was associated with poor bowel recovery. Only 32.8% of the patients went back to work. Initial motor deficit (p = 0.015), motor sequelae (p = 0.001), sphincter dysfunctions sequelae (p = 0.02) and long LOS (p = 0.02) were poor return-to-work prognosis factors. Time to surgery within an early timing

Purpose Spinal thoracolumbar fractures represent 10-14% of pediatric fractures. Most children concerned by such fractures are above 10 years of age. No guidelines presently exist. Analysis of spine pathophysiology and of the various common therapeutic attitudes led us to conduct a review of the different therapeutic approaches in pediatric thoracolumbar fracture. Methods A review of the literature was carried out using the Medline and Embase databases with the search-term “pediatric thoracic lumbar spine fractures”. Results The systematic review identified 44 studies, 24 of which were selected, and 19 were included for analysis. Physiological age was categorized on Risser's classification. In Risser 1 with Magerl A1 fracture, surgical treatment was not necessary and functional (rest and analgesics) or conservative treatment (bracing for 6 weeks) was sufficient. In Risser 1 with Magerl A2, A3 or B fracture, conservative treatment (bracing for 3 months) was the first-line option. In Risser 2–4, conservative treatment with bracing for 3 months was possible in the absence of instability, with kyphosis > 20° and canal compression > 33%; otherwise, treatment should be surgical. Subsequently, in case of onset of secondary instability, surgical treatment can be proposed. We highlight the importance of MRI assessment for diagnosis of thoracolumbar fracture and associated lesions of the intervertebral discs and posterior ligament complex. Children classified as Risser 5 can undergo the same treatment as adults. Conclusion Two main parameters should be assessed in treatment decision-making for thoracolumbar fracture: the Risser scale and the Magerl classification.

Spinal metastases (SpMs) from thyroid cancers (TC) significantly reduce quality of life by causing pain, neurological deficits in addition to increasing mortality. Moreover, prognosis factors including surgery remain debated.Data were stored in a prospective French national multicenter database of patients treated for SpM between January 2014 and 2017. Fifty-one consecutive patients affected by TC with 173 secondary SpM were included.Mean overall survival (OS) time for all patients from the diagnosis of a thyroid SpM event was 9.1 years (SD 8.7 months). The 1-year, 5-year and 10-year survival estimates were 94% (SD 3.3), 83.8.0% (SD 5.2), and 74.5% (SD 9.9). The median period of time between primary thyroid tumor diagnosis and the SpM event was 31.4 months (SD 71.6). In univariate analysis, good ECOG-PS (status 0 and 1) (p 0.0001), ambulatory status (Frankel score) (p 0.0001) and no epidural involvement (p = 0.01), were associated with longer survival, whereas cancer subtype (p = 0.436) and spine surgery showed no association (p = 0.937). Cox multivariate proportional hazard model only identified good ECOG-PS: 0 [HR: 0.3, 95% CI 0.1-0.941; p 0.0001], 1 [HR: 0.8, 95% CI 0.04-2.124; p = 0.001] and ambulatory neurological status: Frankel E [HR: 0.262, 95% CI 0.048-1.443; p = 0.02] to be independent predictors of better survival.For cases presenting SpM from TC, we highlighted that the only prognostic factors were the progression of the cancer (ECOG-PS) and the clinical neurological impact of the SpM (Frankel status). Surgery should be discussed mainly for stabilization and neurological decompression.

Binocular visual impairment related to unilateral idiopathic epiretinal membranes (uiERM) and its association with vision-related quality of life (VR-QoL) has not yet been investigated. This study aimed to explore binocular visual parameters (distance binocular best-corrected visual acuity (BCVA), aniseikonia, stereopsis) and VR-QoL in patients with uiERM. We carried out a prospective single-centre cohort study. The following data were collected: VR-QoL (NEI VFQ-25), distance monocular and binocular BCVA, horizontal and vertical metamorphopsia (M-charts test), horizontal and vertical aniseikonia (NAT TEST) and stereoacuity (TNO test). Multiple linear regression analyses were performed to evaluate factors influencing VR-QoL. Forty-six patients with uiERM and visual complaints were included. Aniseikonia was found in 40 (80%) participants. Stereoacuity was poor (above 120 s of arc) in 46 (100%) participants. Distance monocular BCVA, horizontal metamorphopsia and horizontal aniseikonia were the factors associated with VR-QoL in patients with uiERM. In subjects presenting uiERM, aniseikonia is frequently found and stereopsis is constantly impaired. We advocate quantitative testing of metamorphopsia and aniseikonia in addition to BCVA for the assessment of global visual function. Further investigations are needed to evaluate the effect of vitrectomy on these parameters and VR-QoL. EudraCT Number/ID RCB: 2016-A00252-49

The incidence of spinal metastasis (SpM) is increasing, and life expectancy for patients with malignancy is also rising. The "elderly" represent a population with steady growth in SpM proportion. Bracing is associated with lower survival. We believe that surgery should be considered, regardless of the patient's age.Multicentric prospective study. Through this study, we aimed to clarify and update the prognostic assessment of elderly with spine metastasis (SpM). The incidence SpM is rising, in parallel life expectancy is getting longer and the number of elderly patients presenting malignancy is increasing. Elderly patients with SpM constitute a growing heterogeneous population The patient data used in this study were obtained from a French national multicenter database of patients treated for SpM between 2014 and 2017. Two hundred and forty-three consecutive patients70 years’ old were diagnosed. Median overall survival (OS) time for elderly patients following the event of SpM was 16.3 months. First, we identified significantly worse survival prognostic factors for elderly patients with SpM: poor WHO status 3/4: (hazard ratio [HR]: 2.245, 95% confidence interval [CI] 1.899–2.655; P 0.0001),80 years (HR: 1.758, 95% CI 1.117–2.765; P = 0.015) no-ambulatory neurological status (Franckel A/B status [HR: 3.219, 95% CI 1.621–6.390; P 0.0001)], gastrointestinal cancer (HR: 3.530, 95% CI 1.75–7.1; P 0.0001), lung cancer (HR: 3.452, 95% CI 1.784–6.680; P 0.0001), orthopedic brace treatment (HR: 1.329; 95% CI 1.050–1.683; P = 0.018), and epiduritis (HR: 1.52, 95% CI 1.041–2.22; P = 0.03) were independently poor prognostic factors of survival. The only good prognosis factor identified was thyroid cancer (HR: 0.257, 95% CI 0.07–0.952; P = 0.04). Prognosis factors concerning the survival of elderly patients seem to be the same as those for the general population such as primary cancer histology, neurological status, WHO status, and epiduritis. Age80 years also appears to be an independently poor prognosis factor. Our data suggest that orthopedic brace treatment is also associated with lower survival. Level of Evidence: 2.

Purpose To investigate the epidemiological impact of an ambulatory cataract surgery center providing a fast-track procedure without anesthetic evaluation on the access to cataract healthcare. Setting French nationwide study. Design Retrospective cross-sectional study. Methods The study included individuals undergoing cataract surgery from the French national administrative database of medical information. Data analyses focused on patients living in the Cher and neighboring areas. Epidemiological indicators of patient flow and healthcare efficiency were calculated. A medicoeconomic analysis was performed. Results Between 2012 and 2018, activity increased by +50.2% (3665 to 5506) interventions in the Cher area compared with a national increase of +22.7% (720 351/884 254), while maintaining a constant ophthalmologist workforce. The leakage ratio decreased by 5.9 points (26.3% to 20.4%), whereas the attractiveness and self-sufficiency ratios increased by 2.3 (8.6% to 10.9%) and 8.6 (80.6% to 89.2%) points, respectively. The age- and sex-standardized rate of healthcare utilization for cataract surgery increased by 4.3 points (11.6 to 15.9 cataract surgeries per 1000 inhabitants), making the Cher the second best French area in 2018 for the rate of cataract surgery despite ranking 96th of 109 French areas for ophthalmologist density. The cost of the cataract removal procedure was 523.99€ (666.22€ in the conventional operating room). Conclusions An ambulatory cataract surgery center with a fast-track procedure could represent a solution in medical deserts to improve cataract healthcare without supplementary funding. Nonetheless, consulting activity should be optimized to detect eye disorders and schedule interventions.

Brain metastases natural history from one primary tumor type might be accelerated or favored by using certain systemic chemotherapy. A great deal was described in mice and suggested in human with antiangiogenic drugs, but little is known about the metastatic progression generated by the perverse effect of anticancer drugs. A total of 413 patients who underwent treatment for brain metastasis (2013–2016) were included. The identification of all previous anticancer drugs received by patients from primary tumor diagnosis to brain metastases diagnosis was collated. The median value for the time of first appearance of brain metastasis in all patients was 13.1 months (SD 1.77). The values of brain metastasis-free survival (bMFS) for each primary cancer were: 50.9 months (SD 8.8) for breast, 28.5 months (SD 11.4) for digestive, 27.7 months (SD 18.3) for melanoma, 12.3 months (SD 8.3) for kidney, 1.5 months (SD 0.1) for lung and 26.9 months (SD 18.3) for others (p