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The objectives of the present study was to evaluate the implementation of the program in real life and the evolution of the quality of life (QoL) in breast cancer patients after 3 months of supervised PA in real life and to determine the factors associated with changes in various QoL dimensions.This prospective cohort study was carried out in female patients with breast cancer diagnosed within a maximum of 3 yr. QoL and physical exertion intensity during the supervised physical activity (PA) sessions were assessed by the Quality of Life Questionnaire for Cancer and Borg scale, respectively. Statistical analyses comparing QoL scores between the start and the end of supervised PA program were assessed using paired Student's t -tests. Multivariate analysis was performed by linear regression with only variables with a P value0.15 in univariate model.A total of 93 patients were included in the analyses. There was a significant improvement of social functioning at T3 (∆ = 11.5; P0.001). The improvement of social functioning was significantly and independently associated with the Borg improvement ( β = 2.66 ± 1.31, P = 0.046), chemotherapy ( β = 11.03 ± 5.45, P = 0.046), hormone therapy ( β = -13.91 ± 5.51, P = 0.013), social isolation ( β = -14.81 ± 6.55, P = 0.026), and comorbidities ( β = -15.32 ± 5.59, P = 0.007).We observed a real enthusiasm and need among patients for practicing PA supervised by a sport trainer near their home. The increase in the intensity of exercise over time contributes to the improvement of the QoL, especially on the social functioning. These results, consistent with previous literature, reinforce the importance of exercise intensity on many dimensions of QoL. In addition, patients expressed great satisfaction with the supervised program, resulting in a strong desire to maintain long-term PA.

Malabsorption is a consequence of gastric bypass (GB). GB increases the risk of kidney stone formation. This study aimed to evaluate the accuracy of a screening questionnaire for assessing the risk of lithiasis in this population. We performed a monocentric retrospective study to evaluate a screening questionnaire administered to patients who underwent gastric bypass surgery between 2014 and 2015. Patients were asked to answer a questionnaire that included 22 questions divided into four parts: medical history, episodes of renal colic before and after bypass surgery, and eating habits. A total of 143 patients were included in the study, and the mean age of the patients was 49.1 ± 10.8 years. The time between gastric bypass surgery and the completion of the questionnaire was 50.75 ± 4.95 months. The prevalence of kidney stones in the study population was 19.6%. We found that with a score of ≥6, the sensitivity and specificity were 92.9% and 76.5%, respectively. Positive and negative predictive values were 49.1% and 97.8%, respectively. The ROC curve showed an Area Under the Curve (AUC) of 0.932 ± 0.029 (p < 0.001). We developed a reliable and short questionnaire to identify patients at a high risk of kidney stones after gastric bypass. When the results of the questionnaire were equal to or greater than six, the patient was at a high risk of kidney stone formation. With a good predictive negative value, it could be used in daily practice to screen patients who have undergone gastric bypass and are at a high risk of renal lithiasis.

The incidence rate of giant cell arteritis (GCA) is poorly studied in France. Therefore, we conducted a national hospital database study to assess the overall and regional incidence rates of GCA in France, including overseas territories.Through the national hospitalization database of all patients hospitalized in France, new incidental GCA was identified using International Classification of Diseases, 10th Revision medical codes (M31.5 = GCA; M31.6 = GCA and polymyalgia rheumatica [PMR]) during 2013-2019. The regional incidences were analyzed by graphical methods and Poisson regression.A total of 16,540 new GCA with or without PMR diagnoses were identified in all French hospitals over 7 years. The female/male ratio was 1.8. The crude annual incidence rate of GCA with or without PMR was 9.64 (9.50-9.79) per 100,000 persons aged 50 years or older in continental France and 2.91 (2.35-3.47) in overseas areas. The GCA with or without PMR incidence rate regularly increased with age in both sexes but with a later peak in men (85 vs 80 years in women). The crude incidence rate was 11.43 (11.21-11.65) in women and 7.50 (7.31-7.70) in men. An east-western gradient was noted with an increasing standardized incident rate (SIR) from east to west (P 10This French nationwide study provides new and dynamic insights regarding GCA with or without PMR incident rates at the country and regional levels. Important rate differences were observed between continental France and the overseas areas.

Gilles Loggia,1,2 Alice Pellichero,3 Ilona Moutoussamy,4,5 Rémy Morello,6 Kristell Pothier,1,4 Chantal Chavoix1 1COMETE, Normandie Univ, UNICAEN, INSERM, Caen, 14000, France; 2Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France; 3Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, G1M 2S8, Canada; 4EA 2114, Psychologie des Âges de la Vie et Adaptation, University of Tours, Tours, 37000, France; 5UMR CNRS 7295, Centre de Recherche sur la Cognition et l’Apprentissage, University of Tours and University of Poitiers, Tours, 37000, France; 6Department of Statistics and Clinical Research, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, FranceCorrespondence: Gilles Loggia, INSERM-UniCaen U1075, COMETE, PFRS, 3 rue des Rochambelles, Caen, Cedex, 140320, France, Tel +33 2 31 06 82 14, Fax +33 2 31 06 82 19, Email loggia-g@chu-caen.frPurpose: Engagement in activities promotes healthy living. Evaluating it is a challenging issue. Assessing engagement in activities while differentiating the physical, cognitive, and social component of each activity and taking into account the intensity level involved in each of the three components would be very relevant. Since none of the currently available cognitive reserve and questionnaires on the activities practiced takes into consideration both points, the purpose of this new questionnaire, called Pertinent Activities Practice in Adults (PAPA) questionnaire, is to fill these gaps.Patients and Methods: The questionnaire was developed through a literature review and interviews with older adults (n=177 ≥ 55 years). The intensity level of each item (none, light, moderate, or high) was determined by the compendium of physical activities for the physical component and consensus for the cognitive and social components, then validated by 56 professional experts (6 groups: physiotherapists, neuropsychologists, occupational therapists, geriatricians, etc.).Results: The PAPA questionnaire includes 75 items that give rise to 4 scores (sedentary lifestyle and physical, cognitive, and social activity scores) weighted by the frequency, duration, and intensity level for each component. The weighted percentage of agreement of the expert groups for the intensity levels was never significantly lower than the minimum target threshold (80% of the hypothetical median) except in a single domain (cognitive) for an expert group non-specialized in cognition. Cronbach’s alpha was ≥ 0.85.Conclusion: This questionnaire, which assesses long-term engagement in activities, with separate quantification of the physical, cognitive, and social components of a wide range of activities, should help guide actions to promote healthy aging and reduce dementia risk.Keywords: sedentary behavior, physical activity, social participation, intellectual activity, cognitive reserve, evaluation

Background: Cemiplimab is a monoclonal antibody targeting the PD-1, and phase II trials have shown its efficacy in the treatment of advanced cutaneous squamous cell carcinoma in patients who are not candidates for curative surgery or radiation therapy as a first- or later-line treatment. A synergistic antitumoral response has been demonstrated with concurrent radiotherapy and PD1-immunotherapy. However, no real-life study has demonstrated this effect in advanced cutaneous squamous cell carcinoma. Methods: We conducted a real-life retrospective cohort study to investigate the benefit of concomitant therapy in 33 patients treated with cemiplimab at the University Hospital of Caen, alone (C group) or concomitant to radiotherapy (C/RT group). Our primary objectives were to evaluate the best overall response and objective response rate. Our secondary objectives were the disease control rate, median time to response, progression-free survival, overall survival, clinical benefit of radiotherapy, and safety data. After stopping cemiplimab administration, we performed a follow-up of our patients and performed a descriptive study. Results: We reported an objective response rate of 45.5%, including 47.6% in the cemiplimab group versus 41.6% in the concomitant group. The addition of radiotherapy to cemiplimab enables an earlier clinico-radiological response, with a median duration of 5.5 months in the cemiplimab group versus 3 months in the concomitant therapy group. The response to treatment was prolonged despite discontinuation of cemiplimab, with 91.6% (n = 11/12) and 83.3% (n = 10/12) patients in complete or partial remission at 6 months and 1 year after cessation of cemiplimab and no switch to another oncological treatment, respectively. Radiation therapy also provided a therapeutic effect in 83.3% of the patients in the concomitant group, without increasing the occurrence of adverse events. Conclusions: Our study confirms the efficacy of cemiplimab and radiotherapy in the management of advanced cutaneous squamous cell carcinoma. Concomitant therapy permitted to obtain an earlier radiological response, a beneficial local therapeutic effect of radiotherapy, without any safety alert.

Background : The number of strokes has been steadily increasing due to the ageing of the population and its management has changed dramatically in recent years. Nevertheless, there are few unbiased epidemiological studies to investigate the incidence of strokes and their long-term prognosis. Methods : The Normandy Stroke Study (NSS) is a prospective population-based study of all strokes and transient ischemic attacks in a large urban, suburban, and rural area in the Northwest of France. It is designed to meet the current gold standard in stroke epidemiological study by using multiple overlapping sources for case identification. It also aims to assess the impact of socio-economic disparities and long-term prognosis of stroke through an additional follow-up up to three years after the event to better understand the functional and cognitive prognostic of stroke as well as the quality of life in patients after stroke. Conclusion : NSS will provide important data on epidemiology and long-term consequences of stroke at the population level and will help care providers to adapt resource allocation.

Purpose The coronavirus disease 2019 (COVID-19) pandemic reshaped the usual risk: benefit equilibrium that became a trade-off between the infection exposure risk for the patient (and for staff) and the risk associated with delaying or cancelling the nuclear medicine examination. This study aimed at quantifying the impact of the first COVID-19 lockdown in France on nuclear medicine examination volume together with volume of examination cancellation and non-attendance. Methods We retrospectively assessed the volume of planned examinations from 1 month before to 1 month after the first lockdown in French high-volume nuclear medicine departments (NMD) sharing the same information management system including both university hospitals, UH (n = 7), and cancer centres, CC (n = 2). Results The study enrolled 31,628 consecutive patients referred for a nuclear medicine examination performed or not (NMEP or NMEnP). The total volume of NMEP significantly dropped by 43.4% between the 4 weeks before and after the starting of the lockdown. The comparison of the percentage of NMEP and NMEnP between UH and CC is significantly different (p

The level of evidence of expert recommendations for starting extracorporeal cardiopulmonary resuscitation (ECPR) in refractory out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) is low. Therefore, we reported our experience in the field to identify factors associated with hospital mortality. We conducted a retrospective cohort study of all consecutive patients treated with ECPR for refractory cardiac arrest without return to spontaneous circulation, regardless of cause, at the Caen University Hospital. Factors associated with hospital mortality were analyzed. Eighty-six patients (i.e., 35 OHCA and 51 IHCA) were included. The overall hospital mortality rate was 81% (i.e., 91% and 75% in the OHCA and IHCA groups, respectively). Factors independently associated with mortality were: sex, age > 44 years, and time from collapse until extracorporeal life support (ECLS) initiation. Interestingly, no-shockable rhythm was not associated with mortality. The receiver operating characteristic-area under the curve values of pH value (0.75 [0.60-0.90]) and time from collapse until ECLS initiation over 61 minutes (0.87 [0.76-0.98]) or 74 minutes (0.90 [0.80-1.00]) for predicting hospital mortality showed good discrimination performance. No-shockable rhythm should not be considered a formal exclusion criterion for ECPR. Time from collapse until ECPR initiation is the cornerstone of success of an ECPR strategy in refractory cardiac arrest.

IntroductionThe EMPACOL Project aims to investigate the link between healthcare professionals’ (HCPs) empathy and the results of the curative treatment of non-metastatic colorectal cancer (CRC).Methods and analysisEMPACOL will be an observational multicentric prospective longitudinal study. It will cover eight centres comprising patients with non-metastatic CRC, uncomplicated at diagnosis in two French areas covered by a cancer register over a 2-year period. As estimated by the two cancer registries, during the 2-year inclusion period, the number of cases of non-metastatic CRCs was approximately 480. With an estimated participation rate of about 50%, we expect around 250 patients will be included in this study. Based on the curative strategy, patients will be divided into three groups: group 1 (surgery alone), group 2 (surgery and adjuvant chemotherapy) and group 3 (neo-adjuvant therapy, surgery and adjuvant chemotherapy). The relationship between HCPs’ empathy at the time of announcement and at the end of the strategy, quality of life (QoL) 1 year after the end of treatment and oncological outcomes after 5 years will be investigated. HCPs’ empathy and QoL will be assessed using the patient-reported questionnaires, Consultation and Relational Empathy and European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire, respectively. A relationship between HCPs’ empathy and early outcomes, particularly digestive and genitourinary sequelae, will also be studied for each treatment group. Post-treatment complications will be assessed using the Clavien-Dindo classification. Patients’ anxiety and depression will also be assessed using the Hospital Anxiety and Depression Scale questionnaire.Ethics and disseminationThe Institutional Review Board of the University Hospital of Caen and the Ethics Committee (ID RCB: 2022-A00628-35) have approved the study. Patients will be required to provide oral consent for participation. Results of this study will be disseminated by publication in peer-reviewed journals.Trial registration numberNCT05447611.

Background . To evaluate the impact of switching from U-100 to U-500 insulin in patients with type 2 diabetes mellitus (T2DM) uncontrolled with continuous subcutaneous insulin infusion (CSII) by pump. Methods We retrospectively collected data from patients with T2DM, treated by U-100 CSII, who were switched to U-500 regular insulin where haemoglobin A1c (HbA1c) was >8% and/or insulin total daily dose (TDD) was >100 UI/d. Data collection from patient medical records included HbA1c, lipid levels, liver biomarkers, weight, TDD, declared hypoglycaemic episodes and measured by continuous glucose monitoring (CGM). Results Sixty-five patients were included, aged 63.9 ± 8.6 years, insulin pump since 3.7 ± 3 years, TDD 186 ± 52 U/day, body mass index 39.4 ± 5.3 kg/m², HbA1c 9.03 ± 1.6%. After switching to U-500 insulin, HbA1c dropped by -0.96% (P Conclusions U-100 to U-500 insulin switch improves glucose control in CSII T2DM patients, especially with high baseline HbA1c. Use of concentrated insulin in pumps may represent an advance in the strategy for treating T2DM insulin resistant states with uncontrolled hyperglycaemia after a switch from multiple daily injections to pump therapy.

Resume Introduction Dans le cadre du plan « Sport-Sante-Bien-etre », la Federation francaise de basketball a mis en place le « Basket Sante ». Il s’agit d’un dispositif de sport adapte a tous les publics. Depuis 2015, il y a eu 269 sessions labellisees « Basket Sante » en France. Nous evaluerons l’impact que peut avoir le « Basket Sante » sur l’amelioration de la condition physique des pratiquants. Methodes Il s’agit d’une etude descriptive transversale realisee a l’echelle nationale en France au cours de la saison 2017/2018 dans les clubs et associations labellises « Basket Sante ». Des questionnaires incluant des informations generales ont permis l’evaluation sous forme d’un score (de 7 a 35) de la condition physique de chaque participant avant et apres la mise en place de ce dispositif. Des analyses en composante principale ont ete realisees pour evaluer l’impact de ce dispositif au cours de la periode. Resultats L’etude a recueilli 127 participants (sex-ratio : H/F = 0,34) âges en moyenne de 51,4 ± 14,3 ans, 37 % d’entre eux declaraient avoir une pathologie. L’impact du dispositif a montre que les caracteristiques du groupe « pathologie » se rapprochaient de celles du groupe « sans pathologie » apres la pratique d’une session « Basket Sante ». Conclusion Le « Basket Sante » apparait s’adapter a tous et semblerait avoir un effet significatif sur une amelioration de la condition physique et l’etat de sante des pratiquants. Ce dispositif repond donc a un triple objectif de prevention, de promotion de la sante et de bien-etre.

Resume Introduction Au cours de l’annee 2006, ont ete diffusees les recommandations pour la pratique clinique (RPC) sous l’egide de la Haute Autorite de Sante, sur la prise en charge du cancer du rectum. Les objectifs de cette etude etaient d’evaluer les consequences de l’application de ces RPC dans notre pratique multidisciplinaire en termes de choix des therapeutiques base sur le bilan d’extension, et des criteres de qualite de l’exerese chirurgicale. Secondairement, nous avons evalue l’impact de ces RPC sur les resultats operatoires et carcinologiques. Methodes Tous les patients operes consecutivement a visee curative d’un cancer du rectum sous peritoneal de 1995 a 2017 du centre hospitalier universitaire de Caen, ont ete inclus et divises, selon la date de diffusion des RPC en deux groupes : avant (Gr1) et apres 2006 (Gr2). Etaient colligees dans chaque groupe, les caracteristiques preoperatoires du patient et de la tumeur rectale ; les modalites therapeutiques incluant les donnees perioperatoires, les resultats postoperatoires et oncologiques. Resultats Six cent quatre patients ont ete inclus (Gr1 = 266 et Gr2 = 338). L’application des RPC influencait significativement la realisation : (i) d’un bilan d’extension exhaustif [ex., imagerie par resonnance magnetique pelvienne (p Conclusions L’adhesion aux RPC a permis d’ameliorer la qualite de la prise en charge multidisciplinaire des patients operes a visee curative d’un cancer du rectum sous peritoneal. Toutefois, des progres supplementaires sont encore necessaires pour ameliorer l’exhaustivite de l’adhesion aux RPC.

Resume Position du probleme Le syndrome d’epuisement professionnel (burn out) est une realite dans les professions de sante. De nombreuses etudes font etat d’un epuisement croissant et alarmant chez les medecins et les internes en France. Les etudiants en medecine pourraient etre, affectes par ce syndrome. Notre etude s’interesse a la sensibilite au burn out des etudiants en pre-externat. Methodes Il s’agit d’une etude transversale descriptive par questionnaire regroupant 312 etudiants de DFGSM3 (L3) de la faculte de medecine de Caen. Le MBI-test avec la sous-echelle d’epuisement emotionnel (score EE) depistant le burn out et le GHQ-28 evaluant la morbidite psychiatrique non psychotique ont ete utilises ainsi qu’un questionnaire sur les habitudes de vie et le parcours. Resultats Au total, 42,6 % des etudiants presentent un score EE eleve et un score GHQ-28 positif, 59,8 % presentent un score d’epuisement emotionnel modere a eleve et 53,4 % des etudiants presentent un score positif au GHQ-28. De plus 29,8 % se sentent menaces par le burn out. Differents facteurs apparaissent lies au burn out : le sexe feminin, vouloir arreter ses etudes, le manque d’accompagnement et les modifications de l’appetit. Conclusion Le burn out est une realite et de nombreux facteurs y sont associes. Il faut continuer a agir et mettre en place des prises en charges et des accompagnements chez les etudiants a risque afin de les sensibiliser pour une prevention primaire contre le burn out des le premier cycle des etudes medicales.

An important challenge in epidemiology is to ensure the reliability of collected data. Very few studies have been conducted in farming populations. We assessed the reliability of self-reported data on lifestyle, reproductive history, health and agricultural activities and tasks from the AGRICAN cohort.Our analysis focused on 739 individuals from the 181,842 cohort members who completed the questionnaire twice between 2005 and 2007 with a median time interval of 452 days. Consistency in the responses to questionnaire items (lifestyle, health and agricultural activities including pesticide treatments) was assessed by the percentage of exact agreement (PA), Cohen's Kappa value (K) and the intraclass correlation coefficient (ICC).Agreement was substantial to almost perfect for education, smoking, reproductive history and most health indicators (K/ICC 0.61). Agreement was moderate for alcohol consumption and fair for diet. Agreement was substantial for animal and crop farming activities and tasks such as pesticide use on crops and protective equipment use (PA 81-99%, K/ICC 0.61-0.96). Most tasks showed moderate to substantial agreement, except a few with low agreement. Substantial to perfect agreement was observed for the duration of tasks, based on exact years of beginning and ending.Farmers' answers appeared reliable for most occupational data, including data used to assess individual exposure to specific pesticides, and for most potential confounders.

Background Patients with schizophrenia (SZ) present a higher level of cardiovascular morbidity than the general population due to poor physical fitness and a sedentary lifestyle. Moreover, despite major therapeutic advances in the management of SZ, some clinical symptoms remain resistant to pharmacological approaches. A large number of studies support the effectiveness of physical activity (PA) for both physical and mental health in SZ. The main objective of the present study is to assess the effects of a remote, web-based adapted PA program (e-APA) compared to a health education program (e-HE) on brain plasticity in SZ and healthy volunteers (HV). The secondary objectives are to assess the effects of e-APA on other cerebral variables as well as clinical, neurocognitive, circadian, biological, and physiological variables. Methods: The study is an interventional, multicenter, randomized open-label controlled trial. Forty-two SZ will be randomized to either the active group (e-APA, N = 21) or non-active group (e-HE, N = 21), and 42 HV will be matched to SZ according to age, gender, and level of PA. Interventions will consist of 32 sessions (2x60 minutes/week, for 16 weeks) via supervised home-based videoconferencing. The active group will carry out an individualized PA program of moderate to vigorous intensity. Pre- and post-intervention cerebral magnetic resonance imaging (MRI) will be performed to evaluate changes in global hippocampal volume. Other cerebral assessments using diffusion tensor imaging, arterial spin labelling, spectroscopy and resting-state functional MRI will be performed. In addition, clinical, neurocognitive and circadian rhythms assessments as well as physical tests and biological analyses will be conducted. Discussion: To our knowledge, this is the first study aiming to evaluate the efficacy of APA delivered by supervised home-based videoconferencing in SZ. Moreover, using multimodal MRI, this study could clarify the pathophysiological mechanisms underlying the efficacy of APA. Finally, this innovative approach (remote, web-based APA) might also increase participation in long-term PA since PA-based programs are known to have low adherence and early dropout. The results of this study should promote the inclusion of PA interventions as a novel adjunctive therapy for SZ. Trial registration: ClinicalTrials.gov identifier: NCT03261817. Registered on 16 August 2017.

Background An increased risk of severe maternal morbidity and mortality has been described in migrant women, particularly in those born in sub-Saharan Africa. The mechanisms in question are poorly identified and rarely studied specifically. Objective To compare changes in maternal and perinatal morbidity inequalities among migrant and native women over time, between 2008 and 2014. Material and method A retrospective, single-centre study carried out at the Maternity Unit of the University of Caen Hospital in France. All women who gave birth in 2008 or 2014 were included. Twin pregnancies and delivery before reaching 22 weeks of pregnancy were excluded. Pre-pregnancy characteristics and maternal and perinatal morbidities were collected from the university hospital’s medical and administrative database. We compared the maternal and perinatal morbidity in 2008 and 2014 of women born in France to the morbidity of women born abroad. Secondly, we compared these migrant women between 2008 and 2014 to see if changes in the characteristics of migrant women were associated with a change in the type of maternal and perinatal complications. Results Of the 3,038 and 3,001 women included in 2008 and 2014, respectively, 272 (9.0 %) and 385 (12.8 %) women were migrants. Compared to women born in France, we found two times more severe postpartum hemorrhages in women born in sub-Saharan Africa (aOR = 2.1[1.1−3.9]) and a significant increase in the risk of gestational diabetes in women born in North Africa (aOR = 1.9[1.2−2.9]). We found a significant increase in the risk of severe postpartum hemorrhage (aOR = 2.1[1.5−3.0]) and gestational diabetes (aOR = 3.0[2.5−3.7]) in 2014 compared to 2008. We did not find a significant difference in perinatal morbidity between 2008 and 2014. Conclusion We noted a significant increase in the risk of severe postpartum hemorrhage in women born in sub-Saharan Africa and gestational diabetes in women born in North Africa compared to those born in France, and these risks increase in 2014 relative to 2008.

International audience; Background: Drugs with anticholinergic properties are commonly prescribed in older adults despite growing evidence of their adverse outcomes. Several issues regarding these detrimental effects remain unresolved, such as the putative existence of a threshold above which anticholinergic drug consumption impairs cognitive or mobility performance.Objectives: We aimed to investigate the number of anticholinergic drugs and the anticholinergic burden that leads to mobility or cognitive impairment and compare the effects in community-dwelling older adults in two age groups ("young-old" 55-74 vs. "old-old" ≥ 75 years).Methods: In a cross-sectional study, we identified drugs with anticholinergic (antimuscarinic) properties using the Anticholinergic Drug Scale. Cognition was assessed using the Mini Mental State Examination (MMSE) and the Trail Making Test (TMT-A and TMT-B), and mobility was assessed using the Timed Up and Go (TUG) test.Results: The study population consisted of 177 volunteers, 114 of whom were classed as young-old and 63 were classed as old-old adults. Despite the lack of cutoff values for impaired outcomes in young-old adults, impaired MMSE were significantly more numerous in users than in nonusers of anticholinergic drugs. In old-old adults, receiver operating characteristic (ROC) curve analysis indicated that taking a single anticholinergic drug per day was associated with impaired TMT-B completion time, TMT difference score (B-A), and TUG scores. The cutoff for anticholinergic burden was also one for these same outcomes. Based on these cutoff values, multivariate logistic regressions in old-old adults showed that the increased risk of impaired cognition and mobility was independent of confounding factors, including comorbidities. They also suggested that anticholinergic drugs would affect mobility through executive functions.Conclusions: Drugs with anticholinergic (antimuscarinic) properties are associated with cognitive impairment in individuals as young as 55 years, and only one such drug per day, regardless of its anticholinergic burden, is associated with both impaired cognition and impaired mobility in old-old adults. Therefore, wherever possible, clinicians should avoid prescribing drugs with anticholinergic properties.

IntroductionMany bowel problems following low anterior resection (LAR) for rectal cancer considerably impair the quality of life (QoL) of patients. The LAR syndrome (LARS) scale is a self-report questionnaire to identify and assess bowel dysfunction after rectal cancer surgery. It has been translated and validated in several languages but not in French (metropolitan French). The primary objective is to adapt the LARS scale to the French language (called French-LARS score) and to assess its psychometric properties. Secondary objectives are to assess both the prevalence and severity of LARS and to measure their impact on QoL.Methods and analysisA French multicentre observational cohort study has been designed. The validation study will include translation of the LARS scale following the current international recommendations, assessment of its reliability, convergent and discriminant validities, sensitivity, internal consistency, internal validity and confirmatory analyses. One thousand patients will be enrolled for the analyses. The questionnaire will be initially administered to the first 100 patients to verify the adequacy and degree of comprehension of the questions. Then reproducibility will be investigated by a test–retest procedure in the following 400 patients.An analysis will be conducted to determine the correlation between the LARS score and the Quality of Life Questionnaire (QLQ; European Organization for Treatment and Research of Cancer’s QLQ-C30, QLQ-CR29). Risk factors linked to QoL deterioration will be identified and their impact will be measured. This study will meet the need for a validated tool to improve patient care and QoL.Ethics and disseminationThe institutional review board of the University Hospital of Caen and the ethics committee (CPP Nord Ouest I, 25 January 2019) approved the study.Trial registration numberNCT03569488.

Objective: To compare the mode of delivery between women born in France and migrants.Study design: The study was a retrospective, observational, single-center study conducted at the university maternity unit in Caen. All women who gave birth in 2008 or 2014 were included. Women with multiple pregnancies and women whose pregnancies ended before 22 weeks of gestational age were excluded. The pre-existing characteristics at the time of pregnancy, mode of delivery and postpartum were collected from the University Hospital's medical and administrative computer database. We first compared women born in France to those born abroad with regard to the characteristics of mode of delivery for 2008, then for 2014. Secondly, we compared migrant women between 2008 and 2014 to see if the change in the migration profile was associated with a change in the mode of delivery.Results: Of the 3038 and 3001 women included in 2008 and 2014 respectively, 272 and 385 women were migrants. We observed a significant decrease in the number of spontaneous labors (adjusted odds ratio (aOR) 0.5 [0.4-0.6]) with a significant increase in emergency cesarean sections before (aOR 2.1 [1.4-3.0]) and during labor (aOR 2.2 [1.6-3.2]) among women born in sub-Saharan Africa compared to nonmigrants. And we showed a higher risk of cesarean section prior to labor (aOR 1.2 [1.01-1.4]) and a significant decrease in cesarean section during labor (aOR 0.8 [0.7-0.99]) in 2014 compared to 2008.Conclusion: We observed a significant increase in all types of Cesarean sections among women born abroad compared to those born in France, especially in the subgroup of women born in sub-Saharan Africa. (C) 2019 Elsevier Masson SAS. All rights reserved.

The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) as conditioning regimen prior to autologous stem-cell transplantation (ASCT) remains the standard of care for patients with mantle cell lymphoma (MCL) who are eligible for transplantation. The replacement of carmustine with bendamustine (BeEAM) was described as a promising alternative in non-Hodgkin lymphoma. The aim of this retrospective study was to compare the BeEAM with the BEAM regimen in MCL patients in the frontline setting. Sixty and 108 patients were included in the BeEAM and the BEAM groups, respectively. At 3 years, progression-free survival (PFS) was significantly higher in the BeEAM than in the BEAM group (84% [73-96] vs. 63% [51-79], p = 0.03). The overall survival was not statistically different between the two groups (p = 0.2). In multivariable analysis, BeEAM regimen remained associated with higher PFS (HR = 0.377, 95% CI, 0.146-0.970; p = 0.043). Subgroup analyses in patients treated with prior rituximab-aracytine induction alone showed that BeEAM improved the PFS compared with BEAM regimen (p = 0.04). Despite the high rate of acute renal failure KDIGO III (32%), treatment-related mortality was not increased with the BeEAM regimen. A prospective randomized trial will be necessary to confirm the beneficial effect of the BeEAM regimen in MCL patients undergoing ASCT.

Resume Objectif Evaluer la survie a long terme (5 et 10 ans) et le taux de recidive chez les patients en reponse anatomopathologique complete sur la piece d’œsophagectomie apres radiochimiotherapie neoadjuvante. Methode Entre 1993 et 2014, tous les dossiers de patients consecutifs pris en charge par therapie trimodale pour un cancer de l’œsophage localement avance non metastatique (adenocarcinome ou carcinome epidermoide) ont ete revus. En fonction de l’examen anatomopathologique de la piece operatoire, les patients ont ete classees en deux groupes : un groupe en reponse anatomopathologique complete (RPC) et un groupe avec persistance d’un residu tumoral sur la piece (PRT). L’objectif principal etait la survie globale. Les objectifs secondaires etaient la survie sans recidive, le taux de recidive et les facteurs predictifs de survie globale et de recidive. Resultats Cent trois patients ont ete inclus : 49 dans le groupe RPC et 54 dans le groupe PRT. La mediane de survie globale etait significativement plus longue dans le groupe RPC par rapport au groupe PRT (132 ± 22,3 vs 25,5 ± 4 mois) avec respectivement des taux de survie globale a 5 et 10 ans de 75,2 % vs 29,1 %, et 51,1 % vs 13,6 % (p Conclusions Les patients avec un cancer de l’œsophage localement avance en reponse anatomopathologique complete apres therapie trimodale ont un taux de survie globale a 10 ans de 51 %.

Bariatric surgery in obese subjects can result in remission of type 2 diabetes (T2D) at a distant time post-surgery. The aim of our observational prospective single-centre study was to examine glycaemic patterns in adult T2D candidates for bariatric surgery using a continuous glucose monitoring (CGM) sensor for 14 days after surgery to search for indicators predictive of T2D remission 1 year later.Patients underwent CGM preoperatively and for 14 days postoperatively. Thereafter, body weight and glycated haemoglobin (HbA1c) levels were monitored at 3, 6 and 12 months after surgery.A total of 31 patients (mean age 47±2 years) were analyzed. After surgery, mean interstitial glucose levels fell rapidly from 157±31mg/dL preoperatively to 109±35mg/dL postoperatively (P0.001), reaching nadir levels from day 3 after surgery. Successful bariatric surgery (loss of excess weight ≥50%) was observed in 28 (90%) patients, and diabetes remission (HbA1c≤6% with no antidiabetic treatment) 1 year after surgery was noted in 21 (68%) patients. CGM for 14 days post-surgery allowed prediction of diabetes remission 1 year after surgery: time spent above range14% and standard deviation (SD) of glucose levels33mg/dL were both strong predictors of T2D remission. Indeed, the association of these two criteria predicted diabetes remission with a 100% positive predictive value, 81% sensitivity and 100% specificity and, when combined with the advanced Diabetes Remission (Ad-DiaRem) score, further increased predictive accuracy.The use of 14-day postoperative CGM recordings together with presurgical clinical scores can help to predict diabetes remission 1 year after bariatric surgery.

Objective: Depression is underdiagnosed and thus undertreated. This study aimed to validate the French version of the PHQ-2 (Patient Health Questionnaire-2) and BDF-FS-Fr (Beck Depression Inventory-Fast Screen-France) on patients with chronic kidney disease (CKD) living in France. Method: A cross-sectional study was conducted on 109 patients of the Centre universitaire de maladies rénales, Centre Hospi­talier Universitaire (CHU) de Caen (37 patients with CKD on pre-dialysis and grafting stage, 36 grafted patients, and 36 dialyzed patients). Statistical Approach: Test parameters and statistical aspects of assessing diagnostic and screening tests were used, including knowledge of and ability to calculate, sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios, and the use of ROC (receiver operating characteristic) curves. Results: PHQ-2 and BDI-FS-Fr statistical parameters for depression tested very positively and had a satisfactory AUC (area under the curve). The PHQ-2 had a satisfactory AUC > 0.70, sensitivity > 0.60, and specificity > 0.80. The BDI-FS-Fr had a satisfactory area under the curve (0.859) with sensitivity (83%) and specificity (0.859); and internal consistency (α = 0.668). The PHQ-2 and BDI-FS-Fr showed good internal and external validity of structure, construct validity, criterion validity, discriminant validity, internal consistency, and factorial validity. Conclusion: The French versions of the PHQ-2 and BDI-FS have highly favorable psychometric properties. These instruments are valid self-assessment tools for screening and evaluating depression, its intensity, and its evolution. The PHQ-2 and BDI-FS-Fr thus have very good psychometric properties and are useful tools for researchers and practitioners. Regarding clinical practice in the hospital, clinicians and nurses can use the PHQ-2 to screen quickly for depression during routine consultations, during hospitalization, and in dialysis centers. The 7 items of the BDI-FS-Fr enable us to assess the depressive state, thereby avoiding a false diagnosis of depression among CKD patients in a clinical setting.

In 2006 under the supervision of the French health authorities (HAS), recommendations for clinical practice (RCP) in the management of rectal cancers were first published. The primary objective of this study was to assess the impact of these guidelines on multidisciplinary management in terms of therapeutic strategies based on disease staging and quality indicators for surgical excision. Secondarily, we assessed the impact of the RCPs on postoperative and oncological outcomes.All consecutive patients having undergone curative surgical excision for middle and low (subperitoneal) rectal cancer from 1995 to 2017 in the university hospital of Caen were included in accordance with the relevant French guidelines. They were divided into two groups: before (Gr1) and after (Gr2) 2006. For each group, a chart review was conducted on demographic variables, preoperative rectal tumor features, disease severity variables and quality of surgery variables. Postoperative and oncological outcomes were likewise assessed and compared between the two groups.Six hundred and four patients were included (Gr1, n=266; Gr2, n=338). Compliance with French guidelines significantly improved (i) use of magnetic resonance imaging (P0.0001) and CT-scan (P0.0001)]; (ii) organization of multidisciplinary tumor boards (P0.0001) leading to suitable neo-adjuvant treatment plan classification (P0.0001). Consequently, compliance improved widespread total mesorectal excision (P0.0001), sphincter-sparing surgery (P=0,0005), and completeness of curative resection in the specimen (P0.0001). Although postoperative 90-day mortality was similar, overall postoperative morbidity significantly increased in Gr2 (P0.0001). Overall (P=0.0005) and disease-free survival (P=0.0016) of patients in Gr2 were significantly prolonged and correlated with a significant reduction in local and distant recurrences.Compliance with the relevant French guidelines improved the quality of multidisciplinary management of patients undergoing curative surgery for subperitoneal rectal cancer. However, further progress is still needed to render accession to the recommendations more comprehensive.

The diagnostic workup for primary aldosteronism includes a screening step using the aldosterone-to-renin ratio (ARR) and a confirmatory step based on dynamic testing of aldosterone secretion autonomy. International guidelines suggest that precise clinical and biochemical conditions may allow the bypassing of the confirmatory step, however, data which validate hormone thresholds defining such conditions are lacking. At our tertiary center, we retrospectively examined a cohort of 173 hypertensive patients screened for PA by the ARR, of whom 120 had positive screening and passed a saline infusion test (SIT) or a captopril challenge test (CCT). Fifty-nine had PA, including 34 Conn adenomas and 25 with idiopathic aldosteronism (IA). Using a threshold of 160 pmol/l, post-SIT plasma aldosterone concentration (PAC) identified PA with 86.4% sensitivity, 94.7% specificity, and a negative predictive value of 92.3%. Of those subjects with a high ARR and a PAC above 550 pmol/l, 93% had a positive SIT, while 100% of subjects with a high ARR, but a PAC under 240 pmol/l had a negative SIT. Our results thus validate the biochemical conditions defined in the French and US guidelines for bypassing the confirmatory step in the workup for PA diagnosis.

Background With the rising number of rectal cancer survivors, more patients with sphincter-preserving surgery are having to live with a potentially impaired quality of life. The survey aimed to assess bowel and genitourinary sequelae and their impact on quality of life in an unselected registry-based population of rectal cancer survivors. Methods This cross-sectional cohort survey (registered at ClinicalTrials.gov ; ID: NCT03459235 ) included patients with rectal cancer who underwent curative surgery with sphincter-preserving surgery from January 1, 2007 to January 31, 2015. Patients with recurrent disease, intestinal stoma, or cognitive disorders were excluded. Validated scoring system included the Urinary Symptom Profile in women and the International Prostate Symptom Score in men for urinary function, International Index for Erectile Function 5 in men and Female Sexual Function Index in women for sexual function, and Core 30/ Colo Rectal 29 questionnaires for quality of life and Low Anterior Resection Syndrome score for bowel function. The impact of functional sequelae on global quality of life was evaluated by multiple linear regression. Results Responders (45.3%, 92/203 patients) and nonresponders were comparable according to sex, age, tumor stage, and neoadjuvant chemoradiation. With a mean follow-up of 6.5 years, 65.2% of the rectal cancer survivors had bowel dysfunction, of whom 41.3% experienced major Low Anterior Resection Syndrome and 80% of rectal cancer survivors experienced genitourinary dysfunction. In multiple linear regression, poor bowel function was a significant predictor of global quality of life in men (P = .04) and women (P = .0003). Conclusion This survey highlights the importance of sexual and bowel dysfunction in rectal cancer survivors and the strong correlation between high Low Anterior Resection Syndrome score and inferior quality of life. Further studies are needed to improve knowledge on how to predict bowel dysfunction and how to best support patients with bowel dysfunction.

Negative symptoms can be present at any stage of schizophrenia but their evaluation remains challenging. Self-evaluations may be particularly useful in screening negative symptoms quickly and effectively. The purpose of this study was to determine the sensitivity, the specificity, and the threshold beyond which the negative symptoms are considered pathological in a comparative study between patients with schizophrenia and healthy subjects using the Self-assessment of Negative Symptoms (SNS).One hundred and nine patients with schizophrenia and schizoaffective disorders (DSM-5) and 99 healthy controls were included and evaluated with the SNS. AUROC analyses were performed to assess the discriminant performance of the SNS scale for screening negative symptoms in the whole sample of patients but also in 2 patient sub-samples without high scores of depression or negative symptoms.The SNS (AUROC = 0.942 ± 0.046; p 0.001) appears to be an appropriate screening tool for distinguishing between SZ and HC with a threshold value of 7, and the sensitivity and specificity were 92.7% (95CI = [86.1-96.8]) and 85.9% (95CI = [77.4-92.1]) respectively. A threshold at 7 was also observed in the samples without patients with high level of depressive or negative symptoms.These results indicate that SNS might be a valuable tool for screening negative symptoms in clinical practice regardless the level of depressive and negative symptoms. Further studies using SNS in subjects at high risk for psychosis or with a first psychotic episode would be useful in the detection of negative symptoms.

Introduction Les traitements d’induction de remission (TIR) des vascularites a ANCA (VAA) systemiques ont permis d’ameliorer de facon importante le pronostic chez ces patients. Ces traitements sont neanmoins greves par des effets indesirables, principalement des infections qui representent desormais la premiere cause de mortalite dans la premiere annee suivant le diagnostic. Peu d’etudes se sont interessees au risque d’infection precoce des VAA nouvellement diagnostiquees selon le TIR, par cyclophosphamide (CYC) ou rituximab (RTX). Nous avons compare et analyse le taux d’infection et les facteurs de risque d’infection dans les 6 mois suivant le TIR. Patients et methodes Nous avons inclus, a partir des bases de donnees du CHU de Caen, tous les adultes consecutifs nouvellement diagnostiques d’une granulomatose avec polyangeite ou d’une polyangeite microscopique avec ANCA positif entre janvier 2006 et decembre 2019. Nous avons compare la survie sans infection severe (SIS), definie par un score Common Terminology Criteria for Adverse Events (CTCAE) ≥ 3, et la survie sans infection toute severite confondue (SITSC) dans les 6 mois suivant le TIR. Nous avons utilise une analyse de Cox multivariee pour identifier les facteurs predictifs d’infection. Resultats Nous avons inclus 145 patients, 27 dans le groupe RTX et 118 dans le groupe CYC. Les patients du groupe RTX etaient plus frequemment vaccines contre le pneumocoque (p Discussion Dans cette cohorte, un TIR par RTX, comparativement au traitement par CYC, n’exposait pas a un risque plus important d’infections severes mais exposait en revanche a un risque plus important d’infections toute severite confondue. Nous confirmons, avec cette cohorte, que la dialyse et l’absence de prophylaxie par trimethoprime-sulfamethoxazole sont des facteurs de risques d’infection severe. Il s’agit de la premiere etude a notre connaissance associant un antecedent de maladie urinaire a un risque d’infection severe precoce. La prise en compte de facteurs de risque d’infections a l’induction pourrait permettre d’optimiser la strategie preventive de ces patients de facon plus individuelle. Cette etude etant retrospective, il est possible que les patients consideres comme les plus a risque d’infections aient ete traites par RTX. Ce probable biais de selection a pu avoir majore le risque d’infections dans ce groupe. De plus, la corticotherapie est un important facteur de risque d’infection chez les patients atteints de VAA. Conclusion La survie SIS dans les 6 mois suivant le diagnostic de VAA etait similaire selon le traitement d’induction utilise (RTX ou CYC), mais la survie SITSC etait plus faible dans le groupe RTX malgre une meilleure couverture vaccinale anti-pneumococcique.

Resume Objectif Confirmer la faisabilite de la liberation chirurgicale du canal carpien assistee par echographie en salle de radiologie interventionnelle. Methodes Cette etude a inclus 39 patients atteints du syndrome du canal carpien, confirme par electromyogramme, et ne repondant pas au traitement medical. Les patients ont ete recrutes par le biais de consultations de chirurgie orthopedique et de rhumatologie, et operes en salle de radiologie interventionnelle, sous anesthesie locale. Une voie d’abord unique, au pli de flexion du poignet, a ete utilisee. Les patients ont ete suivis sur une periode de 90 j. Il s’agit d’une etude prospective ouverte non controlee. Resultats Quinze hommes et 24 femmes âges de 21 a 86 ans, dont 23 exercaient une activite professionnelle, ont ete inclus. La duree moyenne de l’intervention chirurgicale etait de 19,0 ± 4,6 min, le temps moyen d’occupation de la salle etait de 38,0 ± 8,1 min et le volume moyen d’anesthesique local employe etait de 14,7 ± 2,3 mL. Le score evaluant la douleur, les fourmillements et la gene ressentis dans la main etait considerablement reduit au jour 15 (49,1 ± 21,1 contre 23,5 ± 19,5 ; p Conclusion D’apres les resultats de cette etude, la procedure chirurgicale de liberation du canal carpien assistee par echographie hors du bloc operatoire semble efficace et bien toleree.

Introduction La densite minerale osseuse (DMO), les fonctions cognitives et l’indice de masse corporelle (IMC) pourraient jouer un role dans le siege des fractures post-chutes. Le but de cette etude etait de determiner si les patients ont un profil osseux, cognitif et anthropometrique particulier en fonction du siege de la fracture post-chute. Patients et methodes Cent six femmes, âgees de 55 ans et plus, victimes d’une chute avec fracture de la hanche (n = 30), de l’humerus (n = 28), du poignet (n = 32) ou de la cheville (n = 16), ont ete incluses dans cette etude transversale. Les caracteristiques osseuses, cognitives, anthropometriques ainsi que plusieurs facteurs de risque de chute, comme la peur de tomber, ont tout d’abord ete compares entre ces differents sieges de fractures. Les variables significatives ont ensuite ete utilisees pour realiser une analyse en composantes principales (ACP). Une comparaison entre les differents profils identifies par l’ACP a ensuite ete realisee. Resultats Les quatre sieges de fractures se differencient significativement par le niveau d’education, la DMO, l’IMC, la peur de tomber, et le nombre d’erreurs au Trail Making Test B, un test de fonctions executives. L’ACP a revele l’existence de quatre profils distincts (nommes P1 a P4), comprenant respectivement 25,8 %, 17,2 %, 26,9 % et 30,1 % des fractures. P1 et P4 comprennent essentiellement des fractures de l’humerus (respectivement, 45,0 % et 41,7 %) et peu de fractures de la hanche (respectivement, 10,0 % et 12,5 %). Au contraire P2 et P3 comprennent essentiellement des fractures de la hanche (respectivement, 33,3 % et 45,5 %) et peu de fractures de l’humerus (respectivement, 7,4 % et 18,2 %). P1 et P4 ont un IMC et une DMO plus eleves que P2 et P3. P2 comprend plus de fractures de la cheville mais moins de fractures de l’humerus et de la hanche que P3 (respectivement, 25,9 % vs 9,1 %, 7,4 % vs 18,2 % et 33,3 % vs 45,5 %). P2 et P3 ont un profil anthropometrique similaire avec un IMC normal mais P3 a une fragilite osseuse legerement plus marquee que P2. P2 a egalement une meilleure education, une meilleure autonomie, moins peur de tomber, une meilleure cognition et est moins polymedique que P3. Conclusion Il ne semble pas exister un profil type caracterisant un siege de fracture post-chute, mais plutot plusieurs profils correspondant a chaque siege de fracture et dependant de la combinaison des caracteristiques des patients. Ces profils se distinguent par des caracteristiques osseuses, cognitives, anthropometriques, mais egalement par la polymedication et la peur de tomber.

The DaptoDP (NCT 2012-005699-33) study aimed to evaluate the pharmacokinetic parameters of daptomycin (DAP) in peritoneal dialysis-related peritonitis (PDRP) patients following intraperitoneal (IP) administration. The authors have already reported the findings on the 200-mg dosing and present here the follow-up results of the 300-mg dosing. The primary endpoint was a dialysate concentration of DAP above the effective concentration in situ during 6 hours of dwell time i.e., 16 mg/L. Secondary endpoints were to avoid the toxic threshold of 120 mg/L DAP and to be above 16 mg/L DAP for 2 hours in plasma. Pharmacokinetic parameters were evaluated on days 1 and 5. Safety data were evaluated on days 1 to 14 based on clinical and biological parameters. Daptomycin was administered in Nutrineal during 6 hours of dwell time for 14 days plus the usual antibiotic therapy in a separate dwell. Because the 200-mg dosing objectives were not reached, a higher DAP dose of 300 mg was tested in the next 3 patients. Effective dialysate and plasma concentrations were achieved at the 300-mg DAP dose with the plasma concentration well below the toxic threshold, even at steady state, during which the accumulation factor never exceeded 3. The optimal DAP dose of 300 mg daily by the IP route, as determined by the pharmacokinetic data, needs to be clinically confirmed prior to routine use. The peritoneal bioavailability of DAP supports using the IP route as an alternative to the intravenous route for peritonitis and systemic infections.