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Lymphopenia is common in patients with sepsis and associated with mortality. Immune-stimulatory therapies likely to restore T-cells count and function are under investigation in sepsis. Our study aimed to assess whether lymphopenia is a reliable prognostic biomarker in Staphylococcus aureus bacteremia. We conducted an ancillary study of the prospective VIRSTA Study including 574 patients with S. aureus bacteremia in two tertiary care centers. Neither lymphocyte count at the onset nor lymphocyte change during the first 4 days was associated with 12-week mortality. These results highlight the importance of characterizing the immune profile of patients with sepsis according to the cause before investigating immunostimulatory therapies to restore lymphocyte proliferation and function.

Type 1 diabetes is a chronic disease that can lead to vision loss when diabetic retinopathy develops. Retinal microvascular alterations occur before the appearance of clinical signs on a fundus examination. This study aimed to analyze retinal vascular parameters on optical coherence tomography angiography (OCT-A) in patients with type 1 diabetes without diabetic retinopathy in comparison with non-diabetic volunteers. This cross-sectional study was conducted at Dijon University Hospital from 2018 to 2020. Vascular densities were measured using macular OCT-A. In total, 98 diabetes patients and 71 non-diabetic volunteers were enrolled. A statistically significant lower vascular density of the inner circle was found in the superficial capillary plexus (SCP) in the diabetes group (p < 0.01). There was a statistically significant correlation between central vascular density in the deep capillary plexus (DCP) and total daily insulin intake (p = 0.042); furthermore, use of the FreeStyle Libre (FSL) device was associated with higher vascular densities in both the SCP (p = 0.034 for outer circle density) and DCP (p < 0.01 for inner circle density and p = 0.023 for outer circle density). Retinal microvascularization was early-altered in type 1 diabetes, and using the FSL device seemed to preserve retinal microvascularization.

Summary Background Patient isolation is widely recommended and used in healthcare institutions to prevent transmission of MDRO. However, its risk-benefit ratio is debated. Aim We undertook a systematic literature review and meta-analysis since 2009 to assess, based on the newly published studies, whether or not there are physical and psychological adverse events associated with patient isolation. Methods Systematic literature review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were systematically searched from PubMed, from the 1st of may 2009 till the 31st of January 2020. The concepts of the research questions were defined as: “Adverse events”, “patient isolation or cohorting”, and “multi-drug resistant organisms colonized or infection patients”. Three reviewers independently screened studies and extracted data. All statistical analysis was performed with Stata Software and R. Findings After screening titles of 15921 articles, abstracts of 196 and reviewing full texts of 50 studies, we included 19 studies. Studies were divided into 3 groups: 4 qualitative studies, 7 observational studies suitable for meta-analysis and 8 other observational studies. Meta-analysis shows no adverse events related to clinical care or patient’s experience associated with patient isolation. Conclusions More studies with correct methodology, including a control group and standardized inclusion criteria, must be conducted to confirm our results.

Background Incomplete vascularization of the retina in preterm infants carries a risk of retinopathy of prematurity (ROP). Progress in neonatal resuscitation in developing countries has led to the survival of an increasing number of premature infants, resulting in an increased rate of ROP and consequently in visual disability. Strategies to reduce ROP involve optimizing oxygen saturation, nutrition, and normalizing factors such as insulin-like growth factor 1 and n-3 long-chain polyunsaturated fatty acids (LC-PUFA). Our previous study, OmegaROP, showed that there is an accumulation or retention of docosahexaenoic acid (DHA) in mothers of infants developing ROP, suggesting abnormalities in the LC-PUFA placental transfer via fatty acid transporting proteins. The present study aims to better understand the LC-PUFA transport dysfunction in the fetoplacental unit during pregnancy and to find a novel target for the prevention of ROP development. Methods The study protocol is designed to evaluate the correlation between the expression level of placental fatty acid receptors and ROP occurrence. This ongoing study will include 100 patients: patients giving birth before 29 weeks of gestational age (GA) and patients with full-term pregnancies. Recruitment is planned for over 46 months. Maternal and cord blood samples as well as placental tissue samples will be taken following delivery. ROP screening will be performed using wide-field camera imaging according to the International Classification of ROP consensus statement. Discussion The results of this study will have a tangible impact on public health. Indeed, if we show a correlation between the expression level of placental omega-3 receptors and the occurrence of ROP, it would be an essential step in discovering novel pathophysiological mechanisms involved in this retinopathy. Trial registration: 2020-A03253-36

IntroductionHeart transplant (HT) recipients have a high risk of developing severe COVID-19. Immunoglobulin G antibodies are considered to provide protective immunity and T-cell activity is thought to confer protection from severe disease. However, data on T-cell response to mRNA vaccination in a context of HT remains limited.MethodsIn 96 HT patients, a IFN-γ release assay and an anti-Spike antibody test were used to evaluate the ability of SARS-CoV-2 mRNA vaccines to generate cellular and humoral immune response. Blood samples were collected few weeks to 7 months after vaccination. Multiple fractional polynomial and LASSO regression models were used to define predictors of T-cell response.ResultsThree to five months after vaccination, three doses of vaccine induced a positive SARS-CoV-2 T-cell response in 47% of recipients and a positive humoral response in 83% of recipients, 11.1% of patients remained negative for both T and B cell responses. Three doses were necessary to reach high IgG response levels (>590 BAU/mL), which were obtained in a third of patients. Immunity was greatly amplified in the group who had three vaccine doses plus COVID-19 infection.ConclusionOur study revealed that T and B immunity decreases over time, leading us to suggest the interest of a booster vaccination at 5 months after the third dose. Moreover, a close follow-up of immune response following vaccination is needed to ensure ongoing immune protection. We also found that significant predictors of higher cellular response were infection and active smoking, regardless of immunosuppressive treatment with mycophenolate mofetil (MMF).

To perform a systematic review and meta-analysis to determine the safety, efficacy, and outcomes of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) as the single embolic agent for the management of non-variceal upper and lower gastrointestinal bleeding (GIB).A literature search using MEDLINE/PubMed, EMBASE, and SCOPUS databases was performed for studies published from January 1980 to December 2019. Data from eligible studies were extracted and evaluated by two independent reviewers. Exclusion criteria were sample size5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. Technical success, clinical success, 30-day rebleeding, 30-day overall and major complications, and 30-day mortality were evaluated. The estimated overall rates were calculated with their 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. Heterogeneity across studies was assessed using the Q test and IFifteen studies with 574 patients were included. For upper GIB (331 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (328 of 331 patients) and 88.0% (237 of 300 patients), and 12.5% (69 of 314 patients) and 15.9% (68 of 331 patients), respectively. Thirty-day overall and major complications occurred in 14.3% (28 of 331 patients) and 2.7% (7 of 331 patients) of patients, respectively. For lower GIB (243 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (78 of 78 patients) and 78.0% (145 of 189 patients), and 15.7% (33 of 218 patients) and 12.7% (14 of 78 patients), respectively. Thirty-day overall and major complications occurred in 13.0% (25 of 228 patients) and 8.6% (19 of 228 patients) of patients, respectively.TAE with NBCA is safe and effective for treating non-variceal GIB, with high clinical success and very low major complication rates.

The aim of this study was to evaluate docosahexaenoic acid (DHA) as a potential antifibrotic agent after glaucoma filtration surgery (GFS) in rats.A total of 36 10-week-old Brown Norway rats underwent GFS. Animals were equally divided into three groups: a control group, a DHA group and a mitomycin C (MMC) group. Intraocular pressure (IOP) was measured using a dynamic rebound tonometer, and a photograph of the surgical site was taken on days 1, 3, 7, 10, 14 and 17. The incorporation of DHA into fibroblasts was evaluated by gas chromatography. The expression of alfa-smooth muscle actin (α-SMA) and Smad proteins was assessed by Western blotting.IOP decreased after surgery in animals from the three groups on day 1 after surgery. Over time, IOP remained lower in the DHA and MMC groups than in the control group (median [interquartile range] 8.0 [7.0-8.0] and 8.0 [7.3-8.0] mmHg vs. 9.0 [8.0-9.0] mmHg, respectively; p 0.001). Bleb area in the DHA and MMC groups remained larger than that of the control group from day 7 to day 14 (3.9 [2.9-5.2] and 3.5 [2.3-4.4] mmThe impact of DHA on IOP and bleb area was similar to that of MMC. The mechanisms of action of DHA in rat eye fibroblasts deserve further investigation.

Objectives Our objective was to identify hospitals with unusual mortality rates for major pancreatectomies over a period of ten years using 30-day mortality data from the French national database. Methods Data for all patients who underwent pancreatectomy were extracted from the national medico-economic database (Programme de Médicalisation des Systèmes d'Information). To identify quality outliers for each hospital, the observed-to-expected 30-day mortality rates were used as a quality indicator. Results A total of 19 494 patients underwent a major pancreatectomy in France between January 2009 and December 2018. The overall 30-day mortality rate was 4.8% (n = 944). For the 2009–2014 period, the funnel plot showed that 10 of the 176 hospitals lie outside the central 95% region and 7 lie outside the central 99.8% region. For the 2015–2018 period, out of 176 hospitals, 6 lie outside the central 95% region and 2 lie outside the central 99.8% region. The change in standardized mortality ratios between 2009–2014 and 2015–2018 testing for differences from the overall change, they were there 4 hospitals lie outside the central 95% region and 0 lie outside the central 99.8% region. Conclusion Over time, the improvement in hospital quality was weak. This study suggests that there is a pressing need to reorganize the supply of care for pancreatic surgery in France.

The aim of this study was to evaluate the impact of adherence to French coronavirus disease 2019 (COVID 19)-related guidelines for intravitreal injection (IVI) practice on the visual outcomes of patients treated with anti-vascular endothelial growth factor (VEGF) agents for macular diseases during the first lockdown period.Observational multicentre study including all patients from 18 centres with an IVI initially planned during the lockdown. Visual acuity (VA, ETDRS) was recorded at 1 and 4 months after lockdown. French COVID 19-related guidelines recommended maintaining IVI practice. We defined three groups of patients: A, adherent to guidelines; NA+, non-adherent with delayed IVIs; and NA-, non-adherent without IVIs performed during the lockdown. Risk factors for non-adherence and visual loss were studied.A total of 3020 eyes of 3020 patients, aged 77.8 ± 11.6 years, 59.8% women, were included. 59.3% were non-adherent(46.7% NA+, 12.6% NA-). A smaller decrease in VA at 4 months was observed in the A group than the NA+ and NA- group (-0.2 ± 6.7, -0.3 ± 6.9 and -1.5 ± 6.9, respectively [p 0.001]). Factors associated with non-adherence were in multivariable analysis, older age, hospital practice, low-density population areas, high viral incidence areas, longer intervals between injection and treat and extent protocol. Factors associated with visual loss at 4 months in multivariable analysis were, being in the NA- group, older age, TE and fixed regimens.Strict adherence to guidelines was associated with better visual outcome, although most of our patients did not attend as planned. Identification of patients at risk could help in the future in case of a new pandemic lockdown.

This study sought to identify risk factors for acute kidney injury (AKI) from pre-operative variables in a population of subjects aged over 65. Eligible patients were aged 65 years or over who underwent scheduled non-cardiac, non-ambulatory surgery. Patients with a diagnosis of AKI recorded in the hospital’s databases were considered since cases, from which 300 patients with no diagnosis of AKI, were drawn at random as controls. In total, 81 cases of post-operative AKI and 239 controls were identified. The incidence of post-operative AKI was 2.87%. Pre-operative creatinine level (p = 0.0001), a history of respiratory insufficiency (p = 0.04), prior vascular surgery (p = 0.0001) and abdominal surgery (p = 0.03) were associated with an increased risk of AKI after surgery. These four variables calculated a score and developed a nomogram for predicting occurrence of post-operative AKI. A history of renal disease was associated with increased risk of post-operative AKI, predominantly in cases of vascular or abdominal surgery.

Optimizing hearing in patients with a unilateral cochlear implant (CI) and contralateral acoustic hearing is a challenge. Evolutionary algorithms (EA) can explore a large set of potential solutions in a stochastic manner to approach the optimum of a minimization problem. The objective of this study was to develop and evaluate an EA-based protocol to modify the default frequency settings of a MAP (fMAP) of the CI in patients with bimodal hearing. Methods: This monocentric prospective study included 27 adult CI users (with post-lingual deafness and contralateral functional hearing). A fitting program based on EA was developed to approach the best fMAP. Generated fMAPs were tested by speech recognition (word recognition score, WRS) in noise and free-field-like conditions. By combining these first fMAPs and adding some random changes, a total of 13 fMAPs over 3 generations were produced. Participants were evaluated before and 45 to 60 days after the fitting by WRS in noise and questionnaires on global sound quality and music perception in bimodal binaural conditions. Results: WRS in noise improved with the EA-based fitting in comparison to the default fMAP (41.67 ± 9.70% versus 64.63 ± 16.34%, respectively, p = 0.0001, signed-rank test). The global sound quality and music perception were also improved, as judged by ratings on questionnaires and scales. Finally, most patients chose to keep the new fitting definitively. Conclusions: By modifying the default fMAPs, the EA improved the speech discrimination in noise and the sound quality in bimodal binaural conditions.

It has been estimated that Copy Number Variants (CNVs) account for 10%-20% of patients affected by Developmental Disorder (DD)/Intellectual Disability (ID). Although array comparative genomic hybridization (array-CGH) represents the gold-standard for the detection of genomic imbalances, common Agilent array-CGH 4 × 180 kb arrays fail to detect CNVs smaller than 30 kb. Whole Exome sequencing (WES) is becoming the reference application for the detection of gene variants and makes it possible also to infer genomic imbalances at single exon resolution. However, the contribution of small CNVs in DD/ID is still underinvestigated. We made use of the eXome Hidden Markov Model (XHMM) software, a tool utilized by the ExAC consortium, to detect CNVs from whole exome sequencing data, in a cohort of 200 unsolved DD/DI patients after array-CGH and WES-based single nucleotide/indel variant analyses. In five out of 200 patients (2.5%), we identified pathogenic CNV(s) smaller than 30 kb, ranging from one to six exons. They included two heterozygous deletions in TCF4 and STXBP1 and three homozygous deletions in PPT1, CLCN2, and PIGN. After reverse phenotyping, all variants were reported as causative. This study shows the interest in applying sequencing-based CNV detection, from available WES data, to reduce the diagnostic odyssey of additional patients unsolved DD/DI patients and compare the CNV-detection yield of Agilent array-CGH 4 × 180kb versus whole exome sequencing.

Ascending aortic aneurysm (AsAA) is a high-risk cardiovascular disease with an increased incidence over years. In this study, we compared different risk factors based on the pre-failure behavior (from a biomechanical point of view) obtained ex-vivo from an equi-biaxial tensile test. A total of 100 patients (63 ± 12 years, 72 males) with AsAA replacement, were recruited. Equi-biaxial tensile tests of AsAA walls were performed on freshly sampled aortic wall tissue after ascending aortic replacement. The aneurysmal aortic walls were divided into four quadrants (medial, anterior, lateral, and posterior) and two directions (longitudinal and circumferential) were considered. The stiffness was represented by the maximum Young modulus (MYM). Based on patient information, the following subgroups were considered: age, gender, hypertension, obesity, dyslipidemia, diabetes, smoking history, aortic insufficiency, aortic stenosis, coronary artery disease, aortic diameter and aortic valve type. In general, when the aortic diameter increased, the aortic wall became thicker. In terms of the MYM, the longitudinal direction was significantly higher than that in the circumferential direction. In the multivariant analysis, the impact factors of age (p = 0.07), smoking (p = 0.05), diabetes (p = 0.03), aortic stenosis (p = 0.02), coronary artery disease (plt; 10sup-3/sup), and aortic diameters (p = 0.02) were significantly influencing the MYM. There was no significant MYM difference when the patients presented arterial hypertension, dyslipidemia, obesity, or bicuspid aortic valve. To conclude, the pre-failure aortic stiffness is multi-factorial, according to our population of 100 patients with AsAA. STATEMENT OF SIGNIFICANCE: Our research on the topic of "Aortic local biomechanical properties in case of ascending aortic aneurysms" is about the biomechanical properties on one hundred aortic samples according to the aortic wall quadrants and the direction. More than ten factors and risks which may impact ascending aortic aneurysms have been studied. According to our knowledge, so far, this article involved the largest population on this topic. It will be our pleasure to share this information with all the readers.

Background Vascular graft infection (VGI) remains a severe disease with high mortality and relapse rates. We performed a retrospective single-center cohort study to highlight factors associated with long-term all-cause mortality in patients with vascular graft infection. Methods All patients hospitalized in our facility over 10 years for VGI were included. VGI was defined by the presence of a vascular graft or an aortic stent graft (stent or fabric), associated with 2 criteria among clinical, biological, imaging, or microbiological elements in favor of VGI. The primary outcome was all-cause mortality. Empirical antibiotic therapy was considered as appropriate when all involved pathogens were susceptible in vitro to the antibiotics used. The surgical strategy was defined as nonoptimal when the graft was not removed in a late-onset surgery (>3 months) or no surgery was performed. Results One hundred forty-six patients were included. Empirical antibiotic therapy was administered in 98 (67%) patients and considered appropriate in 55 (56%) patients. Surgery was performed in 136 patients (96%) and considered as optimal in 106 (73%) patients. In multivariable analysis, appropriate empirical antibiotic therapy was associated with a lower probability of mortality (hazard ratio, 0.47 [95% confidence interval, .30–.79]; P = .002). Long-term survival did not differ according to whether the surgical strategy was considered optimal or not (log-rank = 0.66). Conclusions Appropriate empirical antibiotic therapy is a cornerstone of the management of VGI. Whenever possible, antibiotics must be associated with optimal surgical management. However, surgery could potentially be avoided in comorbid patients who are treated with appropriate antibiotics.

International audience; Le Sénat a sollicité l’expertise du HCSP sur la stratégie de dépistage du Covid-19 en milieu scolaire.Le HCSP recommande de ne pas mettre en place des campagnes de dépistages systématiques transversaux en milieu scolaire, sauf pour des protocoles de recherche scientifique, et dans tous les cas pas dans des écoles maternelles et élémentaires dans lesquelles de telles campagnes de dépistage sont peu efficientes et techniquement trop contraignantes.Le HCSP recommande de recourir au dépistage ciblé en milieu scolaire uniquement en cas de situations épidémiologiques particulières, sur décision conjointe des autorités sanitaires et de l’Éducation nationale. Il conviendra de préciser, avant leurs mises en place, les conditions de ces dépistages ciblés des adultes et des enfants en milieu scolaire (déclinaison opérationnelle [réalisation, rendu des résultats, moyens accordés], accord parental et de l’enfant, technique de prélèvement facile et non invasive, rendu rapide des résultats).Il convient de fortement promouvoir le dépistage à visée diagnostique devant des symptômes compatibles avec une infection par le SARS-CoV-2, l’isolement des cas suspects au domicile jusqu’au résultat du test et le contact tracing au sein de l’institution scolaire si le cas est avéré. Pour cela notamment, une information sur les signes du Covid-19 doit être délivrée de manière systématique et répétée auprès des élèves et des parents et au besoin, au moyen de check-lists.Le HCSP souligne qu’il est nécessaire d’identifier une autorité sanitaire compétente pour piloter les dépistages ciblés. Pour réaliser ces dépistages, il est difficile de mobiliser les personnels médicaux et paramédicaux de l’Éducation nationale qui ont d’autres missions. Des contraintes organisationnelles importantes liées à la réalisation, à la conservation ainsi qu’à l’acheminement des prélèvements doivent être prises en considération.Les modalités d’information des familles doivent être parfaitement définies en amont. Il est nécessaire de veiller aux enjeux éthiques posés par le dépistage en milieu scolaire et notamment les risques de stigmatisation et d’iniquités de traitement.Le HCSP recommande que les efforts de prévention de la transmission de l’infection chez les enfants scolarisés reposent en particulier sur les mesures à destination des adultes (distanciation physique et autres mesures barrières et vaccination). Les élèves de plus de 12 ans, et leurs parents devraient être systématiquement informés de l’intérêt et des modalités de la vaccination anti-Covid-19.

International audience; Covid-19 : dépistage en milieu scolaire – Lettre au Sénat (HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Agathe Billette de Villemeur, Jean-Marc Brignon, Céline Cazorla, Christian Chidiac, Frédérique Claudot, Emmanuel Debost, Éric Gaffet, Jean-François Gehanno, Didier Lepelletier, Francelyne Marano, HCSP, Sophie Matheron, Philippe Minodier, Brigitte Moltrecht, Élisabeth Nicand, Henri Partouche, Bruno Pozzetto, Jean-Louis Roubaty, Gilles Salvat, Fabien Squinazi, Sylvie Van Der Werf, Nicole VernazzaDate du document : 31/07/2021Date de mise en ligne : 04/08/2021 (16 Pages)https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1081Le Sénat a sollicité l’expertise du HCSP sur la stratégie de dépistage du Covid-19 en milieu scolaire.Le HCSP recommande de ne pas mettre en place des campagnes de dépistages systématiques transversaux en milieu scolaire, sauf pour des protocoles de recherche scientifique, et dans tous les cas pas dans des écoles maternelles et élémentaires dans lesquelles de telles campagnes de dépistage sont peu efficientes et techniquement trop contraignantes.Le HCSP recommande de recourir au dépistage ciblé en milieu scolaire uniquement en cas de situations épidémiologiques particulières, sur décision conjointe des autorités sanitaires et de l’Éducation nationale. Il conviendra de préciser, avant leurs mises en place, les conditions de ces dépistages ciblés des adultes et des enfants en milieu scolaire (déclinaison opérationnelle [réalisation, rendu des résultats, moyens accordés], accord parental et de l’enfant, technique de prélèvement facile et non invasive, rendu rapide des résultats).Il convient de fortement promouvoir le dépistage à visée diagnostique devant des symptômes compatibles avec une infection par le SARS-CoV-2, l’isolement des cas suspects au domicile jusqu’au résultat du test et le contact tracing au sein de l’institution scolaire si le cas est avéré. Pour cela notamment, une information sur les signes du Covid-19 doit être délivrée de manière systématique et répétée auprès des élèves et des parents et au besoin, au moyen de check-lists.Le HCSP souligne qu’il est nécessaire d’identifier une autorité sanitaire compétente pour piloter les dépistages ciblés. Pour réaliser ces dépistages, il est difficile de mobiliser les personnels médicaux et paramédicaux de l’Éducation nationale qui ont d’autres missions. Des contraintes organisationnelles importantes liées à la réalisation, à la conservation ainsi qu’à l’acheminement des prélèvements doivent être prises en considération.Les modalités d’information des familles doivent être parfaitement définies en amont. Il est nécessaire de veiller aux enjeux éthiques posés par le dépistage en milieu scolaire et notamment les risques de stigmatisation et d’iniquités de traitement.Le HCSP recommande que les efforts de prévention de la transmission de l’infection chez les enfants scolarisés reposent en particulier sur les mesures à destination des adultes (distanciation physique et autres mesures barrières et vaccination). Les élèves de plus de 12 ans, et leurs parents devraient être systématiquement informés de l’intérêt et des modalités de la vaccination anti-Covid-19.Lire aussi dans les avis et rapports :Épidémie de Covid-19, confinement et santé des enfants du 20 avril 2020Coronavirus SARS-CoV-2 : mesures à mettre en œuvre dans les établissements accueillant des jeunes enfants du 30 avril 2020Coronavirus SARS-CoV-2 : mesures spécifiques aux établissements scolaires en phase 3 du déconfinement du 10 juin 2020Covid-19 : pertinence d’un âge minimal pour tester les enfants par RT-PCR avant un départ en Outre-mer du 2 juillet 2020Covid-19 : doctrines à appliquer dans les milieux scolaire et universitaire et pour l’accueil collectif des mineurs pour la rentrée de septembre 2020 du 7 juillet 2020Covid-19 : Compléments sur les stratégies de prévention de la diffusion du SARS-CoV-2 en EAJE et milieu scolaire du 17 septembre 2020

International audience; Covid-19: Sanitary conditions for the end-of-year celebrations 2020 (HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Yannick Aujard, Anne Berger-Carbonne, Agathe Billette de Villemeur, Jean-Marc Brignon, Sara Brimo, Daniel Camus, Christian Chidiac, HCSP, Frédérique Claudot, Éric Gaffet, Philippe Hartemann, Didier Lepelletier, Yves Lévi, Zeina Mansour, Brigitte Moltrecht, Christian Rabaud, Jocelyn Raude, Jean-Louis Roubaty, Fabien Squinazi, Nicole VernazzaDate du document : 09/12/2020Date de mise en ligne : 01/07/2021https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1049Family and friends will be gathering for the festive season, with the lockdown exit planned for 15 December 2020 by the French Government. The French High Council for Public Health (HCSP) analyses the health risk posed by these gatherings of people and summarizes international recommendations before publishing recommendations on the measures to be applied to limit the risk of Covid-19 contamination in this context. In particular, it provides guidelines to be applied before, during and after family and/or friends gatherings, and gives specific advice on the behaviour to adopt during group meals.Those guidelines are intended to help health authorities in the management of these private events and in the communication of prevention measures to the public. It is also aimed at the population and participants in these gatherings who are looking for concrete measures to apply in order to limit as much as possible their individual risk of infection and the risk of infecting their close circle of friends (clusters) and family in order to approach this festive period in a responsible and serene manner.The HCSP therefore recommends that these measures be widely disseminated through simple messages aimed at the public, particularly those with a low level of health literacy, using wide-ranging media and distribution channels; and by professionals in contact with the public: health, social and community workers, using positive, engaging, empowering but reassuring communication with the population in order to limit the anxiety-inducing effect.Lire en français :Covid-19 : conditions sanitaires pour les fêtes de fin d’année 2020 du 9 décembre 2020

Summary The objective was to describe French hospital nasal screening and decolonization procedures before clean surgery procedures. Information for participants was sent to the French Society for Infection Control members in June 2018. Seventy hospitals participated in the survey; 40% (N = 28) declared having institutional decolonization procedures: 64% (N = 18) in orthopaedic and 56% (N = 15) in cardiac surgeries. All hospitals used mupirocin for nasal decolonization and body decolonization with chlorhexidine (N = 16) or povidone iodine (N = 10). This study is the first to be performed in France giving information in this field. Screening/decolonization procedures are heterogeneous and the evaluation of their clinical impact remains complex.

Background Medial sternotomy is commonly used in cardiac surgery, although it results in intense post-operative pain. The placement of a sternal wound catheter for the administration of local anesthetic represents an effective technique. An initial bolus of tramadol in the sternal wound catheter could potentiate the effect of the local anesthetic and decrease both the post-operative pain and the morphine consumption. Patients and methods We conducted a prospective, randomized, double-blind study at the University Hospital Center, Dijon, France. Patients requiring scheduled or non-extreme emergency surgery for valve disease, aorta disease, atrial myxoma, or coronary artery bypass graft via sternotomy were included. A sternal wound catheter was inserted at the end of the surgery. The patients were randomized to receive either a 2 mg/kg bolus of tramadol (n=80) or a placebo (n=80) in the wound catheter. The bolus administration was followed by a continuous infusion of 1.25% levobupivacaine for the first 48 hrs following surgery. The patients' morphine consumption during the first 48 hrs after extubation was recorded. The other investigated variables were the patients' rescue analgesia, arterial blood gasses, and length of stay in the intensive care unit and in hospital, as well as the incidence of chronic pain at the four-month follow-up point. Results The morphine consumption was found to be comparable in the two groups (38 mg vs 32 mg, p=0.102). No effect was found in terms of the arterial blood gasses, lengths of stay, or incidence of chronic pain. Conclusion The addition of tramadol to the local anesthetic delivered via a wound catheter following sternotomy did not reduce the patients' post-operative morphine consumption. Trial registration Clinicaltrials.gov identifier: NCT02851394.

Background Partial splenic embolization (PSE) has been used to improve thrombocytopenia related to hypersplenism. The optimal embolic agent is still debated. The purpose of this study was to evaluate the safety, hematologic response and outcomes of PSE with cyanoacrylate glue for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy (SC). Methods Retrospective single-center observational report of cancer patients with thrombocytopenia related to hypersplenism and requiring SC who underwent PSE with N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran®2 glue between February 2015 and September 2017. All patients were treated under local anesthesia with a Glubran®2/Lipiodol® mixture of 1:5 ratio. They all received empiric antibiotic coverage. Splenic volume and parenchyma infarction rate were evaluated by CT scan within 1 month of PSE. Primary and secondary endpoints of the current study included a platelet count increase >150×109/L and the initiation of SC, respectively. Periprocedural laboratory values and adverse events were recorded. Results PSE was performed in eight patients (6 males, 2 females; median age, 59 years; range, 33-75 years) for a technical success of 100%. For procedures with adequate follow-up, primary and secondary endpoints were achieved in 100% (7 of 7 patients) and 100% (7 of 7 patients) of patients, respectively. One patient died before follow-up, unrelated to the procedure. Mean splenic infarction post-PSE was 55% (range, 21-70%) on CT scan. For 7 patients with laboratory follow-up, the mean platelet count significantly increased from 74×109/L [range, (62-83) ×109/L] immediately before PSE to a peak level of 272×109/L [range, (161-417) ×109/L] 10 days after PSE (P

International audience; Covid-19 : mesures de prévention en terrasse des bars et restaurants (HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Anne Berger-Carbonne, Agathe Billette de Villemeur, Jean-Marc Brignon, Daniel Camus, Christian Chidiac, Nicolas Eterradossi, Éric Gaffet, Jean-François Gehanno, Philippe Hartemann, Didier Lepelletier, Yves Lévi, Francelyne Marano, Brigitte Moltrecht, Bruno Pozzetto, Christian Rabaud, Jean-Louis Roubaty, Gilles Salvat, Fabien Squinazi, Nicole VernazzaDate du document : 01/05/2021Date de mise en ligne : 01/06/2021https://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=1034Dans un objectif de réouverture des terrasses des bars et restaurants et, compte tenu de la situation épidémiologique et de la couverture vaccinale, en prenant en compte également la matrice décisionnelle figurant dans son avis du 18 avril 2021, le HCSP propose les adaptations suivantes et recommande d’une manière générale d’ouvrir les établissements recevant du public, dans une démarche progressive tenant compte de l’évolution du risque épidémique au niveau national et régional.Spécifiquement pour la réouverture des terrasses des restaurants et des débits de boissons le HCSP préconise :de maintenir le port de masque sur les terrasses pour les personnels et les clients (sauf pendant les temps où les personnes boivent ou mangent) ;de respecter une capacité maximale de 6 personnes par table ;de mettre à disposition les moyens logistiques pour l’hygiène des mains des clients à l’entrée des terrasses ;de maîtriser le risque de flux et les regroupements de personnes au niveau des toilettes et d’assurer leur ventilation et aération ;d’équiper si possible les terrasses avec des écrans de faible hauteur entre les tables (ex. écrans plastiques transparents) pour limiter les contaminations directes et latérales entre les tables ;de ne pas cloisonner par des parois latérales les terrasses pour assurer le renouvellement d’air naturel, et ainsi réduire l’exposition aux aérosols ;de rouvrir les terrasses avec une jauge initiale par exemple de 50% (ou une table sur deux par rapport à la capacité d’accueil habituelle) durant la première étape. Cette jauge doit permettre de respecter les mesures barrières de distanciation physique ;de responsabiliser et d’inciter les clients à respecter les mesures en vigueur dans l’établissement en impliquant leur comportement individuel et collectif sur les terrasses ;de porter cette jauge à 100% lors de la phase 2 de la stratégie globale proposée par le HCSP ;de passer directement à cette phase 2 si le risque épidémique était jugé suffisamment faible à la date choisie pour la réouverture.Lire aussi dans les avis et rapports :Covid-19 : mesures barrières et de distanciation physique dans la restauration collective (hors restauration commerciale) du 21 mai 2020Covid-19 : mesures dans les espaces clos recevant du public en position assise, dans les lieux organisant des manifestations sociales et dans les transports en commun dont les navires de croisière, en phase 3 du déconfinement du 18 juin 2020SARS-CoV-2 : actualisation des connaissances sur la transmission du virus par aérosols du 23 juillet 2020

Multifocality is usually reported as a pejorative factor after percutaneous thermal ablation (PTA) of HCC but little is known in Western series. Recurrence and survival were extracted from a prospective database of all patients who underwent PTA for ≤3 cm HCC. From January 2015 to April 2020, we analyzed 281 patients with unifocal (n = 216), bifocal (n = 46) and trifocal (n = 16) HCC. PTA of bi- and trifocal HCC resulted in a high risk of very early (&lt, 6 months) distant recurrence (38.8% and 50%, respectively). Median RFS was 23.3 months (95% CI:18.6–30.4), 7.7 months (95% CI:5.1–11.43, p = 0.002) and 5.2 months (95% CI:3–12.3, p = 0.015), respectively, for uni-, bi- and trifocal HCC groups. In a multivariate analysis, both bifocal (HR = 2.46, p &lt, 0.001) and trifocal (HR = 2.70, p = 0.021) vs. unifocal HCC independently predicted shorter RFS. Median OS in trifocal HCC group was 30.3 months (95 CI:19.3-not reached). Trifocal vs. unifocal HCC independently predicted shorter OS (HR = 3.30, p = 0.008), whereas bifocal vs. unifocal HCC did not (p = 0.27). Naïve patient (HR = 0.42, p = 0.007), AFP &gt, 100 ng/mL (HR = 3.03, p = 0.008), MELD &gt, 9 (HR = 2.84, p = 0.001) and steatotic HCC (HR = 0.12, p = 0.038) were also independent predictors of OS. In conclusion, multifocal HCCs in a Western population have a dramatically increased risk of distant recurrence. OS after PTA of trifocal HCC is significantly below what was expected after a curative treatment.

International audience; Sports and cultural events: wearing masks to prevent Covid-19 ( HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Anne Berger-Carbonne, Agathe Billette de Villemeur, Jean-Marc Brignon, Daniel Camus, Nicolas Eterradossi, Éric Gaffet, Jean-François Gehanno, Philippe Hartemann, Didier Lepelletier, Yves Lévi, Francelyne Marano, Brigitte Moltrecht, Jean-Louis Roubaty, Fabien SquinaziDate du document : 23/08/2020Date de mise en ligne : 27/05/2021https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1022With the resumption of school, university, socio-cultural, sports and professional activities in September 2020 that necessary leads to population gatherings, and a risk of accelerated circulation of the SARS-CoV-2 virus in the general population, the High Council of Public Health (HCSP) recalls and adapts its doctrine and recommendations.For public reception in the context of sports events, the HCSP recommends to identify a Covid-19 referring person in charge of implementing and maintaining a prevention plan based on the HCSP’s recommendations of 31 May 2020. It recommends prevention measures to be applied before and after sports events, inside and around the sites.For cultural and sportive settings, physical distancing can be adjusted according to the epidemiological and territorial situation. At the moment, the HCSP its recommendations of separating each individual or groups of peoples by one seat.These events are an opportunity to raise awareness about the importance of protective masks: the HCSP recommends to diffuse specific communication when activities will resume in September.Lire en français :Événements sportifs et culturels : port de masque pour la prévention de la Covid-19 du 23 août 2020

International audience; Covid-19: recommendations for masks in enclosed public spaces (HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Anne Berger-Carbonne, Agathe Billette de Villemeur, Jean-Marc Brignon, Daniel Camus, Nicolas Eterradossi, Éric Gaffet, Jean-François Gehanno, Philippe Hartemann, Didier Lepelletier, Yves Lévi, Francelyne Marano, Brigitte Moltrecht, Jean-Louis Roubaty, Fabien SquinaziDate du document : 20/08/2020Date de mise en ligne : 27/05/2021https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1016While the epidemiological surveillance of Covid-19 shows the circulation of the virus is increasing in France, the High Council of Public Health (HCSP) provides recommendations on mask wearing. The present guidelines target higher education establishments but can be applied to other public settings. Cultural and sports settings will be treated separately.The HCSP mentions the international communication operation called "the mask challenge" launched by the WHO. According to the European Centre for Disease Control (ECDC) and recent literature, wearing masks is not only efficient in reducing the spread of the virus through respiratory secretions, but also protects people who wear them correctly from Covid-19. Although mask wearing is normalizing in enclosed environments and outdoor with high densities of people, the HCSP recalls that a physical distance of a least 1 meter between people remains paramount and cannot be abandoned.The HCSP encourages reusable masks to reduce waste and pollution. It recommends to promote the use of reusable masks (in accordance with Afnor recommendations), by facilitating the access to masks that can be reused up to 50 times, with constant and validated breathability and filtration performance, and by simplifying the maintenance conditions. Simple educational information through positive and updated messages should be diffused within public establishments when education and professional activities will resume after summer. The aim is to raise awareness and to enable people to adopt a responsible behaviour.Lire en français :Coronavirus SARS-CoV-2 : recommandations relatives au port de masque dans les lieux collectifs clos du 20 août 2020

International audience; Masks in the fight against the spread of SARS-CoV-2 (HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Marie-Cécile Bayeux-Dunglas, Anne Berger-Carbonne, Marie Beylot-Bary, Agathe Billette de Villemeur, Jean-Marc Brignon, Daniel Camus, Christian Chidiac, Éric Gaffet, Jean-François Gehanno, Evelyne Géhin, Bruno Grandbastien, Michèle Guimon, Joseph Hajjar, Philippe Hartemann, Didier Lepelletier, Yves Lévi, Zeina Mansour, Francelyne Marano, Isabelle Millot-Van Vlierberghe, Philippe Minodier, Brigitte Moltrecht, Yannick Morel, Jean-Louis Roubaty, Gilles Salvat, Thierry Sirdey, Fabien Squinazi, Nicole VernazzaDate du document : 29/10/2020Date de mise en ligne : 27/05/2021https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1031The High Council of Public Health (HCSP) describes the characteristics, performances, indications and target audiences of the different types of masks available: N95 masks, medical mask, and clothe mask.To be efficient in protecting others and oneself masks should be correctly fitted over the nose (to avoid the emission of droplets when sneezing and to ensure that the mask is airtight at the top), the mouth (to avoid the expulsion of droplets when speaking and coughing) and the chin (to fix the mask at the bottom of the face to avoid leaks).Wearing a mask, including by asymptomatic persons, reduces the transmission of SARS-CoV-2, in combination with other protective measures. The HCSP recommends the use of a reusable fabric or clothe mask for the general public, according to the Afnor S76-001 specifications and preferably category 1 (Non sanitary use, UNS1), in public and private indoor spaces and particularly for professionals. The HCSP recommends to read the composition label before using a reusable mask, and to follow the manufacturer’s recommendations, in particular to wash it before the first use and after each use, to wearing it for 4 hours maximum and to replace the masks as soon as they are wet.Clothe masks remain more protective than no mask, without reaching the level of protection of standardized ones. Thus, it is recommended to wear category 2 clothe masks if category 1 clothe masks or equivalent foreign standards are not available, for the general population in public establishments.In this period of very active circulation of the SARS-CoV-2 virus and as a precaution, the HCSP recommends children to wear a suitable mask by children from the age of 6 years in primary schools (from 1st grade to firth grade) is recommended, while respecting specific conditions, such as behavior disabilities.The HCSP specifies that there are no currently documented dermatological, pneumological, ENT, phoniatric or psychiatric contraindications to wear a mask, whatever its type. In the event of skin irritation, the HCSP recommends to seek medical attention to ensure appropriate dermatological treatment.The HCSP issues other recommendations on mask maintenance for the general public, information, communication and promotion of mask. Advice for teachers faced with prolonged mask use is also presented in the annex.Lire en français :Masques dans le cadre de la lutte contre la propagation du virus SARS-CoV-2 du 29 octobre 2020

Disinfection of hospital facilities and ambulances is an important issue for breaking the chain of transmission of viral pathogens. Hydrogen peroxide has provided promising results in laboratory assays. Here, we evaluate the efficacy of a hydrogen peroxide nebulizer for the inactivation of surrogate MS2 bacteriophage and murine norovirus (MNV) in a patient waiting room and the fully equipped cabin of a medical ambulance. We observed an average 3 log

Background and Purpose: In France, the entire population was put under a total lockdown from March 17 to May 11, 2020 during the peak of the coronavirus disease 2019 (COVID-19) pandemic. Whether the lockdown had consequences on the management of medical emergencies such as stroke and transient ischemic attack (TIA) has yet to be fully evaluated. This article describes hospitalization rates for acute stroke in 2 French regions that experienced contrasting rates of COVID-19 infection, before, during, and after the nationwide lockdown (January to June 2020). Methods: All patients admitted for acute stroke/TIA into all public and private hospitals of the 2 study regions were included. Data were retrieved from the National Hospitalization Database (PMSI). In the most affected region (Grand-Est), the hospitalization rates observed in April 2020 were compared with the rates in the same period in the least affected region (Occitanie) and in the 3 prior years (2017–2019). Results: There was a significant decline in hospitalization rates for stroke/TIA within the region most affected by COVID-19 during the month of April 2020 compared with previous years, while no significant change was seen in the least affected region. After lockdown, we observed a fast rebound in the rate of hospitalization for stroke/TIA in the most affected region, contrasting with a slower rebound in the least affected region. In both regions, patients with COVID-19 stroke more frequently had ischemic stroke, a nonsignificant greater prevalence of diabetes, they were less frequently admitted to stroke units, and mortality was higher than in patients without COVID-19. Conclusions: Our results demonstrates a significant drop in stroke/TIA hospitalizations and a fast recovery after the end of the French lockdown in the most affected region, while the least affected region saw a nonsignificant drop in stroke/TIA hospitalizations and a slow recovery. These results and recommendations could be used by the health authorities to prepare for future challenges.

Purpose The bone medullar adiposity is a marker of bone quality to the point that there is a need to investigate the factors which influence or not the density and distribution of this fat in the spine, especially at the lumbar level. The purpose was to test the feasibility of a Dixon three-point technique and investigate the vertebral marrow fat distribution. Material and methods A sagittal sequence Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-squares Estimation (IDEAL) IQ was performed on the lumbar spine of 46 subjects who were not suffering from any bone disease (21 women and 25 men, aged 18–77 years). Medulla adiposity was determined directly from the measurement of the fat fraction in each vertebral body (T12 to S1) obtained on the fat cartography automatically generated by the IDEAL sequence. Results Average vertebral fat fraction was 36.48% (SD 12.82), with a tendency to increase with age and to higher values among men. We observed a craniocaudal gradient of the fat fraction (β = 1.37; p < 0,001; SD 0.11) increasing with age in the lumbar spine from T12 to L5. Through multivariate analysis, this gradient was adjusted for sex, weight and height of the subjects. Conclusion This feasibility study shows the existence of a physiological craniocaudal gradient of vertebral medullar adiposity from T12 to L5. This gradient increases with age but it is independent of sex or BMI. The IDEAL sequence allows quick and reproducible measurement of the spine vertebral medullar adiposity., Spine, Lumbar vertebrae, MRI; Adiposity.

International audience; SARS-CoV-2: Updates on aerosol transmission of the virus (HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Anne Berger-Carbonne, Agathe Billette de Villemeur, Jean-Marc Brignon, Patrick Brochard, Daniel Camus, Christian Chidiac, Éric Gaffet, François Gaie-Levrel, Jean-François Gehanno, Evelyne Géhin, Philippe Hartemann, Didier Lepelletier, Yves Lévi, Francelyne Marano, Philippe Minodier, Brigitte Moltrecht, Bruno Pozzetto, Jean-Louis Roubaty, Gilles Salvat, Fabien Squinazi,Date du document : 23/07/2020Date de mise en ligne : 27/05/2021https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1015Following an open letter sent by 239 international scientists to the World Health Organization (WHO) on 4 July 2020 proposing the reclassification of SARS-CoV-2 as an airborne virus, the WHO asked to take into account this possible form of transmission and to consider some resulting measures.The High Council of Public Health (HCSP) in its previous guidelines (8 and 24 April) had not excluded this risk of airborne transmission and had already issued recommendations for prevention in indoor and outdoor settings. The present document completes these recommendations. It does not concern the healthcare settings.The HCSP reviewed the current state of knowledge on respiratory excretion of the virus as well as available modelling studies and experiments on airborne transmission. The review of the scientific literature that report contamination cases in enclosed public spaces (restaurants, public transports, cruise ships, choir rehearsals, etc.) and professional environments (slaughterhouses, etc.) stresses three conditions favourable to the airborne transmission of the SARS-CoV-2 virus: ventilation and air flow conditions, atmospheric conditions (low temperature, humidity) and the activities and physical efforts performed in these spaces.The HCSP recommends that the general population systematically wear preferably a clothe mask, made of reusable fabric (standard: AFNOR S76-001), in all enclosed public and private spaces and during outdoor gatherings with high densities of people in order to limit the emission of respiratory particles. This measure is necessary to protect others from potential contaminations, especially vulnerable people.The HCSP recalls that other protective barrier measures such as physical distancing, hand hygiene, cleaning and disinfection of surfaces and room ventilation should be applied too.It also provides recommendations for communication on mask wearing and recalls that research is needed to better understand the role of aerosols in viral transmission.Lire en français :SARS-CoV-2 : actualisation des connaissances sur la transmission du virus par aérosols du 23 juillet 2020

International audience; Collective enclosed spaces and Covid-19: mask wearing and possible adaptations at the workplace (HCSP, Avis et Rapports)Ludwig Serge Aho Glélé, Anne Berger-Carbonne, Jean-Marc Brignon, Daniel Camus, Christian Chidiac, Frédérique Claudot, Nicolas Eterradossi, Éric Gaffet, Jean-François Gehanno, Philippe Hartemann, Didier Lepelletier, Yves Lévi, Francelyne Marano, Jean-Louis Roubaty, Gilles Salvat, Michel Setbon, Fabien SquinazDate du document : 28/08/2020Date de mise en ligne : 27/05/2021https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1024Considering the resumption of professional activities from September 2020 leading to an increased risk of SARS-CoV-2 virus transmission within the population, the High Council of Public Health (HCSP) specifies specifies its doctrine and the barrier and organizational measures in the workplace, as well as the possible adaptations for wearing masks.The HCSP recalls the best strategy to reduce the risk of transmission of SARS-CoV-2 virus is to combine masks with physical distancing. Wearing a mask is the only effective measure when a physical distance of at least 1 meter is not guaranteed. Protective visor alone is not sufficient to control the risk.The HCSP stresses that the distance between the workstations, their separation by screens as well as air renewal are essential elements to be taken into account for better risk control. It recommends employees to systematically wear a mask when moving across the company’s rooms and to wash their hands whenever they change work areas. It stresses that a symptomatic employee should not go to work. If employees become symptomatic at the workplace, they should self-isolate then undergo a diagnostic PCR test. Symptomatic employees’ contacts should be traced, isolated and tested.The HCSP reports that minimising social interaction within the company lowers the risk of transmission.Finaly, the HCSP mentions that specific settings of organisation, equipment, ventilation and density of people can allow not to wear masks permanently at one’s desk.Lire en français :Lieux collectifs clos et Covid-19 : port de masque et adaptations possibles en milieu de travail du 28 août 2020