Factors associated with early relapse of infantile haemangioma in children treated for at least six months with oral propranolol: A case-control study using the 2014-2021 French Ouest DataHub.

BACKGROUND: The factors associated with early relapse of infantile haemangioma (IH) after a first course of treatment with oral propranolol for at least six months (initiated after the marketing authorization had been granted) have not previously been investigated. OBJECTIVES: To identify factors associated with the risk of early relapse in children with IH treated with oral propranolol according to the current prescribing guidelines. METHODS: We performed a multicentre, retrospective, case-control study, using the Ouest Data Hub database. All children treated for at least 6 months with oral propranolol for IH between 31 June 2014 and 31 December 2021, and with a follow-up visit at least three months after treatment discontinuation were included. A case was defined as relapse of IH within three months of treatment discontinuation; each case was matched for age at treatment initiation and for centre, with four (relapse-free) controls. The association between relapse and treatment or IH characteristics was expressed as an odds ratio (OR) from univariate and multivariate conditional logistic regressions. RESULTS: A total of 225 children were included. Of these, 36 (16%) relapsed early. In a multivariate analysis, a deep IH component was a risk factor for early relapse [OR = 8.93; 95%CI: 1.0-78.9, p = 0.05]. A propranolol dosage level of less than 3 mg/kg/day protected against early relapse [OR = 0.11; 95%CI: 0.02-0.7, p = 0.02]. Tapering before propranolol discontinuation was not associated with a lower risk of early relapse. CONCLUSION: The risk factors for late and early relapse are probably different. Investigation of the risk factors for early vs. late IH relapse is now warranted.

Persistent swallowing disorders after extubation in mechanically ventilated patients in ICU: a two-center prospective study.

BACKGROUND: Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV). However, there are few clinical studies on persistent SD in critically ill patients undergoing tracheal intubation for MV. The aim of the present study was to assess the incidence and characteristics of clinical manifestations associated with persistent SD. METHODS: We prospectively evaluated in patients requiring more than 7 days of invasive MV the incidence and characteristics of clinical manifestations related to persistent SD. For this purpose, quality of swallowing was assessed within 24 h after extubation by an experienced physical therapist not directly involved in patient management. Swallowing assessment consisted in a specific standardized test combining a swallowing test and a full clinical evaluation of the cranial nerves involved in swallowing. In patients with SD on the first test, a second test was done within 48 h in order to discriminate between transient and persistent SD. RESULTS: Among the 482 patients mechanically ventilated more than 7 days, 138 were enrolled in this study. The first test performed 24 h after extubation revealed SD in 35 patients (25%). According to the second test performed 48 h later, SD were considered transient in 21 (15%) and persistent in 14 (10%) cases. Patients with persistent SD were older (66 ± 16 vs 58 ± 15 years), had lower bodyweight at admission (76 ± 15 vs 87 ± 23 kg) and received less often neuromuscular blocking agents (36% vs 66%) compared to patients without or with only transient SD. Patients with persistent SD had longer duration of Intensive Care Unit (ICU) stay after first extubation and longer delay to oral feeding than patients without or with only transient SD, respectively, 11 ± 9 vs 7 ± 6 days and 23 ± 33 vs 5 ± 7 days. CONCLUSIONS: Based on a specific standardized clinical test, 25% of patients mechanically ventilated more than 7 days exhibited clinical manifestations of SD. However, SD were considered as persistent after extubation in only 10% of them. Persistent SD were associated with longer duration of ICU stay after extubation and longer time of enteral feeding. TRIAL REGISTRATION: The study is registered with Clinical Trials (NCT01360580).

A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study.

INTRODUCTION: While prone positioning (PP) has been shown to improve patient survival in moderate to severe acute respiratory distress syndrome (ARDS) patients, the rate of application of PP in clinical practice still appears low. AIM: This study aimed to determine the prevalence of use of PP in ARDS patients (primary endpoint), the physiological effects of PP, and the reasons for not using it (secondary endpoints). METHODS: The APRONET study was a prospective international 1-day prevalence study performed four times in April, July, and October 2016 and January 2017. On each study day, investigators in each ICU had to screen every patient. For patients with ARDS, use of PP, gas exchange, ventilator settings and plateau pressure (Pplat) were recorded before and at the end of the PP session. Complications of PP and reasons for not using PP were also documented. Values are presented as median (1st-3rd quartiles). RESULTS: Over the study period, 6723 patients were screened in 141 ICUs from 20 countries (77% of the ICUs were European), of whom 735 had ARDS and were analyzed. Overall 101 ARDS patients had at least one session of PP (13.7%), with no differences among the 4 study days. The rate of PP use was 5.9% (11/187), 10.3% (41/399) and 32.9% (49/149) in mild, moderate and severe ARDS, respectively (P = 0.0001). The duration of the first PP session was 18 (16-23) hours. Measured with the patient in the supine position before and at the end of the first PP session, PaO2/FIO2 increased from 101 (76-136) to 171 (118-220) mmHg (P = 0.0001) driving pressure decreased from 14 [11-17] to 13 [10-16] cmH2O (P = 0.001), and Pplat decreased from 26 [23-29] to 25 [23-28] cmH2O (P = 0.04). The most prevalent reason for not using PP (64.3%) was that hypoxemia was not considered sufficiently severe. Complications were reported in 12 patients (11.9%) in whom PP was used (pressure sores in five, hypoxemia in two, endotracheal tube-related in two ocular in two, and a transient increase in intracranial pressure in one). CONCLUSIONS: In conclusion, this prospective international prevalence study found that PP was used in 32.9% of patients with severe ARDS, and was associated with low complication rates, significant increase in oxygenation and a significant decrease in driving pressure.

SmartPilot® view-guided anaesthesia improves postoperative outcomes in hip fracture surgery: a randomized blinded controlled study.

BACKGROUND: Both under-dosage and over-dosage of general anaesthetics can harm frail patients. We hypothesised that computer-assisted anaesthesia using pharmacokinetic/pharmacodynamic models guided by SmartPilot® View (SPV) software could optimise depth of anaesthesia and improve outcomes in patients undergoing hip fracture surgery. METHODS: This prospective, randomized, single-centre, blinded trial included patients undergoing hip fracture surgery under general anaesthesia. In the intervention group, anaesthesia was guided using SPV with predefined targets. In the control group, anaesthesia was delivered by usual practice using the same agents (propofol, sufentanil and desflurane). The primary endpoint was the time spent in the "appropriate anaesthesia zone" defined as bispectral index (BIS) (blinded to the anaesthetist during surgery) of 45-60 and systolic arterial pressure of 80-140 mm Hg. Postoperative complications were recorded for one month in a blinded manner. RESULTS: Of 100 subjects randomised, 97 were analysed (n=47 in SPV and 50 in control group). Anaesthetic drug consumption was reduced in the SPV group (for propofol and desflurane). Intraoperative duration of low BIS (<45) was similar, but cumulative time of low systolic arterial pressure (<80 mm Hg) was significantly shorter in the SPV group (median (Q1-Q3); 3 (0-40) vs 5 (0-116) min, P=0.013). SPV subjects experienced fewer moderate or major postoperative complications at 30-days (8 (17)% vs 18 (36)%, P=0.035) and shorter length of hospitalisation (8 (2-20) vs 8 (2-60) days, P=0.017). CONCLUSIONS: SmartPilot® View-guided anaesthesia reduces intraoperative hypotension duration, occurrence of postoperative complications and length of stay in hip fracture surgery patients. CLINICAL TRIAL REGISTRATION: NCT 02556658.

[National survey on short-term circulatory and/or respiratory support in 2009]. / Enquête nationale sur l'assistance circulatoire et respiratoire de courte durée en 2009.

OBJECTIVE: Indications for short-term circulatory and/or respiratory support (STCRS) increased during the last years. The goal of this survey was to characterize this activity in France in 2009. STUDY DESIGN: Observational retrospective pluricentral. MATERIAL AND METHODS: Each center of cardiothoracic surgery received a questionnaire validated by the Société française de perfusion about the activity, materials and organization used for STCRS. Data were expressed as percentages or median (25-75 percentiles). RESULTS: Forty-one centers on 61 (67%) answered. STCRS was performed respectively by 33 (80.5 %), 36 (87.8 %) and 39 (95.1 %) of centers in 2007, 2008 and 2009 including 10 [4-26], 18 [6-29] and 18 [5-33] cases/center per year. In 2009, types of STCRS installed were veno-arterial in 39 centres (95.1 %), veno-venous in 27 (65.9 %) and Novalung(®) in four (9.8 %), including 18 [5-32], five [2-7] and 15 [1-17] cases respectively. Twenty-nine centers (70.7%) installed STCRS outside the operating theater, and 24 (58.5%) in non-cardiothoracic surgery. A mobile circulatory support unit was created in eight centers (19.5%), however 21 (51.2%) have installed STCRS externally, at distances between 10 [5-55] to 100 [15-200] km, using emergency vehicles in most of the cases (90.5%), but helicopter seldom (19%). CONCLUSION: STCRS has increased over the last few years in France. Externalized activity outside the operating theater was important, time-consuming and used hospital resources therefore modifying the professional activity of perfusionists.

An algorithmic method for determining the kinetic system of receptor-channel complexes.

The mathematical study of receptor-channel kinetics involving numerous sites and conformations of the channel calls for specific analytic methods generally based on stochastic formulation in terms of Markov processes. These methods allow the determination of the number of states from the experimental data. When the number of states is known, it is necessary to try numerous kinetic diagrams to find the best one. The construction of the kinetic diagram and the corresponding kinetic system are based on physiological hypotheses. When the number of states is large, the kinetic schema becomes difficult to establish. We present a method that uses an algorithmic scheme to deduce a kinetic system directly from physiological hypotheses. This method takes into account any number of ligands and sites. The set of all the states given by the combination of site occupation and channel conformations is reduced by using two types of hypothesis: (1) molecular constraints that specify the transitions physically possible between states and (2) kinetic considerations related to the assumed physiology of the system, which gives the conditions necessary for a transition between two states. These hypotheses are expressed in terms of rules operating on the initial states of transitions. The expression of rules does not ensure their coherence (i.e., the fact that each kinetic transition is defined by one and only one rule). A mathematical condition has been found that ensures the coherence of rules. When coherence has been established, the corresponding dynamic system can be automatically generated. Because the rules are established in a systematic way and their coherence can be mathematically established, the computer implementation of this method makes it easy to test various kinetic hypotheses for problems where the number of states is large.

[The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population]. / L'histoire naturelle de 270 cas de syndrome de Wolff-Parkinson-White dans une equête de population générale.

Among 226,464 ambulatory subjects who underwent medical check-ups over a 15-year period, 270 were found to have Wolff-Parkinson-White syndrome (1.2 case in 1,000). The syndrome was more frequent in men (181 cases, 1.4 p. 1,000) than in women (89 cases, 0.9 p. 1,000). 222 subjects were aged from 20 to 49 years (1.4 p. 1,000) and only 48 were between 50 and 80 years of age (0.7 p. 1,000). 197 subjects were re-evaluated: 119 (60.4 p. 100) complained of palpitations and 78 (39.6 p. 100) were asymptomatic. Palpitations began at all ages, even after 50 years, and usually proceeded in short attacks lasting a few seconds or minutes, with a mean recurrence rate of 5 attacks per annum (76.4 p. 100). This constant pattern sometimes was interrupted for months or years. Conversely, in a minority of cases (23.5 p. 100) an unexpected accentuation occurred which lasted for hours or days. As years went by, palpitations tented to decrease and disappear. The pre-excitation area and its degree of fusion with the normal ventricular activation had no influence on the origin and frequency of palpitations. In contrast, sustained tachycardia seemed to be more frequent in cases with lateral and posterior left pre-excitation. Among 270 subjects with pre-excitation syndrome, 7 died including 4 whose death was not due to a cardiac disease, 2 who died suddenly and 1 who succumbed to ventricular tachycardia after a road accident. None of these patients had an associated heart disease. These last 3 cases might contribute to alter the usually favourable prognosis of Wolff-Parkinson-White syndrome.

Is the relationship between blood pressure and cardiovascular risk dependent on body mass index?

The relationship between blood pressure and cardiovascular mortality according to body mass index has been analyzed in two French prospective studies: the Paris Prospective Study, composed of 7,704 men aged 40-53 years examined in 1967-1972, and the Investigations Pré-Cliniques Study, made up of 19,618 men aged 40-69 years who underwent a checkup in 1970-1980. In the Paris Prospective Study, during a mean follow-up of 11.2 years, 241 cardiovascular deaths occurred, while in the Investigations Pré-Cliniques Study, with a mean follow-up of 7.6 years, 262 cardiovascular deaths occurred. A Cox survival analysis was performed on the data of each study to test the interaction of blood pressure and body mass index in the prediction of cardiovascular risk. Both analyses demonstrate a significant negative interaction, suggesting that a decreasing trend of the relative risk of cardiovascular death with increasing body mass index is better supported by the data than a constant relative risk. These results might have some bearing on the problem of the management of hypertension in overweight subjects.

[Prevalence and course of Wolf-Parkinson-White syndrome in a population of 138,048 subjects]. / Prévalence et évolution du syndrome de Wolff-Parkinson-White dans une population de 138 048 sujets.

The prevalence of the Wolff-Parkinson-White (WPW) syndrome, frequency of arrhythmias and their evolution were studied in a group of volunteers consisting in 79,978 men and 59,070 women, aged from 20 to over 70. The higher prevalence of WPW in men than in women (p less than 0.001) decreased significantly with age, much more in men (p less than 0.001) than in women (p less than 0.05). Ventricular pre-excitation was intermittent in 6.7 p. 100 of men and in 16 p. 100 of women. The probable site of pre-excitation, determined on the orientation of the delta wave was more often left than right (104 vs 66, p less than 0.02). The frequency of paroxysmal tachycardia increased with age: 10 p. 100 of the cases from 20 to 39 years of age, 29 p. 100 from 40 to 59, 36 p. 100 at 60 and over (p = 0.05). It was 1.7 times more frequent in cases of left pre-excitation. A hundred and fifty-one patients were followed-up from 1 to 11 years (4.6): 5 patients died, 3 of non-cardiac and 2 of undetermined causes, with one sudden death in a 29 year old man. Fifty-three patients were reviewed 4.5 years after the initial examination: 9 pre-excitations (7 right, 2 left) had disappeared. In conclusion, the higher prevalence of WPW in men decreases with age. This decrease appears to be essentially due to the disappearance of the ventricular pre-excitation and not to an increased mortality. Arrhythmias are more frequent in older patients with left-sided pre-excitation.

[Epidemiologic aspects of hypertension in pregnancy. Study of 442 cases]. / Aspects épidémiologiques de l'hypertension gravidique. Etude sur 442 cas.

We studied retrospectively the case records of 442 women who were followed because of hypertension during a pregnancy. Pregnancy hypertension was more frequent in white european than in black or arabic women. It occurred more frequently in women with an important professional activity than it did in housewives. 58% of patients had a familial history of high blood pressure, 35% were obese, 12% had glucose intolerance and 18% had hypercholesterolemia. Those frequencies were out of proportion with those in the control population. Finally, 32% of patients remained hypertensive after pregnancy. It is concluded that pregnancy hypertension occurs mainly in women whose genetic and metabolic background is that of essential hypertension.

[Prevalence and electrocardiographic forms of the Wolff-Parkinson-White syndrome]. / Prévalence et formes électrocardiographiques du syndrome de Wolff-Parkinson-White.

In a routine electrocardiographic study of 133929 subjects aged from 20 to 73, 136 cases of the Wolff-Parkinson-White syndrome were detected, 6 with intermittent pre-excitation. In this study, the prevelance of WPW was about 1 in a 1000, the highest incidence being in the 20-40 year age group with an equal sex ratio. The ECG analysis of the 136 cases consisted in determining the orientation of the delta wave in the precordial leads to establish the right or left ventricular origin of the pre-excitation, calculating the direction of the delta wave vector in the frontal plane to find out the anterior, lateral or posterior origin of the pre-excitation and analyse the position of the QRS axis to assess the appearances of the latest ventricular activity. The 136 ECGs were then classified according to electrophysiological criteria and the results of mapping: 1. Left ventricular pre-excitation; 74 cases characterised by a dominant delta wave in the right precordial leads. These cases were subdivided into: - 30 cases with posterior paraseptal pre-excitation, axis of the delta wave deviated superiorly and to the left, between -30 degrees and -60 degrees; - 20 cases of lateral pre-excitation with the vector of the delta wave deviated inferiorly and to the right between +100 degrees and +120 degrees; - 24 cases of anterior paraseptal pre-excitation with high amplitude delta and QRS deflections in all precordial leads and a delta wave axis between +50 degrees and +80 degrees. 2. Right ventricular pre-excitation; 62 cases characterised by a negative or isoelectric delta wave in the right precordial leads, including: - 14 posterior paraseptal pre-excitation with significant delta wave axis deviation between -30 degrees and -60 degrees; - 33 lateral pre-excitation with the delta and QRS axis pointing directly to the left at about 0 degrees; - 15 cases of anterior paraseptal pre-excitation with the delta wave axis between +50 degrees and +80 degrees. The cases with terminal forces of left ventricular activation in the same direction as the delta wave, superiorly and to the left at -60 degrees or inferiorly and to the right at +120 degrees, forming a single deflection of over 0,12 seconds' duration, are the result of delayed activation of the anterior or posterior fascicle of the left bundle after a long delay. On the other hand, the cases in which the direction of the pre-excitation is the same but the final part of ventricular activation moves away from the delta are probably the result of tension between the activation of the normal and accessory pathways.

[Distribution and correlations of serum uric-acid in two French adult populations: 13,885 men and 6,861 women (author's transl)]. / Distribution et corrélations de l'uricémie dans deux populations françaises d'adultes: 13,885 hommes et 6,861 femmes.

Distributions and correlations of serum uric acid (SUA) were studied in 13,885 men and 6,861 women who were between the ages of 20 and 90. In men and women the distribution of SUA is unimodal. The average SUA value is 6,28 mg/100 ml SD: 1,19) in men and 5,05 mg/100 ml (SD: 1,10) in women, 27% of the men and 4% of the women have a SUA level above 7 mg/100 ml. In men and in women correlations of SUA with an obesity index is strong (r = 0,272; r = 0,311). In men partial correlations between SUA and age, blood pressure, cholesterolemia, glycemia and hemoglobinemia diminish when obesity index is fixed. In women these correlations are stronger and do not vary when obesity index is fixed. In men and women the correlation between SUA and creatininemia is strong and do not vary when obesity index is fixed.

[Distribution and correlations of serum uric-acid in two French adult populations : 13,885 men and 6,861 women (author's transl)]. / Distribution et corrélations de l'uricémie dans deux populations françaises d'adultes : 13885 hommes et 6861 femmes.

Distributions and correlations of serum uric acid (SUA) were studied in 13.885 men and 6.861 women who were between the ages of 20 and 90. In men and women the distribution of SUA is unimodal. The average SUA value is 628 mg/100 ml (SD : 1,19) IN MEN AND 5,05 MG/100 ML (SD : 1,10) in women. 27% of the men and 4% of the women have a SUA level above 7 mg/100 ml. In men and in women correlations of SUA with an obesity index is strong (r = 0,272; r = 0,311). In men partial correlations between SUA and age, blood pressure, cholesterolemia, glycemia and hemoglobinemia diminish when obesity index is fixed. In women these correlations are stronger and do not vary when obesity index is fixed. In men and women the correlation between SUA and creatininemia is strong and do not vary when obesity index is fixed.