Assistance Publique – Hôpitaux de Paris

The nodal spreading of oral cavity and oropharynx squamous cell carcinoma (OCSCC/OSCC) remains a critical challenge. The pathological nature of lymph nodes adjacent to the tumor is sometimes difficult to interpret on PET/CT during the initial assessment. The primary objective of this study was to evaluate the impact of contralateral node PET/CT hyperfixation on disease-free survival (DFS) in lateralized OCSCC or OSCC. From our database, all patients who had a PET/CT during their management for a lateralized SCC were selected between 2018 and 2021. Clinical, histological and radiological data between patients with and without contralateral nodes on the initial PET/CT were compared, as well as the survival of these patients. The Inselspital, Bern University Hospital (ISB) publicly available dataset was then used, to estimate the positive predictive value (PPV) of a contralateral fixation. Of 48 patients who had a PET/CT for lateralized OCSCC or OSCC, 16 (33%) had contralateral lymph node hyperfixation on PET/CT (PET/CT CLN+). In this group, 4 had a bilateral lymph node dissection (27%), and only one had lymph node metastasis. Using the ISB dataset, we found a PPV of only 35% for these contralateral hyperfixation. There was no significant difference in a multivariate Cox model in terms of DFS between the two subgroups in the case of lateralized tumors. There was no difference in survival between patients with or without contralateral lymph nodes on the initial PET/CT.

Timely discharge of patients who are clinically ready to be discharged from hospitals to the next point of care is a common health system challenge. Ensuring safe and effective discharge holds new urgency, given the backlogs and increased waiting times for inpatient services in many countries after the COVID-19 pandemic. The study aimed to identify policy options for addressing delayed discharges in six European countries (Denmark, France, Germany, the Netherlands, Norway, and Sweden), and to summarise available evidence on their effectiveness. Experts from the Health Systems and Policy Monitor (HSPM) network of the European Observatory on Health Systems and Policies and additional country experts identified relevant policies and initiatives up to November 2023. When evaluations were available, the experts also provided information on their findings. The data collection was followed by a qualitative, cross-country comparative analysis. A total of 17 policies or initiatives were identified in the study countries. Hospital-based initiatives included discharge planning and transitional care. Community and home care initiatives included municipal emergency beds, intensive home rehabilitation, and assisted discharge. Cross-sectoral initiatives ranged from coordination efforts at the regional and municipal levels to decision support systems and financial incentives. Several common factors or principles underpin many of the identified policies and initiatives. These include clarity of responsibility, effective planning and communication, resourcing of community-based capacity, possible unintended consequences of financial penalties, and the need to adopt a systemic approach.

Erythropoietin (EPO) is a glycoprotein hormone primarily known for its central role in red blood cell production, but it is now also recognized for its immunomodulatory effects on a range of immune effectors. Several studies indicate that EPO helps regulate intestinal barrier integrity, although its effect on intraepithelial lymphocytes (IELs) is still unknown. Using multiparameter flow cytometry and both conventional and unsupervised analyses, we conducted an in-depth phenotypic assessment of IELs from the murine duodenum, jejunum, ileum and colon. Our results revealed that in EPO-treated C57BL/6 mice, the absolute IEL count in the colonic epithelium was more than twice that observed in control mice without changes in the frequencies of the various subpopulations, indicating a global increase. This was accompanied by integrin α4β7 overexpression. Furthermore, EPO treatment alters the intestinal microbiota, increasing bacterial load while reducing diversity, with a notable decrease in Muribaculaceae, a taxon involved in microbial cross-feeding. This alteration may contribute to epithelial imbalance and indirectly to the observed increase in IEL density. Importantly, EPO treatment did not trigger colonic mucosal inflammation, although the affected IELs show a microbiota-dependent decrease in CD8αα expression (known to downregulate IEL activity). The present study is the first to provide a phenotypic mapping of IEL populations in the digestive tract of C57BL/6 mice and highlighted a novel regulatory role of EPO on colonic IELs. These results raise important questions about the impact of exogenous EPO supplementation and endogenous EPO fluctuations on intestinal immune responses - particularly in the context of inflammatory diseases.

The optimal tidal volume (VT) during Cardio-Pulmonary Resuscitation (CPR) remains unknown. Capnogram could permit to detect ventilation induced harmful effect. The objectives of the present study were to describe the impact of different VT on hemodynamics during CPR; and to evaluate whether capnogram analysis can assess the influence of ventilation on circulation. Eighteen pigs had five minutes of untreated ventricular fibrillation followed by CPR with automated continuous chest compressions and ventilation settings randomly combining VT 6, 10 or 14ml/kg. Capnograms were recorded to determine thoracic distension patterns. After return of spontaneous circulation (ROSC), all surviving animals were ventilated 2h and lungs were withdrawn for histological analysis. VT was associated with differences in the hemodynamic parameters studied. VT at 6 or 14ml/kg graphically showed poorer cerebral and coronary perfusion pressures and mean arterial pressure than a VT at 10ml/kg. The capnogram could distinguish three levels of thoracic distension. Thoracic distension was associated with differences in the hemodynamic parameters studied. Animals with either low or high distension showed poorer cerebral and coronary perfusion pressures and mean arterial pressure than those with moderate distension. ROSC was obtained in 13 (72%) animals. Histology showed that both low and high VT was associated with a trend towards higher lung damage. In this animal study, a U-shaped relationship observed with VT suggests that both small and large VT may impair circulation. Capnogram analysis could contribute to identify ventilation settings associated with hemodynamic compromise.

Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association and chromosomal anomalies (VACTERL-CA) on the surgical outcomes of EA patients, offering novel insights into risk stratification. All patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry (EAR) between July 2014 and December 2017 were included. Patients were classified into two groups: those with VACTERL-CA and those without these anomalies (non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes. Among 372 patients, 22% (n = 82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 weeks vs. 37.1 weeks, p = 0.004), birth weight (2,312 g vs. 2,663 g, p < 0.001), and APGAR scores at 5 and 10 minutes (p = 0.005). Surgical strategies, including rates of primary anastomosis (88% in both groups), did not differ. Anastomotic leak and stricture rates were similar; however, recurrent fistula was more common in VACTERL-CA (4.9% vs. 1.0%, p = 0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%, p = 0.003), largely due to associated anomalies such as cardiac or neurologic conditions, whereas EA-related mortality was more frequent in non-VACTERL (1% vs. 0%). Sepsis was also more frequent in VACTERL-CA (10.9% vs. 4.5%, p = 0.033). In multivariate analysis, low birth weight (adjusted odds ratios [aOR]: 0.95 per 100 g, p = 0.010) and cardiac malformations (aOR: 2.33, p = 0.002) were independently associated with VACTERL-CA. EA patients with VACTERL-CA represent a high-risk subgroup characterized by prematurity, major cardiac defects, and increased sepsis risk. These findings highlight the need for early cardiac screening, standardized infection-prevention bundles, and tailored multidisciplinary care to improve survival and reduce preventable complications.

Cardiac graft rejection and allograft vasculopathy (CAV) are major causes of morbidity and mortality in heart transplant (HT) patients. While endomyocardial biopsy and invasive coronary angiography remain diagnostic gold standards, their invasiveness highlights the need for safer, noninvasive alternatives. Cardiac computed tomography (CT) has emerged as a promising modality for evaluating both coronary and myocardial status. The primary aim of this study is to evaluate CT-measured extracellular volume (ECVCT) in HT patients compared to a control group and identify its clinical determinants. The secondary objective is to explore the association between ECVCT and CAV severity. In a reference HT center, we conducted a retrospective cohort study of 163 patients comprising 80 HT patients and 83 age- and sex-matched controls without structural heart disease studied with a standardized CT protocol. Twenty-two control patients had concomitant cardiac CT and magnetic resonance (CMR) to validate ECVCT measurements. Determinants of ECVCT including rejection history, CAD-RADS, CAV and cardiovascular risk factors were studied. Median ECVCT was significantly higher in HT patients (34%, IQR 30-38) compared to controls (29%, IQR 27-31; p<0.001). ECVCT was highly correlated with MR-ECV (r=0.88, p<0.001). In HT recipients, elevated ECVCT was independently associated to hypertension , smoking, presence of CAV, elevated CAD-RADS scores and a history of graft rejection, whereas in controls only higher coronary artery calcium scores correlated with increased ECVCT. CONCLUSION: ECVCT is increased in HT patients compared to controls and associated with rejection history and CAV. ECVCT emerges as a promising noninvasive tool for the simultaneous assessment of myocardial alterations and CAV in HT patients showing strong concordance with CMR and high reproducibility. Further multicenter studies are warranted to confirm its role in transplant surveillance protocols.