BP (France)

BackgroundAssisted peritoneal dialysis (PD) has played an important role in France by enabling elderly and frail patients to access home dialysis despite limited autonomy, supported by the widespread involvement of home nursing care. The aim of this study is to describe the evolution of assisted PD in France using data from the RDPLF registry.MethodsIncident PD patients recorded between 1981 and 2025 were analyzed and grouped into consecutive 5-year periods. For each period, we assessed the number of incident patients, the proportion receiving assisted treatment, and mean age, separately for continuous ambulatory PD (CAPD) and automated PD (APD).ResultsA total of 42,000 patients were included. The proportion of assisted CAPD patients increased steadily, peaking at around 72% between 2006 and 2010, before declining to 52% in recent years. In contrast, assisted APD decreased continuously, from approximately 40% in the early 1980s to 12% in 2025. Discussioon: These trends were not related to patient age but were largely explained by a marked reduction in private nurse assistance. APD, more often used by younger patients, was consistently associated with greater autonomy. Over the last five years, PD incidence declined while the proportion of autonomous patients increased. The decrease in the incidence of PD in France could be linked to a preferential selection of independent patients, due to the reduced availability of private home nurses.ConclusionsThe evolution of assisted PD in France raises important public health concerns. Reduced access to home nursing care may limit access to PD for frail patients and hinder its development. The future of home dialysis depends on striking the right balance between patient autonomy and ongoing professional support.

Obesity has been defined as a pandemic for several years, and its management is multidisciplinary with an important role for surgeons. The aim of this survey is to assess the level of knowledge of Togolese trained doctors on metabolic and bariatric surgery (MBS) and its feasibility in Togo. A national Google Form®, cross-sectional survey including medical doctors residing in Togo, or Togolese, volunteers from September 9 to 30, 2023; assessed subjective and objective knowledge of MBS, perceptions regarding indications, referral pathways, and barriers. The data were processed by Epi Info 7.2.5 software. 90 physicians responded with a male predominance (sex ratio M/F = 7.18) and a median age of 34 years. MBS was assumed to be known by 73 practitioners (81.11%). The evaluation criteria showed that the level of MBS-knowledge was complete for 31 physicians (34.44%); average for 32 physicians (35.56%), and insufficient for 27 physicians (30%). In the univariate model, significant predictors of higher MBS-knowledge score were: specialist (P = .0052), higher professional level (P = .0214), and good answer to multi-disciplinary team specialist (P < .0001). There were 75 doctors (83.33%) who validated the feasibility of MBS in Togo. Morbidly obese and financially wealthy patients were indicated by 54.44% of physicians. Concerning care, 61 physicians (67.78%) would be willing to entrust their patient to a specialist residing in Togo. Physicians in Togo show insufficient objective knowledge and misconceptions regarding MBS. Strengthened training, national guidelines, and clear referral pathways are needed.

The Venous Excess Ultrasound (VExUS) score has been developed to grade venous congestion and predict acute kidney injury in cardiac surgical setting by combining inferior vena cava diameter with hepatic, portal, and renal venous Doppler patterns. While initial studies demonstrated associations with acute kidney injury, subsequent non cardiac setting ICU studies yielded contradictory results, prompting reevaluation of what VExUS actually measures. Analysis of VExUS components reveals the score reflects complex interactions between cardiac function, filling pressures, and volume status rather than pure volume assessment. Each component—IVC diameter, hepatic vein flow, portal vein flow, and renal vein flow—is differently influenced by cardiac function and volume status. Observational studies demonstrate that patients with highest VExUS scores often have cardiogenic shock despite low fluid balance, while those with significant volume excess may have low scores when cardiac function is preserved. This evolving understanding necessitates a correction in clinical practice, returning to the original physiological framework where VExUS reflects the interaction of venous return and cardiac function rather than simple volume overload parameter.

BackgroundThe appropriate antithrombotic regimen for patients with chronic coronary syndrome who are at high atherothrombotic risk and receiving long-term oral anticoagulation remains unknown.MethodsWe conducted a multicenter, double-blind, randomized, placebo-controlled trial in France involving patients with chronic coronary syndrome who had undergone a previous stent implantation (>6 months before enrollment) and were at high atherothrombotic risk and currently receiving long-term oral anticoagulation. The patients were randomly assigned in a 1:1 ratio to receive aspirin (100 mg once daily) or placebo; all the patients continued to receive their current oral anticoagulation therapy. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia. The key safety outcome was major bleeding.ResultsA total of 872 patients underwent randomization; 433 were assigned to the aspirin group, and 439 to the placebo group. The trial was stopped early at the advice of the independent data and safety monitoring board after a median follow-up of 2.2 years because of an excess of deaths from any cause in the aspirin group. A primary efficacy outcome event occurred in 73 patients (16.9%) in the aspirin group and in 53 patients (12.1%) in the placebo group (adjusted hazard ratio, 1.53; 95% confidence interval [CI], 1.07 to 2.18; P=0.02). Death from any cause occurred in 58 patients (13.4%) in the aspirin group and in 37 (8.4%) in the placebo group (adjusted hazard ratio, 1.72; 95% CI, 1.14 to 2.58; P=0.01). Major bleeding occurred in 44 patients (10.2%) in the aspirin group and in 15 patients (3.4%) in the placebo group (adjusted hazard ratio, 3.35; 95% CI, 1.87 to 6.00; P<0.001). A total of 467 and 395 serious adverse events were reported in the aspirin group and placebo group, respectively.ConclusionsAmong patients with chronic coronary syndrome at high atherothrombotic risk who were receiving an oral anticoagulant, the addition of aspirin led to a higher risk of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia than placebo, as well as higher risks of death from any cause and major bleeding. (Funded by the French Ministry of Health and Bayer Healthcare; ClinicalTrials.gov number, NCT04217447.)

This study explores the capabilities and limitations of high-temperature electron backscatter diffraction (HT-EBSD) and crystallographic reconstruction methods for analyzing microstructure evolution induced by phase transformations in steels. Using a state-of-the-art CMOS detector with infrared filtering enabled EBSD map acquisition of austenite in real time at temperatures up to 1000 °C with acquisition speed over 1000 points per second (pps) and high indexing rates. These direct observations revealed critical features of the austenite microstructure, including annealing twins and grain size heterogeneities, that reconstruction methods typically overlook. Moreover, it was possible to confirm austenite grain refinement through austenitization cycles in a medium carbon steel and to reveal for the first-time ultrafine parent austenite grains in 10 % chromium oxide dispersion strengthened (ODS) steel, a case where reconstruction methods failed. Furthermore, in-situ HT-EBSD provides ground truth validation for reconstruction methods. By monitoring in-situ the martensitic transformation on 10 %Cr steel, we confirmed both the high accuracy of reconstructed parent austenite orientations and validated the average orientation relationship (OR) established through reconstruction methods. Finally, in-situ HT-EBSD could also provide valuable data for refining reconstruction algorithms to overcome their limitations in capturing precise grain morphology and annealing twins. Despite its advantages, HT-EBSD faces challenges including temperature measurement uncertainties and potential surface artifacts. This study ultimately advocates for judicious combination of both methodologies to comprehensively understand microstructure evolution during steel phase transformations, including the “memory effect” during re-austenitization and identification of austenite nucleation sites. • State of the art HT-EBSD systems enables capturing real-time austenite microstructure up to 1000 °C • HT- EBSD gives new insights in analyzing microstructure evolution induced by phase transformations in steels • Direct observation offers valuable date to validate and refine reconstruction methods. • HT-EBSD faces limitations including temperature uncertainty and potential surface artifacts. • Complementary use of both methodologies provides comprehensive understanding of phase transformation mechanisms in steels.