Clinique Mutualiste Chirurgicale

Health is "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity". Health must therefore be considered in its entirety. To begin with, however, it is vital to move swiftly from the concept of holistic health to its practical implementation. This is what the first Digital Health Network symposium proposed on May 30 and 31, 2024. The Digital Health Network was originally set up by a group of players from the healthcare sector, industry, research and elected representatives, with the aim of pooling feedback from experience as close as possible to local realities. The following points were addressed: i) rebalancing the curative approach with a greater emphasis on prevention and health promotion; ii) rebalancing the genetic approach with a greater emphasis on exposomics; iii) insufficient use of digital technology to improve the health of local populations; iv) governance and organizational challenges from the point of view of local decision-makers and observers, with a focus on research; and v) the ambitions of the Digital Health Network. The symposium provided an opportunity to share case studies of public health challenges in local areas, and possible responses in terms of infrastructure and stakeholder participation: citizens, patients, healthcare professionals, service providers, experts and other stakeholders. The challenges of ageing and geriatric frailty underline the importance of a global, preventive and multidisciplinary approach to promote successful, independent ageing.

Abstract The negative impact of Coronavirus SARS CoV-2 related Disease (COVID-19) in patients with chronic liver disease (CLD) has been described in several cohorts. We report here the results from the largest French cohort in “real-life”. The primary outcome was 30-days mortality. Patients with CLD regardless of etiology, who developed COVID-19 confirmed by a positive PCR and/or an evocative chest CT scan were included. The prognostic influence of clinical and biological features was assessed and multivariate analyses were made. Between 08/05/2020 and 31/12/2021, 1219 patients were included, mostly men (62%), median age 61 years, with advanced liver fibrosis in 46%, alcohol-related in 21% of the cases, complicated by liver failure (CHILD-PUGH B/C) in 170 of patients with cirrhosis (40%). Moreover 366 patients (30%) were immunocompromised, including 271 organ transplant recipients. Hospitalization in intensive care unit was required in 11% of the patients and 159 patients (13%) died, 70% of them from extra-hepatic causes. Overall, the independent risk factors for death were age > 61 years, diabetes, advanced liver fibrosis, and alcoholic etiology of the liver disease. Immunosuppression was not a prognostic factor in multivariate analysis. The results of this cohort confirm a significant vulnerability of COVID-19 patients with CLD. On the other hand, they confirm the absence of excess mortality related to immunosuppression, particularly in liver transplant recipients.

second-largest centenarian population at 108,000. China, India, and Thailand are among the top five, with 60,000, 48,000, and 38,000 centenarians. In each of these countries, centenarians constitute less than 1% of the overall population, but together, they make up 55% of the global centenarian population. Centenarians form a higher percentage of the population in Japan, Thailand, and the U.S., while in China and India, which have younger populations, their proportion is smaller. Japan has about 12 centenarians per 10,000 people, Thailand has five, and the U.S. has three. In contrast, China and India have fewer than one centenarian per 10,000 people. China and India appear on the list mainly due to their large populations, despite centenarians being a small proportion of their relatively young demographics. Conversely, centenarians are a more significant portion of the population in rapidly aging countries like Japan and Italy (Fig. 2 ). Currently, there are 4.8 centenarians per 10,000 people in Japan and 4.1 in Italy, compared to 2.2 in the U.S., which is aging more slowly. Among older adults, centenarians are the fastest-growing age subgroup.

Generation and subsequently accessibility of secondary findings (SF) in diagnostic practice is a subject of debate around the world and particularly in Europe. The French FIND study has been set up to assess patient/parent expectations regarding SF from exome sequencing (ES) and to collect their real-life experience until 1 year after the delivery of results. 340 patients who had ES for undiagnosed developmental disorders were included in this multicenter mixed study (quantitative N = 340; qualitative N = 26). Three groups of actionable SF were rendered: predisposition to late-onset actionable diseases; genetic counseling; pharmacogenomics. Participants expressed strong interest in obtaining SF and a high satisfaction level when a SF is reported. The medical actionability of the SF reinforced parents’ sense of taking action for their child and was seen as an opportunity. While we observed no serious psychological concerns, we showed that these results could have psychological consequences, in particular for late-onset actionable diseases SF, within families already dealing with rare diseases. This study shows that participants remain in favor of accessing SF despite the potential psychological, care, and lifestyle impacts, which are difficult to anticipate. The establishment of a management protocol, including the support of a multidisciplinary team, would be necessary if national policy allows the reporting of these data.

We sought to evaluate the prognostic impact of prostate-specific antigen (PSA) at 6 months after completion of radiotherapy (RT) in patients treated with RT alone, RT plus short-term (st; 3-6 months), and RT plus long-term (lt; 24-36 months) androgen-deprivation therapy (ADT). Individual patient data were obtained from 16 randomized trials evaluating RT ± ADT for localized prostate cancer (PCa) between 1987 and 2011. The lowest PSA recorded within 6 months after RT completion was identified and categorized as < or ≥0.1 ng/mL. The primary outcomes were metastasis-free survival (MFS), PCa-specific mortality (PCSM), and overall survival (OS), from 12 months after random assignment. Ninety-eight percent (n = 2,339/2,376) of patients allocated to RT alone, 84% (n = 4,756/5,658) allocated to RT + stADT, and 77% (n = 1,258/1,626) allocated to RT + ltADT had PSA ≥0.1 ng/mL within 6 months after completing RT. PSA ≥0.1 ng/mL was associated with lower MFS and OS and higher PCSM among patients allocated to RT ± ADT (RT - MFS: hazard ratio [HR], 2.24 [95% CI, 1.21 to 4.16]; PCSM: subdistribution hazard ratio [sHR], 1.82 [0.51 to 6.49]; OS: HR, 1.72 [0.97 to 3.05]; RT + stADT - MFS: HR, 1.27 [1.12 to 1.44]; PCSM: sHR, 2.10 [1.52 to 2.92]; OS: HR, 1.26 [1.11 to 1.44]; RT + ltADT - MFS: HR, 1.58 [1.27 to 1.96]; PCSM: sHR, 1.97 [1.11 to 3.49]; OS: HR, 1.59 [1.27 to 1.99]). Five-year MFS rates among patients allocated to RT, RT + stADT, and RT + ltADT were 91% versus 79%, 83% versus 76%, and 87% versus 74%, respectively, based on PSA < or ≥0.1 ng/mL. PSA ≥0.1 ng/mL within 6 months after RT completion was prognostic for lt outcomes in patients treated with RT ± ADT for localized PCa. This can be used to counsel patients treated with RT ± ADT and in guiding clinical trial design evaluating novel systemic therapies with RT + ADT as well as (de)intensification strategies.

Ceftazidime is commonly used as a key antibiotic against Pseudomonas aeruginosa in critically ill patients. ICU patients have severely altered and variable antibiotic pharmacokinetics, resulting in lower antimicrobial concentrations and potentially poor outcome. Several factors, including obesity and renal function, may influence pharmacokinetics. Thus, the objective of the study was to evaluate the impact of obesity and renal function on ceftazidime plasma concentrations and dosing regimen in ICU patients. All consecutive adult patients from six ICUs, treated with continuous ceftazidime infusion and under therapeutic drug monitoring evaluation, were included. Obesity was defined as BMI ≥30 kg/m². Glomerular filtration rate (GFR) was estimated by the Chronic Kidney Disease Epidemiology Collaboration formula. The ceftazidime recommended target for plasma concentrations was between 35 and 80 mg/L. A total of 98 patients (45 obese), with an average weight of 90 (±25) kg, were included. Mean GFR was 84.1 (±40.4) mL/min/1.73 m2. Recommended ceftazidime plasma concentrations were achieved for only 48.0% of patients, with median dosing regimen of 6 g/day. Obese patients had lower ceftazidime plasma concentrations compared with non-obese patients (37.8 versus 56.3 mg/L; P = 0.0042) despite similar dosing regimens (5.83 g/day versus 5.52 g/day, P = 0.2529). Almost all augmented renal clearance patients were underdosed despite ceftazidime dosing of 6.6 (±0.8) g/day. Weight-based ceftazidime dosing seemed to attenuate such obesity-related discrepancies, regardless of GFR. Obese ICU patients required significantly greater ceftazidime doses to achieve the target range. A tailored dosing regimen may be considered based on weight and GFR. Future prospective studies should be performed to confirm this individualized dosing approach.

Gabriel Nové-Josserand (1868-1949) studied medicine in Lyon under Professor Louis Léopold Ollier at the very end of Ollier's career. He wrote his thesis on a subject close to his master's heart, bone growth disorders due to growth plate alteration, with an experimental and a clinical part, following the principles of Claude Bernard. In 1894, he came top in the first ever recruitment examination for surgeons in Lyon and became head of paediatric surgery at the Hôpital de la Charité, where he spent most of his surgical career. A brilliant and sought-after teacher, his work on congenital hip dislocation led to very early national and international recognition. After training with Lorenz in Vienna, he imported and improved on Lorenz's technique for surgical reduction, highlighting the importance of the labrum. He worked on a variety of conditions including tuberculous arthritis, coxalgia, poliomyelitis and clubfoot. He helped establish the French Society of Orthopaedics (Société Française d'Orthopédie) in 1918. In 1921, he became the first chair of paediatric surgery in Lyon, and in 1929, he and Prof. Louis Ombrédanne from Paris were among the ten French cofounders of the SICO(T), a society he chaired at its second conference in London in 1933. He was received on this occasion as an honorary fellow of the Royal College of Surgeons. A brilliant surgeon with a keen analytical sense, he left his mark on the Lyon school of orthopaedic surgery founded by his mentor, Ollier, which he helped to perpetuate.