Hôpital Maison Blanche

Open Latarjet (Lt) and arthroscopic Bankart associated with Hill-Sachs remplissage (BHSR) have been commonly proposed to treat anterior shoulder instability. Patients undergoing either Latarjet or arthroscopic Bankart repair with remplissage, when matched according to relevant demographic and injury-specific variables, would have equivalent clinical and radiographic outcomes at a minimum 5-year follow-up. Cohort study; Level of evidence, 3. In a retrospective multicentric study, including 325 patients treated operatively for primary chronic anterior shoulder instability, 220 patients were reviewed with a minimum follow-up of 5 years. In this database, patients in the Lt and BSHR groups were matched 1 to 1 based on age at surgery, sex, amount of glenoid bone loss, and length and width of the Hill-Sachs lesion. Clinical outcomes were assessed using active range of motion, subjective shoulder value (SSV), Rowe scores, and Walch-Duplay scores. Recurrent instability, postoperative complications, and return to sports (RTS) were compared. Arthritis was evaluated according to the Samilson and Prieto classification. A total of 68 patients (34 patients in the Lt group matched to 34 patients in the BHSR group) were analyzed at a mean follow-up of 90 ± 25 months. Preoperatively, the mean age was 25 ± 6.5 years, the glenoid bone loss was <6% (mean, 5.58% ± 5.52%), and the width and depth of the Hill-Sachs lesion were <27 mm (mean, 15.7 ± 6.91 mm) and 5 mm (mean, 4.8 ± 2.41 mm), respectively, in the 2 groups. Postoperatively, 1 hematoma required a revision in the Lt group. The recurrence rate was 6% (n = 2) in the Lt versus 14% (n = 5) in the BHSR group (P = .2) at the final follow-up. RTS at 1 year was higher in the Lt group (82% vs 62%; P < .01). There was no difference in active range of motion, Rowe scores, and Walch-Duplay scores at the last follow-up. However, the SSV was higher in the Lt group (92% vs 81%; P = .003). The arthritis rate was 20% (grade 1: n = 6; grade 2: n = 1) in the LT group versus 3% (grade 1: n = 1) in the BHSR group (P = .054), with no clinical effect on functional scores. At >7 years of follow-up, there was no statistical difference in the recurrence rate between patients in the Lt and BHSR groups. However, RTS was greater at 1 year after the Lt procedure. The possibility of degenerative arthritis developing in the Lt group is worrisome and requires a longer follow-up to assess potential clinical impairment.

BackgroundDespite improvement in acute care of immune-mediated thrombotic thrombocytopenic purpura (iTTP), numerous studies showed that patients with iTTP have inferior mental health and health-related quality of life (HRQoL). Caplacizumab led to shorter hospitalization, less plasma exchange, and improved survival in iTTP and might influence long-term HRQoL.ObjectivesWe aimed to address the impact of iTTP on HRQoL, posttraumatic stress disease, depression, and anxiety, as well as the possible role of caplacizumab on improving these features.MethodsWe conducted a survey among patients with iTTP enrolled in the French thrombotic microangiopathy registry: patients completed the Short Form (SF)-36 HRQoL, the Hospital Anxiety and Depression Scale screening for anxiety and depression, and the Posttraumatic Stress Disorder Checklist for DSM-IV posttraumatic stress disease questionnaires. Results were compared to those of a sample of the French general population.ResultsA total of 101 patients with iTTP in remission (45 patients previously treated with caplacizumab and 56 patients without caplacizumab) and 76 healthy controls were included. Patients with iTTP had significantly lower scores in all domains in the SF-36 survey and higher anxiety and depression scores than healthy controls. Advanced age was associated with improved SF-36 scores, lower anxiety scores and less severe anxiety cases. Furthermore, the use of caplacizumab led to a lower risk of severe anxiety.ConclusionBased on our results, HRQoL is decreased in patients with iTTP, and depression and anxiety are more prevalent. Caplacizumab treatment might influence long-term mental and psychological outcomes in iTTP by shortening the duration of treatment with plasma exchange.

Aortic diseases represent major public health concern and are associated with high rates of morbidity and mortality. Artificial Intelligence (AI) has the potential to revolutionize healthcare, with various potential applications for aortic patients. The aim of this review is to summarize the main applications of AI in aortic diseases, highlighting current trends, key findings and discussing current limitations and future opportunities. A scoping literature review was performed to identify the main applications of AI in aortic aneurysm and dissection. The main applications included detection and diagnosis, prognosis assessment, assistance for aortic repair, development of virtual assistants and support for education, and new tools for vascular research. Current results highlighted several limitations related to technical considerations as well as challenges in link with ethic and legal framework. AI offers a wide range of opportunities for the management of aortic diseases including new tools for clinical practice, education and research. While current applications showed a proof-of-concept, further efforts of validation are required for implementation in daily clinical practice. International multicenter research will play a major role to develop, validate, follow and establish guidelines to ensure a safe and efficient use of AI-tools to improve patients care.

This study aims to develop magnetically labeled iPSC-derived extracellular vesicles (magneto-EVs) for MRI/MPI and myocardial repair in a theranostic manner. Using optimized electroporation and purification protocols, we prepared magneto-EVs with high SuperSPIO20 loading efficiency (1.77 ng Fe/10? EVs) and well-preserved therapeutic effects. In vitro MPI results reveal that the detectability of magneto-EVs is ~1 × 109 EVs/mL. In vivo MPI shows that MPI can detect magneto-iPSC-EVs injected intramyocardially in mouse hearts for up to 7 days following myocardial infarction. MPI quantification showed that 32% of injected EVs remained in the heart after 24 hours, with a further ~50% decrease by day 7, indicating progressive clearance or biodegradation of magneto-EVs from the injected site. Despite this low retention and rapid clearance, magneto-EVs led to significant improvement in left ventricular ejection fraction (37.3% increase) and scar formation (61.0% reduction). This theranostic EV imaging platform enables quantitative MPI monitoring of EV delivery and predicting therapeutic outcomes.

Brigatinib and alectinib are next-generation anaplastic lymphoma kinase inhibitors (ALKis) showing efficacy against naïve and post-crizotinib-treated advanced ALK+ non-small-cell lung cancers (NSCLCs). Real-world data on alectinib efficacy after brigatinib failure are lacking. Alectinib efficacy was retrospectively assessed in patients previously treated with brigatinib during an early-access program (EAP) from 1 August 2016 to 21 January 2019. The primary endpoint was alectinib median progression-free survival (mPFS) according to local investigators. Among the 183 patients included in the brigatinib EAP, 92 (50.3%) received ≥1 agent(s) post-brigatinib; 30 (16.4%) received alectinib, 19 (10.4%) immediately post-brigatinib; 11 (6%) after ≥1 other treatment line(s). With median follow-up at 25.5 (95% CI: 10.6-30.5) months, mPFS on brigatinib for the study population (n = 30) was 13.6 (95% CI: 6.3-17.7) months. For patients given alectinib immediately post-brigatinib, mPFS and median overall survival (mOS) were 4.8 (95% CI: 2.0-12.5) and 27 (95% CI: 12.5-not reached (NR)) months, respectively. In this subgroup, brigatinib was discontinued for toxicity or progression for 5/19 (26%) or 14/19 (74%) patients, with mPFS lasting 12.5 (95% CI: 3.3-17.9 and 3.4 (95% CI: 0.9-9.2) months, respectively. For patients receiving ≥1 agent(s) between brigatinib and alectinib, with median follow-up at 13.3 (95% CI: 2.3-31.5) months, mPFS and mOS were 5.0 (95% CI: 0.5-18.8) and 19 (95% CI: 2.3-NR) months, respectively. According to the results of this retrospective real-world study, alectinib post-brigatinib showed limited overall activity but remains an option for patients with advanced ALK+ NSCLCs, especially when brigatinib was discontinued because of toxicity.