Laboratoire Informatique d'Avignon

Vedolizumab has become the preferred first-line advanced therapy in ulcerative colitis (UC). However, the optimal second-line treatment following vedolizumab failure remains unclear. We aimed to evaluate the effectiveness and safety of second-line therapies after first-line vedolizumab. We conducted a multicenter retrospective study including UC patients from 31 centers who received infliximab (IFX), subcutaneous (SC) anti-TNFs, or ustekinumab after vedolizumab failure. The primary endpoint was steroid-free clinical remission (SFCR) at week 14. Predictors of remission were identified using multivariate logistic regression. Among 196 patients, 99 received IFX, 27 anti-TNF SC, and 70 ustekinumab. At week 14, SFCR was achieved in 78 patients (39.8%): 38 (38.4%) with IFX, 8 (29.6%) with anti-TNF SC, and 32 (45.7%) with ustekinumab, with no significant difference between groups (p=0.32). Median treatment persistence ranged from 8 to 9.2months. Baseline corticosteroid use was associated with lower odds of SFCR (OR=0.37, 95% CI [0.18-0.73]). Adverse events occurred in 15.8% of patients, including 12.2% serious events. Overall adverse events were less frequent with ustekinumab than with IFX (10.0% vs. 24.2%, p=0.02), while serious events were comparable (5.7% vs. 16.1%, p=0.08). Discontinuation due to adverse events was more frequent with IFX (12.1%) and anti-TNF SC (14.8%) than with ustekinumab (2.9%, p=0.045 and 0.049). In UC patients failing vedolizumab, second-line IFX, anti-TNF SC, and ustekinumab showed similar effectiveness and persistence. Infliximab remains a robust option for rapid control in high inflammatory burden, whereas ustekinumab may be preferred for its superior safety profile in high-risk patients.

Data are needed on the effect of oxygen delivered through a high-flow nasal cannula, as compared with standard oxygen therapy, on intubation and mortality in patients with acute hypoxemic respiratory failure. In this multicenter, open-label trial, we randomly assigned patients who had acute hypoxemic respiratory failure to receive high-flow-oxygen or standard-oxygen therapy. All the patients had a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 or less, a respiratory rate of more than 25 breaths per minute, and pulmonary infiltrate on chest imaging. The primary outcome was death by day 28. A total of 1116 patients underwent randomization. Of these patients, 1110 (556 in the high-flow-oxygen group and 554 in the standard-oxygen group) were included in the analysis. Mortality at day 28 was 14.6% (in 81 of 556 patients) in the high-flow-oxygen group and 14.6% (in 81 of 554 patients) in the standard-oxygen group (difference, -0.05 percentage points; 95% confidence interval [CI], -4.21 to 4.10; P = 0.98). The incidence of intubation by day 28 was 42.4% (in 236 of 556 patients) in the high-flow-oxygen group and 48.4% (in 268 of 554 patients) in the standard-oxygen group (difference, -5.93 percentage points; 95% CI, -11.78 to -0.08). Serious adverse events (cardiac arrest or pneumothorax) occurred during spontaneous breathing in 13 patients (2.3%) in the high-flow-oxygen group and in 6 patients (1.1%) in the standard-oxygen group. Among patients with acute hypoxemic respiratory failure, the use of oxygen delivered through a high-flow nasal cannula did not significantly reduce mortality at day 28. (Funded by the French Ministry of Health and Fisher and Paykel Healthcare; SOHO ClinicalTrials.gov number, NCT04468126.).

Acute urinary retention (AUR) is a common urological emergency, particularly in elderly men, often associated with benign prostatic hyperplasia (BPH). It requires prompt intervention to relieve symptoms and prevent complications. The French Urological Association Male LUTS Panel (CTMH) aimed to develop evidence-based guidelines for managing BPH-related AUR in men. A systematic PubMed literature review was conducted, evaluating studies by level of evidence and methodological quality. Guidelines were developed through CTMH member consensus. Drainage method selection (urethral or suprapubic catheter) should consider patient-specific contraindications. Suprapubic catheterization may offer superior patient comfort and reduced colonization rates. Clean intermittent self-catheterization represents a viable alternative with improved quality of life. Alpha-blockers (alfuzosin 10mg, tamsulosin 0.4mg, silodosin 8mg) administered for 2-3days significantly improve trial without catheter success rates, with no agent demonstrating superiority. Short catheterization duration (<3-5days) reduces complications without compromising outcomes. Perioperative AUR prevention may benefit from tamsulosin in high-risk patients (spinal anesthesia, previous AUR, age>60, known BPH). Evidence remains insufficient to recommend immediate surgery without trial without catheter or to establish optimal surgical technique. These CTMH guidelines provide evidence-based recommendations for AUR management, emphasizing alpha-blocker therapy before trial without catheter and considering patient-specific factors when selecting drainage methods. Further research is needed to optimize surgical timing and technique selection.

Background:Recurrent anterior shoulder instability often requires surgical intervention, with 2 prominent approaches: anatomic (eg, Bankart) and nonanatomic (eg, Latarjet) procedures. While most surgeons favor arthroscopic Bankart, the open Latarjet procedure offers advantages such as quicker recovery and lower redislocation rates. On the other hand, complications include postoperative pain due to an impingement between hardware and soft tissue, resolved through screw removal.Purpose/Hypothesis:The purpose of this study was (1) to assess the Walch-Duplay score for functional outcomes and (2) to examine Subjective Shoulder Value (SSV), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) scores, as well as satisfaction and return-to-sports rate. It was hypothesized that screw removal does not significantly affect functional outcomes.Study Design:Cohort study; Level of evidence 3.Methods:Clinical data from a single-operator series of 692 shoulders treated for anterior instability with Latarjet technique between 2007 and 2021 were analyzed. Those who underwent revision surgery, previously underwent surgery on the shoulder, and had concomitant shoulder injuries were excluded. A total of 530 shoulders were eligible, and of these, 41 shoulders needed screw removal (7.7%). Propensity score matching yielded 41 pairs of shoulders split between the screw removal and no revision group.Results:At a mean follow-up of 85.0 months, the Walch-Duplay functional score was 76 ± 19 (median, 80; range, 15.0-100.0) and 81 ± 22 (median, 85; range, 0.0-100.0) ) in patients for no revision and screw removal, respectively (P = .15); SSV was 82 ± 15 (median, 85; range, 40.0-100) and 86 ± 14 (median, 90; range 40.0-100.0) (P = .14), respectively; SANE was 89 ± 19 (median, 100; range 0.0-100.0) and 89 ± 14 (median, 95; range 50.0-100) (P = .16), respectively; and VAS was 0.7 ± 1.3 (median, 0; range, 0-5) and 1.1 ± 1.5 (median, 1; range 0-5) (P = .06). Satisfaction and return-to-sport rates were statistically significantly lower in the screw removal group (P = .03 and P = .04, respectively).Conclusion:Our results confirm that screw removal after the open Latarjet procedure does not substantially affect functional outcomes. However, we acknowledge a lower return to sports and worse satisfaction scores in the screw removal group.

Due to their limited resources, Internet of Things (IoT) networks are vulnerable to attacks like aggressive denial-of-service (DoS) attacks aimed at draining device energy. IoT devices often have non-rechargeable or hard-to-recharge batteries, especially when deployed in hostile areas, making them prime targets for energy depletion attacks such as barrage attacks. To mitigate these threats, security systems must implement lightweight measures. This paper proposes a new game theory-based mechanism to defend IoT devices against energy depletion. Game theory effectively models the adversarial interactions between attackers and defenders. Our approach uses a dynamic game with incomplete information to derive optimal detection, defense, and attack strategies, establishing a Perfect Bayesian Nash Equilibrium (PBNE) to protect IoT device energy under constant attack. This dynamic game involves repeated interactions where at least one player lacks complete information about the other. The proposed model offers a high-performance solution for conserving IoT device energy. Simulation results demonstrate its effectiveness, showing that it can save, on average, 95.19% of the energy expended in receiving packets during an attack and can deter attackers. This approach ensures the sustainability of IoT networks against persistent energy depletion attacks.