Lille’s Cardiology Hospital

Fostamatinib is available in France since October 2021 for the treatment of adult chronic immune thrombocytopenia (ITP). French health authorities requested a 3-year, prospective, multicenter registry to provide real-world evidence about the effectiveness and safety of fostamatinib. Patients' characteristics, treatment response (ongoing exposure to fostamatinib and a platelet count ≥ 30 × 109/L with no rescue in the previous 4 weeks) after 3, 6, 12, and 24 months (M); bleeding; fostamatinib discontinuation; adverse drug reactions (ADRs) and other events of interest have been analyzed. In total, 164 patients were included (median age: 59 years; 55.5% women; 84.1% had previous bleeding; 30 had secondary ITP; 89.0% had chronic ITP). The median ITP duration was 7.2 years and the median number of previous ITP treatments was 6. The response rate was 44.0% (70/159) at M3, 41.9% (62/148) at M6, 32.4% (44/136) at M12 and 20.0% (21/105) at M24. Concomitant treatment (mostlyTPO-RA) was used in > 60.0% of responders at each endpoint. The cumulative discontinuation rate at each endpointwas, respectively, 27.0%, 44.6%, 55.9%, and 76.2%. Seventy-one (43.3%) patients experienced at least one bleeding duringfostamatinib exposure; none was fatal. One hundred adverse drug reactions (8 serious) were observed in 61 (36.7%)patients, including diarrhea in 28 (17.1%) patients, arterial hypertension in 17 (10.4%). Seven thrombosis (4.3%) and40 infections (12 serious) were reported in 25 patients (15.2%), mostly in patients with known risk factors. In conclusion,fostamatinib in combination with TPO-RA should be considered in difficult-to-treat ITP patients. No new safety signal was observed.

Deep and continuous sedation addresses the refractory suffering of patients expected to die in the short term. This practice creates a distinctive experience for both healthcare professionals and relatives. The objective of this study was to describe their psychological adjustment after caring for cancer patients for whom deep sedation was implemented. APSY-SED is a multicenter, prospective, longitudinal study using mixed methods. This report focuses on quantitative data collected during the initial (T1) phase, at the onset of sedation. Relatives completed questionnaires assessing attachment style (RSQ), anxiety and depression (STAI-S, BDI-II), and satisfaction with end-of-life care (CANHELP). Healthcare professionals completed a job satisfaction questionnaire (Karasek questionnaire). The sample included 52 relatives and 46 healthcare professionals from five French hospitals. Satisfaction with needs negatively predicted depression (β = -2.68, P = 0.007). Anxiety was predicted by total CanHelp (β = 4.13, P = 0.004), but reduced by satisfaction with involvement (β = -1.84, P = 0.035) and relationship with doctors and nurses (β = -1.77, P = 0.008). ANOVA showed higher satisfaction when sedation was patient-initiated (P = 0.015). Among professionals, 19.6% reported job strain; job latitude was high (M = 76.83, SD = 7.57). These findings underscore the need for targeted emotional support for anxious relatives and highlight the protective role of satisfactory end-of-life care in mitigating depressive symptoms. Clear protocols and communication may help preserve high job satisfaction among healthcare professionals. Further longitudinal and qualitative research is necessary to clarify how these factors evolve over time within continuous deep sedation contexts.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer management, leading to unprecedented improvements in clinical outcomes. Several adverse events from ICIs have been documented, but the risk and clinical relevance of bone adverse events (BAEs) remain uncertain. Sporadic reports describe inflammatory cytokine upregulation, osteoporosis onset during ICI treatment, and increased risk of fragility fractures. In this review, original articles written in English and published up to June 2025, were identified in PubMed, Scopus, and WOS databases by using pre-selected keywords. Based on pre-defined inclusion/exclusion criteria, 23 articles were included in the final analysis. As BAEs, we considered the following conditions: fractures, osteoporosis, osteopenia, bone pain, altered bone metabolism markers. Overall, we found 1610 cancer patients developing at least one BAE, whose percentage was highly variable among studies (range 0.3-88.9%), reflecting the differences in study design, patient enrollment, and BAE recording. Median age was > 55 years, and BAEs were reported in patients with various primary solid tumors, most commonly lung cancer patients (10/23 studies), mainly treated with programmed cell death protein-1 (PD-1)/PD-1 ligand (PD-L1) inhibitors. However, several limitations of the studies emerged from the analysis and are highlighted in the manuscript. In conclusion, BAEs may occur more frequently among patients treated with ICIs but are likely to be underreported in most studies. Further investigation is needed to estimate and mitigate the risk of such events, since diagnostic techniques and anti-osteoporotic drugs are widely available in the clinical practice. A research agenda focusing on higher-quality reporting of BAEs from ICIs is warranted.

This national Delphi study provides the first context-adapted POCUS curriculum for pediatric emergency medicine in France. By identifying priority skills and preferred teaching modalities, it offers a structured approach to competency-based POCUS training that may be adapted to other countries facing similar challenges in pediatric emergency education. • Point-of-care ultrasound (POCUS) is a core skill in pediatric emergency medicine. In France, however, training remains absent from the resident's curriculum. International programs cannot be directly implemented due to differences in training structures, scope of practice, and available resources. • This national Delphi study establishes the first context-adapted POCUS curriculum for pediatric emergency medicine in France, identifying 20 core learning objectives and consensus-based teaching modalities to support structured, competency-based training.