Médipole Garonne

Abstract Background Tricuspid transcatheter edge-to-edge repair (T-TEER) is an emerging therapeutic intervention for patients with significant tricuspid regurgitation (TR). However, patient selection for T-TEER remains challenging. Prior studies have identified several hemodynamic markers, including the TAPSE/systolic PAP ratio (TAPSE/sPAP), cardiac output (CO), and pulmonary artery pulsatility index (PAPi), as potentially predictive of relevant outcome. The prognostic utility of these parameters in guiding patient selection for T-TEER remains to be fully elucidated. Objective To generate hypothesis as regards the prognostic value of these three invasive hemodynamic markers obtained from right heart catheterization (RHC) in patients eligible to T-TEER in terms of clinical response at one year ("improvement" versus "worse or no change" – the main outcome of TRI-FR trial, based on clinical events (unscheduled hospitalization for heart failure, death, tricuspid surgery) as well as PGA, NYHA and KCCQ). Methods All randomized patients in TRI-FR (N = 300) were eligible and analyzed, except those who withdrew their consent (N = 5), those allocated to T-TEER who experience a technical failure (TR grade 4+ or more in post-intervention) (N = 25), and those who had missing values for at least one of three RHC markers (N = 66). In each treatment arm, a linear relationship between RHC markers and outcome was first assessed using a generalized additive model, transformations were then applied accordingly. We fitted univariate and multivariable logistic regression models. The performances of the final model were investigated through discrimination, expressed as the area under the receiver-operating curve (AUC) and calibration (graphically). Results Out of 148 patients allocated to guideline directed medical therapy (GDMT) alone, and 152 patients allocated to T-TEER on top of GDMT, 109 and 100 were analyzed, and an improvement was observed in 39 out of 106 (36.8%) and 77 (77.8%) out of 99 patients assessed, respectively. In the GDMT alone arm, PAPi (log-transformed) and CO (3-degree polynomial) moderately predicted improvement (AUC = 0.696 and calibration far from good). In the T-TEER on top of GDMT, CO (3-degree polynomial) and TAPSE/sPAP (2-degree polynomial) moderately predicted improvement (AUC = 0.730 and moderate calibration). There were no significant relationship between hemodynamic measures and change in KCCQ or in 6-minute walk distance. Conclusion Key hemodynamic measures might be taken in account for patient selection for tricuspid valve interventions. This hypothesis has to be confirmed and probably added to other key clinical, biological and echocardiographic parameters.

In the Tri.FR trial, tricuspid transcatheter edge-to-edge repair (T-TEER) reduced severity of tricuspid regurgitation (TR) and improved the composite clinical score, driven by patient-reported outcomes. The purpose of this study was to describe the longitudinal impact of T-TEER on different dimensions and items of quality of life compared with guideline-directed medical treatment (OMT) alone. Patients were randomized to T-TEER+OMT (n=152) or OMT alone (n=148). Health status was assessed at baseline, 6weeks, 6months, and 1year using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure (MLHF) Questionnaire. Mixed effects linear regression analysed changes over time. Patients receiving T-TEER+OMT experienced a significant increase in KCCQ overall summary score (KCCQ-OS) at all time points: +17.0 points (95% confidence interval [CI] 13.1-21.5) at 6weeks, +15.9 points (95% CI 11.2-20.6) at 6months, and +18.7 points (95% CI 13.8-23.6) at 1year. The mean between-group difference in KCCQ-OS was +10.3 points (95% CI 5.6-15.0) in favour of T-TEER+OMT, evident at 6weeks and sustained for 1year. Similarly, MLHF total scores improved significantly in the T-TEER group (mean between-group difference -8.61 points, 95% CI -12.6 to -4.6), including physical (-3.9, 95% CI -5.9 to -1.9) and emotional (-2.2, 95% CI -3.4 to -1.0) subscales. Compared with OMT alone, T-TEER resulted in substantial, multidimensional, and sustained improvements in patient-reported quality of life. These findings reinforce the value of T-TEER in managing severe symptomatic TR.

The First French Fall Prevention Day for Elderly People took place in Montpellier on October 1, 2024. This event highlighted the elderly people's interest in: i) public conference providing information on fall risk factors and general preventive measures; ii) workshops across the metropolitan area offering individual fall risk assessments, personalized advice based on identified risk levels and factors. It also highlighted healthcare professionals and training institutes interest in: i) information on the roles of various field actors in the care pathway for older individuals at moderate or high fall risk; ii) new organizational models and technologies developed to implement national and global fall prevention recommendations. This inaugural event will lead to the creation of a fall and fracture prevention group within the French Society of Geriatrics and Gerontology, establishing a specific connection with the European Geriatric Medicine Society Falls and Fracture Prevention Group, whose missions will be: i) the development of training and informational materials to support the implementation of the world recommendations and the French fall prevention plan; and ii) the support an organization of an annual National Fall Prevention Day throughout France by the National Academy of Medicine and Regional Health Agencies.

Bone and joint infections are complex and require a long course of antibiotics. Dalbavancin is a long half-life lipoglycopeptide, only indicated for skin and soft tissue infections. Studies on bone and joint diffusion are promising. The objective of this study was to evaluate the efficacy and safety of dalbavancin in combination with piperacillin-tazobactam for intra-operative treatment of knee or hip prosthetic joint infections. This retrospective and bicentric study was conducted between 2018 and 2022 and included 56 patients. The criteria used to diagnose prosthetic joint infections were those established in 2011 by the MusculoSkeletal Infection Society (MSIS), modified in 2013 at the International Consensus Meeting on Periprosthetic Joint Infections. The efficacy endpoint was the absence of relapse during the two-year follow-up period. Gram-positive cocci infections were the most common. All Gram-positive bacteria were susceptible to dalbavancin. The cure rate at two years was 91.5%. Only four patients experienced treatment failure. Few adverse events were reported, mainly digestive ones (diarrhea and pain). This study provides data outside of the marketing authorization, while respecting the authorized dosage in a population of patients with clearly defined inclusion criteria and a two-year follow-up.

Clinical findings are generally sufficient to make the diagnosis of lateral epicondylitis of the elbow. Ultrasound (US), in conjunction with standard radiography, is a simple and cost-effective way to confirm the diagnosis, and it is also useful for eliminating most differential diagnoses and guiding treatment.US analysis of the muscle bodies and tendon laminae of the lateral epicondyle muscles, starting distally at the wrist and extending up to the lateral epicondyle, assists in understanding the complex fibrous architecture of the proximal tendons inserting on the lateral epicondyle. Pain when the US probe passes over an area of hypoechoic tendinosis, hyperemia in Doppler mode, and an intratendinous split are the signs to look for in patients. US helps guide needling or injection by targeting pathologic areas.Other examinations (computed tomography arthrogram and magnetic resonance imaging) are used as a second line of defense, particularly in cases of bone or joint pathology.