Semen from 10 932 male partners of infertile couples was analysed and sperm parameter trends were evaluated at the Reproduction Biology Laboratory of the University Hospital of Marseille （France） between 1988 and 20...Semen from 10 932 male partners of infertile couples was analysed and sperm parameter trends were evaluated at the Reproduction Biology Laboratory of the University Hospital of Marseille （France） between 1988 and 2007. After 3-6 days of abstinence, semen samples were collected. Measurements of seminal fluid volume, pH, sperm concentration, total sperm count, motility and detailed morphology of spermatozoa were performed. Sperm parameters were analysed on the entire population and in men with normal total numeration （ 〉~ 40 million per ejaculate）. The whole population demonstrated declining trends in sperm concentration （1.5% per year）, total sperm count （1.6% per year）, total motility （0.4% per year）, rapid motility （5.5% per year） and normal morphology （2.2% per year）. In the group of selected samples with total normal sperm count, the same trends of sperm quality deterioration with time were observed. Our results clearly indicate that the auality of semen decreased in this population over the study period.展开更多
BACKGROUND DNA mutational analysis of pancreatic cystic fluid (CF) is a useful adjunct to the evaluation of pancreatic cysts. KRAS/GNAS or RAF/PTPRD/CTNNB1/RNF43 mutations are highly specific to precancerous or advanc...BACKGROUND DNA mutational analysis of pancreatic cystic fluid (CF) is a useful adjunct to the evaluation of pancreatic cysts. KRAS/GNAS or RAF/PTPRD/CTNNB1/RNF43 mutations are highly specific to precancerous or advanced neoplasia. Several studies recently demonstrated the ability of next-generation sequencing (NGS)analysis to detect DNA mutations in pancreatic CF, but few studies have performed a systematic comparative analysis between pancreatic CF and neoplastic surgical tissue (NT). The value of CF-NGS analysis indicators for determining surgical resection necessitates evaluation. AIM To confirm whether CF genomic profiles are a reliable malignancy predictor by comparing NGS mutational analyses of CF and NT. METHODS Patients requiring surgery for high-risk pancreatic cysts were included in a multicenter prospective pilot study. DNA from CF (collected by endoscopic ultrasound-guided fine needle aspiration (known as EUS-FNA)) and NT (collected by surgery) were analyzed by NGS. The primary objective was to compare the mutation profiles of paired DNA samples. The secondary objective was to correlate the presence of specific mutations (KRAS/GNAS, RAF/ PTPRD/CTNNB1/RNF43/POLD1/TP53) with a final cancer diagnosis. Sensitivity and specificity were also evaluated. RESULTS Between December 2016 and October 2017, 20 patients were included in this pilot study. Surgery was delayed for 3 patients. Concordant CF-NT genotypes were found in 15/17 paired DNA, with a higher proportion of mutated alleles in CF than in NT. NGS was possible for all pancreatic CF collected by EUS-FNA. In 2 cases, the presence of a KRAS/GNAS mutation was discordant between CF and NT. No mutations were found in 3 patients with NT or pancreatic cysts with high-grade dysplasia. The sensitivity and specificity of KRAS/GNAS mutations in CF to predict an appropriate indication for surgical resection were 0.78 and 0.62, respectively. The sensitivity and specificity of RAF/PTPRD/CTNNB1 /RNF43/POLD1/TP53 mutations in CF were 0.55 and 1.0, respectively. CONCLUSION Mutational analyses of CF and NT were highly concordant, confirming the value of NGS analysis of CF in the preoperative malignancy assessment. However, these results need to be confirmed on a larger scale.展开更多
Testicular sperm extraction is widely used in the treatment of male infertility in cases of non-obstructive azoospermia. Identifying spermatogenetic foci within the testes is critical for testicular sperm extraction. ...Testicular sperm extraction is widely used in the treatment of male infertility in cases of non-obstructive azoospermia. Identifying spermatogenetic foci within the testes is critical for testicular sperm extraction. Two-photon laser scanning microscopy （TPLSM） is an autofluorescence-based microscopy technique that allows observation at a cellular level in the depth of fresh living tissues and does not require any histological processing （fixation or staining）. The wavelengths previously used have shown no phototoxicity on sperm. We used TPLSM to detect spermatogenetic foci in fresh mouse testicular parenchyma without disrupting the tunica albuginea. Fresh surgically retrieved testes were observed using TPLSM within 1 h after extraction. Contralateral testes for each animal were observed using standard histology. Using TPLSM we were able to observe and measure the diameter of seminiferous tubules through the tunica albuginea, similar to the histological control. Structures within epithelial tubules were also observed, although their nature has yet to be identified. TPLSM is a real-time microscopy technique that could detect spermatogenetic foci.展开更多
Dear Editor,During the early spring of 2020,as the COVID-19(coronavirus disease 2019)pandemic spread across the globe like a viral tsunami,many countries urgently implemented unprecedented mitigation measures to slow ...Dear Editor,During the early spring of 2020,as the COVID-19(coronavirus disease 2019)pandemic spread across the globe like a viral tsunami,many countries urgently implemented unprecedented mitigation measures to slow it down,following the example of China,where the disease first emerged at the end of 2019.As a result,more than 3 billion unprepared people worldwide had to cope with living under stringent lockdown measures for weeks or months,depending on the country.Together with the deaths of hundreds of thousands of people from this disease,a frightening emotional shock has touched populations everywhere around the planet.Millions have lost their jobs,others have had their personal lives changed drastically;the elderly,for example,have sometimes been isolated from any visits.To our knowledge,no guidelines to prevent psychological trauma have been proposed,even for the most vulnerable individuals.Nonetheless,before this crisis began,several experts had warned about the potential impact of such measures on the populations’mental health.展开更多
AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging(MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy vol...AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging(MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy volunteers(6 females and 8 males) between 30 and 58 years old and devoid of articular pain. Subjectswere asked to lie down in the supine position with the right hand positioned above the pelvic region on top of a home-built rigid platform attached to the scanner bed. The wrist was wrapped with a flexible surface coil. MRI investigations were performed at 3T(Verio-Siemens) using volume interpolated breath hold examination(VIBE) and dual echo steady state(DESS) MRI sequences. Cartilage cross sectional area(CSA) was measured on a slice of interest selected from a 3D dataset of the entire carpus and metacarpalphalangeal areas on the basis of anatomical criteria using conventional image processing radiology software. Cartilage cross-sectional areas between opposite bones in the carpal region were manually selected and quantified using a thresholding method.RESULTS: Cartilage CSA measurements performed on a selected predefined slice were 292.4 ± 39 mm2 using the VIBE sequence and slightly lower, 270.4 ± 50.6 mm2, with the DESS sequence. The inter(14.1%) and intra(2.4%) subject variability was similar for both MRI methods. The coefficients of variation computed for the repeated measurements were also comparable for the VIBE(2.4%) and the DESS(4.8%) sequences. The carpus length averaged over the group was 37.5 ± 2.8 mm with a 7.45% between-subjects coefficient of variation. Of note, wrist cartilage CSA measured with either the VIBE or the DESS sequences was linearly related to the carpal bone length. The variability between subjects was significantly reduced to 8.4% when the CSA was normalized with respect to the carpal bone length.CONCLUSION: The ratio between wrist cartilage CSA and carpal bone length is a highly reproducible standardized measurement which normalizes the natural diversity between individuals.展开更多
Kidney transplantation is the best replacement treatment for the end-stage renal disease.Currently,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the c...Kidney transplantation is the best replacement treatment for the end-stage renal disease.Currently,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach.To expand the pool of organs amenable for transplantation,kidneys coming from older patients have been employed;however,the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors.This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients.According to the most updated evidence,the use of grafts with a small renal mass,after bench table tumor excision,may be considered a safe option for high-risk patients in hemodialysis.On the other hand,an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function.Finally,in case of a renal tumor in native kidney,a radical nephrectomy is usually recommended.展开更多
Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A datab...Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.展开更多
The coronavirus disease 2019(COVID-19)pandemic has raised concerns about the mental health and social well-being of youth,including its potential to increase or exacerbate substance use behaviors[1].Among adolescents,...The coronavirus disease 2019(COVID-19)pandemic has raised concerns about the mental health and social well-being of youth,including its potential to increase or exacerbate substance use behaviors[1].Among adolescents,the COVID-19pandemic has resulted in limited face-to-face school contact and thus missed milestones in preventing alcohol and substance use.展开更多
Background::The elimination of Plasmodium vivax malaria requires 8-aminoquinolines,which are contraindicated in patients with glucose-6-phosphate dehydrogenase(G6PD)deficiency due to the risk of acute haemolytic anaem...Background::The elimination of Plasmodium vivax malaria requires 8-aminoquinolines,which are contraindicated in patients with glucose-6-phosphate dehydrogenase(G6PD)deficiency due to the risk of acute haemolytic anaemia.Several point-of-care devices have been developed to detect G6PD deficiency.The objective of the present study was to evaluate the performance of two of these devices against G6PD genotypes in Mauritania.Methods::Outpatients were screened for G6PD deficiency using CareStart?rapid diagnostic test(RDT)and CareStart?G6PD biosensor in Nouakchott,Mauritania,in 2019-2020.African-type and Mediterranean-type G6PD genotypes commonly observed in Africa were determined by polymerase chain reaction-restriction fragment length polymorphism and sequencing.Qualitative variables were compared using Fisher’s exact test.Results::Of 323 patients(74 males and 249 females),5 males and 2 homozygous females had the African-type A-genotype:A-(202)in 3 males and 2 females and G6PD A-(968)in 2 males.Among heterozygous females,13 carried G6PD A-(202),12 G6PD A-(968),and 3 G6PD A-(542)variants.None had the Mediterranean-type G6PD genotype.Eight had a positive G6PD RDT result,including all 7 hemizygous males and homozygous females with A-or A-A-(0.12 to 2.34 IU/g haemoglobin,according to G6PD biosensor),but RDT performed poorly(sensitivity,11.1%at the cutoff level of<30%)and yielded many false negative tests.Thirty-seven(50.0%)males and 141(56.6%)females were anaemic.The adjusted median values of G6PD activity were 5.72 and 5.34 IU/g haemoglobin in non-anaemic males(n=35)and non-anaemic males and females(n=130)with normal G6PD genotypes using G6PD biosensor,respectively.Based on the adjusted median of 5.34 IU/g haemoglobin,the performance of G6PD biosensor against genotyping was as follows:at 30%cut-off,the sensitivity and specificity were 85.7%and 91.7%,respectively,and at 80%cut-off,the sensitivity was 100%while the specificity was 64.9%.Conclusions::Although this pilot study supports the utility of biosensor to screen for G6PD deficiency in patients,further investigation in parallel with spectrophotometry is required to promote and validate a more extensive use of this point-of-care device in areas where P.vivax is highly prevalent in Mauritania.展开更多
Background:Plasmodium falciparum malaria is endemic in the southern sahelian zone of Mauritania where intense internal and trans-border human and livestock movement occurs.The risk of importation and spread of drugres...Background:Plasmodium falciparum malaria is endemic in the southern sahelian zone of Mauritania where intense internal and trans-border human and livestock movement occurs.The risk of importation and spread of drugresistant parasites need to be regularly assessed in this region.The objective of the study was to assess the recent malaria situation near the Mauritania-Mali border.Methods:Between February 2015 and December 2017,patients with fever or history of fever during the previous 48 h,presenting at the health centre of Kobeni city,were screened for malaria using a rapid diagnostic test(RDT)and microscopic examination of blood smears.The diagnosis was later confirmed by PCR.Cohen’s kappa statistics was used to estimate the degree of agreement between diagnostic methods.Fisher’s exact test was used to compare proportions.The odds ratio was calculated to measure the association between the use of bed nets and malaria infection.Results:A total of 2326 febrile patients(mean age,20.2 years)were screened for malaria.The presence of malaria parasites was detected by RDT and microscopy in 53.0%and 49.3%of febrile patients,respectively,and was confirmed by PCR in 59.7%(45 missing data).Of 1361 PCR-positive samples,1205(88.5%)were P.falciparum,47(3.5%)P.vivax,and 99(7.3%)P.falciparum-P.vivax mixed infection.Malaria transmission occurred mostly during and shortly after the rainy season.The annual rainfall was relatively low in 2016(267 mm)and 2017(274 mm),compared to 2015(448 mm),and coincided with a decline in malaria prevalence in 2016–2017.Although 71.8%of febrile patients reported to possess at least one bed net in the household in our questionnaire,its reported use was not protective against malaria infection(odds ratio:1.1,95%CI:0.91–1.32).Conclusions:Our study confirmed that P.falciparum is the dominant species in the sahelian zone and that malaria transmission is seasonal and associated with rainfall in this zone.The application of the current national policy based on rapid and reliable malaria diagnosis,case management with artemisinin-based combination therapy,intermittent preventive treatment for pregnant women,distribution and use of long-lasting insecticide impregnated bed nets,and the planned introduction of seasonal malaria chemoprevention for all children under 6 years old is expected to sustainably reduce malaria transmission in this zone.展开更多
Objectives To our best knowledge,no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19.‘Patients’voice is an excellent means to capture data on...Objectives To our best knowledge,no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19.‘Patients’voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences,and to test whether these clusters were associated with a higher risk of poor clinical outcomes.Design Cross-sectional online survey using life-event calendars.Setting All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France.Participants 312 patients responded to the survey.Main outcome measures From the day of symptom onset to the day of hospitalisation,we defined a symptom sequence as the time-ordered vector of the successive symptom grades(grade 1,grade 2,grade 3).State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences.Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit(ICU)and COVID-19 sequelae after hospitalisation.Results Three clusters of symptom sequences were identified among 312 complete prehospital pathways.A specific group of patients(29%)experienced extended symptoms of severe COVID-19,persisting for an average duration of 7.5 days before hospitalisation.This group had a significantly higher probability of being admitted to ICU(adjusted OR 2.01).They were less likely to know a loved one who was a healthcare worker,and more likely to have a lower level of education.Similarly,this group of patients,who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time,may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation.Conclusion and relevance This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors,such as lower education levels and limited connections to the medical field,on patients’experiences.展开更多
Background Although smoking is classified as a risk factor for severe COVID-19 outcomes,there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic.Thus,this study aims to analyze the trends o...Background Although smoking is classified as a risk factor for severe COVID-19 outcomes,there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic.Thus,this study aims to analyze the trends of prevalence of smoking in adolescents over the COVID-19 pandemic period.Methods The present study used data from middle to high school adolescents between 2005 and 2021 who participated in the Korea Youth Risk Behavior Web-based Survey(KYRBS).We evaluated the smoking prevalence(ever or daily)by year groups and estimated the slope in smoking prevalence before and during the pandemic.Results A total of 1,137,823 adolescents participated in the study[mean age,15.04 years[95%confidence interval(CI)15.03-15.06];and male,52.4%(95%CI 51.7-53.1)].The prevalence of ever smokers was 27.7%(95%CI 27.3-28.1)between 2005 and 2008 but decreased to 9.8%(95%CI 9.3-10.3)in 2021.A consistent trend was found in daily smokers,as the estimates decreased from 5.4%(95%CI 5.2-5.6)between 2005 and 2008 to 2.3%(95%CI 2.1-2.5)in 2021.However,the downward slope in the overall prevalence of ever smokers and daily smokers became less pronounced in the COVID-19 pandemic period than in the pre-pandemic period.In the subgroup with substance use,the decreasing slope in daily smokers was significantly more pronounced during the pandemic than during the pre-pandemic period.Conclusions The proportion of ever smokers and daily smokers showed a less pronounced decreasing trend during the pandemic.The findings of our study provide an overall understanding of the pandemic's impact on smoking prevalence in adolescents.展开更多
Background Although previous studies have provided data on early pandemic periods of alcohol and substance use in adolescents,more adequate studies are needed to predict the trends of alcohol and substance use during ...Background Although previous studies have provided data on early pandemic periods of alcohol and substance use in adolescents,more adequate studies are needed to predict the trends of alcohol and substance use during recent periods,including the mid-pandemic period.This study investigated the changes in alcohol and substance use,except tobacco use,throughout the pre-,early-,and mid-pandemic periods in adolescents using a nationwide serial cross-sectional survey from South Korea.Methods Data on 1,109,776 Korean adolescents aged 13–18 years from 2005 to 2021 were obtained in a survey operated by the Korea Disease Control and Prevention Agency.We evaluated adolescents’alcohol and substance consumption prevalence and compared the slope of alcohol and substance prevalence before and during the COVID-19 pandemic to see the trend changes.We define the pre-COVID-19 period as consisting of four groups of consecutive years(2005–2008,2009–2012,2013–2015,and 2016–2019).The COVID-19 pandemic period is composed of 2020(early-pandemic era)and 2021(midpandemic era).Results More than a million adolescents successfully met the inclusion criteria.The weighted prevalence of current alcohol use was 26.8%[95%confidence interval(CI)26.4–27.1]from 2005 to 2008 and 10.5%(95%CI 10.1–11.0)in 2020 and 2021.The weighted prevalence of substance use was 1.1%(95%CI 1.1–1.2)from 2005 to 2008 and 0.7%(95%CI 0.6–0.7)between 2020 and 2021.From 2005 to 2021,the overall trend of use of both alcohol and drugs was found to decrease,but the decline has slowed since COVID-19 epidemic(current alcohol use:βdiff 0.167;95%CI 0.150–0.184;substance use:βdiff 0.152;95%CI 0.110–0.194).The changes in the slope of current alcohol and substance use showed a consistent slowdown with regard to sex,grade,residence area,and smoking status from 2005 to 2021.Conclusion The overall prevalence of alcohol consumption and substance use among over one million Korean adolescents from the early and mid-stage(2020–2021)of the COVID-19 pandemic showed a slower decline than expected given the increase during the prepandemic period(2005–2019).展开更多
Background Researches on the mental health of Korean adolescents during COVID-19 have largely focused on those from monocultural families,but there is limited data on sadness,suicidal ideation,and suicide attempts in ...Background Researches on the mental health of Korean adolescents during COVID-19 have largely focused on those from monocultural families,but there is limited data on sadness,suicidal ideation,and suicide attempts in multicultural adolescents.Methods This nationwide serial cross-sectional study included 688,708 adolescents aged 12–18 years who participated in the Korean Youth Risk Behavior Web-based Survey from 2011 to 2022.We compared and analyzed the prevalence of sadness,suicidal ideation,and suicide attempts among multicultural and monocultural adolescents.Multicultural adolescents were defined as those with at least one non-Korean parent.Results In 2021,the prevalence of sadness among multicultural adolescents was 31.86%[95%confidence interval(CI)30.00–33.71],suicidal ideation 17.17%(15.74–18.61),and suicide attempts 4.25%(3.51–4.99).Among monocultural adolescents,the prevalence rates were 26.09%(25.50–26.69)for sadness,12.41%(11.97–12.85)for suicidal ideation,and 1.92%(1.76–2.67)for suicide attempts.Adolescents from multicultural backgrounds were found to have higher rates of sadness,suicidal ideation,and suicide attempts.In the general population,these rates had decreased during the pre-pandemic period but increased after the onset of the pandemic then stabilized from 2020 to 2021.Female gender,smoking,alcohol use,and low school performance emerged as significant risk factors.However,no distinct risk factors specifically linked to suicide attempts were identified.Joinpoint regression analysis results aligned with the beta slope values in the main findings,reflecting a consistent pattern across both analyses.Conclusions This study revealed that sadness,suicidal ideation,and suicide attempts increased during the pandemic,reversing a pre-pandemic decline.Multicultural adolescents faced these issues more than monocultural ones,underlining the need for targeted public health measures to support at-risk adolescents during pandemics.展开更多
文摘Semen from 10 932 male partners of infertile couples was analysed and sperm parameter trends were evaluated at the Reproduction Biology Laboratory of the University Hospital of Marseille （France） between 1988 and 2007. After 3-6 days of abstinence, semen samples were collected. Measurements of seminal fluid volume, pH, sperm concentration, total sperm count, motility and detailed morphology of spermatozoa were performed. Sperm parameters were analysed on the entire population and in men with normal total numeration （ 〉~ 40 million per ejaculate）. The whole population demonstrated declining trends in sperm concentration （1.5% per year）, total sperm count （1.6% per year）, total motility （0.4% per year）, rapid motility （5.5% per year） and normal morphology （2.2% per year）. In the group of selected samples with total normal sperm count, the same trends of sperm quality deterioration with time were observed. Our results clearly indicate that the auality of semen decreased in this population over the study period.
文摘BACKGROUND DNA mutational analysis of pancreatic cystic fluid (CF) is a useful adjunct to the evaluation of pancreatic cysts. KRAS/GNAS or RAF/PTPRD/CTNNB1/RNF43 mutations are highly specific to precancerous or advanced neoplasia. Several studies recently demonstrated the ability of next-generation sequencing (NGS)analysis to detect DNA mutations in pancreatic CF, but few studies have performed a systematic comparative analysis between pancreatic CF and neoplastic surgical tissue (NT). The value of CF-NGS analysis indicators for determining surgical resection necessitates evaluation. AIM To confirm whether CF genomic profiles are a reliable malignancy predictor by comparing NGS mutational analyses of CF and NT. METHODS Patients requiring surgery for high-risk pancreatic cysts were included in a multicenter prospective pilot study. DNA from CF (collected by endoscopic ultrasound-guided fine needle aspiration (known as EUS-FNA)) and NT (collected by surgery) were analyzed by NGS. The primary objective was to compare the mutation profiles of paired DNA samples. The secondary objective was to correlate the presence of specific mutations (KRAS/GNAS, RAF/ PTPRD/CTNNB1/RNF43/POLD1/TP53) with a final cancer diagnosis. Sensitivity and specificity were also evaluated. RESULTS Between December 2016 and October 2017, 20 patients were included in this pilot study. Surgery was delayed for 3 patients. Concordant CF-NT genotypes were found in 15/17 paired DNA, with a higher proportion of mutated alleles in CF than in NT. NGS was possible for all pancreatic CF collected by EUS-FNA. In 2 cases, the presence of a KRAS/GNAS mutation was discordant between CF and NT. No mutations were found in 3 patients with NT or pancreatic cysts with high-grade dysplasia. The sensitivity and specificity of KRAS/GNAS mutations in CF to predict an appropriate indication for surgical resection were 0.78 and 0.62, respectively. The sensitivity and specificity of RAF/PTPRD/CTNNB1 /RNF43/POLD1/TP53 mutations in CF were 0.55 and 1.0, respectively. CONCLUSION Mutational analyses of CF and NT were highly concordant, confirming the value of NGS analysis of CF in the preoperative malignancy assessment. However, these results need to be confirmed on a larger scale.
文摘Testicular sperm extraction is widely used in the treatment of male infertility in cases of non-obstructive azoospermia. Identifying spermatogenetic foci within the testes is critical for testicular sperm extraction. Two-photon laser scanning microscopy （TPLSM） is an autofluorescence-based microscopy technique that allows observation at a cellular level in the depth of fresh living tissues and does not require any histological processing （fixation or staining）. The wavelengths previously used have shown no phototoxicity on sperm. We used TPLSM to detect spermatogenetic foci in fresh mouse testicular parenchyma without disrupting the tunica albuginea. Fresh surgically retrieved testes were observed using TPLSM within 1 h after extraction. Contralateral testes for each animal were observed using standard histology. Using TPLSM we were able to observe and measure the diameter of seminiferous tubules through the tunica albuginea, similar to the histological control. Structures within epithelial tubules were also observed, although their nature has yet to be identified. TPLSM is a real-time microscopy technique that could detect spermatogenetic foci.
基金funded by the French and National Agency for Research(ANR,grant ANR-20-COVI-0035-01)the Fondation de France and the National Research Institute for Sustainable Development(IRD).
文摘Dear Editor,During the early spring of 2020,as the COVID-19(coronavirus disease 2019)pandemic spread across the globe like a viral tsunami,many countries urgently implemented unprecedented mitigation measures to slow it down,following the example of China,where the disease first emerged at the end of 2019.As a result,more than 3 billion unprepared people worldwide had to cope with living under stringent lockdown measures for weeks or months,depending on the country.Together with the deaths of hundreds of thousands of people from this disease,a frightening emotional shock has touched populations everywhere around the planet.Millions have lost their jobs,others have had their personal lives changed drastically;the elderly,for example,have sometimes been isolated from any visits.To our knowledge,no guidelines to prevent psychological trauma have been proposed,even for the most vulnerable individuals.Nonetheless,before this crisis began,several experts had warned about the potential impact of such measures on the populations’mental health.
基金Supported by Aix-Marseille University and APHM(Assistance Publique Hopitaux de Marseille),No.CNRS(UMR#7339)
文摘AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging(MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy volunteers(6 females and 8 males) between 30 and 58 years old and devoid of articular pain. Subjectswere asked to lie down in the supine position with the right hand positioned above the pelvic region on top of a home-built rigid platform attached to the scanner bed. The wrist was wrapped with a flexible surface coil. MRI investigations were performed at 3T(Verio-Siemens) using volume interpolated breath hold examination(VIBE) and dual echo steady state(DESS) MRI sequences. Cartilage cross sectional area(CSA) was measured on a slice of interest selected from a 3D dataset of the entire carpus and metacarpalphalangeal areas on the basis of anatomical criteria using conventional image processing radiology software. Cartilage cross-sectional areas between opposite bones in the carpal region were manually selected and quantified using a thresholding method.RESULTS: Cartilage CSA measurements performed on a selected predefined slice were 292.4 ± 39 mm2 using the VIBE sequence and slightly lower, 270.4 ± 50.6 mm2, with the DESS sequence. The inter(14.1%) and intra(2.4%) subject variability was similar for both MRI methods. The coefficients of variation computed for the repeated measurements were also comparable for the VIBE(2.4%) and the DESS(4.8%) sequences. The carpus length averaged over the group was 37.5 ± 2.8 mm with a 7.45% between-subjects coefficient of variation. Of note, wrist cartilage CSA measured with either the VIBE or the DESS sequences was linearly related to the carpal bone length. The variability between subjects was significantly reduced to 8.4% when the CSA was normalized with respect to the carpal bone length.CONCLUSION: The ratio between wrist cartilage CSA and carpal bone length is a highly reproducible standardized measurement which normalizes the natural diversity between individuals.
文摘Kidney transplantation is the best replacement treatment for the end-stage renal disease.Currently,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach.To expand the pool of organs amenable for transplantation,kidneys coming from older patients have been employed;however,the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors.This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients.According to the most updated evidence,the use of grafts with a small renal mass,after bench table tumor excision,may be considered a safe option for high-risk patients in hemodialysis.On the other hand,an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function.Finally,in case of a renal tumor in native kidney,a radical nephrectomy is usually recommended.
文摘Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health&WelfareRepublic of Korea[grant number:HV22C0233]。
文摘The coronavirus disease 2019(COVID-19)pandemic has raised concerns about the mental health and social well-being of youth,including its potential to increase or exacerbate substance use behaviors[1].Among adolescents,the COVID-19pandemic has resulted in limited face-to-face school contact and thus missed milestones in preventing alcohol and substance use.
文摘Background::The elimination of Plasmodium vivax malaria requires 8-aminoquinolines,which are contraindicated in patients with glucose-6-phosphate dehydrogenase(G6PD)deficiency due to the risk of acute haemolytic anaemia.Several point-of-care devices have been developed to detect G6PD deficiency.The objective of the present study was to evaluate the performance of two of these devices against G6PD genotypes in Mauritania.Methods::Outpatients were screened for G6PD deficiency using CareStart?rapid diagnostic test(RDT)and CareStart?G6PD biosensor in Nouakchott,Mauritania,in 2019-2020.African-type and Mediterranean-type G6PD genotypes commonly observed in Africa were determined by polymerase chain reaction-restriction fragment length polymorphism and sequencing.Qualitative variables were compared using Fisher’s exact test.Results::Of 323 patients(74 males and 249 females),5 males and 2 homozygous females had the African-type A-genotype:A-(202)in 3 males and 2 females and G6PD A-(968)in 2 males.Among heterozygous females,13 carried G6PD A-(202),12 G6PD A-(968),and 3 G6PD A-(542)variants.None had the Mediterranean-type G6PD genotype.Eight had a positive G6PD RDT result,including all 7 hemizygous males and homozygous females with A-or A-A-(0.12 to 2.34 IU/g haemoglobin,according to G6PD biosensor),but RDT performed poorly(sensitivity,11.1%at the cutoff level of<30%)and yielded many false negative tests.Thirty-seven(50.0%)males and 141(56.6%)females were anaemic.The adjusted median values of G6PD activity were 5.72 and 5.34 IU/g haemoglobin in non-anaemic males(n=35)and non-anaemic males and females(n=130)with normal G6PD genotypes using G6PD biosensor,respectively.Based on the adjusted median of 5.34 IU/g haemoglobin,the performance of G6PD biosensor against genotyping was as follows:at 30%cut-off,the sensitivity and specificity were 85.7%and 91.7%,respectively,and at 80%cut-off,the sensitivity was 100%while the specificity was 64.9%.Conclusions::Although this pilot study supports the utility of biosensor to screen for G6PD deficiency in patients,further investigation in parallel with spectrophotometry is required to promote and validate a more extensive use of this point-of-care device in areas where P.vivax is highly prevalent in Mauritania.
文摘Background:Plasmodium falciparum malaria is endemic in the southern sahelian zone of Mauritania where intense internal and trans-border human and livestock movement occurs.The risk of importation and spread of drugresistant parasites need to be regularly assessed in this region.The objective of the study was to assess the recent malaria situation near the Mauritania-Mali border.Methods:Between February 2015 and December 2017,patients with fever or history of fever during the previous 48 h,presenting at the health centre of Kobeni city,were screened for malaria using a rapid diagnostic test(RDT)and microscopic examination of blood smears.The diagnosis was later confirmed by PCR.Cohen’s kappa statistics was used to estimate the degree of agreement between diagnostic methods.Fisher’s exact test was used to compare proportions.The odds ratio was calculated to measure the association between the use of bed nets and malaria infection.Results:A total of 2326 febrile patients(mean age,20.2 years)were screened for malaria.The presence of malaria parasites was detected by RDT and microscopy in 53.0%and 49.3%of febrile patients,respectively,and was confirmed by PCR in 59.7%(45 missing data).Of 1361 PCR-positive samples,1205(88.5%)were P.falciparum,47(3.5%)P.vivax,and 99(7.3%)P.falciparum-P.vivax mixed infection.Malaria transmission occurred mostly during and shortly after the rainy season.The annual rainfall was relatively low in 2016(267 mm)and 2017(274 mm),compared to 2015(448 mm),and coincided with a decline in malaria prevalence in 2016–2017.Although 71.8%of febrile patients reported to possess at least one bed net in the household in our questionnaire,its reported use was not protective against malaria infection(odds ratio:1.1,95%CI:0.91–1.32).Conclusions:Our study confirmed that P.falciparum is the dominant species in the sahelian zone and that malaria transmission is seasonal and associated with rainfall in this zone.The application of the current national policy based on rapid and reliable malaria diagnosis,case management with artemisinin-based combination therapy,intermittent preventive treatment for pregnant women,distribution and use of long-lasting insecticide impregnated bed nets,and the planned introduction of seasonal malaria chemoprevention for all children under 6 years old is expected to sustainably reduce malaria transmission in this zone.
基金funded by Agence Nationale de la Recherche'Résilience Covid-19'(ANR-21-COVR 0043).
文摘Objectives To our best knowledge,no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19.‘Patients’voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences,and to test whether these clusters were associated with a higher risk of poor clinical outcomes.Design Cross-sectional online survey using life-event calendars.Setting All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France.Participants 312 patients responded to the survey.Main outcome measures From the day of symptom onset to the day of hospitalisation,we defined a symptom sequence as the time-ordered vector of the successive symptom grades(grade 1,grade 2,grade 3).State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences.Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit(ICU)and COVID-19 sequelae after hospitalisation.Results Three clusters of symptom sequences were identified among 312 complete prehospital pathways.A specific group of patients(29%)experienced extended symptoms of severe COVID-19,persisting for an average duration of 7.5 days before hospitalisation.This group had a significantly higher probability of being admitted to ICU(adjusted OR 2.01).They were less likely to know a loved one who was a healthcare worker,and more likely to have a lower level of education.Similarly,this group of patients,who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time,may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation.Conclusion and relevance This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors,such as lower education levels and limited connections to the medical field,on patients’experiences.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),funded by the Ministry of Health&Welfare,Republic of Korea(grant number:HV22C0233)the National Research Foundation of Korea(NRF)grant funded by the Korea government(NRF2021R1I1A2059735)。
文摘Background Although smoking is classified as a risk factor for severe COVID-19 outcomes,there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic.Thus,this study aims to analyze the trends of prevalence of smoking in adolescents over the COVID-19 pandemic period.Methods The present study used data from middle to high school adolescents between 2005 and 2021 who participated in the Korea Youth Risk Behavior Web-based Survey(KYRBS).We evaluated the smoking prevalence(ever or daily)by year groups and estimated the slope in smoking prevalence before and during the pandemic.Results A total of 1,137,823 adolescents participated in the study[mean age,15.04 years[95%confidence interval(CI)15.03-15.06];and male,52.4%(95%CI 51.7-53.1)].The prevalence of ever smokers was 27.7%(95%CI 27.3-28.1)between 2005 and 2008 but decreased to 9.8%(95%CI 9.3-10.3)in 2021.A consistent trend was found in daily smokers,as the estimates decreased from 5.4%(95%CI 5.2-5.6)between 2005 and 2008 to 2.3%(95%CI 2.1-2.5)in 2021.However,the downward slope in the overall prevalence of ever smokers and daily smokers became less pronounced in the COVID-19 pandemic period than in the pre-pandemic period.In the subgroup with substance use,the decreasing slope in daily smokers was significantly more pronounced during the pandemic than during the pre-pandemic period.Conclusions The proportion of ever smokers and daily smokers showed a less pronounced decreasing trend during the pandemic.The findings of our study provide an overall understanding of the pandemic's impact on smoking prevalence in adolescents.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health&Welfare,Republic of Korea(grant number:HV22C0233 and grant number:HI22C1976)The funders had no role in study design,data collection,data analysis,data interpretation,or writing of the report.
文摘Background Although previous studies have provided data on early pandemic periods of alcohol and substance use in adolescents,more adequate studies are needed to predict the trends of alcohol and substance use during recent periods,including the mid-pandemic period.This study investigated the changes in alcohol and substance use,except tobacco use,throughout the pre-,early-,and mid-pandemic periods in adolescents using a nationwide serial cross-sectional survey from South Korea.Methods Data on 1,109,776 Korean adolescents aged 13–18 years from 2005 to 2021 were obtained in a survey operated by the Korea Disease Control and Prevention Agency.We evaluated adolescents’alcohol and substance consumption prevalence and compared the slope of alcohol and substance prevalence before and during the COVID-19 pandemic to see the trend changes.We define the pre-COVID-19 period as consisting of four groups of consecutive years(2005–2008,2009–2012,2013–2015,and 2016–2019).The COVID-19 pandemic period is composed of 2020(early-pandemic era)and 2021(midpandemic era).Results More than a million adolescents successfully met the inclusion criteria.The weighted prevalence of current alcohol use was 26.8%[95%confidence interval(CI)26.4–27.1]from 2005 to 2008 and 10.5%(95%CI 10.1–11.0)in 2020 and 2021.The weighted prevalence of substance use was 1.1%(95%CI 1.1–1.2)from 2005 to 2008 and 0.7%(95%CI 0.6–0.7)between 2020 and 2021.From 2005 to 2021,the overall trend of use of both alcohol and drugs was found to decrease,but the decline has slowed since COVID-19 epidemic(current alcohol use:βdiff 0.167;95%CI 0.150–0.184;substance use:βdiff 0.152;95%CI 0.110–0.194).The changes in the slope of current alcohol and substance use showed a consistent slowdown with regard to sex,grade,residence area,and smoking status from 2005 to 2021.Conclusion The overall prevalence of alcohol consumption and substance use among over one million Korean adolescents from the early and mid-stage(2020–2021)of the COVID-19 pandemic showed a slower decline than expected given the increase during the prepandemic period(2005–2019).
基金supported by the National Research Foundation of Korea(NRF)grant funded by the Korean Government(MSIT,RS-2023-00248157)the MSIT(Ministry of Science and ICT),Korea,under the ITRC(Information Technology Research Center)support program(IITP-2024-RS-2024-00438239)supervised by the IITP(Institute for Information&Communications Technology Planning&Evaluation).
文摘Background Researches on the mental health of Korean adolescents during COVID-19 have largely focused on those from monocultural families,but there is limited data on sadness,suicidal ideation,and suicide attempts in multicultural adolescents.Methods This nationwide serial cross-sectional study included 688,708 adolescents aged 12–18 years who participated in the Korean Youth Risk Behavior Web-based Survey from 2011 to 2022.We compared and analyzed the prevalence of sadness,suicidal ideation,and suicide attempts among multicultural and monocultural adolescents.Multicultural adolescents were defined as those with at least one non-Korean parent.Results In 2021,the prevalence of sadness among multicultural adolescents was 31.86%[95%confidence interval(CI)30.00–33.71],suicidal ideation 17.17%(15.74–18.61),and suicide attempts 4.25%(3.51–4.99).Among monocultural adolescents,the prevalence rates were 26.09%(25.50–26.69)for sadness,12.41%(11.97–12.85)for suicidal ideation,and 1.92%(1.76–2.67)for suicide attempts.Adolescents from multicultural backgrounds were found to have higher rates of sadness,suicidal ideation,and suicide attempts.In the general population,these rates had decreased during the pre-pandemic period but increased after the onset of the pandemic then stabilized from 2020 to 2021.Female gender,smoking,alcohol use,and low school performance emerged as significant risk factors.However,no distinct risk factors specifically linked to suicide attempts were identified.Joinpoint regression analysis results aligned with the beta slope values in the main findings,reflecting a consistent pattern across both analyses.Conclusions This study revealed that sadness,suicidal ideation,and suicide attempts increased during the pandemic,reversing a pre-pandemic decline.Multicultural adolescents faced these issues more than monocultural ones,underlining the need for targeted public health measures to support at-risk adolescents during pandemics.
