IMPACT de la déprivation sociale sur les difficultés psychosociales au décours d’un cancer pédiatrique:uneétude prospective IMPACT of the Social Deprivation on Psychosocial Difficulties of Pediatric Cancer Survivors:A Prospective Study

The posttreatment period is a key part of the management of pediatric cancer.During this time,school and psychological difficulties have been described in childhood cancer survivors(CCS)and can be prognostic for the success of social reintegration.This study estimated the influence of the household’s socioeconomic status(SES)on these psychosocial difficulties.This study is based on a prospective multicentric database and focused on children who received a psychosocial evaluation during their follow-up from 2013 to 2020.We retrieved data on school and psychological difficulties.Household SES was estimated by a social deprivation score.Data from1003 patients were analyzed.School difficulties were noted in 22%of CCS.A greater social deprivation was significantly associated with school difficulty.Tumor relapse,treatment with hematopoietic stem cell transplantation,and central nervous system(CNS)tumors remained significant risk factors.In the subgroup of CNS tumors,school difficulties were increased and associated with greater social deprivation.Psychological difficulties were not associated with the deprivation score.There is a link between SES and school difficulties in CCS.Further investigations should be carried out for children with CNS tumors,which is the population of the greatest concern.

Construction of Parsimonious Event Risk Scores by an Ensemble Method. An Illustration for Short-Term Predictions in Chronic Heart Failure Patients from the GISSI-HF Trial

Selecting which explanatory variables to include in a given score is a common difficulty, as a balance must be found between statistical fit and practical application. This article presents a methodology for constructing parsimonious event risk scores combining a stepwise selection of variables with ensemble scores obtained by aggregation of several scores, using several classifiers, bootstrap samples and various modalities of random selection of variables. Selection methods based on a probabilistic model can be used to achieve a stepwise selection for a given classifier such as logistic regression, but not directly for an ensemble classifier constructed by aggregation of several classifiers. Three selection methods are proposed in this framework, two involving a backward selection of the variables based on their coefficients in an ensemble score and the third involving a forward selection of the variables maximizing the AUC. The stepwise selection allows constructing a succession of scores, with the practitioner able to choose which score best fits his needs. These three methods are compared in an application to construct parsimonious short-term event risk scores in chronic HF patients, using as event the composite endpoint of death or hospitalization for worsening HF within 180 days of a visit. Focusing on the fastest method, four scores are constructed, yielding out-of-bag AUCs ranging from 0.81 (26 variables) to 0.76 (2 variables).

Construction and Update of an Online Ensemble Score Involving Linear Discriminant Analysis and Logistic Regression

The present aim is to update, upon arrival of new learning data, the parameters of a score constructed with an ensemble method involving linear discriminant analysis and logistic regression in an online setting, without the need to store all of the previously obtained data. Poisson bootstrap and stochastic approximation processes were used with online standardized data to avoid numerical explosions, the convergence of which has been established theoretically. This empirical convergence of online ensemble scores to a reference “batch” score was studied on five different datasets from which data streams were simulated, comparing six different processes to construct the online scores. For each score, 50 replications using a total of 10N observations (N being the size of the dataset) were performed to assess the convergence and the stability of the method, computing the mean and standard deviation of a convergence criterion. A complementary study using 100N observations was also performed. All tested processes on all datasets converged after N iterations, except for one process on one dataset. The best processes were averaged processes using online standardized data and a piecewise constant step-size.

Plasma 17-hydroxyprogesterone/cortisol ratio is not a predictor of systemic hypotension in extremely premature infants

Background/aims: To determine whether the 17-hydroxyprogesterone (17-OHP)/cortisol ratio as a marker of immature11-beta hydroxylase activity can predict severe systemic hypotension in preterm neonates. Methods: Serum cortisol and 17-OHP concentrations were measured in capillary blood deposited on blotter paper on day 3 post-natal age (Day 3) in infants less than 32 weeks postmenstrual age (PMA). The predictive value of 17-OHP/cortisol ratio for a first episode of systemic hypotension occurring after Day 3 (FESH) was evaluated. Results: Of 105 infants included, 14 patients (13%) presented a FESH. Neither the 17-OHP/cortisol ratio, nor the 17-OHP or cortisol concentrations were associated with the occurrence of a FESH when adjusted for potential confounding factors. 17-OHP and cortisol were inversely associated to PMA (r = ﹣0.36 and ﹣0.40, respectively). Cortisol, but not 17-OHP, was associated with the type of hospitalization unit, the respiratory support and the presence of a patent ductus arteriosus. The 17-OHP/cortisol ratio was associated with the type of hospitalization unit only. Conclusions: The 17-OHP/ cortisol ratio at Day 3 did not predict the occurrence of a first episode of systemic hypotension after Day3 inpreterm neonates.

Pembrolizumab as a novel therapeutic option for patients with refractory thymic epithelial tumor:A case report

BACKGROUND Thymic epithelial carcinomas are rare and have a poor prognosis.Treatment of thymic epithelial carcinoma is multimodal and includes surgery,post-operative radiation therapy,adjuvant and neoadjuvant chemotherapy,or exclusive chemotherapy based on disease resectability.However,there is currently no standard treatment regimen for metastatic and recurrent thymic carcinoma.CASE SUMMARY A 45-year-old Caucasian male,with no past medical history,presented with hepatalgia and a cervical mass.A computed tomography(CT)scan showed multiple suspect lesions in the lungs,liver,and anterior mediastinum associated with mediastinal and cervical adenopathy.CT-guided percutaneous biopsies of the liver lesions and anterior mediastinal mass were performed,confirming the histopathology of thymic epithelial carcinoma.Management consisted of several chemotherapy regimens and radiation therapy,administered between April 2016 and December 2018.The patient achieved complete metabolic response.Fluorodeoxyglucose positron emission tomography/CT performed in June 2019 showed disease relapse,with reappearance of a large hypermetabolic hepatic mass and involvement of mediastinal and axillary lymph nodes.Intravenous pembrolizumab(200 mg,every 3 wk)was administered after two prior systemic therapies.The patient’s response to treatment was last documented on March 5,2020.CONCLUSION Pembrolizumab was successful in treatment of a patient with programmed deathligand 1-negative metastatic thymic carcinoma,pretreated with chemotherapy.

Tourette综合征和深部脑刺激

In this prospective double blind randomised “ N of 1” study, a patient wit h a severe form of Tourette’ s syndrome was treated with bilateral high frequen cy stimulation of the centromedianparafascicular complex (Ce- Pf) of the thalam us, the internal part of the globus pallidus (GPi), or both. Stimulation of eith er target improved tic severity by 70% , markedly ameliorated coprolalia, and e liminated self injuries. Severe forms of Tourette’ s syndrome may benefit from stimulation of neuronal circuits within the basal ganglia, thus confirming the r ole of the dysfunction of limbic striatopallido- thalamo- cort- ical systems in this disorder.

Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

Neurodevelopment from 0 to 24 months in normocephalic children,in utero exposed to Zika virus in 2016:A cohort study

Zika virus(ZIKV)is a neurotropic arbovirus almost exclusively transmitted by the bite of Aedes species mosquitoes[1].An outbreak of ZIKV infection was first confirmed in Northeast of Brazil,early 2015.The prevalence of micro-cephaly in 15 states of Brazil with laboratory-confirmed ZIKV transmission significantly exceeded that in four states without confirmed ZIKV transmission[2].