The Beaujon Hospital (French: Hôpital Beaujon) is located in Clichy, Paris, France and is operated by APHDP. It was named after Nicolas Beaujon, an eighteenth-century French banker. It opened in 1935 and was designed by Jean Walter.
BackgroundSpinal epidural abscesses (SEA) are rare but severe infections with a risk of neurological sequelae. Data focusing specifically on Staphylococcus aureus SEA remain scarce, despite this pathogen being the leading cause. The prognosis of primary versus secondary SEA, and the role of medical versus surgical management remain debated. We aimed to describe the clinical, microbiological and therapeutic features of S. aureus SEA and to identify potential prognostic factors.MethodsWe conducted a retrospective review of S. aureus SEA managed in two French tertiary centers. Comparative analyses were performed between primary and secondary SEA, and between patients with favorable versus poor neurological outcomes.ResultsBetween May 2007 and June 2025, 65 patients were included, representing the largest cohort focusing exclusively on S. aureus SEA. Median age was 61 years (IQR 51-71), with a male predominance (63%). Intravenous drug use was frequent (16%). Most cases were secondary to spondylodiscitis (86%), while primary SEA accounted for 14% and were associated with more severe initial neurological deficits. A cutaneous portal of entry was associated with better outcomes, whereas implant-related infections and unidentified sources predicted poorer prognosis. Methicillin-resistant S. aureus showed a non-significant trend toward worse outcomes. Surgery was performed in 40% of patients, mainly in those with deficits. Among medically managed patients, 78% were alive without neurological sequelae at three months.ConclusionThis study highlights clinical differences between primary and secondary SEA and the prognostic value of portal-of-entry identification. Conservative management appears effective in selected patients without neurological deficits, provided careful multidisciplinary monitoring is ensured.
BACKGROUND AND AIMS:The impact of Physical activity (PA) on the activity of inflammatory bowel disease (IBD) remains unclear. PATIENTS AND METHODS:A descriptive cross-sectional study included consecutive patients with Crohn's disease (CD), ulcerative colitis (UC). PA was assessed using the short International Physical Activity Questionnaire. PA was classified as low, medium or high PA. PA was also assessed according to WHO recommendations. IBD activity was evaluated using PRO-2, while IBD-related disability was assessed with the IBD-disk questionnaire. RESULTS:Among a total of 2514 patients (1715 CD), only 28.8% met the WHO recommendations on PA (49.8% had low PA, 35.2% had medium PA, and 15.0% had high PA). Medium and high PA levels were associated with a higher rate of patient-reported clinical remission in patients with CD (OR 1.30 [1.08-1.57] for medium PA, and 1.33 [1.03-1.72] for high PA vs. low PA; p-trend=0.02) but not in those with UC. Higher PA levels were associated with less IBD-related disability in both CD, and UC. CONCLUSION:In a large cohort of IBD patients, moderate and high PA was associated with higher rates of clinical remission in patients with CD and lower IBD-related disability in both CD and UC patients.
BACKGROUND : Endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) is emerging as an alternative to choledochoduodenostomy (EUS-CDS) for malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Comparative data on long-term patency are limited. METHODS : This retrospective international study analyzed two historical cohorts of patients who underwent EUS-GBD or EUS-CDS for MDBO after failed ERCP between March 2017 and May 2024. Eligible patients were aged ≥ 18 years with at least 6 months' follow-up or confirmed death. The primary outcome, after 1 : 1 propensity score matching, was 12-month biliary patency. Secondary outcomes included technical and clinical success, adverse events (AEs), reintervention rates, and overall survival. RESULTS : Before matching, 294 patients were included (142 EUS-GBD; 152 EUS-CDS). After matching, 200 patients were analyzed (100 per group). Technical success was 100 % for EUS-GBD and 97 % for EUS-CDS (P = 0.25). Clinical success was 80.5 % for EUS-GBD and 90.6 % for EUS-CDS (P = 0.08). At 12 months, the probability of biliary patency was significantly higher with EUS-GBD than EUS-CDS (86.2 % [95 %CI 74.2 %-92.9 %] vs. 63.8 % [95 %CI 49.5-75.0]; P = 0.01). Biliary reintervention-free survival was significantly longer with EUS-GBD (log-rank, P < 0.001). Periprocedural AEs occurred in 7.0 % vs. 10.0 % (P = 0.61), delayed AEs in 27.0 % vs. 30.0 % (P = 0.75), and reintervention rates were comparable (23.0 % vs. 26.0 %; P = 0.74). Overall survival did not differ significantly (log-rank, P = 0.59). CONCLUSION : In patients with MDBO after failed ERCP, EUS-GBD achieved higher 12-month biliary patency than EUS-CDS, with comparable rates of technical and clinical success, morbidity, reintervention, and overall survival.
Introduction:Liver resection (LR) is a potentially curative treatment of hepatocellular carcinoma (HCC), but early recurrence rates remain high reaching as high as 70%. Accurate prediction of disease-free survival (DFS) after LR is crucial to optimize patients' selection for clinical trials evaluating adjuvant strategies. This study assessed machine learning (ML) models for predicting DFS after LR for HCC. Methods:A total of 663 patients who underwent LR between 2010 and 2020 in 3 French HPB referral centers were analyzed. Three ML models - random survival forest (RSF), gradient boosting survival (GBS), and fast survival support vector machine (FSSVM) - were compared with the Cox proportional hazards regression model. Model performance was assessed using C-index and time-dependent area under the curve (AUC). External validation was performed using an independent cohort from a fourth center. Statistical comparisons between models were conducted using paired t tests. Results:After a median follow up of 52 months, recurrence occurred in 43% of patients and median DFS was 15 months. In the training cohort, RSF achieved the highest discrimination (C-index = 0.721 ± 0.027) and predictive accuracy (AUC = 0.768 ± 0.039) among the four evaluated models. Cox, GBS, and FSSVM showed comparable performance (C-index = 0.684-0.699; AUC = 0.718-0.745). Paired t tests demonstrated that RSF significantly outperformed Cox for both C-index (p = 0.023) and AUC (p = 0.039). In the external validation cohort, all ML models outperformed Cox regression, with RSF showing the highest performance (C-index 0.817, AUC 0.863), suggesting strong generalizability. Conclusions:RSF significantly improved DFS prediction compared with Cox regression and yielded the best discriminatory performance in both training and external validation cohorts. These findings highlight the value of ML-based survival models, particularly RSF, for enhancing individualized postoperative prognostication and refining patient selection for clinical trials evaluating adjuvant treatment to surveillance after LR for HCC.
Maternal iron requirements increase during pregnancy. Placental transfer is unidirectional via transferrin receptor 1 and ferroportin, and most fetal iron accumulation occurs in the third trimester. Iron deficiency during pregnancy is associated with maternal fatigue, reduced work capacity, and increased risk of anemia, as well as adverse outcomes such as preterm birth, low birthweight, and impaired neonatal iron stores, which may affect early neurodevelopment. Oral iron supplementation reduces anemia and improves iron status. In women at risk of deficiency, lower prophylactic doses are commonly used. Intravenous iron is effective and generally safe from the second trimester in women who do not respond to or tolerate oral therapy. However, iron status shows a U-shaped association with outcomes: elevated maternal iron has been associated with preterm birth, low birthweight, and possible neurodevelopmental effects. Excess iron may induce oxidative stress and placental iron loading. Hepcidin suppression in the second and third trimesters enhances iron absorption. Important gaps remain regarding hepcidin regulation, placental transport mechanisms, safe upper supplementation limits, and optimal dosing strategies. While supplementation clearly benefits iron-deficient women, current evidence supports screening-based rather than universal supplementation in iron-replete populations. Herein, we discuss the need for iron during pregnancy, the impact of dysmetabolism, and the molecular actors at the cellular and systemic levels to build a translational bridge between clinical unmet needs and fundamental knowledge.
