波尔多塞甘大学

Anti-NMDA receptor encephalitis (also called anti-NMDAr encephalitis) has been described since 2007 and most often manifests itself through psychiatric and cognitive disorders and dysautonomia. This diagnosis is still little known among practitioners. In rare cases, this pathology has a solely psychiatric presentation. We propose here to address the situation of a 26-year-old young woman who presented with a psychotic-like decompensation, with some atypical points, leading to a form of diagnostic wandering for almost a year before the hypothesis of ANTI-NMDAr encephalitis was validated and appropriate therapy was initiated. In this article, we describe the care pathway of this patient, the clinical hypotheses and the multidisciplinary consultations that led to this diagnosis. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

INTRODUCTION:Radiofrequency ablation is a cornerstone therapy for patients with ischemic cardiomyopathy (ICM) presenting with ventricular tachycardia (VT). In this context, ablation is typically performed endocardially as a first-line approach. However, despite acute procedural success, the risk of recurrence remains high, potentially due to the presence of epicardial substrate. Several observational studies have suggested the potential benefits of a first-line endo-epicardial approach in decreasing recurrence. In this context, the EPIC-VT trial was designed to compare endocardial-only ablation versus combined endo-epicardial ablation as a first-line approach in ICM patients with VT. METHODS:The EPIC-VT trial is a prospective, multicenter, controlled, randomized, open-label superiority trial with two parallel groups (endocardial-only approach vs. combined endo-epicardial approach) in a 1:1 ratio. The primary objective of this study is to demonstrate that a combined endo-epicardial approach reduces the risk of VT recurrence compared to an endocardial approach alone in patients with ICM. Patients will be followed for 2 years after the procedure. RESULTS AND CONCLUSION:To date, only retrospective studies have compared VA recurrences in patients with ICM, depending on whether ablation was performed using an endocardial or an endo-epicardial approach, with conflicting results. A meta-analysis suggested an advantage of the endo-epicardial approach over the endocardial approach (odds ratio = 0.39 [95% CI: 0.18-0.83]). However, the level of evidence remains low, and no controlled randomized study has confirmed this hypothesis. If the EPIC-VT study confirms the superiority of a first-line endo-epicardial approach, such strategy could become the preferred option for VT ablation in ICM, thereby reducing the risk of VA recurrence.

We read with great interest the manuscript by Tian et al published in Gut. Tian et al report that in colorectal cancer (CRC) at stages III/IV, the presence of extracellular AGR2 in the tumour environment is due to its secretion by tumourassociated neutrophils (TANs). This, in turn, promotes tumour cells migration and invasion. Although these findings are original and exciting, it is essential to put them in the context of the biology of anterior gradient (AGR) proteins. AGR2 is the most studied member of the AGR family, which contains three proteins and belongs to the superfamily of protein disulfide isomerases. AGR13 exhibit all the features of endoplasmic reticulum (ER) resident proteins by containing a signal peptide and an ER retention motif. AGR2 and AGR3 can be secreted in the extracellular milieu to trigger cell migration, and for AGR2 only, epithelialtomesenchymal transition, chemoattraction of monocytes and myofibroblast activation. 6 Moreover, AGR2 is strongly expressed in endodermderived organs (lung stomach, colon prostate, intestine) and as such, is almost exclusively expressed in mucosal epithelial cells. Its overexpression has been associated with tumour aggressiveness in various cancers. Tian et al claim that in CRC, AGR2 is only produced by tumourinfiltrating neutrophils (TANs) which impacts on the migration of CRC cells through the activation of signalling pathways depending on CD98hccCT and Rho GTPases. Although this result is interesting, it is surprising that no expression of AGR2 is detected in tumour epithelial cells. We aimed at further documenting the expression levels of AGR2 protein in TANinfiltrated CRC. To do so, 21 CRC samples from our European institutions and covering 3 aetiologies including microsatellite stable (MSS) and mismatch repair and instable (MSI) adenocarcinomas (ADK) and CRC from patients with inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (IBD+PSC) or not (IBDCRC) at stages III/IV. These samples were processed for immunohistochemistry with antiAGR2 (antiAGR2 (M03) 1C3, Abnova, 1/800) and antiMPO antibody as a neutrophil marker (antiMPO (MAB3174), R&D System, 1/1000) and the images quantified (figure 1A,B). We also show data from the Human Protein Atlas (figure 1C,D). Mutually exclusive staining of AGR2 and MPO in CRC stages III/IV from various aetiologies were found thereby indicating that if TAN do express AGR2, it is marginal (figure 1A). Riener et al showed that AGR2 expression is lost or decreased in the majority of leftsided CRC, and is significantly associated with reduced overall patient survival suggesting that AGR2 might be a tumour suppressor. However, these results neither did correspond to the Tian et al article nor to their previous report in which results in discrepancies were speculated to come from variabilities in subjects or experimentalists. Hence one should rely on large international cohorts of patients with CRC to link AGR2 expression to specific aetiologies. Recent results from our laboratories did not confirm AGR2 loss of expression Letter