Background:Intradialytic hypotension (IDH) is a frequent complication of hemodialysis, associated with patient discomfort, end-organ injury, and higher mortality. Prediction remains challenging. The value of relative blood volume (RBV) monitoring is debated. We investigated whether RBV indicates IDH risk and enables real-time prediction. Methods:In this prospective, multicenter study, 56 patients across 459 hemodialysis sessions were monitored with RBV sensors. IDH was defined as a systolic blood pressure <90 mmHg with a ≥20 mmHg decrease from baseline. RBV trajectories were analyzed using unsupervised clustering to identify risk patterns, and a time-varying RBV threshold was derived. Associations with IDH were tested using generalized linear mixed models (GLMMs) with patient as random effects. Predictive performance was evaluated using GLMMs and benchmarked against XGBoost, with validation performed session wise and patient wise. Results:IDH occurred in 29.7% of sessions and was associated with RBV decline. At the time of measurement, each 1% decrease in RBV increased IDH risk (OR = 1.05; P < .001). Falling below the dynamic RBV threshold doubled the odds of IDH (OR = 2.37; P < .001). In predictive analysis assessing IDH occurrence within the subsequent 10-60 minutes, GLMMs showed good discrimination in session-wise validation (AUC = 0.77) but were less accurate in patient-wise validation (AUC = 0.62). Incorporating patient-specific features improved patient-wise performance (AUC = 0.85 for GLMM; 0.86 for XGBoost). Conclusions:RBV decline is a robust predictor of IDH. Including RBV in real-time risk models may help personalize ultrafiltration strategies and improve dialysis safety.
Takotsubo cardiomyopathy is a transient form of stress-induced cardiomyopathy triggered by emotional or physical stressors. Although cardiac complications occur in nearly half of patients, atrioventricular conduction disturbances are rare, and the optimal management strategy, including the decision regarding pacemaker implantation and its timing, remains uncertain. We report the case of an 80-year-old woman who presented with Takotsubo cardiomyopathy and persistent complete heart block requiring pacemaker implantation with conduction system pacing despite recovery of the left ventricular systolic function.
This study investigates the prevalence of sleep disorders among patients with fibromyalgia syndrome (FMS) in French pain clinics, addressing a gap between international and national data. It also aims to describe associated factors such as quality of life (QoL), pain, daily functioning, and psychological symptoms. The study included 508 patients with an average age of 46 ± 10 years. Patients attending a specialized chronic pain center, either at their initial consultation or within the first year of follow-up, completed online self-administered questionnaires. Questionnaire were related to sleep disorders, pain, anxiety and QoL. In this sample, sleep disorders were highly prevalent among French patients with FMS (95.3
Gut microbial species contribute to colorectal cancer (CRC) by interacting with tumor or immune cells, however if CRC-associated bacteria engage with stromal components of the tumor microenvironment remains unclear. Here, we report interaction between the CRC-associated bacterium Fusobacterium nucleatum and cancer-associated fibroblasts (CAFs), and show that F. nucleatum is present in the stromal compartment in murine CRC models in vivo and can attach to and invade CAFs. F. nucleatum-exposed CAFs exhibit a pronounced inflammatory-CAF (iCAF) phenotype, marked by elevated expression of established iCAF markers, secretion of pro-inflammatory cytokines such as CXCL1, IL-6 and IL-8, generation of reactive oxygen species (ROS), and an increased metabolic activity. In co-culture experiments, the interaction of cancer cells with F. nucleatum-stimulated CAFs enhances invasion, a finding further validated in vivo. Altogether, our results point to a role for the tumor microbiome in CRC progression by remodeling the tumor microenvironment through its influence on cancer-associated fibroblasts, suggesting novel therapeutic strategies for targeting CRC.
Abstract Background Children in out-of-home care constitute a vulnerable population often experiencing mental health challenges related to early adversity and placement disruptions. The Circle of Security Parenting program® (COS-P) is an attachment-based intervention designed to enhance carer sensitivity and reflective competence, ultimately improving the quality of carer-child relationships. Methods This study protocol follows a mixed-methods randomized controlled trial evaluating the effectiveness of the COS-P program for foster carers in France. A total of 70 foster carers will be randomly assigned to either the intervention group (receiving COS-P in addition to Treatment as Usual) or the waitlist control group (receiving Treatment as Usual only). Quantitative measures, including the Caregiving Composite Questionnaire, Parenting Stress Index, and the Marschak Interaction Method, will be administered at baseline and at follow-up). Qualitative data will be collected through focus groups with foster carers and COS-P facilitators, and through self-confrontation interviews with a subset of foster carers. Discussion This study is the first to evaluate the COS-P program for foster carers in France. Findings will provide valuable insights into the program’s effectiveness in improving carer-child relationships and foster carer well-being, ultimately contributing to better outcomes for children in out-of-home care. The study will also explore potential moderators of treatment outcome, and shed light on the subjective experiences of participants. Trial registration This trial is registered on ClinicalTrials.gov : NCT06701877.
