BACKGROUND:Data are needed on the effect of oxygen delivered through a high-flow nasal cannula, as compared with standard oxygen therapy, on intubation and mortality in patients with acute hypoxemic respiratory failure. METHODS:In this multicenter, open-label trial, we randomly assigned patients who had acute hypoxemic respiratory failure to receive high-flow-oxygen or standard-oxygen therapy. All the patients had a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 or less, a respiratory rate of more than 25 breaths per minute, and pulmonary infiltrate on chest imaging. The primary outcome was death by day 28. RESULTS:A total of 1116 patients underwent randomization. Of these patients, 1110 (556 in the high-flow-oxygen group and 554 in the standard-oxygen group) were included in the analysis. Mortality at day 28 was 14.6% (in 81 of 556 patients) in the high-flow-oxygen group and 14.6% (in 81 of 554 patients) in the standard-oxygen group (difference, -0.05 percentage points; 95% confidence interval [CI], -4.21 to 4.10; P = 0.98). The incidence of intubation by day 28 was 42.4% (in 236 of 556 patients) in the high-flow-oxygen group and 48.4% (in 268 of 554 patients) in the standard-oxygen group (difference, -5.93 percentage points; 95% CI, -11.78 to -0.08). Serious adverse events (cardiac arrest or pneumothorax) occurred during spontaneous breathing in 13 patients (2.3%) in the high-flow-oxygen group and in 6 patients (1.1%) in the standard-oxygen group. CONCLUSIONS:Among patients with acute hypoxemic respiratory failure, the use of oxygen delivered through a high-flow nasal cannula did not significantly reduce mortality at day 28. (Funded by the French Ministry of Health and Fisher and Paykel Healthcare; SOHO ClinicalTrials.gov number, NCT04468126.).
Introduction:Acute otitis media (AOM) is associated with the development of permanent sensorineural hearing loss (SNHL). The potential role of steroids in preventing cochlear damage secondary to AOM has been discussed. Objective:To critically analyze the current evidence on the use of steroids to prevent AOM-associated SNHL. Data synthesis:A total of 15 studies was categorized into 3 groups: 1) studies on histopathological changes in the inner ear secondary to AOM (n 5); 2) those on the relationship between AOM and hearing outcomes (n = 5); and 3) studies on the (hearing or histological) outcomes of AOM treatment using steroids (n = 5). Experimental studies in animals and human temporal bones revealed that AOM is associated with the upregulation of proinflammatory cytokines in the middle and inner ears, resulting in an inflammatory process. Inflammatory cytokines and bacterial toxins translocate from the middle to the inner ears through the semipermeable round window membrane, causing structural damage to the neuroepithelium, mainly in the cochlear basal turn. In experimental studies, the use of steroids has been shown to reduce the expression of inflammatory cells and cytokines and the structural damage affecting the stria vascularis and hair cells. One study clinically evaluated the effects of steroids on AOM patients with SNHL, and it demonstrated significant improvements in hearing thresholds. Conclusion:Experimental data demonstrate that steroids can reduce the expression of inflammatory cytokines and reduce structural damage to the cochlear neurosensory epithelium. However, these findings have yet to be translated to a clinical setting due to the lack of high-level evidence.
Introduction Le diagnostic de MCL repose sur la présence de troubles cognitifs légers et de critères cliniques centraux qui peuvent être substitués par des biomarqueurs dont la scintigraphie myocardique au MIBG. Objectifs Évaluer l’utilisation de l’imagerie nucléaire dans la MCL en analysant le nombre de patients avec DATScan négatif et scintigraphie myocardique MIBG positive dont l’évolution clinique confirme l’évolution vers une MCL prodromale. Méthodes Il s’agit d’une étude observationnelle rétrospective sur des patients adressés au CMRR du CHU d’Angers et ayant bénéficié d’un DATScan et/ou d’une scintiMIBG sur indication neurologique, entre 2021 et avril 2024. Les patients inclus avaient un trouble cognitif léger avec un seul critère central, répartis en groupes DAT−MIBG+, DAT+, DAT−MIBG−. Les données cliniques étaient recueillies pour être comparées. L’étude multicentrique complémentaire sur Rennes, Nantes et Tours n’a pas permis d’inclure de patient. Résultats Nous avons inclus 8 patients avec DATScan négatif, 6 patients avec DAT−MIBG+, 2 patients DAT−MIBG− et 29 patients dans le groupe DAT+.Tous les patients DAT−MIBG+ ont évolué vers une MCL probable selon les critères cliniques seuls, dans un délai de 6 mois à 1 an après la réalisation de la scintigraphie MIBG.Nous ne retrouvons pas de différence significative dans les caractéristiques cliniques des patients inclus qui permettrait d’orienter la prescription de l’examen. Discussion L’étude présente un faible effectif du fait des habitudes de prescription françaises de scintigraphie MIBG différentes d’autres pays. L’intérêt était de combiner l’étude de deux examens dans une même cohorte. Elle a permis d’échanger sur les pratiques d’utilisation de cette imagerie de façon multicentrique et interroge sur les aspects économiques et sa place dans la stratégie diagnostique. Conclusion Cette étude sur une faible cohorte montre l’intérêt de la scintigraphie myocardique au MIBG à un stade précoce, renforçant les recommandations internationales dans la stratégie diagnostique de la MCL prodromale.
Background and ObjectivesDevelopmental and epileptic encephalopathies (DEEs) with early burst-suppression EEG (EIDEE-BS) are among the most severe neonatal epileptic syndromes, typically presenting in the first months of life with refractory seizures and profound neurodevelopmental impairment. Although variants in the KCNQ2, STXBP1, and SCN2A genes are recognized as major causes, the full genetic spectrum remains uncertain. We aimed to delineate the electroclinical characteristics, genetic etiologies, and long-term outcomes in a large MRI-negative EIDEE-BS cohort.MethodsWe retrospectively analyzed 110 patients with BS EEG enrolled from a database of 1,540 individuals with suspected genetic epilepsies (2008-2023). Clinical, EEG, and genetic data were systematically collected. Patients were stratified into 4 groups: KCNQ2, STXBP1, "other pathogenic variants," and "without a genetic diagnosis." EEG traces were reviewed independently, and outcomes were assessed through long-term follow-up.ResultsPathogenic or likely pathogenic variants were identified in 62.7% of patients and involved 23 genes, including 2 copy number variants. KCNQ2 (n = 24) and STXBP1 (n = 16) accounted for one-third of diagnoses, whereas SCN2A (n = 3) and KCNT1 (n = 2) were less frequent. In KCNQ2 cases, seizures and BS onset occurred earlier than in STXBP1 cases: mean 2 days vs 6 weeks for seizures and 3 days vs 2 months for BS, respectively. A typical BS pattern (bursts longer than suppressions) strongly correlated with KCNQ2 and STXBP1 variants. Novel associations were found with DPM1, GRIN2A, KCNT2, PIGO, PURA, WWOX, and candidate genes (KMT2E, SNAP25, and SYT1). Most variants were de novo heterozygous; however, recessive and X-linked inheritance patterns were also observed. Mortality was high (25%), primarily from status epilepticus and complications of severe disability. Most patients (72.5%) had persistent seizures at follow-up (a mean of 6.5 years), as well as profound intellectual disabilities, irrespective of genotype.DiscussionThis large series highlights the strong monogenic basis of EIDEE-BS. KCNQ2, STXBP1, and SCN2A were the most commonly affected genes. Early EEG features, particularly BS timing and morphology, can help anticipate the underlying genotype and guide precision therapy, including the early use of sodium channel blockers in selected cases. These findings support recent ILAE reclassification efforts and underscore the importance of comprehensive genomic testing for improved diagnosis and counseling.
Numerous studies have compared reusable flexible ureteroscopes (RUFU) and single-use flexible ureteroscopes (SUFU). However, patients’ opinions (PO) have not yet been assessed. This study aimed to evaluate PO regarding RUFU versus SUFU. A multicenter anonymous survey was conducted among patients consulting for urolithiasis in eight French centers between September 2024 and April 2025. Participants completed a nine-item questionnaire validated by an expert panel, assessing demographic and medical characteristics, ureteroscope preferences, environmental considerations (EC), scenario-based choices, and willingness to pay. 186 patients were analyzed. Median age was 55years and 60.2
