The difficulty to restore normoglycemia in insulin-dependent diabetes led from the 1970s to search for matching the insulin needs and insulin delivery. The first systems in which an intravenous insulin infusion was driven by algorithms taking into account the glucose level and its current variations according to a continuous monitoring of intravenous glucose have been developed at patient bedside. The feasibility of ambulatory use came from the availability of miniaturized glucose sensors and wearable or implantable insulin pumps in the early 2000s. The systems using a central intravenous glucose sensor and an implantable pump infusing intraperitoneal insulin have shown positive results but appeared as too complex for usual practice. Hence, the subcutaneous route has been privileged both for glucose monitoring and for insulin delivery. Predictive algorithms of glucose evolution had to be designed for basal insulin delivery and the need for announcing food intakes and physical exercise imposed due to the delays between insulin infusion and its biological action, leading to hybrid, semi-automated systems. Once their safety and efficacy had been demonstrated in a supervised mode, various industrial devices appeared on the market. The provided benefit combines an increased time spent in normoglycemia, a reduction of hypoglycemic events and a somewhat improved quality of life. Their clinical dissemination is associated with a continuing research to make available fully-automated systems, and ultimately implantable.
Hemophilia A, a severe bleeding disorder resulting from a functional deficiency in coagulation factor VIII (FVIII), has mainly been treated with prophylactic FVIII replacement therapy. Although effective, this approach is limited by frequent intravenous infusions and the risk of developing inhibitory antibodies in 20 to 30% of severely affected patients. This review describes the development of FVIII-independent therapeutic strategies, focusing on antibody-based approaches that have fundamentally reshaped the clinical management of hemophilia A. The "first revolution" was the advent of bispecific antibodies that replace activated FVIII (FVIIIa), initiated by emicizumab. Emicizumab mimics the cofactor function of FVIIIa, and has the advantage that it combines subcutaneous administration with a long half-life. Its clinical success has led to the development of more effective variants, such as NXT007 and Mim8. Also conventional monoclonal antibodies (concizumab and marstacimab) have been developed. They restore hemostasis by inhibiting tissue factor pathway inhibitor (TFPI), a natural anticoagulant. Both antibodies are effective for hemophilia A and B, regardless of inhibitor status. Finally, the "new revolution" concerns single-domain antibodies (nanobodies) derived from camelids, with particular reference to Inno8, an orally bioavailable bispecific nanobody currently in clinical trials. Inno8 promises to offer protection similar to that of emicizumab with the convenience of daily oral administration.
Introduction: Occupational health (OH), based on a multidisciplinary approach, represents a strategic lever for an active public health (PH) prevention policy. In response to the growing emergence of diseases linked to both lifestyle and working conditions, it has moved beyond the sole prevention of occupational hazards and now adopts an integrated approach focused on overall health. Objective: To analyze the strategic role of OH in an active prevention policy, by examining the broadening of its missions, its alignment with PH policies, the obstacles to its integration, and the prospects for improvement. Method: A narrative review of scientific, institutional, and regulatory literature was conducted, supplemented by a comparative analysis of OH systems and practices, particularly in connection with National Public Health Plans and Programs. Results: OH plays a central role in the prevention of occupational risks, the promotion of overall workplace health, access to care for disadvantaged populations, and the production of epidemiological data essential for health surveillance. As such, it serves as an operational relay for PH policies. However, its integration is hindered by institutional silos, heterogeneity of systems, lack of recognition, and insufficient intersectoral coordination. Conclusion: Strengthening the articulation between occupational health (OH) and public health (PH) requires shared governance, enhanced institutional recognition, data sharing, and the development of common tools. This integrative approach, grounded in a synergistic dynamic between occupational risk prevention, health promotion, and population protection, helps optimize the effectiveness, equity, and sustainability of prevention policies at both individual and collective levels.
Autoantibodies (aAbs) are classically associated with autoimmune diseases. They may exert pathogenic effects that directly contribute to the disease. Most often, the target autoantigens are membrane-bound molecules, accessible to aAbs on the cell surface, and their expression is specific to certain cells or tissues - features that explain the organ-specific clinical phenotype of these pathologies. Idiopathic inflammatory myopathies (or myositis) represent a notable exception to this paradigm due to the intracellular and ubiquitous nature of the autoantigens recognized by the aAbs. This is particularly the case in immune-mediated necrotizing myopathies (IMNM), which present an almost exclusively muscular clinical phenotype, where pathogenic aAbs target the signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), two ubiquitous and intracellular proteins. This paradox raises fundamental questions regarding the reason for the organ-specificity of the disease and the accessibility of circulating aAbs to their target located within the cytoplasm. This review summarizes current knowledge on the pathophysiology of IMNM and discusses the probable pathogenicity of anti-SRP and anti-HMGCR aAbs through functional inhibition of their antigenic targets, involving non-conventional mechanisms of cellular penetration. We hypothesize that this may be at least partially related to the unique mechanical constraints exerted on the sarcolemma due to the contractile nature of muscle fibers.
Advances in cancer therapies have significantly improved prognosis. By 2026, 85% of patients diagnosed with cancer will be in remission. The increasing complexity of oncological treatments allows for improved progressionfree survival, at the expense of the risk of cardiotoxicity. This often refers, but is not restricted to, heart failure or left ventricular dysfunction. The European Society of Cardiology, through the first cardio-oncology guidelines, has defined thresholds for left ventricular ejection fraction, longitudinal function through echocardiographic deformation indices, and even cardiac biomarkers. It is therefore essential to develop robust strategies to predict, detect, and early diagnose these side effects, and to prevent them. Several strategies for cardioprotection have been studied, both pharmacological and behavioural, with sometimes contradictory results. Optimal control of classical cardiovascular risk factors remains the cornerstone of preventing cardiotoxicity from oncological treatments.
A growing body of evidence supports the existence of a kidney-brain axis that may contribute to the cognitive decline observed in chronic kidney disease (CKD). Current demographic trends suggest that incidence and prevalence of both conditions will continue to rise. In this narrative review, we aim to explore the epidemiological data supporting the association between CKD and neurocognitive health; the potential existence of a CKD-specific cognitive pattern; the underlying pathophysiological mechanisms; and the diagnostic and therapeutic implications, both pharmacological and non-pharmacological. Epidemiological studies consistently indicate an association between CKD and cognitive impairment. Executive functions are frequently affected, although no distinct CKD-related cognitive phenotype has yet been clearly defined. The pathophysiology extends beyond vascular contribution and involves multiple interdependent mechanisms, with a key role attributed to the accumulation of uremic toxins in CKD. Accurate diagnosis of both CKD and cognitive impairment requires careful selection and application of appropriate tests and biomarkers. Therapeutic strategies include both pharmacological and non-pharmacological interventions. The complexity of the kidney-brain axis highlights the need for expanded research efforts and multidisciplinary collaboration among patients, healthcare providers, nephrologists, neurologists, geriatricians, radiologists, and basic scientists.
Principle of mutual aid and solidarity, confraternity is the subject of various criticisms coming sometimes from civil society, sometimes from the medical community itself. Some accuse it for restricting doctors; freedom of expression, others for cultivating outdated corporatism. These critics misunderstand the ethical scope of fraternal obligation whose cleansing and pacifying effect meets the needs of patients. What is worth questioning is not the principle itself but its rigid vision and maximalist use.
Cardio-oncology is a rapidly expanding discipline, born out of the need to prevent and manage cardiovascular diseases in patients affected by cancer, including treatment-related toxicities. Given the increasing complexity of oncological care pathways and the increasing number of at-risk patients, structuring a dedicated cardiooncology service has become a key priority. This organisation relies on close collaboration between oncologists and cardiologists, within a fully integrated multidisciplinary approach. Establishing an effective cardio-oncology programme requires clearly defined, coordinated care pathways tailored to each institution. Appointing an oncologist-cardiologist leadership team is essential to ensure consistency and seamless patient management. Developing standardised protocols based on international guidelines, incorporating risk assessment tools and surveillance strategies, and implementing personalised follow-up are all critical steps in guaranteeing high-quality, safe care. Cardio-oncology must also be integrated into long-term survivorship care, in close coordination with primary care providers and cardiac rehabilitation centres. Furthermore, developing networks of care, accrediting specialist reference centres, and incorporating technological innovations-such as artificial intelligence and wearable devices-will help to optimise patient management and ensure equitable access to cardio-oncology expertise across the healthcare system.
Since the 1990s, cancer-related mortality has steadily decreased, drastically increasing the number of survivors. However, the adverse drug reactions of anticancer drugs, particularly cardiotoxicities, have increased in parallel and became a major issue. In 2019, 11% of cancer survivors died from cardiovascular diseases, making cardiooncology an essential expertise. Cardiac dysfunction, including heart failure, is the most common cardiotoxicity encountered. Pharmacology plays a central role in the prevention and management of these cardiotoxicities. Since the 2000s, many new anticancer drugs have been developed, requiring solid pharmacological knowledge to evaluate adverse drug reactions. The concept of "permissive cardiotoxicity" involves assessing the benefit-risk balance to guide management. Heart failure attributable to anticancer drugs became a significant problem with the arrival of trastuzumab in 2001, when it was found that 33% of patients treated for breast cancer experienced heart failure due to this drug, even though they had a low cardiovascular risk. Many other drugs have since been associated with the occurrence of heart failure, requiring increased involvement of cardiologists. The management of heart failure attributed to anticancer drugs follows the general guidelines for the general population, with some specificities added. A multidisciplinary evaluation is recommended to determine the imputability of anticancer drugs and whether or not to discontinue them. Management must be individualized, prioritizing the benefit-risk balance.
Sleep is an essential component of the physical, cognitive, and emotional development of children and adolescents. In childhood, sufficient and regular sleep supports learning, concentration, and emotional balance. Conversely, a lack of sleep leads to irritability, mood disturbances, attention difficulties, and impulsive or hyperactive behaviours, often associated with excessive daytime sleepiness. The causes of sleep deprivation are numerous and closely linked to modern lifestyles. Excessive screen exposure reduced physical activity, an unbalanced diet, and irregular schedules profoundly disrupt the sleep-wake rhythm. Among adolescents, delayed sleep phase syndrome - a biological tendency to fall asleep and wake up later - further aggravates sleep deprivation, resulting in fatigue, decreased academic performance, and social or family difficulties. In addition, some specific disorders, insomnia, obstructive sleep apnea, narcolepsy, and other hypersomnolence, contribute to worsening daytime sleepiness. These disorders are often underdiagnosed despite their harmful effects on both physical and mental health. Children with neurodevelopmental disorders, such as ADHD or autism spectrum disorder, are par ticularly vulnerable, as their sleep difficulties exacerbate behavioural and cognitive problems. Sleep also plays a crucial role with respect to chrono-pharmacology and as co-morbid factor in many mental or physical diseases. Prevention and education play a crucial role in preserving healthy sleep. It is essential to inform children/ado lescents, parents, teachers, and healthcare professionals about age-appropriate sleep needs, to maintain naptime in nursery schools, to limit evening screen use, and to detect sleep disorders early. The Academy recommends including sleep monitoring in children's health records from birth, raising public awareness through national campaigns, and incorporating sleep education into school curricula. Finally, the 2025-2026 interministerial roadmap, established as part of the National Cause "Mental Health", aims improving prevention, professional training, and access to care. By doing so, it recognizes sleep as a major pillar of public health, alongside nutrition and physical activity.
Migraine is a debilitating neurological condition which treatment combines an acute therapy for all patients, a preventive therapy for patients with multiple monthly migraines, lifestyle and dietary measures promoting regular physiological rhythms, and management of any comorbidities, particularly depression. Traditional oral treatments remain widely used and recommended as first-line options, including nonsteroidal anti-inflammatory drugs and triptans for acute attacks, and classic beta-blockers, antiepileptics, or antidepressants for prophylaxis. These conventional preventive treatments have limited efficacy and common adverse effects, leading to their discontinuation. Fortunately, the last decade has seen a therapeutic revolution in migraine management. CGRP-targeting antibodies and gepants offer migraine sufferers highly effective, well-tolerated, and customizable options, addressing the limitations of traditional treatments. Despite these advances, many patients still must insist on being taken seriously. In France, only 15% of migraine sufferers receive satisfactory management and highly effective therapies directly targeting the CGRP pathway (antibodies and gepants) are still not reimbursed.
The cartilage is a specialized connective tissue of mesenchymal origin, which covers the extremities of the bones at the joint level. The cartilage has a fundamental biomechanical function, which ensures a perfect sliding of the joint surfaces, even under heavy load. These biomechanical properties are linked to the very particular hydrophilic properties of the proteoglycans in the extracellular matrix. The cartilage has a specific characteristic that it does not heal when damaged. The healing process leads to a fibrous or fibro-cartilaginous tissue without biomechanical properties, which can lead to an osteoarthritis evolution. Three different lesions can be observed for cartilage: lesions without loss of cartilage, pure monotissular cartilage lesions, osteochondral lesions. The treatment of a cartilage or an osteochondral lesion depends on many different criteria, as the characteristics of the lesion, of the whole joint and of the patient. Bone marrow stimulation techniques aim to favor the recruitment of cells as mesenchymal stem cells from subchondral bone, in order to have a fibrocartilage repair. They are not technically demanding. Pridie's drilling is now replaced by the micro fracturing technique as proposed. The refixation of an osteochondral fragment has to be done when it is possible. Autologous osteochondral transplan tation named mosaicplasty has the advantage of implanting a viable hyaline cartilage in the lesion with moderate morbidity at the donor site. Nevertheless, there is no true integration with the surrounding cartilage. Osteochon dral allograft transplantations may replace large defects in a single stage procedure but have disadvantages due to their availability, and long-term results of incorporation are questionable. Cell therapy by autologous chondro cyte implantation has evolved overtime since the first description by Brittberg. This two stages technique needs a specialized laboratory able to treat the cartilage biopsy in order to isolate the chondrocytes and to culture them in 2 or 3 dimensional conditions on a scaffold or matrix. This technique is one of the most promising for the future. And finally, a no biological way is the using of a metal prosthetic button shaped and sized according to the defect, but clinical experience still remains very limited.
The production and consumption of ultra-processed foods (UTFs) are steadily increasing in high-, middle-and low-income countries. The most common, yet widely criticised, definition is the Nova 4 classification, which defines them as foods to which five or more ingredients have been industrially added. A substantial body of concordant prospective or cross-sectional observational epidemiological data from diverse continents has been demonstrated to indicate a 10-30% increased risk of non-communicable diseases over the long term, depending on the type of food consumed, with a linear dose-response effect observed in the majority of cases. To date, only two short-term randomised clinical trials have been conducted. Although increased consumption of UTFs alone cannot be considered a definitive cause of the increase in the prevalence of non-communicable diseases, it is very likely that it contributes to this phenomenon, which justifies state nutritional policy measures to advise populations and individuals to limit their consumption. A number of mechanistic hypotheses have been advanced, almost exclusively in experimental models in rodents. It is imperative that fundamental and clinical research be continued and expanded, with particular emphasis on the implementation of randomized clinical trials of sufficient duration. The assertion that they would be unethical on the grounds that prospective epidemiology alone would be sufficient to prove a cause-and-effect relationship and that the matter would be completely settled is not accurate. In the absence of this, all randomised trials in nutrition would be rendered unnecessary. The agri-food industry, which must accept a significant degree of responsibility with regard to both product design and the promotion of the foods it sells, must take into account the worrying data that has been accumulated and work with researchers, and vice versa, without either side ignoring the progress that has been made in terms of public health by modern distribution channels, at a time when hunter-gatherers no longer constitute the majority of the world's population.
Migraine is a common and disabling neurological disorder underpinned by a complex pathophysiology involving multiple interactions between the peripheral and central nervous systems, vascular structures, and specific mo lecular pathways. Far from being a simple headache, it results from a multifaceted cascade of neurobiological events that remain only partially understood. This review aims to present recent advances in the understanding of migraine mechanisms, encompassing neurovascular neurotransmitters, hypothalamic circuits, and cortical phenomena. Discovery of the crucial role of calcitonin gene-related peptide (CGRP) in migraine headache has led to the development of highly effective targeted therapies. Understanding how a migraine attack unfolds is essential not only to improving its management but also to appreciating why migraine remains one of the major challenges in modern neurology.
With the constant identification of nutrient sources, new types of food are being proposed for human (and animal) diets. Nevertheless, in France as in the European Union, from the moment they are first placed on the market, foodstuffs (products) must comply with current regulations on health and safety, fair trading, consumer protection and the protection of food-producing animals. The regulatory classification of a food or "novel food" is therefore decisive for its authorization, production and marketing. Several examples, including edible insects, will illustrate the main foundations of food legislation and its requirements in terms of human health.
Predictive models based on artificial intelligence (AI) are transforming the search for new treatments for complex chronic conditions such as Sjogren's disease or Systemic Lupus Erythematosus. Computational models of these autoimmune diseases are built from patient molecular profiling data obtained through multiomics technologies integrated by AI. These analyses help to represent patient heterogeneity and to identify relevant therapeutic targets among the molecular pathways dysregulated in these diseases. AI is also used to identify and optimize drug candidates that interact with these therapeutic targets, and to design combined therapies. Cohorts of virtual patients can be created to predict in silico the efficacy of drug candidates. By stratifying patients into molecularly defined subgroups thus enabling optimized therapeutic options AI is fostering a computational precision medicine that could ultimately link detailed individual patient characteristics with the predicted properties of billions of drug candidates with the aim to propose increasingly personalized treatments.
This review provides an integrative analysis of the relationship between animal and plant protein sources and human health, combining several complementary methodological approaches. The analysis at different levels ranges from fundamental metabolic mechanisms related to amino acids, to the long-term epidemiological impacts of dietary protein profiles, including interventional nutritional studies. The relationships between animal and plant protein intake and protein metabolism, particularly in the postprandial anabolic phase, highlight differences between proteins taken in isolation, but the repercussions on medium-term metabolism, muscle function, or the risk of sarcopenia are not well documented. On the other hand, data from randomised controlled trials combined with the results of large observational cohorts establish strong links between plant protein consumption and reduced cardiometabolic risk. Substitution modelling approaches point in particular to the long-term health benefits of replacing certain animal protein sources such as red meat and charcuterie with certain plant protein sources such as legumes. Analysis of the `protein package' sheds light on the mechanisms underlying the observed effects and associations, demonstrating the importance of plant protein sources that provide beneficial nutrients and bioactive compounds. We conclude that the issue of protein sources should not be reduced to a binary consideration of animal and plant sources, but should be addressed in detail at the level of protein sources and dietary patterns, taking an integrative approach. From a global perspective, the future also lies in integrating the other dimensions of sustainability.
Spontaneous intracranial hypotension (SIH) is a rare but probably underdiagnosed cause of secondary headache. It results from cerebrospinal fluid (CSF) hypovolemia, usually due to a dural tear or a CSF-venous fistula. The typical clinical presentation combines orthostatic headache with neck pain, nausea, vomiting, and often cochleovestibular symptoms. Numerous atypical presentations have been reported in recent years, reflecting the heterogeneity of the syndrome. SIH can occasionally lead to severe manifestations, sometimes related to complications such as subdural hematomas or cerebral venous thrombosis. Brain magnetic resonance imaging (MRI) with gadolinium contrast reveals characteristic findings, the most specific of which being diffuse pachymeningeal enhancement. In some cases, the abnormalities are less pronounced, and the Bern score can assist in diagnosis. Spinal MRI with T2 Fat Saturation (T2 FAT SAT) sequences is a non-invasive imaging technique of choice, identifying direct or indirect signs of dural breach. The lumbar epidural blood patch remains the first-line treatment, performed with an appropriate blood volume and followed by a prolonged bed rest. In cases of therapeutic failure, further etiological investigation using invasive imaging techniques should be undertaken to enable targeted management, including surgical repair or endovascular intervention when indicated.
Since the PASS/LAS health studies entry reform implemented in 2020, places have remained vacant in the second year of pharmacy studies. A lack of attractiveness has been observed due to the lack of awareness of the multiple professions in pharmacy, but a major cause appears to be the loss of visibility and lisibility of the access to the pharmacy course, which had already been noted during the implementation of a common first year in health studies (PACES) in 2010. The PASS/LAS scheme seemed too complex and ultimately ineffective in achieving the set objective of social diversification and training of students entering in health studies. The bi-academic working group aimed to precisely analyze the causes of the disaffection with pharmacy studies, through both a quantitative and qualitative analysis of entry into the pharmacy course. Nine recommendations for an improvement of the PASS/LAS system are proposed in this report, which should feed into the ongoing national reflection on a new reform of entry into health studies that is expected for the 2026-2027 academic year.
Food processing dates back thousands of years, with its origins in the Neolithic period. Evolving through various transitions, it has led to the evolution of the human species and offers significant advantages in terms of preservation, food safety and accessibility. Today, however, it is criticized for its "ultra-processing" aspects, and faces new challenges: producing healthy, high-quality food (clean-label, nutritional quality, etc.), ensuring the transition to a circular economy, reducing environmental impacts and ensuring food security by diversifying protein sources. These issues present real challenges and problems that need to be overcome. Examples will help to illustrate these points.
