La prise en charge thérapeutique du cancer bronchopulmonaire localement avancé, bien que décrite dans les référentiels, reste complexe. L'étude ESCAP-2020-CPHG est une cohorte française, nationale, multicentrique, prospective, de vraie vie sur le cancer bronchopulmonaire primitif [1]. 7219 patients (pts) ont été inclus en 2020 dont 3794 CBNPCNépi sans addiction oncogénique connue. Parmi eux, 645 pts (17,0 %) présentaient un stade localement avancé (307 IIIA, 338 IIIB + C). Nous rapportons ici la première ligne de traitement de ces pts ainsi que leur mortalité à 2 ans. Cette dernière est comparée à celle de la cohorte ESCAP-2011 réalisée selon la même méthodologie. Un traitement chirurgical à visée curative était plus souvent réalisé chez les IIIA que chez les IIIB + C (47,6 % vs 12,4 %). La chirurgie était principalement une lobectomie (IIIA : 69,2 %, IIIB + C : 71,4 %) mais également des pneumonectomies (IIIA : 10,3 %, IIIB + C : 14,3 %). La CT était associée dans 56,8 % chez les IIIA, 59,5 % chez les IIIB + C. Elle est adjuvante dans 86,7 % des cas chez les IIIA, 84,0 % des cas chez les IIIB + C. Elle associait un sel de platine le plus souvent à la vinorelbine (IIIA : 54,2 %, IIIB + C : 36,0 %) mais également au pemetrexed ou au paclitaxel. Le carboplatine était plus souvent utilisé chez les IIIB + C (76,0 % vs 50,6 %). Un traitement par radiochimiothérapie (RT-CT) était plus souvent réalisé chez les IIIB + C (30,5 % vs 19,5 %). Il était réalisé essentiellement de façon concomitante (79,6 % chez les IIIB + C et 73,3 % chez les IIIA). La CT associait un sel de platine, principalement du carboplatine (70,9 % chez les IIIB + C, 93,3 % chez les IIIA,) au paclitaxel (IIIB + C : 41,7 %, IIIA : 60,0 %), moins souvent au pemetrexed ou à la vinorelbine. Une IO (durvalumab) était encore peu associée (IIIB + C : 24,3 %, IIIA : 17,8 %). Un traitement systémique (TS) seul était plus souvent réalisé chez les IIIB + C (37,3 % vs 20,5 %). Il comportait une CT seule (associant principalement du carboplatine au paclitaxel ou au pemetrexed), une association CT – IO (immunothérapie) (essentiellement carboplatine – pemetrexed – pembrolizumab), plus rarement une IO seule (pembrolizumab). Des soins palliatifs exclusifs étaient réalisés chez 4,6 % des IIIA et 3,6 % des IIIB + C. La survie à 2 ans des CBNPCNépi localement avancés a augmenté de 39,3 % en 2010 à 55 % en 2020 (65,0 % pour les IIIA, 46,0 % pour les IIIB + IIIC). La survie à 2 ans des CBNPCNépi localement avancés a significativement augmenté au cours des 10 dernières années grâce à une stadification plus précise permettant un traitement plus personnalisé correspondant aux référentiels. L'amélioration des techniques d'irradiation, l'évolution des stratégies thérapeutiques (CT adjuvante, RT-CT concomitante) et les nouvelles molécules anticancéreuses (IO) contribuent également à cette augmentation.

Since 2015, immune checkpoint inhibitors (ICI) have really improved treatment for advanced lung cancer. One such drug is pembrolizumab that has been initially developped at 2 mg/kg and then moved to a flat dose of 200 mg each 3 weeks (Q3W), which correspond approximatively in European patients to 3 mg/kg. There are several arguments in favor of equivalent ICI activity with a spacing of the intervals between 2 infusions (i.e. pembrolizumab 200 mg each 6 weeks (Q6W)), despite a reduced dose/intensity: 1) it has not been demonstrated that permanent blocking of immune control points is necessary to obtain a prolonged response, 2) the 27 days half-live of pembrolizumab allows consideration of intervals greater than 3 weeks between infusions, assuming that there is no minimum effective serum dose described for these antibodies, 3) larger infusion interval might improve the patient's quality of life (QoL) by reducing the hospitalization time (when pemetrexed is discontinued for toxicity and pembrolizumab continued as a single agent), 4) a substantial economic gain is possible, with a major budget impact at the nationwide. This multicentric randomized study assessing a new mode of ICI administration based on increased interval time between 2 infusions as maintenance treatment in patients with non-squamous non-small cell lung cancer (pembrolizumab 200 mg Q6W, PULSE arm) compared with the Standard of Care (pembrolizumab 200 mg Q3W, SoC arm) on overall survival (OS). Randomization (1:1) is stratified on gender, maintenance treatment and PD-L1 status. Median OS is assumed to be 22months in patients treated by SoC without progression during induction. The efficacy in the PULSE arm is expected to be similar to the one in the SoC arm with a median OS < 17.1months considered unacceptable (non-inferiority limit). Inclusion of 1108 patients is required to observe an HR of at most 1.25 with an interim analysis at mi-accrual (664 events, one-sided α=2.5%, power=80%). With 5% of non-usable data, 1166 patients should be randomized. The inclusions started since March 2023. This study also assess the toxicity, the pharmacokinetic parameters of pembrolizumab, saturation of the target on circulating lymphocytes, the QoL and economic impact. EudraCT 2021-006795-16; NCT05692999. N. Cozic - Gustave Roussy. Gustave Roussy, Villejuif, France. PULSE trial is expected in - France: a national grant is obtained from the Hospital Clinical Research Program - Spain and France: a binational grant is obtained from Cancer Research Innovation in Science (CRIS) - Belgium: a grant from the KCE Trials Prioritisation Group is pending.

Systematic molecular profiling has emerged this last decade as a cornerstone of management of advanced nonsquamous (NSq) Non-Small Cell Lung Cancer (NSCLC). However, access to these analyses may be heterogeneous especially between academic and non-academic centers. We sought to study the proportion of patients who benefit from a complete molecular profile in the real-world setting. Between 01/01 and 12/31/2020, all patients diagnosed with a lung cancer in one of the 82 participating centers from the French Pulmonologist College of General Hospital (CPHG), were included in a national prospective cohort study (KBP-CPHG 2020). The results of molecular testing were systematically collected at diagnosis. A sister study was conducted in 2010. For this analysis, we considered all patients with an advanced stage non-squamous NSCLC. KBP-2020-CPHG cohort included 8,999 patients with a diagnosis of lung cancer. From the general population, 3,560 patients had an advanced stage NSq NSCLC. Overall, 3,122 patients (87.7%) had at least one molecular analysis in 2020, as compared to 1,434 (53.0%) in 2010. Regarding alterations for which an approved drug is available in France, testing of EGFR mutation, ALK and ROS1 rearrangement and BRAF mutation was performed in 2,634 (74.3%), 2,772 (78%), 2,390 (67.3%) and 1,913 (53.9%) patients respectively. Results of other alterations are reported in Table. Of note, 11.5% of patients were analyzed for RET and 9% for NTRK.Table: 1699PAlteration testingTestedPositiveGeneN (3,560)%N%EGFR2,63474.3%39214.9%ALK2,77278%742.7%ROS12,39067.3%391.6%BRAF1,91353.9%93 (V600E, 43)4.9% 2.2%KRAS2,04057.6%773 (G12C, 404)37.9% (19.8%)HER21,56244.1%281.8%cMET ex141,18333.4%554.6%RET/NTRAK1/NRG1407/312/23911.5%/8.8%/4.6%10/1/02.5%/0.3%/0% Open table in a new tab Molecular testing has been remarkably implemented in the diagnostic work-up of advanced NSq NSCLC patients in routine practice in non-academic hospitals in France. Alterations detectable by immunohistochemistry or NGS are those which are most easily tested. Efforts should be made on detection of rare fusion transcripts.

Afin d’optimiser l’efficacité du traitement par pression positive continue (PPC) du syndrome d’apnées hypopnées obstructives (SAHOS), nous avons évalué le caractère prédictif du niveau de variabilité de la pression (Pvar) et de la pression efficace (Peff) sur l’efficacité du mode constant ou autopiloté de la PPC. Dans le cadre d’une étude nationale, prospective, multicentrique, (PREDIVARIUS) nous avons évalué l’efficacité à 3 mois de la PPC constante et de l’auto-PPC, dans 2 groupes de patients SAHOS randomisés initialement en fonction du mode de PPC utilisé. Cette évaluation a été réalisée à l’aide d’un critère principal de jugement composite associant l’index d’apnées hypopnées (IAH) obtenu par polygraphie sous PPC et le score d’Epworth à 3 mois. Ces résultats ont été analysés en fonction de valeurs de Pvar et de Peff obtenus initialement après 7 jours de traitement par auto-PPC à partir des rapports de PPC. Au total, 616 patients SAHOS d’âge moyen 56,8 ans ± 11,2 ont été répartis dans 2 groupes, de sévérité polygraphique identique et la PPC a été utilisée avec une même observance dans les 2 groupes (constante : 5,78h ± 1,9 vs auto-PPc : 5,85h ± 1,9). Après 3 mois de traitement, il n’existait pas de différence entre les 2 groupes en termes d’IAH et d’Epworth (constante : respectivement 6,11/h ± 7,94 et 6,02 ± 4,37 ; auto-PPC : respectivement 5,71/h ± 6,75 et 6,05 ± 4,5). L’amélioration des chiffres tensionnels était identique dans les 2 groupes, malgré une amélioration significativement plus marquée dans le groupe P constante de la saturation en oxygène minimale (p = 0,005) et moyenne (p = 0,009) au cours du sommeil. Bien que le degré de variabilité n’ait pas influencé l’efficacité d’un mode ventilatoire en particulier, une plus grande variabilité initiale du niveau de pression s’est accompagnée d’un d’IAH résiduel significativement plus élevé à 3 mois quel que soit le mode ventilatoire (p = 0,008). PPC constante et auto-PPC présentent une même efficacité sur la régression des troubles respiratoires nocturnes qui devra être précisée après une analyse complète de l’ensemble des résultats.

Afin de favoriser le choix entre PPC constante et AutoPPC, nous avons évalué le caractère prédictif de critères cliniques et polygraphiques, ainsi que des données de rapports de PPC au cours des premiers jours de traitement. Nous avons analysé les résultats à l’inclusion et après 7 jours de traitement par autoPPC de patients SAHOS (IAH > 30/h), dans le cadre d’une étude nationale, prospective, multicentrique, (PREDIVARIUS). Sous AutoPPC, la variabilité de la Pression (varPPC) était évaluée à partir de la différence P95 – P médiane (AutoSet S9 – Resmed) ou P90 – P moyenne (PR1 – Respironics), et la pression efficace (Peff) était estimée à partir de la P95 ou la P90. Au total, 798 patients d’âge moyen 56,5 ± 11,7 ans, obèses (IMC moyen : 33,1 ± 6,9 kg/m2) ont été inclus dans 22 centres différents. Il s’agissait de patients sévères (IAH moyen initial : 51,2 ± 20,9/h, temps avec SaO2 inférieure à 90 % (SaO2 90) : 17,4 ± 19,5 %). À j7, l’observance était de 5,8 ± 1,9 h, et la Peff moyenne était de 11,2 ± 2,8 cmH2O avec une variabilité de 2,6 ± 1 cmH2O. Nous avons retrouvé une corrélation significative entre Peff et varPPC (rS = 0,59 ; p < 0,0001). La variabilité ne présentait que de très faibles corrélations avec certaines données cliniques et polygraphiques initiales étudiées. En revanche, Peff était corrélée significativement avec l’IAH initial (rS = 0,26 ; p < 0,0001), ainsi qu’avec la SaO290 (rS = 0,28 ; p < 0,0001), et la SaO2 minimale (rS = −0,30 ; p < 0,0001) initiales. Il s’agit des premiers résultats permettant d’évoquer les facteurs conditionnant le comportement de la pression au cours du traitement par PPC pouvant orienter le choix thérapeutique dans la prise en charge du SAHOS.

Recently, the generalized fractional reaction–diffusion equation subject to an external linear force field has been proposed to describe the transport processes in disordered systems. The solution of this generalized model can be formally expressed in closed form through the Fox function. For the sack of completeness, we dedicate this work to construct a neatly derivation of the generalized fractional reaction–diffusion equation. Remarkably, such derivation could in general offer some novel and inspiring inspection to the phenomena of anomalous transport. For instance, there is a strong evidence that the fractional calculus offers some physical insight into the origin of fractional dynamics for a systems which exhibit multiple trapping.

Despite a variable prevalence in the literature, OSAS is characterized by a higher frequency in men. This study involved a review of published data describing the impact of gender on features of OSAS. In women, OSAS seems to be associated with certain anatomical factors such as more significant obesity, a thinner oropharyngeal junction, a shorter uvula and reduced upper airway (UA) collapsibility, in comparison with men. Sleep related breathing disorders observed during pregnancy are more likely UA resistance syndrome than true OSAS, and are associated with severe fetal and maternal complications that could be improved by the use of nasal CPAP. Though OSAS symptoms are underestimated by women, the Epworth score as well as snoring are not influenced by gender. Gender does not seem to be a risk factor for increased mortality. Compliance with nasal CPAP is identical in both sexes, but oral appliance seem to be more effective in women. Further studies are needed to produce the required complementary data to confirm specific sex-related features in the diagnosis and treatment of OSAS.

Introduction. - The French Society of Anaesthesiology (SFAR) recommends the use of pre printed self-stick syringe labels. However, French anaesthesia-syringe labelling customs is yet unknown.Study design. - Therefore, a national phone survey was performed in order to investigate this issue.Results. - Forty-five percent of the answering centers (324/722) used colour self-stick labels, with a larger proportion in public centers and a large regional variability. The kind of colour code differed from an area to another. Among centers using colour labels, the international recommended colour code was used in only 36% of them. The majority of health care providers declare to be favourable to the use of the colour self-stick labels and the standardization of the colour code as well. A relationship between the University hospital and the surrounded area has been observed for the use of the colour labels and the choice of the colour code.Conclusion. - Colour labels are used in France by nearly half of the centers, but international colour code is less spread. (C) 2008 Elsevier Masson SAS. Tons droits reserves.

Despite a variable prevalence in the literature, HAS is characterized by a higher frequency in men. This study involved a review of published data describing the impact of gender on features of OSAS.In women, HAS seems to be associated with certain anatomical factors such as more significant obesity, a thinner oropharyngeal junction, a shorter uvula and reduced upper airway (UA) collapsibility, in comparison with men. Sleep related breathing disorders observed during pregnancy are more likely UA resistance syndrome than true OSAS, and are associated with severe fetal and maternal complications that could be improved by the use of nasal CPAP. Though HAS symptoms are underestimated by women, the Epworth score as well as snoring are not influenced by gender. Gender does not seem to be a risk factor for increased mortality. Compliance with nasal CPAP is identical in both sexes, but oral appliance seem to be more effective in women.Further studies are needed to produce the required complementary data to confirm specific sex-related features in the diagnosis and treatment of OSAS.

Although general practitioners (GPs) are frequently the first healthcare professionals whom asthma patients refer to for their symptoms, few studies have explored the extent of adherence to guidelines for asthma management based on data provided directly by GPs.Aims of the present study were to assess drug prescriptions for asthma by GPs and to evaluate prescriptive adherence to GINA guidelines (GL) and its relationship with disease control in real life.995 asthmatic patients (45% males, mean age 43.3 ± 17.7 yrs) were enrolled by 107 Italian GPs distributed throughout the country. Data on diagnosis, disease severity, prescribed anti-asthmatic drugs and control were collected through questionnaires filled out by GPs taking into consideration the 2009 GINA Guidelines. Data on drug use and chronic sinusitis, nasal polyposis, chronic bronchitis, emphysema were reported by patients through a self-administered questionnaire.The large majority of patients were classified by GPs as having intermittent (48.4%) or mild persistent asthma (25.3%); 61% had co-morbid allergic rhinitis (AR). The prevalent therapeutic regimen used by patients was a combination of inhaled corticosteroids (ICS) plus long-acting β2-agonists (LABA) (54.1%), even in the intermittent/mild persistent group. ICS as mono-therapy or in combination with other drugs but LABA, was the second most frequently adopted treatment (14.4%). In general, the GPs adherence to GL treatment indications was 28.8%, with a significant association with a good asthma control (OR 1.85, 95% CI 1.18–2.92). On the other hand, comorbidity (OR 0.52, 95% CI 0.32–0.84), moderate (0.44, 0.28–0.69) and severe (0.06, 0.02–0.20) persistent asthma showed significant negative effects on asthma control.Our results show that over-treatment of intermittent/mild persistent asthma is frequent in the GPs setting while therapeutic regimens are more appropriately applied for moderate/severe asthma. In general, we found low adherence to GINA GL treatment recommendations even if its relevance in asthma control was confirmed.

INTRODUCTION:Pneumoperitoneum is known to be a rare complication of invasive mechanical ventilation. However it has not previously been described as a consequence of non-invasive ventilation.CASE REPORT:The authors report a case of pneumoperitoneum associated with pneumomediastinum occurring in a 64-year-old patient treated for 3 years with bilevel ventilation via a nasal mask (expiratory pressure = 9 cm H2O, inspiratory pressure = 15 cm H2O) for obesity hypoventilation syndrome. Respiratory and gastroenterological investigations did not demonstrate a cause for this complication which resolved spontaneously following the cessation of ventilation. Nine months later, clinical deterioration and a worsening of blood gas parameters led to a recommencement of non-invasive mechanical ventilation at the same levels as previously. Over two years of follow up there have been no clinical or radiological signs of a recurrence of pneumomediastinum or pneumoperitoneum.CONCLUSION:In the absence of any other explanation, barotrauma due to nasal ventilation appears to be the most likely explanation for this complication.

Introduction Pneumoperitoneum is known to be a rare complication of invasive mechanical ventilation. However it has not previously been described as a consequence of non-invasive ventilation.Case report The authors report a case of pneumoperitoneum associated with pneumomediastinum occurring in a 64-year-old patient treated for 3 years with bilevel ventilation via a nasal mask (expiratory pressure = 9 cm H2O, inspiratory pressure = 15 cm H2O) for obesity hypoventilation syndrome. Respiratory and gastroenterological investigations did not demonstrate a cause for this complication which resolved spontaneously following the cessation of ventilation. Nine months later, clinical deterioration and a worsening of blood gas parameters led to a recommencement of non-invasive mechanical ventilation at the same levels as previously. Over two years of follow up there have been no clinical or radiological signs of a recurrence of pneumomediastinum or pneumoperitoneum.Conclusion In the absence of any other explanation, barotrauma due to nasal ventilation appears to be the most likely explanation for this complication.

Rev Mal Respir 2004 ; 21 : 865-72 870 Evaluation de la motivation vis-a-vis de l’amaigrissement dans le traitement du syndrome d’apnees du sommeil V. Levrat1, V. Ahari2, P. Ingrand3, J.P. Neau4, J. Paquereau4, B. Pinon4, J.C. Meurice1,4 1 Service de Pneumologie, CHU de Poitiers, Poitiers, France 2 Laboratoire Insudie, Poitiers, France 3 Departement de Biostatistiques Medicales, Faculte de Medecine de Poitiers, Poitiers, France 4 Institut Universitaire Veille – Sommeil de Poitiers, Poitiers, France.