Detection of focal to bilateral tonic-clonic seizures using a connected shirt.

OBJECTIVE: This study was undertaken to develop and evaluate a machine learning-based algorithm for the detection of focal to bilateral tonic-clonic seizures (FBTCS) using a novel multimodal connected shirt. METHODS: We prospectively recruited patients with epilepsy admitted to our epilepsy monitoring unit and asked them to wear the connected shirt while under simultaneous video-electroencephalographic monitoring. Electrocardiographic (ECG) and accelerometric (ACC) signals recorded with the connected shirt were used for the development of the seizure detection algorithm. First, we used a sliding window to extract linear and nonlinear features from both ECG and ACC signals. Then, we trained an extreme gradient boosting algorithm (XGBoost) to detect FBTCS according to seizure onset and offset annotated by three board-certified epileptologists. Finally, we applied a postprocessing step to regularize the classification output. A patientwise nested cross-validation was implemented to evaluate the performances in terms of sensitivity, false alarm rate (FAR), time in false warning (TiW), detection latency, and receiver operating characteristic area under the curve (ROC-AUC). RESULTS: We recorded 66 FBTCS from 42 patients who wore the connected shirt for a total of 8067 continuous hours. The XGBoost algorithm reached a sensitivity of 84.8% (56/66 seizures), with a median FAR of .55/24 h and a median TiW of 10 s/alarm. ROC-AUC was .90 (95% confidence interval = .88-.91). Median detection latency from the time of progression to the bilateral tonic-clonic phase was 25.5 s. SIGNIFICANCE: The novel connected shirt allowed accurate detection of FBTCS with a low false alarm rate in a hospital setting. Prospective studies in a residential setting with a real-time and online seizure detection algorithm are required to validate the performance and usability of this device.

Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications - A consensus document of the International Union of Phlebology-2023.

BACKGROUND: Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events. OBJECTIVES: To categorise contraindications to sclerotherapy based on the available scientific evidence. METHODS: An international, multi-disciplinary panel of phlebologists reviewed the available scientific evidence and developed consensus where evidence was lacking or limited. RESULTS: Absolute Contraindications to sclerotherapy where the risk of harm would outweigh any benefits include known hypersensitivity to sclerosing agents; acute venous thromboembolism (VTE); severe neurological or cardiac adverse events complicating a previous sclerotherapy treatment; severe acute systemic illness or infection; and critical limb ischaemia. Relative Contraindications to sclerotherapy where the potential benefits of the proposed treatment would outweigh the risk of harm or the risks may be mitigated by other measures include pregnancy, postpartum and breastfeeding; hypercoagulable states with risk of VTE; risk of neurological adverse events; risk of cardiac adverse events and poorly controlled chronic systemic illness. Conditions and circumstances where Warnings and Precautions should be considered before proceeding with sclerotherapy include risk of cutaneous necrosis or cosmetic complications such as pigmentation and telangiectatic matting; intake of medications such as the oral contraceptive and other exogenous oestrogens, disulfiram and minocycline; and psychosocial factors and psychiatric comorbidities that may increase the risk of adverse events or compromise optimal treatment outcomes. CONCLUSIONS: Sclerotherapy can achieve safe clinical outcomes provided that (1) patient-related risk factors and in particular all material risks are (1a) adequately identified and the risk benefit ratio is clearly and openly discussed with treatment candidates within a reasonable timeframe prior to the actual procedure; (1b) when an individual is not a suitable candidate for the proposed intervention, conservative treatment options including the option of 'no intervention as a treatment option' are discussed; (1c) complex cases are referred for treatment in controlled and standardised settings and by practitioners with more expertise in the field; (1d) only suitable individuals with no absolute contraindications or those with relative contraindications where the benefits outweigh the risks are offered intervention; (1e) if proceeding with intervention, appropriate prophylactic measures and other risk-mitigating strategies are adopted and appropriate follow-up is organised; and (2) procedure-related risk factors are minimised by ensuring the treating physicians (2a) have adequate training in general phlebology with additional training in duplex ultrasound, procedural phlebology and in particular sclerotherapy; (2b) maintain their knowledge and competency over time and (2c) review and optimise their treatment strategies and techniques on a regular basis to keep up with the ongoing progress in medical technology and contemporary scientific evidence.

Clinical Perspectives and Management of Edema in Chronic Venous Disease-What about Ruscus?

Background: Edema is highly prevalent in patients with cardiovascular disease and is associated with various underlying pathologic conditions, making it challenging for physicians to diagnose and manage. Methods: We report on presentations from a virtual symposium at the Annual Meeting of the European Venous Forum (25 June 2021), which examined edema classification within clinical practice, provided guidance on making differential diagnoses and reviewed evidence for the use of the treatment combination of Ruscus extract, hesperidin methyl chalcone and vitamin C. Results: The understanding of the pathophysiologic mechanisms underlying fluid build-up in chronic venous disease (CVD) is limited. Despite amendments to the classic Starling Principle, discrepancies exist between the theories proposed and real-world evidence. Given the varied disease presentations seen in edema patients, thorough clinical examinations are recommended in order to make a differential diagnosis. The recent CEAP classification update states that edema should be considered a sign of CVD. The combination of Ruscus extract, hesperidin methyl chalcone and vitamin C improves venous tone and lymph contractility and reduces macromolecule permeability and inflammation. Conclusions: Data from randomized controlled trials support guideline recommendations for the use of Ruscus extract, hesperidin methyl chalcone and vitamin C to relieve major CVD-related symptoms and edema.

Monitoring hunted species of cultural significance: Estimates of trends, population sizes and harvesting rates of flying-fox (Pteropus sp.) in New Caledonia.

Assessing population trends and their underlying factors is critical to propose efficient conservation actions. This assessment can be particularly challenging when dealing with highly mobile, shy and nocturnal animals such as flying-foxes. Here we investigated the dynamics of hunted populations of Pteropus ornatus and P. tonganus in the Northern Province of New Caledonia. First, an ethno-ecological survey involving 219 local experts identified 494 flying-fox roosts. Current status was assessed for 379 of them, among which 125 were no longer occupied, representing a loss of 33% over ca. 40 years. Second, species-specific counts conducted at 35 roosts, and a sample of animals killed by hunters, revealed that the endemic species, P. ornatus, was dominant (68.5%). Between 2010 and 2016, 30 roosts were counted annually during the pre-parturition period. Roosts size averaged 1,425 ± 2,151 individuals (N = 180 counts) and showed high among-year variations (roost-specific CV = 37-162%). If we recorded significant inter-annual variation, we did not detect a significant decline over the 7-yr period, although one roost went possibly extinct. Population size of the two species combined was estimated at 338,000-859,000 individuals distributed over ca. 400 roosts in the Northern Province. Flying-foxes are popular game species and constitute traditional food for all communities of New Caledonia. Annual bags derived from a food survey allowed us to estimate harvesting rates at 5-14%. Such a level of harvesting for species with a 'slow' demography, the occurrence of poaching and illegal trade, suggest the current species use might not be sustainable and further investigations are critically needed.

An integrative appraisal of the hormonal and metabolic changes induced by acute stress using king penguins as a model.

A large number of studies have focused on the reactivity of the hypothalamic-pituitaryadrenal (HPA) axis and the consequences of glucocorticoids (GC) in mediating life-history trade-offs. Although short-term increases in GCs are viewed as adaptive, mobilizing energy substrates allowing animals to deal with impending threats (e.g. stimulating hepatic gluconeogenesis, stimulating lipolysis, mobilizing amino acids), few studies have actually measured the exact time-course of substrate mobilisation in response to acute stress in natural conditions. We evaluated the hormonal and metabolic components of the stress response to acute stress in 32 free-living king penguins (Aptenodytes patagonicus). We monitored changes in blood GCs (corticosterone, CORT), glucose, lactate, ketone bodies (ß-hydroxybutyrate), non-esterified fatty acids, and uric acid in response to a standardized capture-restraint protocol lasting for up to 90min. Furthermore, we tested whether the vigilance status of the animal (alert or asleep) affected its perception of the capture, thereby modulating the hormonal and metabolic stress responses. The time course of energy mobilisation followed the characteristic pattern expected from laboratory and theoretical models, with a rapid depletion of those energy stores linked to rapid adrenergic responses (i.e. glucose and ketone bodies), followed by a mobilisation of energy stores associated with the sustained longer-term GC response (i.e. fats and protein stores). HPA reactivity was generally slower than reported in other birds, and there was high inter-individual variability. Sleeping birds had higher GC and glucose responses to acute stress, suggesting a more rapid mobilization of energy stores. Our results highlight the importance of considering HPA and metabolic responses to acute stress against species-specific life history and ecological relevant backgrounds.

Sclerotherapy is a safe method of treatment of chronic venous disorders in older patients: A prospective and comparative study of consecutive patients.

Objectives An aging population requires evaluation of methods of treatment for older patients. Our objective was to evaluate the indications, practical modalities, safety and tolerability of sclerotherapy in patients 75 years of age and older (group 1) and compare with a control group of patients 18 to74 years of age (group 2). Method This observational, multicentre, prospective and comparative study was conducted by the French Society of Phlebology. Each centre collected in 10 to 20 patients ≥75 years of age and an equal number of patients <75 years of age treated by sclerotherapy, the treatment indication, the patient's personal history, the CEAP clinical class, the type of the veins being treated, the characteristics of sclerotherapy and the complications (immediately after treatment and at one-month follow-up). Results Population: In total, 418 patients were enrolled in 15 centres: 176 patients in group 1 (mean: 79.4 years) and 242 patients in group 2 (mean: 52.7 years).CEAP clinical classes C4, C5 and C6, history of deep vein thrombosis (12.5%) and superficial vein thrombosis (11.9%), long-term anticoagulant therapy (9.1%) and antiplatelet therapy (16.5%) were more frequent in older patients.All types of veins were treated from saphenous veins to telangiectasias. Sclerotherapy features: There was no difference in concentration of the sclerosing agents. When foam sclerotherapy was used (84% of patients), the injected volume was lower in group 1. COMPLICATIONS: One vasovagal syncope occurred in group 1. One asymptomatic distal deep vein thrombosis, confined to the Medial Gastrocnemius Veins, was reported in both groups at one-month follow-up. Conclusions This study shows the feasibility and safety of sclerotherapy in older patients, with no specific complications nor need for special precautions.

Complications associated with 27 031 ultrasound-guided axillary brachial plexus blocks: a web-based survey of 36 French centres.

BACKGROUND: Ultrasound guidance improves the efficacy of peripheral nerve blocks, reducing performance time and local anaesthetic doses. It should also reduce the risk of systemic toxicity of local anaesthetic and nerve injuries. OBJECTIVE: The primary objective of this prospective study was to estimate the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks in a multicentre observational cohort. DESIGN: Prospective multicentre observational study. SETTING: Thirty-six French centres participated in the study between 2009 and 2012. PATIENTS: A total of 27 031 axillary brachial plexus blocks were recorded. INTERVENTIONS: The study objective, the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks (intravascular injection of local anaesthetic and neurological deficit at hospital discharge), was based on data collected by anaesthesiologists through a web-based case report form. MAIN OUTCOME MEASURE: Incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks. RESULTS: Of 27 031 blocks performed, the incidence of systemic toxicity of local anaesthetic was very low at 1.5 per 10 000, and the overall incidence of postoperative neurological symptoms was 0.37 per 10 000. CONCLUSION: We have reported a large series of ultrasound-guided axillary brachial plexus blocks in a multicentre study. Our results confirm the low incidence of local anaesthetic systemic toxicity and postoperative neurological complications as previously described.

Endovenous chemical (and physical) treatments for varices: what's new?

The constant evolution of endo-venous ablative techniques for varicose veins arises from the need for: better patient's comfort, reduced incidence of side effects, better results at short-, mid- and long-term follow-up, as well as reduction of operating time and technical simplicity. All these goals have been aimed at but so far no new technology has been able to achieve them all or to demonstrate it, furthermore the increase of price must be compensated by a considerable improvement of results and a serious reduction of side effects to be incrementally cost effective. We present in this article several recent evolutions of sclerotherapy (chemical ablation). New technologies include: proprietary ready-made foam (Varithena®) foam sclerotherapy with catheter and tumescence, foam + Holmium laser (LAFOS®), liquid sclerosant with rotating wire (clarivein®), liquid sclerosant + endo-venous clip (V-Block®) and endovenous cyano-acrylate glue (Venaseal™).

Complications of sclerotherapy: an update.

OBJECTIVES: To describe, determine the incidence of, and explain the adverse reactions associated with the use of sclerotherapy and sclerosing agents. MATERIAL AND METHODS: Review of current literature and personal research, with special attention to the French registry of 12,173 sclerotherapy sessions. RESULTS: The nature and incidence of side effects of sclerosing agents vary according to the injection form: liquid or foam. They must be differentiated from complications of the method, which are less specific and often related to an inappropriate technique. Severe adverse events are rare, especially in relation to the billions of injections administered. CONCLUSION: Complications and side effects of sclerotherapy are uncommon; the method has demonstrated its safety, with 0.22% of complications per session with liquid sclerosant and 0.58% with foamed sclerosant, but several points remain unclear, and more research is needed. Patient's informed consent can be better obtained thanks to the current knowledge herein summarized.

The French polidocanol study on long-term side effects: a survey covering 3,357 patient years.

BACKGROUND: AIMS Short- and mid-term side effects of sclerotherapy, in particular with polidocanol (lauromacrogol 400), have been previously described in our registry of 12,173 sessions. The objective of this follow-up registry was to evaluate the long-term incidence of adverse events with polidocanol. METHODS: The physicians involved in the initial French registry were contacted and asked to partake in the follow-up survey. Initially included patients were controlled at the latest possible date to determine whether a complication had occurred after the end of the initial survey. RESULTS: Data on 1,605 patients included in the French registry were reviewed with a maximum follow-up of 60 months, covering 3,357 patient years. Five (0.4%) adverse events were observed in patients treated with liquid polidocanol and 46 (1.1%) in patients treated with polidocanol foam. The most frequent side effects were visual disturbances (n=14), and the most severe were muscular vein thrombosis (n=8). The onset of side effects was mostly observed directly after sclerotherapy or in the 6 months after (84% in the first year). One deep vein thrombosis recurrence occurred in a patient with heterozygote Factor V Leiden after stopping anticoagulant treatment (foam sclerotherapy). CONCLUSIONS: Foam sclerotherapy is a recognized reference method in the treatment of varicose veins of all types. This study demonstrates that polidocanol is a safe sclerosing agent in the short and long term.

Health-Identity: mobile services for consumers of medicines.

New technologies for drug identification, traceability and mobile platforms make it possible to personalise the services provided to consumers of medicine. This paper presents the Health-Identity platform, a mobile application which gives consumers the assurance that the drug they have in their hands is a genuine product and can be consumed without risk according to their stored patient profile (allergies, health state, current medication, etc.).