Dermatological manifestations in Costello syndrome: A prospective multicentric study of 31 HRAS-positive variant patients.

BACKGROUND: Data on dermatological manifestations of Costello syndrome (CS) remain heterogeneous and lack in validated description. OBJECTIVES: To describe the dermatological manifestations of CS; compare them with the literature findings; assess those discriminating CS from other RASopathies, including cardiofaciocutaneous syndrome (CFCS) and the main types of Noonan syndrome (NS); and test for dermatological phenotype-genotype correlations. METHODS: We performed a 10-year, large, prospective, multicentric, collaborative dermatological and genetic study. RESULTS: Thirty-one patients were enrolled. Hair abnormalities were ubiquitous, including wavy or curly hair and excessive eyebrows, respectively in 68% and 56%. Acral excessive skin (AES), papillomas and keratotic papules (PKP), acanthosis nigricans (AN), palmoplantar hyperkeratosis (PPHK) and 'cobblestone' papillomatous papules of the upper lip (CPPUL), were noted respectively in 84%, 61%, 65%, 55% and 32%. Excessive eyebrows, PKP, AN, CCPUL and AES best differentiated CS from CFCS and NS. Multiple melanocytic naevi (>50) may constitute a new marker of attenuated CS associated with intragenic duplication in HRAS. Oral acitretin may be highly beneficial for therapeutic management of PPHK. No significant dermatological phenotype-genotype correlation was determined between patients with and without HRAS c.34G>A (p.G12S). CONCLUSIONS AND RELEVANCE: This validated phenotypic characterization of a large number of patients with CS will allow future researchers to make a positive diagnosis, and to differentiate CS from CFCS and NS.

EOSedge vs. standard digital radiography: image quality and dose exposure in hip-focused scanning.

OBJECTIVES: To compare the image quality and X-ray exposure dose from EOSedge versus standard digital radiography (SDR) focused on the hip for replacement or prosthesis revision surgery. MATERIALS & METHODS: This prospective single centre study included 97 patients between November 2022 and April 2023. For preoperative assessment, SDR radiographs from frontal pelvic and hip profile were indispensable. Often, surgeon requested spine radiograph from EOSedge, to which we added frontal pelvic and hip profile. A radiologist with 4 years' experience established a score based on European guidelines to evaluate the EOSedge versus SDR image quality. Quality scores (QS) were compared using paired Student's t test. The entrance skin dose (ESD) and dose area product (DAP) of the images were recorded. RESULTS: A total of 97 patients, including 49 women and 48 men (mean 68.10 years ± 13.28) were assessed. The QSEOSedge was significantly higher than the QSSDR, with differences of 1.34 ± 1.90 (p < 0.001) and 1.74 ± 1.90 (p < 0.001), respectively. The difference in total QS was 3.08 ± 3.48 (p < 0.001). The radiation delivered (ESD x DAP) by EOSedge was 29 times lower than that delivered by SDR for frontal pelvic imaging (0.35 ± 0.91 versus 10.20 ± 12.63; p < 0.001) and 17 times lower for hip profile imaging (0.41 ± 0.84 versus 6.91 ± 9.70; p < 0.001). CONCLUSION: This study highlighted the superior image quality of EOSedge images focused on the pelvis and hip compared to SDR, with significantly less radiation exposure.

"Primary anterior septoplasty in a cleft repair improves deviation of the anterior septum but not that of the posterior bone structure."

BACKGROUND: Evaluation of the result on the nasal septum (NS) of primary anterior septoplasty in cleft surgery is lacking. The deviation in patients with a cleft between those with (S+) and without (S-) primary anterior septoplasty during a cleft lip repair was compared. METHODS: This was a retrospective, descriptive, single-center study. The NS was evaluated on computed tomography scans obtained pre-operatively from patients who underwent surgery for an alveolar cleft defect. Deviation of the NS was evaluated based on the following parameters: 3D configuration of the NS; anterior, middle, or posterior severity of the NS deviation; location of the most projected point; and severity index. RESULTS: The mean age of evaluation was 6.18 years. A total of 44 (S-) and 48 (S+) patients were included. The NS was less prominent in the (S+) than in (S-) group, 6.25% vs 25%. respectively. In the anterior part, the NS was normal in 79% (S+) and 1% (S-) of the patients. In the posterior region, the prominent deviation rate was approximately 7% in both groups. The greatest deviation point location was identical in both groups. The severity index was higher in the (S-) than in (S+) group, except in the middle part of the NS. CONCLUSIONS: Primary anterior septoplasty corrects only the anterior aspect of the NS in most children with CL and CLP. However, the posterior aspect of the NS remains deviated. A posterior deviation is likely to lead to nasal obstruction therefore regular monitoring is required all along the growing period.

Attainment of LDL-cholesterol target in high cardiovascular risk type 1 diabetic French people.

AIMS -: As people with type 1 diabetes have increased risk of cardiovascular morbi-mortality, management of cardiovascular risk factors is of crucial importance. We assessed the prevalence and factors associated with LDL-cholesterol (LDL-c) target achievement in patients with type 1 diabetes at high and very-high cardiovascular risk. METHODS -: In this observational multicenter study, we included hospitalized patients with type 1 diabetes who had a fasting blood lipid analysis at admission. Cardiovascular risk level and LDL-c target values were defined according to ESC/EAS guidelines into force at admission: LDL-c target for very-high risk (VHR) and high risk (HR) patients was 1.4 and 1.8 mmol/l respectively for patients included from September 2019 (2019 guidelines) and 1.8 and 2.6 mmol/l respectively for patients included in 2016-2019 (2016 guidelines). LDL-c target attainment was assessed in HR and VHR patients, and factors associated with attainment were identified with multivariable analysis. RESULTS -: We included 85 HR patients (median age 37y [interquartile range: 27;45], 64% females) and 356 VHR patients (49 [35;61] years, 42% females). In HR patients, 7% were treated with statins, and 35.3% achieved the LDL-c target. Increasing age (odds ratio 0.58 [95% confidence interval: 0.38;0.89]), body mass index (0.86 [0.75;0.98]), and HbA1c (0.69 [0.50;0.94]) were independently associated with lower odds of attaining LDL-c target. In VHR patients, 36% were treated with statins, and 17.4% achieved LDL-c target. Statin treatment (2.33 [1.22;4.43]), secondary prevention (2.33 [1.21;4.48]) and chronic renal failure (2.82 [1.42;5.61]) were associated with higher odds of attaining LDL-c target. CONCLUSION -: Control of LDL-c is highly insufficient in both HR and VHR patients. Cardiovascular risk evaluation and better control of risk factors may help decrease cardiovascular morbi-mortality in patients with type 1 diabetes. REGISTRATION NUMBER: NCT03449784.

PRADOC: A Multicenter Randomized Controlled Trial to Assess the Efficiency of PRADO-IC, a Nationwide Pragmatic Transition Care Management Plan for Hospitalized Patients With Heart Failure in France.

BACKGROUND: The PRADO-IC (Programme de Retour à Domicile après une Insuffisance Cardiaque) is a transition care program designed to improve the coordination of care between hospital and home that was generalized in France in 2014. The PRADO-IC consists of an administrative assistant who visits patients during hospitalization to schedule follow-up visits. The aim of the present study was to evaluate the PRADO-IC program based on the hypotheses provided by health authorities. METHODS AND RESULTS: The PRADOC study is a multicenter, controlled, randomized, open-label, mixed-method trial of the transition program PRADO-IC versus usual management in patients hospitalized with heart failure (standard of care group; NCT03396081). A total of 404 patients were recruited between April 2018 and May 2021. The mean patient age was 75 years (±12 years) in both groups. The 2 groups were well balanced regarding severity indices. At discharge, patients homogeneously received the recommended drugs. There was no difference between groups regarding hospitalizations for acute heart failure at 1 year, with 24.60% in the standard of care group and 25.40% in the PRADO-IC group during the year following the index hospitalization (hazard ratio, 1.04 [95% CI, 0.69-1.56]; P=0.85) or cardiovascular mortality (hazard ratio, 0.67 [95% CI, 0.34-1.31]; P=0.24). CONCLUSIONS: The PRADO-IC has not significantly improved clinical outcomes, though a trend toward reduced cardiovascular mortality is evident. These results will help in understanding how transitional care programs remain to be integrated in pathways of current patients, including telemonitoring, and to better tailor individualized approaches. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03396081.

Cerebral vasculitis as a complication of pneumococcal meningitis: A cohort study.

OBJECTIVE: Cerebral vasculitis (CV) is a severe complication of pneumococcal meningitis (PM); whether dexamethasone use can reduce its occurrence remains to be determined. METHODS: This is a retrospective observational bicentric study analyzing all adults with proven PM hospitalized between January 2002 and December 2020 in two tertiary hospitals. Extrapolating from a standardized definition of primary angiitis of the central nervous system, we defined CV as worsened neurological symptoms associated with compatible imaging. All images were analyzed by a radiologist, and two neurologists reviewed all inconclusive cases of suspected CV for adjudication. Factors associated with CV were analyzed, including dexamethasone use. A subgroup analysis was limited to patients with a lumbar puncture at PM diagnosis. RESULTS: Among 168 patients with PM, 49 (29.2%) had CV, occurring after a median of 8 days (IQR 5-13) of PM diagnosis. In multivariate analysis (N = 151), initial CRP was associated with CV (OR 1.28 per 50-unit increase, p = 0.003), which was marginally linked with delayed hospital admission more than 48 hours after first symptoms (OR 2.39, p = 0.06) and prior NSAID intake (OR 2.94, p = 0.05). Dexamethasone administration did not impact CV occurrence. In 133 patients having undergone lumbar puncture, CSF protein level > 4.4 g/L (OR 4.50, p = 0.006) was associated with CV. CONCLUSIONS: In our cohort, CV was a frequent and severe complication of PM, often occurring in association with unduly delayed medical care, high CRP at admission, and high levels of protein in CSF.

Safety, Efficacy and Mid-Term Outcome for Transarterial Embolization (TAE) of Renal Angiomyolipoma (AML) Using Ethylene Vinyl Alcohol Copolymer Liquid Embolic Agent (EVOH).

Transarterial embolization (TAE) of renal angiomyolipoma (AML) is effective in treating and preventing hemorrhage. We report our experience using EVOH with a single-center retrospective study of all AML embolized with EVOH between June 2013 and March 2022 at the Montpellier University Hospital. A total of 29 embolizations were carried out in 24 consecutive patients (mean age: 53.86 years; 21 women and 3 men) with 25 AMLs for severe bleeding, symptomatic AML, tumor size > 4 cm, or presence of aneurysm(s) > 5 mm. Data collected included imaging and clinical outcomes, tuberous sclerosis complex status, change in AML volume, rebleeding, renal function, volume and concentration of EVOH used, and complications. Out of 29 embolizations performed for 25 AMLs, four were performed in an emergency. Technical success was achieved for 24/25 AMLs. Mean AML volume reduction was 53.59% after a mean follow-up time of 446 days using MRI or CT scan. Aneurysms on angiogram and the symptomatological nature of AML, as well as secondary TAE and multiple arterial pedicles, were statistically associated (p < 0.05). Two patients (8%) underwent nephrectomy after TAE. Four patients had a second embolization. Minor and major complication rates were 12% and 8%, respectively. Neither rebleeding nor renal function impairment was noticed. TAE of AML using EVOH is, thus, highly effective and safe.