[Management of chronic ulcers: punch grafting]. / Prise en charge des ulcères chroniques : la greffe en pastilles.

Chronic ulcers are a common but important dermatological problem and a major source of expense in the western countries. Skin graft is a surgical procedure in which skin or skin substitute is transplanted in order to close a wound. This article aims to review the different categories of grafts, their indications for the healing of chronic ulcers of the lower limbs, emphasizing the position of punch grafts in the treatment arsenal.

Les ulcères chroniques représentent un problème dermatologique courant et donc une source majeure de dépenses dans les pays occidentaux. La greffe de peau est une intervention chirurgicale au cours de laquelle la peau ou un substitut de peau est transplanté afin de favoriser la cicatrisation d'une plaie. Cet article a pour but de faire le point sur les différentes catégories de greffe, leurs indications dans la prise en charge des ulcères chroniques des membres inférieurs en soulignant la place des greffes en pastilles dans l'arsenal thérapeutique à disposition.

The atherosclerosis burden score.

Purpose: We carried out this study to evaluate the predictive value of atherosclerosis burden score (ABS) to predict coronary artery disease (CAD) among asymptomatic patients without known cardiovascular disease (CVD), as compared to other imaging or functional techniques, namely coronary artery calcium (CAC) score, carotid intima-media thickness (C-IMT), and ankle brachial index (ABI). Patients and methods: This prospective study included 198 asymptomatic consecutive patients referred for evaluation of their cardiovascular (CV) risk and for therapeutic advice. Traditional CV risk factors, ABS, CAC score, C-IMT, ABI and an ECG-synchronized coronary CT-angiography (CCTA) were performed for each patient. We compared the predictive values of these atherosclerosis markers to detect CAD defined as coronary stenosis ≥30% objectivated by CCTA. Results: Among the whole sample, the area under the receiver-operating characteristic curve (ROC-AUC) was significantly higher for CAC score (0.81, p=0.015) than for ABS, the reference (0.70) but these values were lower for C-IMT (0.60, p=0.16) and particularly for ABI (0.56, p=0.0015). However, among patients at intermediate risk of coronary heart disease (CHD), according to Framingham risk score (FRS), the differences between the ROC-AUC values for ABS (0.70) and CAC score (0.76, p=0.36) were less pronounced. Again, as compared to ABS, the ROC-AUC values were lower for C-IMT (0.60, p=0.21) and ABI (0.57, p=0.06). Conclusions: ABS, an ultrasonographic score based on the assessment of carotid and femoral plaque burden, predicts more accurately CAD than other non-radiation tools analyzed here, and has a similar performance to CAC in patients at intermediate CHD risk. Thus, ABS could be an appropriate non-invasive and safe method to improve the detection of high-risk patients who will benefit from a more intensive therapy for the primary prevention of CVD.

[Artificial intelligence and the skin specialist]. / L'intelligence artificielle et le dermatologue.

Artificial intelligence's progress is spread on front pages of both lay and scientific journals. After Chess, after Go, before Dota2 and Starcraft, super-trained softwares have equaled or out-performed dermatologists. But what is the future of these computer programs and how will they change clinical practice for both the general practitioner and the skin specialist? It is time to ask these questions, even though the promises of these new technologies are not yet available.

Les progrès de l'intelligence artificielle s'étalent chaque jour dans les journaux laïques comme scientifiques. Après les échecs, après le jeu de Go, avant Dota2 et Starcraft, des programmes surentraînés ont fait aussi bien, voire mieux qu'un groupe de dermatologues. Mais quel est l'avenir de ces super-programmes et comment vont-ils changer la pratique médicale, pour le médecin de premier recours et pour le spécialiste ? Le temps est venu de se poser ces questions, même si les promesses de ces nouvelles technologies se refusent à nous pour l'instant.