[Current issues surrounding Parkinson's disease]. / Enjeux actuels autour de la maladie de Parkinson.

The number of people suffering from Parkinson's disease is constantly increasing. Diagnosis is based on the motor and non-motor symptoms present throughout the course of the disease. To preserve patient autonomy, the main therapeutic challenge is to propose a treatment adapted to each profile, in conjunction with the implementation of non-medication strategies, reflection on improved accessibility to existing medication and research into innovative therapies.

[Territorial gradation, multi-professionality and IPA: new levers for monitoring Parkinson's patients]. / Gradation territoriale, pluriprofessionnalité et IPA : nouveaux leviers pour suivre les patients parkinsoniens.

The rapid increase in the number of Parkinson's patients in the population is raising questions about the organization of expert resources. The creation of advanced practice nurses is likely to have an impact on this public health issue, as is the implementation of multi-level care gradation and the prospects for paramedical development.

[An update on total neoadjuvant treatment of adenocarcinoma of the rectum]. / Actualisation des données sur le traitement néoadjuvant total de l'adénocarcinome du rectum.

A major advance has been made in the management of rectal cancer, with the emergence in 2021 of total neoadjuvant treatment. The main publications from the RAPIDO and PRODIGE-23 trials reported a significant improvement in progression-free survival and the pathological complete response rate. The aim of this review is to synthesize recent data on neoadjuvant treatment of rectal cancer, to explain the long-term results of the RAPIDO and PRODIGE-23 trials, and to put them into perspective, considering current advances in de-escalation strategies. The update of the 5-year survival data from the RAPIDO trial highlights an increased risk of loco-regional relapse, with 11.7% of relapses in the experimental group and 8.1% in the control group, while the update of the PRODIGE-23 trial confirms the benefits of this treatment regimen, with a significant improvement in overall survival. In addition, the results of the OPRA and PROPSPECT trials confirm the benefit of total neoadjuvant treatment with induction chemotherapy, as well as the possibility of surgical de-escalation in the OPRA trial and radiotherapy in the PROSPECT trial. The challenge for the future is to identify patients who require total neoadjuvant treatment with the aim of curative surgery to obtain a cure without local or distant relapse, and those for whom therapeutic de-escalation can be envisaged.

[The benefits of PSI when dealing with large numbers of victims]. / L'intérêt de disposer d'ISP lors de la prise en charge de nombreuses victimes.

The Many Victims plan describes aims to organize evacuations in a coherent manner, to preserve the human and material resources capacity of the fire and rescue service. The aim is to avoid postponing the disaster on the ground to the hospital and to guarantee the continuity of response to the current risk and an over-event. In this device, the firefighter nurse is an asset by his ability to take care of serious victims without the physical presence of a doctor, in a context of crisis.

[Introduction of treatments for heart failure and reduced ejection fraction under 50 % : In-hospital optimization using an algorithmic approach]. / Introduction hospitalière des traitements de l'insuffisance cardiaque à fraction d'éjection altérée < 50 % : mise au point et proposition d'algorithme.

Recent international guidelines recommend rapid initiation and titration of basic treatments of heart failure but do not explain how to achieve this goal. Despite these recommendations, implementation of treatment in daily practice is poor. This may be partly explained by the profile of the patients (frailty, comorbidities), safety considerations and tolerability issues related to kydney function, low blood pressure or heart rate and hyperkalaemia. In this special article, we intended to help the physician, through an algorithmic approach, to quickly and safely introduce guideline-directed medical therapy in the field of heart failure with ejection fraction under 50%.

[Substance use among adolescents: Addiction or self-handicap strategy?] / Consommation de substances psychoactives chez les adolescents : addiction ou stratégie d'auto-handicap ?

Self-handicapping strategies consist of creating or declaring obstacles to oneself before a situation of accomplishment that threatens the self, as might be the case during an academic assessment or a sporting competition, in order to protect oneself from a possible failure or to valorise oneself in the event of success. It turns out that beyond the physiological effects sought and the dependence linked to the product, the consumption of psychoactive substances can serve as an excuse for users in the event of failure, thus protecting their sense of competence or enhancing it in the event of success, for having succeeded in spite of their consumption, which is known to have a negative impact on performance.

[Prevention of pertussis in newborns: Should pregnant women be vaccinated at each pregnancy?] / Prévention de la coqueluche chez le nouveau-né : faut-il vacciner les femmes enceintes à chaque grossesse ?

Pertussis is a respiratory disease that can be fatal at all ages but especially in infants before their mandatory vaccination. Recent epidemiological data shows a decrease in the number of pertussis cases, but a resurgence cannot be excluded in the coming years due to the cyclic evolution of the disease and the loosening of hygiene measures. Two approaches are used to protect infants before their vaccination: vaccination of the mother during pregnancy and vaccination of all the infant's close relatives (cocooning). The vaccination of the mother during pregnancy is more effective. The uncertain risk of chorioamniotitis associated with vaccination during pregnancy is insufficient to question this strategy.

[Chair of Mining Engineering and Mineral Economics-the Future]. / Bergbaukunde, quo vadis?

In order to tackle climate change and increasing competition in access to resources, the European Union has defined far-reaching transformations in the areas of energy and digitalisation as well as the conversion of the economic system towards an inclusive, circular economy in the so-called Green Deal. From a mining perspective, these transformations mean a continued growing demand for raw materials, which must be met by extracting mineral raw materials from primary deposits. However, increased quantities with "business as usual" would also increase the environmental and social impacts of mining, which is not an option, especially in Europe and Austria.Due to these facts, there is a need for research on new and improved mining methods and planning, as well as on optimised processes and machinery. This article describes how the Chair of Mining Engineering and Mineral Economics at Montanuniversität Leoben intends to use these challenges as an opportunity with its updated strategy, both for research and for teaching. For the research area, sustainability and involvement in the shaping of raw materials policy should form the framework. With a focus on digitisation and underground mining as well as strengthening the areas of open-pit mining, conveying technology and geoinformatics, research is to be future-proofed for these upcoming transformations. Teaching will continue to include a basic engineering education with specialisation in mining, whereby digitalisation will play an increasingly strong role.

Patient-centered management strategy for concurrent musculoskeletal complaints in elbows, shoulders, and neck after an isolated hand/forearm complaint: A prospective interventional study.

The aim was to evaluate patient-reported outcomes before and after a patient-centered management strategy targeting concurrent proximal musculoskeletal complaints (MSCs) in patients with an isolated hand/forearm complaint. A prospective interventional study included 66 patients. Intervention targeting concurrent MSCs was implemented as a patient-centered add-on to standard treatment for primary hand/forearm complaints. The patient-centered management strategy included patient education, individualized exercises, and manual therapy. Patient-reported outcome measures and pain questionnaires regarding the location, frequency, and intensity of pain in hands, elbows, shoulders, and neck were collected at baseline, after the last session of the patient-centered management strategy, and at 3-month follow-up. There were significant improvements in all patient-reported outcomes between baseline and follow-up. DASH scores improved significantly, by 17-29 points on the 3 subscales. There was a significant improvement of 6 points in PCS, 2 points in HADS, and 0.051 points in EQ-5D index. Median pain intensity on NRS decreased from 6 (4-8) to 5 (2.5-7) in hands, 3 (0-6) to 0 (0-3) in elbows, 5 (2-7) to 2.5 (0-5) in shoulders, and 3 (0-6) to 2 (0-3) in the neck, between baseline and discharge. Patients reporting concurrent MSCs in the elbow, shoulder, and neck after an isolated hand/forearm complaint may benefit from patient-centered management comprising patient education, individualized exercises, and manual therapy targeting pain and functional deficits in the upper-limb and neck. LEVEL OF EVIDENCE: IV.

Future treatment options in metastatic clear cell renal cell carcinoma.

The field of clear cell renal cell carcinoma (ccRCC) has undergone major changes in the last decade, both in terms of the understanding of the mechanisms of oncogenesis and the role of the tumor microenvironment in anti-tumor immunity, as well as in therapeutic developments. After the era of tyrosine kinase inhibitors (TKIs) targeting VEGFR and then the era of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway, we are now entering the era of combination therapy for first-line metastatic cancer (m-ccRCC), such as combinations including a TKI and a PD-1 inhibitor or combinations of PD-1 and CTLA-4 blockers. In this extremely dynamic environment, new molecules with various mechanisms of action will appear in the very near future: immune response modulators (other ICIs, pro-inflammatory cytokines, gut microbiota modulators), new anti-angiogenic agents (new TKIs, anti-HIF-1α antibodies), agents affecting cell metabolism (glutaminase inhibitors, tryptophan regulators or adenosine A2A receptor antagonists) or epigenetic regulators (HDAC inhibitors). In parallel, new strategies are being evaluated that could rapidly change the standards of management of advanced disease, including therapeutic intensification with triple combinations or, conversely, adaptive and/or alternative de-escalation regimens (SURF trial), and biomarker-driven treatments (BIONIKK trial). The main new molecules and strategies currently being evaluated are reviewed in this article.

Is Better Understanding of Management Strategies for Adults With Type 1 Diabetes Associated With a Lower Risk of Developing Hypoglycemia During and After Physical Activity?

BACKGROUND: We aim to determine how knowledge and type 1 diabetes (T1D) management strategies are associated with hypoglycemic risk for physical activity (PA)-induced hypoglycemia among people with T1D (PWT1D). METHODS: One hundred thirty-seven physically active adults with T1D completed diabetes management, PA habits and PA-associated hypoglycemia questionnaire. RESULTS: PA-associated hypoglycemia (during PA, within 1 hour of PA and overnight after PA) was reported by 49% to 61% of respondents, with 18% indicating that they felt inadequately equipped to perform regular PA safely. For during PA, more hypoglycemia was reported by PWT1D with more knowledge of hypoglycemia prevention strategies and those using continuous subcutaneous insulin infusion (CSII) vs multiple injections, those with decreasing basal rate 30 to 60 minutes before PA vs no adjustment before PA, and those taking snacks for unplanned PA vs no snacking. For within 1 hour after PA, more hypoglycemia was reported by PWT1D less knowledgeable about insulin pharmacokinetics and those practicing pre- vs post-dinner PA. For overnight after PA, more hypoglycemia was reported by PWT1D with shorter diabetes duration; CSII users having greater understanding of exercise-induced glucose fluctuations; those reporting reducing nocturnal insulin infusion rates vs no adjustment at night; those engaged in PA for at least 31 minutes; and those engaged in moderate and vigorous PA (vs light PA) as well as regularly performing interval training vs nonregular practice. Glycated hemoglobin and use of continuous glucose monitoring were not associated with any timing of reported PA-associated hypoglycemia. CONCLUSIONS: PA-associated hypoglycemia is common among PWT1D. Greater knowledge of PA and T1D management is not associated with less PA-associated hypoglycemia. Diabetes management confidence could encourage higher tolerance for hypoglycemic risk.

[Promotion of Covid-19 vaccination by nursing students]. / Promotion de la vaccination contre la Covid-19 par des étudiants en soins infirmiers.

In the midst of Covid-19 pandemic, on the cusp of a fourth wave, second-year nursing students conducted a campaign to promote vaccination. This educational activity is part of the evaluation of teaching unit 4.6 of semester 3 "educational and preventive care". It is conducted in the form of a project and is based on the principle of so-called active teaching methods.

[Should French pregnant women be vaccinated against pertussis during pregnancy?] / Faut-il vacciner les femmes enceintes françaises contre la coqueluche ?

Many countries with a high perinatal level have started a policy of vaccination of pregnant women against pertussis. To date, France has not chosen this policy. The objective was to review knowledge on pertussis mortality in infants. Compare the strategies available to protect the infant before his first vaccination, scheduled for two months of age. We proceeded to a litterature analysis, from January 1998 to 2021. Search by the following keywords used ; "Whooping cough, vaccination, pregnancy, strategy, cocooning", on the scientific basis of "Pubmed", as well as French and foreign vaccination recommendations. Currently 90% of whooping cough deaths are concerning infants under six months of age and this mortality represents 2% of mortality in the first year of life. Vaccination at birth is not effective. The cocooning strategy, which consists of vaccinating those around the child, is expensive and difficult to implement. A systematic vaccination policy for pregnant women is effective and reasonably expensive when compared to the cocooning strategy. In England, it was recently accompanied by a 78% reduction in confirmed cases of pertussis in infants under six months of age. In conclusion, compared to cocooning strategy, pertussis vaccination of pregnant women appears more effective and cost-effective, and this with each pregnancy.

[Ethical issues of vaccination against Sars-CoV-2]. / Enjeux éthiques de la vaccination contre le Sars-CoV-2.

As a tool for public health, the vaccination policy is based on the analysis of benefits and risks. Thus, the National Consultative Ethics Committee has been at the heart of the orientations taken in terms of the deployment of the vaccination against severe acute respiratory syndrome coronavirus 2, by contributing its reflections on the associated ethical issues.

The Dural Dark-Side Approach for falcine and tentorial meningioma: A surgical series of five patients.

INTRODUCTION: Falcine or tentorial meningioma can be complex to resect. When large meningiomas are located in eloquent areas, a direct ipsilateral surgical approach may cause brain injury and postoperative neurological deficits. In this series, 5 patients were surgically treated using a contralateral transfalcine or transtentorial approach to minimize brain retraction. This strategy was called the Dural Dark-Side Approach (DDSA). The aim was to analyze the quality of tumor resection and postoperative outcome. MATERIAL AND METHODS: In our department, from June 2018 to January 2020, 5 patients underwent microsurgical DDSA for resection of 4 falcine and 1 tentorial meningioma. All tumors were selected on the following two criteria: large>40mm diameter tumor, with surrounding functional cortex. Clinical and radiologic data were retrospectively analyzed. RESULTS AND DISCUSSION: Mean follow-up was 20 months. No patients required use of a rigid retractor during surgery. Gross total resection was performed in 3 patients and near-total resection in 2. All patients had favorable neurologic outcome. Postoperative MRI showed no ipsilateral or contralateral brain lesions. CONCLUSION: This series suggested that meticulous DDSA allows excellent resection in selected large falcine or tentorial meningioma. The approach offered a safe and effective surgical corridor without injuring the surrounding healthy parenchyma.

Hospital compounding to face shortage: A case study of the development of a lopinavir-ritonavir oral suspension during the first wave of SARS-COV-2 in France.

The potential usefulness of lopinavir-ritonavir on Covid 19 infection during the first wave of contamination in France had boosted Kaletra® syrup prescription to the point of causing its national shortage. In the intensive care units of Parisian hospitals in charge of patients with life-threatening viral contamination, caregivers had to resort to lopinavir-ritonavir-based tablets, crushing them and then dispersing the powder in milk to facilitate administration by nasogastric tube. The difficulties and poor control of this degraded mode, which does not always ensure control of the amount of the drug in the prepared dose and may induce insufficient antiviral exposure, led us to develop in a very short time, while ensuring quality control proportional to the risk, a liquid form as an alternative to Kaletra® oral solution shortage. For this purpose, we describe this compounding formulation and its preparation process, while justifying the quality control strategy adapted to the risk as well as its chemical and physical stability. Based on the chemical and physical studies, the preparation was showed to be stable during at least 2 months between +2°C and +8°C and 1 week at room temperature. This has resulted in the design of kits that include multi-dose packaging and a measuring device and contain the appropriate quantities of drugs to ensure at least one week's treatment for each patient, during which time the kit in use can be stored at room temperature. The intensive care team used this treatment under conditions that they considered well adapted until the imported specialty became available.

Mise à jour 2021 des recommandations pour la pratique clinique de Nice/Saint-Paul-de-Vence dans le cancer de l'ovaire épithélial de haut grade: Updated 2021 recommendations for the clinical practice of Nice/Saint-Paul-de-Vence in epithelial high grade ovarian cancer.

Since the previous 2013 and 2016 recommendations for clinical practice (RPC) Nice/Saint-Paul-de-Vence for gynecological cancers, the management of ovarian cancer has become more complex with the evolution of the quality criteria recommended for surgery and the integration of molecular biology for the decision of medical treatments, especially for high grade epithelial ovarian cancers. Surgical indications have become more precise both in the first line and in the context of relapse. Treatments with PARP inhibitors is a major advance in medical management with significant efficacy in maintenance after response to platinum-based chemotherapy. The benefit already known in the case of late relapse has also been demonstrated in first-line treatment with progression-free survival never observed in this pathology with patients with very long responses, especially in the case of BRCA gene abnormalities (somatic or constitutional). In 2021, medical and surgical strategies in front line including PARP inhibitors associated or not with bevacizumab as a maintenance complement after platinum chemotherapy are guided by both response to platinum agents and molecular profiling including BRCA (somatic or constitutional) genetic status and homologous recombination pathway (HRD) abnormalities, that should be early tested. On behalf of the GINECO national oncologist group, we have updated the guidelines for high grade ovarian epithelial cancer (excepted rare tumors) in order to allow rapid dissemination of the latest advances to the medical community and improve daily practice.

Aspects cliniques : Cancers HER2 et atteinte du système nerveux central, que faire en 2021 ?: Central nervous system metastases from HER2 positive breast cancers: what to do in 2021?

Metastatic breast cancer is the second most common cause of brain metastasis (BM), and this problem is particularly marked for the amplified HER2 subtype (HER2+), with a cumulative incidence reaching up to 49 % in the ER-/HER2+ subgroup. Literature review shows that therapeutic progress has been major since the marketing of systemic anti-HER2+ treatments, with life expectancies now relatively unaffected by brain development. The recommended treatments are, on the one hand, specific treatment for brain development and, on the other hand, appropriate systemic treatment. Regarding local treatments, we will always favor surgery when possible, especially for large metastases, and stereotaxic radiotherapy, possibly iterative. One should be wary of whole brain irradiation which has never been shown to improve overall survival, but which is clearly associated with more cognitive toxicities. All the systemic anti-HER2 treatments currently on the market have shown efficacy on BM from HER2+ breast cancer and must therefore be chosen above all on the basis of their potential activity on the systemic disease at the time of cerebral evolution. If BM evolution happen without concomitant systemic progression, and local treatment can control it, it is not recommended to change the current medical treatment. Finally, randomized clinical studies opened to patients with active brain disease are starting to be published. The first of them showed the benefit of the triple combination tucatinib-trastuzumab-capecitabine in this context.