Publications by authors named "Bruno Pereira"

832 Publications

Burnout in French General Practitioners: A Nationwide Prospective Study.

Int J Environ Res Public Health 2021 Nov 16;18(22). Epub 2021 Nov 16.

Department of General Surgery, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France.

Background: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout.

Methods: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children.

Results: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9-5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15-3.16), working in a suburban area (5.23, 2.18-12.58), and having more than 28 appointments per day (1.95, 1.19-3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93-2.59, = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02-1.67 and 1.86, 1.34-2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51-0.83; 0.66, 0.48-0.92; and 0.42, 95%CI 0.23-0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13-0.47), as did group practice for intermediate level of burnout (0.71, 0.51-0.96).

Conclusion: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.
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http://dx.doi.org/10.3390/ijerph182212044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624683PMC
November 2021

Impact of Air Transport on SpO/FiO among Critical COVID-19 Patients during the First Pandemic Wave in France.

J Clin Med 2021 Nov 9;10(22). Epub 2021 Nov 9.

Clinical Research and Innovation Direction, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France.

During the first wave of the COVID-19 pandemic, some French regions were more affected than others. To relieve those areas most affected, the French government organized transfers of critical patients, notably by plane or helicopter. Our objective was to investigate the impact of such transfers on the pulse oximetric saturation (SpO)-to-inspired fraction of oxygen (FiO) ratio among transferred critical patients with COVID-19. We conducted a retrospective study on medical and paramedical records. The primary endpoint was the change in SpO/FiO during transfers. Thirty-eight patients were transferred between 28 March and 5 April 2020, with a mean age of 62.4 years and a mean body mass index of 29.8 kg/m. The population was 69.7% male, and the leading medical history was hypertension (42.1%), diabetes (34.2%), and dyslipidemia (18.4%). Of 28 patients with full data, we found a decrease of 28.9 points in SpO/FiO (95% confidence interval, 5.8 to 52.1, = 0.01) between the starting and the arrival intensive care units (SpO/FiO, 187.3 ± 61.3 and 158.4 ± 62.8 mmHg, respectively). Air medical transfers organized to relieve intensive care unit teams under surging conditions during the first COVID wave were associated with significant decreases in arterial oxygenation.
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http://dx.doi.org/10.3390/jcm10225223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624612PMC
November 2021

Effect of acute dietary- versus combined dietary and exercise-induced energy deficits on subsequent energy intake, appetite and food reward in adolescents with obesity.

Physiol Behav 2021 Nov 17;244:113650. Epub 2021 Nov 17.

Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France; Observatoire National de l'Activité Physique et de la Sédentarité (ONAPS), Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France; International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France.

Background: Acute dietary-induced energy deficits have been shown to favor compensatory appetitive responses. The aim of this study was to compare energy intake (EI), appetite sensations and the hedonic responses to equivalent energy deficits induced by dietary restriction alone and combined with exercise in adolescents with obesity.

Methods: In a within-subjects design, seventeen adolescents with obesity (12-16 years, Tanner stage 3-5, 6 males) randomly completed three 14 h conditions: (i) control (CON); (ii) deficit induced by diet only (Def-EI) and; (iii) deficit induced by combined diet and physical exercise (Def-mixed). Breakfast and lunch were calibrated to generate a 500 kcal deficit in Def-EI and 250 kcal deficit in Def-mixed. A 250 kcal deficit was created through a cycling exercise set at 65% VO in Def-mixed. Ad libitum EI, macronutrients and relative EI (REI) were assessed at dinner, subjective appetite sensations taken at regular intervals, and food reward measured before dinner.

Results: EI at dinner was significantly lower in Def-EI compared to CON (p = 0.014; Effect size (ES): -0.59 [-1.07; -0.12]), with no difference between Def-mixed and both CON and Def-EI. Total REI was lower in both deficit conditions compared with CON (Def-mixed: p < 0.001; ES: -3.80 [-4.27; -3.32], Def-EI: p < 0.001; ES: -4.90 [-5.37; -4.42] respectively), indicating incomplete compensation for the energy deficits. Absolute protein ingestion at dinner was lower in Def-EI than Def-mixed (p = 0.037; ES: -0.50 [-0.98; -0.03]) and absolute lipid ingestion was lower in Def-EI than in CON (p = 0.033; ES: -0.51 [-0.99; -0.04]). A higher proportion of protein and a lower proportion of carbohydrates was observed in Def-mixed than in Def-EI (p = 0.078; ES: -0.42 [-0.90; 0.04] and p = 0.067; ES: 0.44 [-0.03; 0.92] respectively). Total area under the curve for appetite sensations were similar between conditions. Explicit liking for sweet relative to savoury food was lower in Def-mixed compared to CON (p = 0.027; ES: -0.53 [-1.01; -0.06]) with no difference in food reward between Def-EI and CON.

Conclusion: Neither of the two acute isoenergetic deficits led to subsequent appetitive compensation, with the dietary deficit even inducing a lower ad libitum EI at the subsequent dinner. Further studies are needed to better understand the appetitive response to dietary and exercise energy balance manipulations in this population.
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http://dx.doi.org/10.1016/j.physbeh.2021.113650DOI Listing
November 2021

3-Year Clinical Outcomes After Implantation of Permanent-Polymer Versus Polymer-Free Stent: ReCre8 Landmark Analysis.

JACC Cardiovasc Interv 2021 Nov;14(22):2477-2486

Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address:

Objectives: The aim of this analysis was to assess long-term clinical outcomes of the polymer-free Amphilimus-eluting stent (PF-AES) compared with a latest generation permanent-polymer drug-eluting stent (DES) in an all-comers population.

Background: PF-AES possess multiple properties improving targeted drug elution without the presence of polymers. Evaluation of long-term clinical performance of PF-AES versus latest generation permanent-polymer DES has not yet been performed in a large randomized trial introducing shortened dual-antiplatelet therapy.

Methods: In this physician-initiated, multicenter, randomized, all-comers trial, patients undergoing percutaneous coronary intervention with implantation of DES were enrolled. Patients were stratified for diabetes and troponin status and randomized to implantation of a permanent-polymer zotarolimus-eluting stent (PP-ZES) or a PF-AES. Dual-antiplatelet therapy duration was 12 months in troponin-positive patients and 1 month in troponin-negative patients. A noninferiority analysis was conducted to compare the 2 arms regarding target lesion failure (TLF) between 1 and 3 years.

Results: A total of 1,491 patients were randomized and treated. In this landmark analysis, between 1- and 3-year follow-up, TLF occurred in 35 patients (4.9%) in the PP-ZES arm and 37 PF-AES patients (5.1%). Clinical noninferiority of the PF-AES was confirmed, with a risk difference of 0.2% (upper limit 1-sided 95% CI: 2.2%; P = 0.0031).

Conclusions: ReCre8 (Randomized "All-Comer" Evaluation of a Permanent Polymer Resolute Integrity Stent Versus a Polymer Free Cre8 Stent) is the first randomized, multicenter trial with a head-to-head comparison of PP-ZES compared with PF-AES to investigate clinical outcomes of these new-generation DES in an all-comers population with long-term follow-up. On the basis of the present results, PF-AES are clinically noninferior to PP-ZES regarding TLF between 1 and 3 years. (Randomized "All-Comer" Evaluation of a Permanent Polymer Resolute Integrity Stent Versus a Polymer Free Cre8 Stent; NCT02328898).
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http://dx.doi.org/10.1016/j.jcin.2021.08.078DOI Listing
November 2021

Faster and less invasive tools to identify patients with ileal colonization by adherent-invasive E. coli in Crohn's disease.

United European Gastroenterol J 2021 Nov;9(9):1007-1018

Université Clermont Auvergne/Inserm U1071, USC-INRAe 2018, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont-Ferrand, France.

Background And Aims: The identification of Crohn's disease (CD)-associated adherent and invasive Escherichia coli (AIEC) is time-consuming and requires ileal biopsies. We aimed to identify a faster and less invasive methods to detect ileal colonization by AIEC in CD patients.

Methods: CD patients requiring ileo-colonoscopy were consecutively enrolled in this prospective multicenter study. Samples from saliva, serum, stools, and ileal biopsies of CD patients were collected.

Results: Among 102 CD patients, the prevalence of AIEC on ileal biopsies was 24.5%. The abundance and global invasive ability of ileal-associated total E. coli were respectively ten-fold (p = 0.0065) and two-fold (p = 0.0007) higher in AIEC-positive (vs. AIEC-negative), while abundance of total E. coli in the feces was not correlated with AIEC status in the ileum. The best threshold of ileal total E. coli was 60 cfu/biopsy to detect AIEC-positive patients, with high negative predictive value (NPV) (94.1%[80.3-99.3]), while the global invasive ability (>9000 internalized bacteria) was able to detect the presence of AIEC with high positive predictive value (80.0% [55.2-100.0]). Overall, 78.1% of the AIEC + patients were colonized by two or less different AIEC strains. The level of serum anti-total E. coli antibodies (AEcAb) was higher in AIEC-positive patients (p = 0.038) with a very high negative predictive value (96.6% [89.9-100.0]) (p = 0.038) for a cut-off value > 1.9 × 10 .

Conclusions: More than two thirds of AIEC-positive CD patients were colonized by two or less AIEC strains. While stools samples are not accurate to screen AIEC status, the AEcAb level appears to be an attractive, rapid and easier biomarker to identify patients with Crohn's disease harboring AIEC.
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http://dx.doi.org/10.1002/ueg2.12161DOI Listing
November 2021

Adverse Collateral Effects of COVID-19 Public Health Restrictions on Physical Fitness and Cognitive Performance in Primary School Children.

Int J Environ Res Public Health 2021 10 22;18(21). Epub 2021 Oct 22.

National Observatory for Physical Activity and Sedentary Behaviors, 63000 Clermont-Ferrand, France.

The aim of the present study was to evaluate whether the COVID-19-related confinement and social restrictions affected the levels of physical fitness and academic achievement in primary school French children. A total of 206 primary school children (106 before confinements and 100 after restrictions) completed a test battery evaluating their anthropometric characteristics, body compositions, activity preferences, cognitive performances and physical fitness. The performance of the Standing Long Jump was better at T0 (169.9 ± 142.5 cm) compared to T1 (135.2 ± 31.4 cm) ( = 0.0367), and the Medicine Ball Throw performance declined from T0 to T1 (297.3 ± 81.1 cm vs. 249 ± 52 cm; < 0.0001). Motor skills (26.9 ± 6.2 s vs. 30.9 ± 5.4 s; < 0.0001), the shuttle-run test (stages completed), Maximal Aerobic Speed, and the estimated VO were lower at T1 compared to T0 ( < 0.0001). Executive functioning was found to be greater at T0 compared to T1 ( < 0.0001). Explicit liking or wanting for sedentary or physical activities did not change between T0 and T1. Both overall physical fitness and cognitive performance drastically declined among primary school French children with the COVID-19-related public health restrictions, which reinforces the need to urgently develop preventive strategies in anticipation of further mitigation measures.
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http://dx.doi.org/10.3390/ijerph182111099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583224PMC
October 2021

Inhaled nitric oxide before induction of anesthesia in patients with pulmonary hypertension.

Ann Card Anaesth 2021 Oct-Dec;24(4):452-457

Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Paris, France.

Background: The aim of this study was to examine the action of inhaled nitric oxide in the patients with pulmonary hypertension administered with a face mask before anesthesia induction.

Methods: Ten adult patients scheduled for heart surgery with sternotomy were included in this prospective, interventional, single centre study. The inclusion criteria were patients scheduled for heart surgery with sternotomy with cardiopulmonary bypass (CPB), aged >18 years which presents a pulmonary hypertension (PH) (class 2 or 3 according to the Dana Point classification) with systolic pulmonary arterial pressure (PAPS) >40 mmHg diagnosed by preoperative right cardiac catheterization or by transthoracic echocardiography. The exclusion criteria were: heart transplant, PH of type 1, 4, 5, according to the Dana Point classification, methemoglobin reductase deficit, incapacity to understand the protocol and sign the consent.

Results: The administration of iNO decrease pulmonary hypertension (P < 0,001 compared to room air; P = 0,01 compared to pure oxygen administration). The iNO administration did not improve arterial blood oxygenation. The hyperoxia, decrease the cardiac index even with right ventricular post charge decrease. The increased blood oxygenation content cause systemic vascular vasoconstriction and decrease the peripheral oxygen extraction showed with VO linear increase (P < 0,001).

Conclusions: The administration of inhaled nitric oxide with a face mask before anaesthesia induction is safe and effective method to reduce pulmonary hypertension. The oxygen and hyperoxia influences the systemic vascular resistance and peripheral oxygen consumption.
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http://dx.doi.org/10.4103/aca.ACA_82_20DOI Listing
November 2021

Structural and Functional Correlates of Hallucinations and Illusions in Parkinson's Disease.

J Parkinsons Dis 2021 Nov 4. Epub 2021 Nov 4.

Université Clermont Auvergne, IGCNC, InstitutPascal, Clermont-Ferrand University Hospital, Neurology Department, Clermont-Ferrand, France.

Background: Visual illusions (VI) in Parkinson's disease (PD) are generally considered as an early feature of the psychosis spectrum leading to fully formed visual hallucinations (VH), although this sequential relationship has not been clearly demonstrated.

Objective: We aimed to determine whether there are any overlapping, potentially graded patterns of structural and functional connectivity abnormalities in PD with VI and with VH. Such a finding would argue for a continuum between these entities, whereas distinct imaging features would suggest different neural underpinnings for the phenomena.

Methods: In this case control study, we compared structural and resting state functional MRI brain patterns of PD patients with VH (PD-H, n = 20), with VI (PD-I, n = 19), and without VH or VI (PD-C, n = 23).

Results: 1) PD-H had hypo-connectivity between the ILO and anterior cingulate precuneus and parahippocampal gyrus compared to PD-C and PD-I; 2) In contrast, PD-I had hyper-connectivity between the inferior frontal gyrus and the postcentral gyrus compared to PD-C and PD-H. Moreover, PD-I had higher levels of functional connectivity between the amygdala, hippocampus, insula, and fronto-temporal regions compared to PD-H, together with divergent patterns toward the cingulate. 3) Both PD-I and PD-H had functional hypo-connectivity between the lingual gyrus and the parahippocampal region vs. PD-C, and no significant grey matter volume differences was observed between PD-I and PD-H.

Conclusion: Distinct patterns of functional connectivity characterized VI and VH in PD, suggesting that these two perceptual experiences, while probably linked and driven by at least some similar mechanisms, could reflect differing neural dysfunction.
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http://dx.doi.org/10.3233/JPD-212838DOI Listing
November 2021

Complications of Adenoviral Keratoconjunctivitis in Ophthalmologists and Orthoptists: Epidemiology and Risk Factor, A Retrospective Questionnaire Analysis.

Cornea 2021 Nov 6. Epub 2021 Nov 6.

University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, Genetic Reproduction and Development Laboratory (GReD), Translational Approach to Epithelial Injury and Repair Team, Clermont-Ferrand, France; University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Biostatistics, Clermont-Ferrand, France; CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Intensive Care Unit, Clermont-Ferrand, France; and Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont-Ferrand, France.

Purpose: The purpose of this study was to assess the medical history of adenoviral keratoconjunctivitis (AK) and subepithelial infiltrates (SEIs) among French ophthalmologists and orthoptists and the frequency of unreported occupational diseases. We also described short-term and long-term consequences of AK and evaluated associated factors.

Methods: The REDCap questionnaire was diffused online several times over 7 consecutive months, from October 2019 to May 2020, through mailing lists (French Society of Ophthalmology, residents, and hospital departments), social networks, and by word of mouth.

Results: Seven hundred ten participants were included with a response rate of 6.2% for ophthalmologists, 3.8% for orthoptists, and 28.3% for ophthalmology residents. The medical history of AK was found in 24.1% (95% confidence interval 21%-27.2%) of respondents and SEI in 43.9% (36.5%-51.3%) of the AK population. In total, 87.1% (82.1%-92.1%) of AK occupational diseases were not declared. In total, 57.7% of respondents took 9.4 ± 6.2 days of sick leave, mostly unofficial, and 95.7% stopped surgeries for 13.0 ± 6.6 days. Among the AK population, 39.8% had current sequelae, with 17.5% having persistent SEIs, 19.9% using current therapy, and 16.4% experiencing continuing discomfort. SEIs were associated with wearing contact lenses (odds ratio 3.31, 95% confidence interval 1.19-9.21) and smoking (4.07, 1.30-12.8). Corticosteroid therapy was associated with a greater number of sequelae (3.84, 1.51-9.75).

Conclusions: AK and SEI affect a large proportion of ophthalmologists and orthoptists, possibly for years, with high morbidity leading to occupational discomfort. Few practitioners asked for either to be recognized as an occupational disease. Associated factors would require a dedicated study.
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http://dx.doi.org/10.1097/ICO.0000000000002909DOI Listing
November 2021

Augmented reality in laparoscopic liver resection evaluated on an ex-vivo animal model with pseudo-tumours.

Surg Endosc 2021 Nov 3. Epub 2021 Nov 3.

Institut Pascal, UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Bâtiment 3C, 28 place Henri Dunant, 63000, Clermont-Ferrand, France.

Background: The aim of this study was to assess the performance of our augmented reality (AR) software (Hepataug) during laparoscopic resection of liver tumours and compare it to standard ultrasonography (US).

Materials And Methods: Ninety pseudo-tumours ranging from 10 to 20 mm were created in sheep cadaveric livers by injection of alginate. CT-scans were then performed and 3D models reconstructed using a medical image segmentation software (MITK). The livers were placed in a pelvi-trainer on an inclined plane, approximately perpendicular to the laparoscope. The aim was to obtain free resection margins, as close as possible to 1 cm. Laparoscopic resection was performed using US alone (n = 30, US group), AR alone (n = 30, AR group) and both US and AR (n = 30, ARUS group). R0 resection, maximal margins, minimal margins and mean margins were assessed after histopathologic examination, adjusted to the tumour depth and to a liver zone-wise difficulty level.

Results: The minimal margins were not different between the three groups (8.8, 8.0 and 6.9 mm in the US, AR and ARUS groups, respectively). The maximal margins were larger in the US group compared to the AR and ARUS groups after adjustment on depth and zone difficulty (21 vs. 18 mm, p = 0.001 and 21 vs. 19.5 mm, p = 0.037, respectively). The mean margins, which reflect the variability of the measurements, were larger in the US group than in the ARUS group after adjustment on depth and zone difficulty (15.2 vs. 12.8 mm, p < 0.001). When considering only the most difficult zone (difficulty 3), there were more R1/R2 resections in the US group than in the AR + ARUS group (50% vs. 21%, p = 0.019).

Conclusion: Laparoscopic liver resection using AR seems to provide more accurate resection margins with less variability than the gold standard US navigation, particularly in difficult to access liver zones with deep tumours.
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http://dx.doi.org/10.1007/s00464-021-08798-zDOI Listing
November 2021

Radiographic Study in Patients Submitted to Cementless Total Knee Arthroplasties: Minimum Follow-Up of 2 Years.

Rev Bras Ortop (Sao Paulo) 2021 Oct 28;56(5):628-633. Epub 2021 Oct 28.

Grupo de Cirurgia do Joelho, Instituto de Fraturas, Ortopedia e Reabilitação (IFOR), São Bernardo do Campo, SP, Brasil.

 Radiographic evaluate if there are signs of early loosening of the cementless total knee arthroplasties Amplitude-Score® (Amplitude Surgical SAS, Valence, France), checking with a follow-up time ranging from 2 to 5.75 years (mean of 3.75 years).  Descriptive longitudinal investigation of observational nature, non-comparative, through a static radiographic study of annual control, of a case series, in a single center, all operated on by the same surgeon (S.M.). All cementless arthroplasties that met the inclusion and exclusion criteria performed from March 2012 to October 2014 were included.  Among the 46 cementless knee arthroplasties evaluated in 40 patients, no radiographic signs of early loosening were verified.  Cementless arthroplasty promotes optimal osteointegration, with no early release, and it is essential that the surgical technique is perfectly respected.
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http://dx.doi.org/10.1055/s-0041-1731355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558939PMC
October 2021

Beneficial effects of hypotaurine supplementation in preparation and freezing media on human sperm cryo-capacitation and DNA quality.

Basic Clin Androl 2021 Nov 4;31(1):26. Epub 2021 Nov 4.

CHU Clermont Ferrand, CHU Estaing, Assistance Médicale à la Procréation - CECOS, F-63003, Clermont-Ferrand, France.

Background: Although widely used, slow freezing considerably modifies the functions of human spermatozoa. Cryopreservation induces nuclear sperm alterations and cryo-capacitation, reducing the chances of pregnancy. Hypotaurine is naturally present in the male and female genital tracts and has capacitating, osmolytic and anti-oxidant properties. The analysis were performed on surplus semen of men with normal (n = 19) or abnormal (n = 14) sperm parameters. Spermatozoa were selected by density gradient centrifugation before slow freezing. For each sample, these steps were performed in parallel with ("H+" arm) or without ("H-" arm) hypotaurine supplementation. After thawing, we measured total and progressive mobility, vitality, acrosome integrity, markers of capacitation signaling pathway and nuclear quality. For the latter, we focused on sperm chromatin packaging, DNA fragmentation and the presence of vacuoles in the sperm nucleus.

Results: Post-thaw spermatozoa selected and frozen in the presence of hypotaurine had a higher vitality (+ 16.7%, p < 0.001), progressive and total motility (+ 39.9% and +  21.6% respectively, p < 0.005) than spermatozoa from the control "H-" arm. Hypotaurine also reduced the non-specific phosphorylation of the capacitation protein markers P110 and P80 (p < 0.01), indicating a decrease in cryo-capacitation. Hypotaurine supplementation reduced chromatin decondensation, measured by chromomycin A3 (- 16.1%, p < 0.05), DNA fragmentation (- 18.7%, p < 0.05) and nuclear vacuolization (- 20.8%, p < 0.05).

Conclusion: Our study is the first to demonstrate beneficial effects of hypotaurine supplementation in preparation and freezing procedures on human spermatozoa sperm fertilization capacity and nucleus quality. Hypotaurine supplementation limited cryo-capacitation, increased the proportion of live and progressively motile spermatozoa and reduces the percentage of spermatozoa showing chromatin decondensation, DNA fragmentation and nuclear vacuolation.

Trial Registration: Clinical Trial, NCT04011813 . Registered 19 May 2019 - Retrospectively registered.
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http://dx.doi.org/10.1186/s12610-021-00144-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567682PMC
November 2021

Estimation of sample size in randomized controlled trials in multiple sclerosis studying annualized relapse rates: A systematic review.

Mult Scler 2021 Oct 26:13524585211052400. Epub 2021 Oct 26.

Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France.

Background: In multiple sclerosis (MS) studies, the most appropriate model for the distribution of the number of relapses was shown to be the negative binomial (NB) distribution.

Objective: To determine whether the sample-size estimation (SSE) and the analysis of annualized relapse rates (ARRs) in randomized controlled trials (RCTs) were aligned and compare the SSE between normal and NB distributions.

Methods: Systematic review of phase 3 and 4 RCTs for which the primary endpoint was ARR in relapsing remitting MS published since 2008 in pre-selected major medical journals. A PubMed search was performed on 30 November 2020. We checked whether the SSE and ARR analyses were congruent. We also performed standardized (fixed α/β, number of arms and overdispersion) SSEs using data collected from the studies.

Results: Twenty articles (22 studies) were selected. NB distribution (or quasi-Poisson) was used for SSE in only 7/22 studies, whereas 21/22 used it for ARR analyses. SSE relying on NB regression necessitated a smaller sample size in 21/22 of our calculations.

Conclusion: SSE was rarely performed using the most appropriate model. However, the use of an NB model is recommended to optimize the number of included patients and to be congruent with the final analysis.
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http://dx.doi.org/10.1177/13524585211052400DOI Listing
October 2021

Efficacy and safety of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for IgA nephropathy in children.

Pediatr Nephrol 2021 Oct 22. Epub 2021 Oct 22.

Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, 190, 2nd Floor, Room # 281, Belo Horizonte, MG, 30130-100, Brazil.

Background: IgA nephropathy (IgAN) is one of the most prevalent primary glomerulopathies in children. There are various studies investigating the efficacy of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in adults with IgAN. However, only few studies evaluated the efficacy of these medications in pediatric patients.

Objective: To evaluate the efficacy and safety of ACEI/ARB in children with IgAN.

Data Sources: Databases including PubMed, Web of Science, Cochrane, Scopus, and Google Scholar were searched between the 1st of April and 20th of July of 2021 using the keywords "IgA Nephropathy," "Berger's Disease," "Angiotensin-Converting Enzyme Inhibitors," "Angiotensin Receptor Antagonists," "Angiotensin II Type 1 Receptor Blockers," and similar entry terms collected from the Medical Subject Headings (MeSH).

Study Eligibility Criteria: Observational studies (case series, case-control, cohort, and cross-sectional) and clinical trials with descriptions of pediatric patients (under 19 years old) with histopathological diagnosis of IgA nephropathy and who received ACEI and/or ARB.

Participants And Interventions: Pediatric patients (under 19 years old) with histopathological diagnosis of IgA nephropathy and who received ACEI and/or ARB.

Study Appraisal: For quality assessment, the Risk of Bias 2 tool (RoB 2), the Risk Of Bias In Non-randomized Studies of Interventions tool (ROBINS-I), the National Institutes of Health (NIH) quality assessment tool, and the Newcastle-Ottawa Scale (NOS) were used.

Results: After recovering 1,471 studies, only eight, published between 2003 and 2019, met the eligibility criteria and were included in this systematic review. Of the 737 included children in the studies, 202 (25.8%) used ACEI/ARB and were compared with placebo and other therapy regimens. Of the seven studies that evaluated proteinuria, six reported an efficacy of ACEI/ARB in reducing this marker. ACEI/ARB also showed a possible effect in reducing hematuria and oxidative stress. The most common side effect was dizziness.

Limitations: The number of studies about the treatment with ACEI/ARB in children with IgAN is scarce. In addition, the studies are very heterogeneous. There are few studies that compared ACEI/ARB with placebo.

Conclusions And Implications Of Key Findings: The use of ACEI and/or ARB appears to be safe and to reduce proteinuria in pediatric patients with IgAN. Nonetheless, further randomized controlled trials, with greater methodological rigor and longer follow-up time, are required to establish the efficacy and safety of this therapy in this population.

Systematic Review Registration Number: The protocol of this systematic literature review was registered in PROSPERO under the number CRD42021245375, and in the OSF registries ( https://osf.io/qft4z/ ) with the registration https://doi.org/10.17605/OSF.IO/VADYR . A higher resolution version of the Graphical abstract is available as Supplementary information.
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http://dx.doi.org/10.1007/s00467-021-05316-0DOI Listing
October 2021

Critical Drug Loss Induced by Silicone and Polyurethane Implantable Catheters in a Simulated Infusion Setup with Three Model Drugs.

Pharmaceutics 2021 Oct 16;13(10). Epub 2021 Oct 16.

Université Clermont Auvergne, CHU Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, F-63000 Clermont-Ferrand, France.

Silicone and polyurethane are biocompatible materials used for the manufacture of implantable catheters, but are known to induce drug loss by sorption, causing potentially important clinical consequences. Despite this, their impact on the drugs infused through them is rarely studied, or they are studied individually and not part of a complete infusion setup. The aim of this work was to experimentally investigate the drug loss that these devices can cause, on their own and within a complete infusion setup. Paracetamol, diazepam, and insulin were chosen as models to assess drug sorption. Four commonly used silicone and polyurethane catheters were studied independently and as part of two different setups composed of a syringe, an extension set, and silicone or polyurethane implantable catheter. Simulated infusion through the catheter alone or through the complete setup were tested, at flowrates of 1 mL/h and 10 mL/h. Drug concentrations were monitored by liquid chromatography, and the silicone and polyurethane materials were characterized by ATR-IR spectroscopy and Zeta surface potential measurements. The losses observed with the complete setups followed the same trend as the losses induced individually by the most sorptive device of the setup. With the complete setups, no loss of paracetamol was observed, but diazepam and insulin maximum losses were respectively of 96.4 ± 0.9% and 54.0 ± 5.6%, when using a polyurethane catheter. Overall, catheters were shown to be the cause of some extremely high drug losses that could not be countered by optimizing the extension set in the setup.
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http://dx.doi.org/10.3390/pharmaceutics13101709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8539077PMC
October 2021

Preoperative REM Sleep Behavior Disorder and Subthalamic Nucleus Deep Brain Stimulation Outcome in Parkinson Disease 1 Year After Surgery.

Neurology 2021 Nov 19;97(20):e1994-e2006. Epub 2021 Oct 19.

From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France.

Background And Objectives: To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD.

Methods: We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD-) probable RBD preoperatively.

Results: At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years; = 0.02), had less motor impairment (Movement Disorder Society-sponsored version of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] III "off": 38.7 ± 16.2 vs 43.4 ± 7.1; = 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; < 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4; = 0.003), and had worse quality of life (Parkinson's Disease Questionnaire-39: 33 ± 12 vs 29 ± 12; = 0.03), as compared to pre-opRBD- patients. Both pre-opRBD+ and pre-opRBD- patients had significant MDS-UPDRS IV score decrease (-37% and -33%, respectively), MDS-UPDRS III "med 'off'/stim 'on'" score decrease (-52% and -54%), and dopaminergic treatment decrease (-52% and -49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes.

Conclusions: In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery.

Trial Registration Information: NCT02360683.

Classification Of Evidence: This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery.
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http://dx.doi.org/10.1212/WNL.0000000000012862DOI Listing
November 2021

Effects of a Short Daytime Nap on the Cognitive Performance: A Systematic Review and Meta-Analysis.

Int J Environ Res Public Health 2021 09 28;18(19). Epub 2021 Sep 28.

CNRS, INSERM, GReD, University Hospital of Clermont-Ferrand, Ophthalmology, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France.

Background: Napping in the workplace is under debate, with interesting results on work efficiency and well-being of workers. In this systematic review and meta-analysis, we aimed to assess the benefits of a short daytime nap on cognitive performance.

Methods: PubMed, Cochrane Library, ScienceDirect and PsycInfo databases were searched until 19 August 2021. Cognitive performance in working-aged adults, both before and following a daytime nap or under control conditions (no nap), was analysed by time and by type of cognitive function (alertness, executive function and memory).

Results: We included 11 studies (all in laboratory conditions including one with a subgroup in working conditions) for a total of 381 participants. Mean duration of nap was 55.4 ± 29.4 min. Overall cognitive performance did not differ at baseline (t0) between groups (effect size -0.03, 95% CI -0.14 to 0.07), and improved in the nap group following the nap (t1) (0.18, 0.09 to 0.27), especially for alertness (0.29, 0.10 to 0.48). Sensitivity analyses gave similar results comparing only randomized controlled trials, and after exclusion of outliers. Whatever the model used, performance mainly improved until 120 min after nap, with conflicting results during the sleep inertia period. Early naps in the afternoon (before 1.00 p.m.) gave better cognitive performance (0.24, -0.07 to 0.34). The benefits of napping were independent of sex and age. Duration of nap and time between nap and t1 did not influence cognitive performance.

Conclusions: Despite the fact that our meta-analyses included almost exclusively laboratory studies, daytime napping in the afternoon improved cognitive performance with beneficial effects of early nap. More studies in real work condition are warranted before implementing daytime napping at work as a preventive measure to improve work efficiency.
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http://dx.doi.org/10.3390/ijerph181910212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507757PMC
September 2021

Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and meta-analysis.

Pharmacol Res Perspect 2021 10;9(5):e00844

Department of General Practice, Clermont Auvergne University, Clermont-Ferrand, France.

This review aims to assess the benefits and adverse effects of sacubitril/valsartan in heart failure, with a focus on important patient outcomes. A systematic review was conducted of double-blind randomized controlled trials (RCTs) comparing sacubitril/valsartan versus a reference drug, in heart failure patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction, published in French or English. Searches were undertaken of Medline, Cochrane Central, and Embase. The primary outcomes were all-cause mortality and adverse events. From 2 082 articles analyzed, 5 were included. For all-cause mortality, the absolute numbers for HFrEF (2 RCTs, 4627 patients) were 16% on sacubitril/valsartan and 18% on enalapril, with a risk ratio (RR) of 0.85 [CI = 0.78, 0.93], and 13% vs 14% in with HFpEF (2 RCTs, 5097 patients), with no statistical difference. Under the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the evidence for HFrEF patients was of moderate quality. For HFrEF patients, an increased risk of symptomatic hypotension and angioedema (low quality of evidence) was shown. There was no statistical difference for the risk of hyperkalemia or worsening renal function. There was a protective RR (0.50 [0.34, 0.75]) for worsening renal function for patients with HFpEF, with a high quality of evidence despite similar absolute numbers (1.4% vs. 2.8%). To keep in mind for shared decision-making, sacubitril/valsartan reduces all-cause mortality in HFrEF patients but for HFpEF further data are needed. Take into consideration the small number of studies to date to assess the risks.
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http://dx.doi.org/10.1002/prp2.844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495680PMC
October 2021

The major worldwide stress of healthcare professionals during the first wave of the COVID-19 pandemic - the international COVISTRESS survey.

PLoS One 2021 6;16(10):e0257840. Epub 2021 Oct 6.

Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont-Ferrand, France.

Introduction: The COVID-19 pandemic has initiated an upheaval in society and has been the cause of considerable stress during this period. Healthcare professionals have been on the front line during this health crisis, particularly paramedical staff. The aim of this study was to assess the high level of stress of healthcare workers during the first wave of the pandemic.

Materials And Methods: The COVISTRESS international study is a questionnaire disseminated online collecting demographic and stress-related data over the globe, during the pandemic. Stress levels were evaluated using non-calibrated visual analog scale, from 0 (no stress) to 100 (maximal stress).

Results: Among the 13,537 individuals from 44 countries who completed the survey from January to June 2020, we included 10,051 workers (including 1379 healthcare workers, 631 medical doctors and 748 paramedical staff). The stress levels during the first wave of the pandemic were 57.8 ± 33 in the whole cohort, 65.3 ± 29.1 in medical doctors, and 73.6 ± 27.7 in paramedical staff. Healthcare professionals and especially paramedical staff had the highest levels of stress (p < 0.001 vs non-healthcare workers). Across all occupational categories, women had systematically significantly higher levels of work-related stress than men (p < 0.001). There was a negative correlation between age and stress level (r = -0.098, p < 0.001). Healthcare professionals demonstrated an increased risk of very-high stress levels (>80) compared to other workers (OR = 2.13, 95% CI 1.87-2.41). Paramedical staff risk for very-high levels of stress was higher than doctors' (1.88, 1.50-2.34). The risk of high levels of stress also increased in women (1.83, 1.61-2.09; p < 0.001 vs. men) and in people aged <50 (1.45, 1.26-1.66; p < 0.001 vs. aged >50).

Conclusions: The first wave of the pandemic was a major stressful event for healthcare workers, especially paramedical staff. Among individuals, women were the most at risk while age was a protective factor.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257840PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8494302PMC
October 2021

Impact of obesity in kidney transplantation: a prospective cohort study from French registries between 2008 and 2014.

Nephrol Dial Transplant 2021 Oct 5. Epub 2021 Oct 5.

Service de Néphrologie, Dialyse et Transplantation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.

Background: The access of obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis. The aim of this study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes.

Methods: We carried out a prospective cohort study using two French registries REIN and CRISTAL on 7 270 kidney transplant patients between 2008 and 2014 in France. We compared obese patients with non-obese patients and obese patients who lost more than 10% of weight before the transplant (Obese WL and Obese nWL).

Results: The mean BMI in our obese patients was 32 kg/m2. Graft survival was lower in obese patients than in non-obese patients (HR = 1.40, IC 95% [1.09; 1.78], P = 0.007) whereas patient survival was similar (HR = 0.94, IC 95% [0.73; 1.23], P = 0.66). Graft survival was significantly lower in Obese WL than in Obese nWL (HR = 2.17, CI 95% [1.02; 4.63], P = 0.045) whereas patient survival was similar in the two groups (HR = 0.79, IC 95% [0.35; 1.77], P = 0.56).

Conclusion: Grade I obesity does not seem to be a risk factor for excess mortality after kidney transplantation and should not be an obstacle to having access to a graft. Weight loss before a kidney transplant in this patients should not be essential for registration on waiting list.
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http://dx.doi.org/10.1093/ndt/gfab277DOI Listing
October 2021

Systematic review and meta-analysis of early removal of urinary catheter after colorectal surgery with infraperitoneal anastomosis.

Langenbecks Arch Surg 2021 Oct 2. Epub 2021 Oct 2.

Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France.

Aim Of The Study: To review and to analyse the feasibility of using no urinary catheter or a catheter for less than 24 h compared with longer post-operative catheter after colorectal surgery with infraperitoneal dissection.

Methods: We performed a systematic review and meta-analysis of studies comparing no urinary catheter or a catheter for less than 24 h (early removal, ER) and urinary catheter drainage for 2 days or longer (late removal, LR) after colorectal surgery with infraperitoneal dissection. Primary endpoint was acute urinary retention (AUR) requiring a re-catheterization. Secondary endpoints were urinary tract infection (UTI), overall morbidity and hospital length of stay. Meta-analysis met the PRISMA criteria, with a random model.

Results: Out of 3659 articles found, 82 comparative studies on catheter duration were selected, of which five were in colorectal surgery: three randomized trials, one retrospective and one prospective series. There were 396 ER and 410 LR patients. All had undergone surgery with infraperitoneal dissection. There was no significant difference regarding AUR (OR = 2.09 [95%CI 0.97-4.52]) but significantly less UTI (OR = 0.39 [95%CI 0.22-0.67]) for early urinary catheter removal. The number needed to harm was much higher for AUR than for UTI (23.3 vs. 8).

Conclusion: This meta-analysis suggests that, in terms of benefit/risk ratio, in colorectal surgery with infraperitoneal anastomosis, early removal (< 24 h) of the urinary catheter would be beneficial (because of a more frequent UTI after LR than AUR after ER) and would reduce the occurrence of UTI if no AUR risk factors are present. However, these findings should be interpreted with caution because of the low quality of evidence.
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http://dx.doi.org/10.1007/s00423-021-02342-2DOI Listing
October 2021

TiONTs bio-inspired coatings: revisiting electrochemical, morphological, structural, and mechanical properties.

Nanotechnology 2021 Oct 22;33(2). Epub 2021 Oct 22.

Chemistry Graduate Program, Campus CEDETEG, Midwestern Parana State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia, 85040-167, Guarapuava, Brazil.

By altering some synthesis variables, the morphology and structural properties of anodic TiOnanotube arrays (TiONTs) can be tailored to a specific application. This study aims to investigate the effect of electrolyte-containing ions from human plasma and annealing temperature on structural, morphological, and mechanical parameters of TiONTs films, targeting its potential biomedical applications. Bio-inspired TiONTs were grown from Tiand its Ti6Al4V alloy by potentiostatic anodization in the recently developed SBF-based electrolyte, maintained at 10 °C and 40 °C. The thermal investigation was performed by TGA/DSC and used to define the phase transition temperatures used for annealing (450 °C and 650 °C). Morphological and structural parameters were evaluated by FE-SEM, XRD, contact angle measurements, and nanoindentation. Results show that self-organized as-formed TiONTs were grown under all synthesis conditions with different wettability profiles for each substrate group. At 450 °C annealing temperature, the beginning of nanostructures collapse starts, becoming evident at 650 °C. The nanoindentation characterization reveals that both electrolyte and thermal annealing exhibited low effects on the hardness and Young's modulus. The tailoring of specific properties by different synthesis conditions could allow the individualization of treatments and better performance.
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http://dx.doi.org/10.1088/1361-6528/ac2b6bDOI Listing
October 2021

Allograft and autograft provide similar retear rates for the management of large and massive rotator cuff tears: a review and meta-analysis.

Knee Surg Sports Traumatol Arthrosc 2021 Sep 29. Epub 2021 Sep 29.

Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France.

Purpose: Currently, autografts and allografts are largely used to treat large or massive rotator cuff tear (RCT), without any evidence in favour of one graft or the other. The purpose of this study was to determine the rate of retear of autograft and allograft in the treatment of large or massive posterosuperior RCT.

Method: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating clinical and radiological results of surgical treatment with autograft or allograft for large or massive RCT since 2008. The main criterion was the retear rate of the graft assessed on MRI or US scan at 1-year minimum follow-up. Partial tear were classified as "tear".

Results: The overall retear rate was 23.6% (15.5-32.7) at a mean follow-up of 18.4 ± 7.8 (12-36) months. There was no significant difference between the two kinds of graft, with a retear rate of 27.0% (15.4-40.2) and 20.9% (9.9-34.2) with autograft and allograft respectively (n.s.). Similar improvements of functional scores (+ 28.8 to 38.4 points for the Constant score, + 33.6 to 38.4 points for the ASES, and - 4.0 to - 4.1 points for pain-VAS) were reported in the two groups after at 27.2 ± 11.1 (12-48) months. The rate of complications except retear was 1.8% (0.2, 3.7) with autograft and 0.5% (0.8, 1.8) with allograft (n.s.).

Conclusion: The use of autograft and allograft for the treatment of large or massive RCT leads to similar retear rate and clinical outcomes at short to medium terms.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00167-021-06745-yDOI Listing
September 2021

Portuguese Football Federation consensus statement 2020: nutrition and performance in football.

BMJ Open Sport Exerc Med 2021 26;7(3):e001082. Epub 2021 Aug 26.

Portugal Football School, Portuguese Football Federation, Cruz Quebrada, Portugal.

Nutrition is an undeniable part of promoting health and performance among football (soccer) players. Nevertheless, nutritional strategies adopted in elite football can vary significantly depending on culture, habit and practical constraints and might not always be supported by scientific evidence. Therefore, a group of 28 Portuguese experts on sports nutrition, sports science and sports medicine sought to discuss current practices in the elite football landscape and review the existing evidence on nutritional strategies to be applied when supporting football players. Starting from understanding football's physical and physiological demands, five different moments were identified: preparing to play, match-day, recovery after matches, between matches and during injury or rehabilitation periods. When applicable, specificities of nutritional support to young athletes and female players were also addressed. The result is a set of practical recommendations that gathered consensus among involved experts, highlighting carbohydrates periodisation, hydration and conscious use of dietary supplements.
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http://dx.doi.org/10.1136/bmjsem-2021-001082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395276PMC
August 2021

Sleep in children and adolescents with juvenile idiopathic arthritis: a systematic review and meta-analysis of case-control studies.

Sleep 2021 Sep 15. Epub 2021 Sep 15.

Université de Toulon, Laboratoire IAPS, Toulon, France.

Study Objectives: Juvenile idiopathic arthritis (JIA) is one of the most common pediatric rheumatic disease. However, sleep alteration associated with this auto-immune disease remain unclear. We aimed in this systematic review and meta-analysis to compare sleep duration, quality, and architecture in JIA subjects with those in their healthy peers.

Methods: Systematic search performed in PubMed, EMBase, Cochrane, and PsycINFO databases included 19 studies in the qualitative synthesis of which 10 met the inclusion criteria for the meta-analysis.

Results: Pooled results from subjective methods indicated pronounced sleep disturbances and complaints in youth with JIA compared with their healthy counterparts. This was further confirmed by Increased difficulty maintaining sleep (wake after sleep onset; SMD: -0.69; CI: -1.29; -0.09, p =0.02) and a tendency to increased difficulty initiating sleep (sleep onset latency; SMD: -0.29; CI: -0.60; 0.03, p =0.07). There were no remarkable differences in sleep duration or sleep architecture between JIA patients and healthy controls. High heterogeneity was found for several outcomes. This could be explained by the different methods used as well as associated sleep disorders, medication and comorbidities.

Conclusions: Although included studies were methodologically diverse, the summarized results of our review and meta-analysis bring evidence that children with JIA present more fragmented sleep compared to healthy peers. Thereby, the implementation of strategies to manage and improve sleep in this population are needed and might have a beneficial effect on the symptoms and functions of JIA.
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http://dx.doi.org/10.1093/sleep/zsab233DOI Listing
September 2021

Impact of the COVID-19 confinement on movement behaviors among French young children: the ONAPS national survey.

Minerva Pediatr (Torino) 2021 09 13. Epub 2021 Sep 13.

National Observatory for Physical Activity and Sedentary behaviors (ONAPS), Clermont-Ferrand, France -

Background: The present study examines the effects of the COVID-19 confinement on healthrelated behaviors (physical activity, sedentary behaviors) of young French children.

Methods: Parents of 348 French children under 6 years of age completed an online survey launched during the first days of the initial COVID-19-related confinement. They were asked to indicate whether their kids increased, decreased or maintained their physical activity level, time spent in sedentary behaviors, and sleep time. Information regarding the configuration of their home environment (access to outdoor facilities, implantation area) and lifestyle habits (solitary activity, parents' solicitation; nap time; night waking episodes and night duration) were also collected.

Results: A total of 25.0% of the children were reported to decrease, 24.7% maintained and 50.3% increase their physical activity during the confinement. Greater proportions of kids who had access to a collective (51.4%) or individual (53.7%) outdoor area increased their physical activity. Regardless of the housing situation (urban, suburban or rural) or access to outdoor facilities, the majority of children increased their screen time (60.4%). Two-thirds (66.7%) of parents reported nap time remained unchanged for their kids. Fifty-one percent of parents admitted a link between teleworking and their kids' screen time.

Conclusions: Health behaviors were differentially impacted in very young kids during a confinement period. Importantly, a majority of parents admitted a causal effect of telecommuting on their kids' screen exposure. The present results also show that the proneness to increase physical activity during confinement is positively related to access to a favorable outdoor environment.
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http://dx.doi.org/10.23736/S2724-5276.21.06194-2DOI Listing
September 2021

Infrared augmented reality device versus standard procedure for peripheral venous catheterisation in children less than 3 years old: A quasi-experimental cluster randomised controlled trial.

J Clin Nurs 2021 Aug 29. Epub 2021 Aug 29.

CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, Clermont-Ferrand, France.

Aim And Objective: The objective of this study was to evaluate the AccuVeinAV400® viewing device for peripheral venous catheter insertion in children on the first try.

Background: Inserting a peripheral venous catheter is the most frequent invasive procedure carried out by healthcare professionals in hospitalised children. Several attempts are sometimes necessary, and veins can be damaged.

Design: A quasi-experimental cluster randomised controlled trial based on the CONSORT 2010 guidelines.

Methods: This randomised study comparing standard practice to the use of AccuVein400 was carried out on children who were less than 3 years old, with difficult intravenous access (DIVA Score), hospitalised in three paediatric units and who needed cannulation.

Result: A total of 304 children were included (156 in the AccuVein arm and 148 in the standard arm). There was no significant difference between AccuVein and standard groups in age (respectively, 2.5 ± 0.9 years vs. 2.5 ± 0.8), or mean DIVA score (respectively 5.9 ± 1.3 vs. 5.5 ± 1.2). The success of cannulation on the first attempt was 40.38% in the AccuVein arm vs. 41.2% in the standard arm (p = .6). The caregiver's assessment of pain on the Face Legs Activity Cry Consolability scale was 4.8 ± 0.2 in the AccuVein arm vs. 5.0 ± 0.2 (p = .4).

Conclusions: The use of AccuVein400® did not lead to greater success in intravenous insertion at the first attempt in children under 3 years of age with difficult intravenous access.

Relevance To Clinical Practice: This device can therefore be used according to the healthcare professionals' situation and needs. It is widely used in paediatric wards, and our study shows that it offers a support tool that reassures healthcare professionals and helps validate their choice of vein easiest to catheterise.
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http://dx.doi.org/10.1111/jocn.16017DOI Listing
August 2021

Organ-on-Chip Approaches for Intestinal 3D In Vitro Modeling.

Cell Mol Gastroenterol Hepatol 2021 Aug 25. Epub 2021 Aug 25.

Institute for Research and Innovation in Health, Instituto de Investigação e Inovação em Saúde, Porto, Portugal; IPATIMUP, Institute of Molecular Pathology and Immunology, Porto, Portugal. Electronic address:

The intestinal epithelium has one of the highest turnover rates in the human body, which is supported by intestinal stem cells. Culture models of intestinal physiology have been evolving to incorporate different tissue and microenvironmental elements. However, these models also display gaps that limit their similarity with native conditions. Microfluidics technology arose from the application of microfabrication techniques to fluid manipulation. Recently, microfluidic approaches have been coupled with cell culture, creating self-contained and modular in vitro models with easily controllable features named organs-on-chip. Intestine-on-chip models have enabled the recreation of the proliferative and differentiated compartments of the intestinal epithelium, the long-term maintenance of commensals, and the intraluminal perfusion of organoids. In addition, studies based on human primary intestinal cells have shown that these systems have a closer transcriptomic profile and functionality to the intestine in vivo, when compared with other in vitro models. The design flexibility inherent to microfluidic technology allows the simultaneous combination of components such as shear stress, peristalsis-like strain, 3-dimensional structure, oxygen gradient, and co-cultures with other important cell types involved in gut physiology. The versatility and complexity of the intestine-on-chip grants it the potential for applications in disease modeling, host-microbiota studies, stem cell biology, and, ultimately, the translation to the pharmaceutical industry and clinics as a reliable high-throughput platform for drug testing and personalized medicine, respectively. This review focuses on the physiological importance of several components that have been incorporated into intestine-on-chip models and highlights interesting features developed in other types of in vitro models that might contribute to the refinement of these systems.
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http://dx.doi.org/10.1016/j.jcmgh.2021.08.015DOI Listing
August 2021

Development, Characterization and Cell Viability Inhibition of PVA Spheres Loaded with Doxorubicin and 4'-Amino-1-Naphthyl-Chalcone (D14) for Osteosarcoma.

Polymers (Basel) 2021 Aug 6;13(16). Epub 2021 Aug 6.

Biotechnology Unit, University of Ribeirão Preto, Ribeirão Preto 14096-900, SP, Brazil.

Chalcones (1,3-diaryl-2-propen-1-ones) are naturally occurring polyphenols with known anticancer activity against a variety of tumor cell lines, including osteosarcoma (OS). In this paper, we present the preparation and characterization of spheres (~2 mm) from polyvinyl alcohol (PVA) containing a combination of 4'-Amino-1-Naphthyl-Chalcone (D14) and doxorubicin, to act as a new polymeric dual-drug anticancer delivery. D14 is a potent inhibitor of osteosarcoma progression and, when combined with doxorubicin, presents a synergetic effect; hence, physically crosslinked PVA spheres loaded with D14 and doxorubicin were prepared using liquid nitrogen and six freeze-thawing cycles. Physical-chemical characterization using a scanning electron microscope (SEM), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) presented that the drugs were incorporated into the spheres via weak interactions between the drugs and the polymeric chains, resulting in overall good drug stability. The cytotoxicity activity of the PVA spheres co-encapsulating both drugs was tested against the U2OS human osteosarcoma cell line by 3- (4,5-dimethylthiazol-2-yl) -2,5-diphenyltetrazolium bromide (MTT) assay, and compared to the spheres carrying either D14 or doxorubicin alone. The co-delivery showed a cytotoxic effect 2.6-fold greater than doxorubicin alone, revealing a significant synergistic effect with a coefficient of drug interaction (CDI) of 0.49. The obtained results suggest this developed PVA sphere as a potential dual-drug delivery system that could be used for the prominent synergistic anticancer activity of co-delivering D14 and doxorubicin, providing a new potential strategy for improved osteosarcoma treatment.
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http://dx.doi.org/10.3390/polym13162611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401585PMC
August 2021
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