Central Paris Research Articles

Sexual behaviors and risk of extended-spectrum β-lactamase-producing Enterobacterales carriage: a cross-sectional analysis

Sexual transmission of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) is suspected. We aimed to identify clusters of sexual behavior associated with ESBL-E carriage among individuals at risk of sexually transmitted infections (STI). In this cross-sectional study, patients attending an STI-screening center and HIV outpatient clinic in Paris, France between 2018-2019 were asked questions on the following sexual activities in the last 6 months: receptive/insertive anal intercourse, passive/active rimming, receptive/insertive fellatio, receptive/insertive fisting, receptive/insertive fingering, active/passive cunnilingus. ESBL-E carriage was determined from rectal swabs. Bayesian latent class analysis was used to identify clusters of sexual activity, which were then associated with ESBL-E carriage using logistic regression. Among 1211 men who have sex with men (MSM), those belonging to two latent classes with higher prevalence of insertive fingering and active rimming (ESBL-E prevalence=15.3%, N=124 and 16.0%, N=100) and one class with higher proportions of all behaviors (24.3%, N=70) had a higher risk of ESBL-E carriage compared to those in a class with few sexual behaviors (7.3%, N=259) after adjustment. Among 439 other men and 479 women, no clear associations between sexual clusters and ESBL-E carriage were observed. Sexual behaviors are associated with varying degrees of ESBL-E carriage, particularly among MSM.

Medically assisted reproduction (MAR) with sperm donation: Comparison of the profiles and medical pathways of unmarried women and women in heterosexual couples

Research questionThe legislation allowing unmarried women to undergo medically assisted reproduction (MAR) with sperm donation was adopted in France on August 2, 2021. This major advancement, and its impact on French society, led us to a closer examination of the requests made by unmarried women and the outcomes of ART attempts. DesignA retrospective single center cohort study was conducted in a fertility center in Paris, France. All unmarried women and women in heterosexual couple seeking for MAR using sperm donation between September 2021 and October 2022 were included. Medical and socio-demographic data, as well as details and outcomes of MAR attempts were analyzed until October 31, 2023. ResultsTwo hundred seventy-two unmarried women and 76 women in heterosexual couple were included. Results were compared between the two groups. Unmarried women were significantly older, with a significant decrease in anti-Müllerian hormone (AMH) and antral follicle count (AFC). They also exhibited a higher prevalence of gynecological pathologies associated with infertility, such as endometriosis. Unmarried women were more likely to work in intermediate occupations, whereas women in heterosexual couple more often had employee status. Among unmarried women who had undergone at least one MAR attempt by October 31, 2023, significantly lower cumulative early and ongoing pregnancy rates were observed. ConclusionsFemale age appears to play a major role in the likehood of pregnancy and live birth. It is therefore crucial to inform women initiating the process of MAR with sperm donation that success is not guaranteed.

Treatment modalities of marginal zone lymphoma and overall survival, haematological response, and underlying Sjögren's disease activity: a multicentre, retrospective, observational study

Sjögren's disease is the autoimmune disease with the highest risk of lymphoma development. There is no consensus on the optimal way to manage Sjögren's disease complicated by lymphoma. We aimed to describe characteristics, therapeutic strategies, and outcomes of non-Hodgkin lymphoma associated with Sjögren's disease, and their effect on lymphoma and Sjögren's disease prognoses. We did a multicentre, retrospective, observational study including patients with Sjögren's disease according to the 2016 American College of Rheumatology-European League Against Rheumatism criteria who did not fulfil diagnostic criteria for other connective tissue diseases. We included patients with a lymphoma diagnosis made before Jan 1, 2020, from two expert centres in Paris (France); from the French, multicentre, prospective Assessment of Systemic Signs and Evolution of Sjögren's Syndrome cohort; and via practitioners registered with the Club Rhumatismes et Inflammation. Using inverse probability of treatment weighting, the effect of lymphoma treatment was compared in relation to three endpoints: lymphoma progression-free survival, new Sjögren's disease systemic activity, and overall survival. Exploratory analyses also aimed to identify factors associated with lymphoma relapse, new Sjögren's disease systemic activity, and overall survival. People with lived experience were not involved in this research. 106 patients with Sjögren's disease who developed lymphoma were included in the study. The most frequent histological subtype was mucosa-associated lymphoid tissue lymphoma (68 [64%] of 106 patients), followed by other marginal zone subtypes (14 [13%] of 106 patients) and diffuse large B-cell lymphoma (14 [13%] of 106 patients). Among the 82 patients with marginal zone lymphoma (72 [88%] women and ten (12%) men; mean age at lymphoma diagnosis 57·5 years [SD 14·8]), multivariable analysis showed that pulmonary localisation was associated with mortality (hazard ratio [HR] 7·92 [95% CI 1·70-37·0]). A watch and wait approach was proposed in 19 (23%) of 82 patients with marginal zone lymphoma, 13 (16%) had first-line localised treatment (surgery or radiotherapy), and 50 (61%) had first-line systemic treatment. After a median follow-up of 7 years, 26 patients (32%) had lymphoma relapse, nine (11%) died, and 27 (33%) had new Sjögren's disease systemic activity. After inverse probability of treatment weighting, patients with systemic treatment at lymphoma diagnosis had a reduced risk of new Sjögren's disease activity (HR 0·43 [95% CI 0·21-0·90]). When comparing patients treated with a combination of chemotherapy and anti-CD20 therapy (n=32) with patients treated with monotherapy (n=18) as a first-line therapy for lymphoma, lymphoma-progression-free survival was improved in patients treated with combination therapy (HR 0·36 [95% CI 0·14-0·94]). The were no differences in new Sjögren's disease systemic activity or overall survival according to combination therapy or monotherapy. A systemic treatment strategy for Sjögren's disease-associated lymphoma, rather than localised treatment or a watch and wait strategy, reduces the risk of new Sjögren's disease systemic activity and combination therapy is associated with decreased risk of lymphoma relapse. None.

“#AsiatiquesDeFrance”: confronting anti-Asian racism in contemporary France through digital media

Anti-Asian racism and violence have escalated around the world, coinciding with the start of the COVID-19 pandemic. Yet, in France, racially motivated violence against people perceived as “Asian” was already on the rise, even before the pandemic. Frustrated by the lack of public outrage and the inaction of government authorities, people of Asian heritage in France – who have come from a diverse range of countries, over several generations – have begun mobilizing collectively in new and more ambitious ways. Young people, in particular, have taken to the internet. Using social media platforms, they have not only organized in-person events, including protest marches in central Paris that have numbered in the tens of thousands of people, but have also cultivated online communities focusing on racial solidarity with just as many followers. Social media accounts, hashtags, YouTube webseries, podcasts, and internet-based projects aiming to combat anti-Asian racism while also promoting intersectional racial justice, have thus proliferated in the past few years. This article examines a few prominent examples of these works, including the viral video “#AsiatiquesDeFrance” (2017), to argue that all of these forms convey common messages that deal explicitly with issues of cultural assimilation, national belonging, racial othering, and racism faced by people of Asian heritage in France.

Enterococcal endocarditis management and relapses.

Enterococcus faecalis is the third micro-organism causing endocarditis and is associated with a significant relapse rate. The objective of this study was to describe the management of patients with Enterococcus faecalis endocarditis (EE) and its implication for relapses. We conducted a monocentric, retrospective analysis of all patients hospitalized for EE including endocarditis or infection of cardiac implantable electronic device defined by the modified ESC 2015 Duke criteria in a referral centre in Paris, France. Between October 2016, and September 2022, 54 patients with EE were included, mostly men (n = 40, 74%) with a median age of 75 [68-80] years. A high risk for infective endocarditis (IE) was found in 42 patients (78%), including 14 (26%) previous histories of IE, and 32 (59%) histories of valvular cardiac surgery. The aortic valve was the most frequently affected (n = 36, 67%). Combination therapy was mainly amoxicillin-ceftriaxone during all the curative antibiotic therapy duration (n = 31, 57%). Surgery was indicated for 40 patients (74%), but only 27 (50%) were operated on, mainly due to their frailty. Among the 17 deaths (32%), six (11%) happened during the first hospitalization for EE. A suppressive antibiotic treatment was initiated in 15 (29%) patients, mostly because of not performing surgery. During the 6-year study period an EE relapse occurred in three (6%) patients. EE is a worrying disease associated with a high risk of relapse and significant mortality. Suppressive antibiotic therapy could be a key treatment to limit the occurrence of relapses.

Refractive outcomes of Carlevale IOLs compared to Artisan iris-claw IOLs considering the type of incision

Refractive outcomes of Carlevale IOLs compared to Artisan iris-claw IOLs considering the type of incision

Maintenance oxytocin in the immediate postpartum period: Frequency, determinants and practices in a tertiary maternity unit

ObjectiveTo prevent post-partum haemorrhage (PPH), national and international guidelines recommend the administration of a prophylactic injection of oxytocin after all vaginal births. Although additional maintenance oxytocin is not recommended in the immediate postpartum, its administration is quite common (30 % of French births in 2021). To assess in a single center, the frequency and determinants associated with the administration of maintenance oxytocin in immediate postpartum. Study designA retrospective observational single-centre study was conducted in a tertiary-care university centre in Paris (France), with data from April-May 2022. All women who gave birth vaginally at or after 37 weeks, except for those with immediate PPH. Univariate and multivariate analysis were performed to compare determinants between the group receiving maintenance oxytocin and the control group without this intervention. A sensitivity analysis in a population of women at low risk of PPH was performed. Maternal, obstetrical, perinatal and organisational determinants were collected. ResultsThis study included 584 patients, 278 (47.6 %) of whom received maintenance oxytocin. We observed a significantly higher rate of maintenance oxytocin administration to parous women (OR 1.57, 90 %CI 1.09–2.27) and women with a history of PPH (OR 2.88, 90 %CI 1.08–9.08). Additional maintenance oxytocin was also administered more often when the midwife handling the birth had more than 5 years of practice since completion of training (OR 1.77, 1.24–2.53) or during night-time births (OR 1.47, 90 %CI 1.03–2.10). ConclusionMaintenance oxytocin administration is a frequent practice, performed for almost half the patients in our center. This practice is associated with maternal and obstetric factors, but also with health professionals' individual decisions and practices.

Management perspectives from patients with fibromyalgia experiences with the healthcare pathway: a qualitative study.

Fibromyalgia is a prevalent condition affecting 1-2% of the general population and can result in significant disability. Physicians and patients frequently encounter challenges in managing this condition. The aim of this study was to explore novel management approaches through a qualitative analysis of the doctor-patient relationship. Telephonic interviews were conducted with fibromyalgia patients to investigate their healthcare experiences. Qualitative analysis was performed on patients' narratives using interpretative phenomenological analysis, a methodology that delves into each individual's subjectivity. A total of 19 adult patients with fibromyalgia, primarily middle-aged women (84% women, mean age 49.8 years), recruited from two university centers in Paris, were included in the study. The narratives of participants revealed substantial suffering and considerable functional impairment, which is paradoxical for a condition often considered benign. They reported an ongoing sense of loss of control, exacerbated by an imbalanced patient-doctor relationship. Patients constantly feared not being heard or believed, and they frequently sought attention from their caregivers. Most participants displayed significant ambivalence toward the nature of their condition and actively sought causal links. Patients' adaptive strategies sometimes worsened their symptoms, as in the case of muscular deconditioning. The healthcare system appeared deficient in managing these patients, characterized by a lack of health professional training, frequent inappropriate responses from healthcare providers, and stigmatization of psychological conditions. Despite its perceived benign nature, fibromyalgia should be regarded as a severe condition due to its substantial long-term consequences. Participants reported a challenging experience with the doctor-patient relationship, marked by a strong sense of dependence and a lack of recognition. The care pathway for these patients appeared unsuitable and disorderly, potentially resulting in iatrogenic consequences. The management of patients with fibromyalgia should be enhanced and directed toward a patient-centered approach. The study provides practical recommendations regarding communication methods and patient care.

Impaired mitochondrial dynamics in the blood of patients with Alzheimer’s disease and Lewy body dementia

AbstractBackgroundMitochondrial dysfunction is an early event in Alzheimer’s disease (AD) physiopathology and may contribute to neuronal loss in several neurodegenerative diseases, such as Lewy body dementia (LBD). The role of mitochondrial dysfunction in AD have been mostly explored in brain post‐mortem tissues. These studies have particularly highlighted abnormal expression levels of mitochondrial fission and fusion protein. The balance between fission and fusion mechanisms is essential to maintain a pool of functional mitochondria inside the cell. Further studies suggest that this dysfunction may also be observed in immune cells, both in the central nervous system as in blood compartment.In this context, we investigate if mitochondrial dysfunction, in particularly, imbalance of mitochondrial fusion and fission could be detected in peripheral blood mononuclear cells (PBMCs) from AD and LBD patients compared to PBMCs from healthy control subjects.MethodOur study is a monocentric retrospective study, using blood derived PBMCs from AD, LBD patients and neurological controls followed at the Cognitive Neurology Center (CNC) in Paris. PBMCs were isolated and stored in Lariboisière hospital’s biobank. Mitochondrial protein level were measured using immunoblot technique.ResultOur results show a significant alteration of fusion (MFN2 and OPA1) and fission proteins level (FIS1) in PBMCs of AD and LBD patients.ConclusionThese new findings pave the way to explore the proteins implicated in mitochondrial homeostasis at peripheral levels, and may provide a new tool to follow the progression of mitochondrial dysfunction in neurodegenerative diseases.

Changes in the Immunogenetic Landscape with the Age of Disease Onset in Acquired Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria: An Analysis of a Cohort of Adult and Pediatric Patients from the French National Reference Center for Aplastic Anemia

Over the past decade, the role of HLA molecules in the pathophysiology of immune aplastic anemia (IAA) has been highlighted by the identification of somatic clonal losses of HLA molecules on leukocytes and the enrichment of certain HLA alleles in patients with AA compared to the general population. More recently, the analysis of the HLA Evolutionary Divergence (HED) score in a large US adult cohort showed that IAA patients were carrying class II HLA molecules whose antigen-binding sites were characterized by a high degree of structural homology and that low class II HED score was associated with a higher risk of malignant progression and poorer survival (Pagliuca et al., Blood, 2021). To evaluate these findings in an independent cohort, we conducted a retrospective study of a large cohort of adult and pediatric patients diagnosed with IAA and/or PNH included in 2 different centers in Paris from the French National Center for Aplastic Anemia (RIME observatory). Patients' 2-field HLA genotyping for HLA-A, -B, -C, -DRB1, -DQB1 and -DPB1 loci and HLA-DQA1 genotype imputations were compared with those of a control cohort of 593 allogeneic donors in the context of hematologic malignancies. The MidasHLA R package was used to assess HLA-disease associations using logistic regression analysis with a dominant inheritance model (Benjamini-Hochberg adjusted p-values). HED metrics, used as a surrogate for the width of the immunopeptidome presented by the patient's HLA molecules (Pierini and Lenz, Mol. Biol. Evol., 2018) were calculated for the different HLA loci and for the entire HLA class I and HLA class II genes (mean of HED scores for the corresponding loci). The cohort consisted of 449 patients who were children (<15 years of age, n=130), adolescents and young adults (15-25 years of age, n= 141), and adults (> 25 years of age, n= 178) at the time of diagnosis. Fifty-five percent had IAA, 28% had AA with a PNH clone, 8% had hepatitis-associated AA and 9% had hemolytic PNH. The distribution of diagnoses differed across age groups, with a decreasing incidence of hepatitis-associated AA and an increasing incidence of both AA/PNH and PNH with age. We first confirmed a strong association between patients and the DRB1*15:01, DQB1*06:02 and DQA1*01:02 alleles (these 3 alleles being in strong linkage disequilibrium) in addition to a few additional alleles at the DPB1 and B loci (Figure 1). This finding was consistent with several published studies in populations of different ethnicities. Using stepwise conditional testing, we then showed that only DQB1*06:02 (and DPB1*01:01 to a much smaller extent) remained associated with the disease (OR=2.49, adjusted p-value = 7.55E-09). Interestingly, the DQB1*06:02 association was lost when analyzing the subset of pediatric patients. Among patients, we then demonstrated a strong correlation between the age at disease onset and the presence of the DQB1*06:02 (Figure 2, exact Fisher's test, p=0.0005), DQA1*01:02 (p= 0.006) and DRB1*15:01 alleles (p< 0.0001). Intriguingly, we additionally found an overrepresentation of the ancestral A*01:01 B*08:01 DRB1*03:01 haplotype among patients with primary PNH (14.6%) compared to both patients with AA/PNH (2.4%, p=0.009) and controls (6.3%, p=0.083). Next, we investigated the HED metrics at the different HLA loci. There was no significant decrease in HED scores in patients compared to control, either at the DQB1, DQA1 and DRB1 loci or for the overall HED Class II score (mean value of HED-DRB1, -DQB1 and -DPB1), even in the subsets of DRB1*15:01 or DQB1*06:02 non-carriers. This result differed from the aforementioned US study, likely due to differences in geographic inclusion areas between the 2 cohorts. To rule out bias due to the inclusion of pediatric patients in our cohort, we then focused on the adult-onset subgroup and observed similar results. However, considering the entire cohort and despite no differences between patients and controls, we identified a strong association between age at onset and HED-B and HED-Class I (mean value of HED-A, -B and -C), with the divergence increasing with age (Kendall correlation test, p=0.001 and p=0.007, respectively). Taken together, these results highlight different immunogenetic landscapes according to the age of disease onset. We can hypothesize that the immune-mediated pathophysiological mechanisms may differ with age with a preponderant role of DQB1*06:02 appearing at later age of disease onset.

The Study of Historical Progression in the Distribution of Urban Commercial Space Locations—Example of Paris

Commercial space locations are a long-term investment for developers, and they are crucial for sustainable profitability. The distribution of commercial spaces in Paris has undergone a constant evolutionary process over the past few centuries, influenced by various socioeconomic factors. This study investigates the evolution of commercial space locations in Paris over three historical stages—1690, 1860, and 2023, using Space Syntax and Cluster Analysis. By examining the historical progression of Parisian commercial spaces from an urban planning perspective, this article aims to provide insights for urban developers to strategically plan for commercial spaces. The first part of the study is an analysis of the centrality and accessibility of commercial space locations within the urban street network using Space Syntax. Next, Cluster Analysis is employed to further examine the distribution patterns of commercial spaces with high centrality. By comparing the results from three different historical stages, the study reveals two major patterns. One is a full-scale optimization of commercial space centrality within the historical core of Paris. Another one is the fission and consolidation of commercial spaces into multi-centric clusters and a geographical dispersal from central Paris. Finally, a multi-disciplinary discussion is conducted to decode the socioeconomic motivations behind these patterns and provide guidance for future commercial planning.

Psychiatric burden in a cohort of adults with Niemann Pick type C disease: from psychotic symptoms to frontal lobe behavioral disorders

ObjectivesTo describe Niemann-Pick type C (NP-C) behavioral symptoms (focusing on psychotic symptoms) and its relation to frontal lobe functioning.MethodsWe retrospectively reviewed medical charts of NP-C-patients followed in the Lysosomal Diseases reference center in Paris Pitié-Salpêtrière. We collected demographic data, psychiatric clinical manifestations, psychometric scales, and extended neuropsychological data including executive and behavioral frontal lobe functions evaluations.ResultsNineteen patients were included in the study with ten of them having experienced at least one acute psychotic episode, being inaugural for six of them. Most of the patients suffered from behavioral (15/17) and cognitive disorders (18/19) (including executive dysfunction (11/12), apathy (13/17), impaired social cognition (11/13) and stereotyped behaviors (5/10). For five patients, quality of life was significantly impaired by these abnormal behaviors. Concerning frontal neuropsychological evaluation, Facial emotion recognition was by far the most performed neuropsychological test (n = 8) and the score was always abnormal. It is noteworthy that psychotic symptoms were often drug resistant (8/9) and that Miglustat was associated with a better control of psychotic symptoms.ConclusionsWe report a high frequency of psychiatric symptoms in NP-C encompassing acute psychotic manifestations, often presenting early in the course of the disease with atypical features. We also report disabling behavioral manifestations related to frontal dysfunction.

IgA nephropathy in children with minimal proteinuria: to biopsy or not to biopsy?

Tubulointerstitial lesions and glomerular inflammation severity have been shown to correlate with proteinuria in children with IgA nephropathy (cIgAN). However, there is a lack of data regarding severity of histopathologic findings in cIgAN in patients with minimal to absent proteinuria since kidney biopsy indications are not well defined in these cases. Twenty-eight cIgAN patients with kidney biopsy from 4 different centers in Paris (France) and Montreal (Canada) with a urine protein/creatinine ratio (UPCr) ≤ 0.03g/mmol and a normal estimated glomerular filtration rate (eGFR > 90ml/min/1.73 m2) on the day of kidney biopsy prior to treatment were included. Median age was 11.82 (9.32-13.45) years, and median follow-up was 4years (2.87-6.53). At time of biopsy, median eGFR was 116 (102.3-139.7) ml/min/1.73 m2, and median UPCr was 0.02 (0.011-0.03) g/mmol. Microscopic or macroscopic hematuria was present in 35.7% and 64.3% of cases, respectively. Kidney biopsy microscopy analysis showed mesangial (M1), endocapillary (E1), or extracapillary (C1) hypercellularity in 53.5%, 32.1%, and 7.1% of patients, respectively. Chronic histological lesions were also present: glomerulosclerosis (S1) in 42.8% and tubular atrophy/interstitial fibrosis in 7.1%. Podocytopathic features were detected in 21.4%. An ACE inhibitor or immunosuppressive therapy (IS) was prescribed in 42.8% and 21.4% of these patients respectively. One-third (35.7%) received no treatment. At last follow-up, median eGFR was 111.9 (90.47-136.1) ml/min/1.73 m2, and median UPCr was 0.028 (0.01-0.03) g/mmol. cIgAN with minimal proteinuria at time of biopsy might be linked with acute and chronic glomerular lesions.

Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease

Abstract Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.

“It's easier to make money.” The homeless youth of Châtelet-les-Halles, an extreme case of disadvantaged entrepreneurs within the informal economy

This article examines homeless youth as a specific category of disadvantaged entrepreneurs in the Châtelet-les-Halles district in central Paris. It proceeds by showing how the investigation into the informal economic activities of homeless youth, examined through the lens of disadvantaged entrepreneurship and geography, represents a novel research area, particularly within the Parisian context. It is distinguished by its original four-year ethnographic and geographic methodology, encompassing street observations, recorded and unrecorded interviews, and the use of Facebook and geographic information systems to observe and understand 10 homeless youths and their environment. After presenting and exploring the sociological, economic, and geographic context of Châtelet-les-Halles, specifically focusing on the activities of homeless youth, the article provides an analysis of the informal entrepreneurial endeavors pursued by these individuals. Finally, the discussion articulates the notion of geographical context with entrepreneurial creativity and resilience, to better understand how informal entrepreneurial activities are developed in urban environments.

Epidemiological features of ophthalmic emergencies during the COVID-19 lockdown: Impact of the health crisis in a tertiary care center

The goal of this study is to examine changing patterns of ophthalmic visits in an emergency eye care unit of a tertiary referral center in Paris, France, during the Coronavirus disease-19 (COVID-19) pandemic compared to a control period. This was a single-center, retrospective, observational, epidemiological study. We included all visits in the emergency eye care unit of the Quinze-Vingts National Ophthalmology Center, Paris, France, from March 17, 2020 to April 30, 2020, and a corresponding time period in 2016. We analyzed patients' demographic factors, chief complaints, referral patterns, examination findings, treatment provided, hospitalizations and surgical interventions. During the 6weeks of lockdown, 3547 emergency visits were recorded. The control group contained 2108 patients from June 6-19, 2016. There was a decrease of approximately 50% in the number of average daily visitations. The frequency of serious diagnoses (including severe eye inflammation, serious infections, retinal vascular pathologies, surgical emergencies, and neuro-ophthalmology), increased overall during the period (P=0.03). The proportion of low severity pathologies decreased (P<0.001) between the two periods. In addition, an increased amount of ancillary testing was performed (P<0.001). Finally, the rate of hospitalizations was significantly lower during the lockdown period (P<0.001). A significant reduction in total ophthalmic presentations in the emergency eye care unit was observed during the lockdown period. However, the proportion of emergencies requiring specialized treatments (surgical, infectious, inflammatory and neuro-ophthalmological pathologies) increased.

O-003 Mechanics of human embryo compaction

Abstract Study question How the human embryo builds the blastocyst is crucial to improve ART, as morphology of human embryo is a prime determinant to assess implantation potential. Summary answer An evolutionarily conserved increase in cell contractility is required to generate the forces driving the compaction, which is the first morphogenetic event shaping the body. What is known already The shaping of the human embryo begins with compaction, during which cells come into close contact and form a tighter structure. ART studies suggest that human embryos fail compaction primarily because of defective adhesion. Based on our current understanding of animal morphogenesis, other morphogenetic engines, such as cell contractility, could be involved in shaping the human embryo. However, the molecular, cellular and physical mechanisms driving human embryo morphogenesis remain uncharacterized. Study design, size, duration A total of 54 frozen embryos have been used for this work. The use of human embryos donated for research was allowed by the Agence de la Biomédecine (approval number RE 17-011R) in compliance with the International Society for Stem Cell Research guidelines. Donated embryos were cryopreserved and stored at three different centers in Paris. Embryos were then transferred to the Institut Curie where they were immediately thawed and used for the research project. Participants/materials, setting, methods Using micropipette aspiration on human embryos, we mapped cell surface tensions during compaction. Drug inhibition and immunostaining of cell contractility and cell-cell adhesion in human embryos reveal what drives the surface tension responsible for compaction. To evaluate cell contractility we focused on F-actin and myosin motor proteins, for adhesion we focused on E-cadherin. Main results and the role of chance Mapping cell surface tensions during human compaction reveals a 4-fold increase of tension at the cell-medium interface, from 0.62 ± 0.04 to 2.35 ± 0.08 nN/µm (mean ± SEM of 147 measurements on 10 embryos, Student’s t test p &amp;lt; 10-5), while cell-cell contacts keep a steady tension ∼0.6 nN/µm. Therefore, increased tension at the cell-medium interface drives human embryo compaction, which is qualitatively similar to compaction in mouse embryos (from ∼0.2 to 0.4 nN/µm). Further comparison between human and mouse reveals qualitatively similar but quantitavely different mechanical strategies, with human embryos being mechanically least efficient. Inhibition of cell contractility and cell-cell adhesion in human embryos reveals that, while both cellular processes are required for compaction, adhesion involvement plays a permissive role. Only contractility controls the surface tension responsible for compaction. Interestingly, cell contractility and cell-cell adhesion exhibit distinct mechanical signatures when faulty. Analyzing the mechanical signature of naturally failing embryos, we find evidence that non-compacting embryos or partially compacting embryos with excluded cells have defective contractility. Limitations, reasons for caution Given the need to use embryos donated to research, which are valuable samples, our sample size is small but sufficient to show statistically significant differences. Moreover, these embryos come from infertile patients undergoing ART. Wider implications of the findings Excluded cells from compaction could be aneuploid to protect the embryonic tissue from chromosomal abnormalities. Is there a correlation between their mechanical signature and the fact that they may be aneuploid remains an open question. How physical laws are used to produce the breathtaking diversity of the shapes of life? Trial registration number ‘not applicable'

Acceptance of diagnosis and management satisfaction of patients with “suspected Lyme borreliosis” after 12 months in a multidisciplinary reference center: a prospective cohort study

IntroductionBecause patients with a “suspicion of Lyme borreliosis (LB)” may experience medical wandering and difficult care paths, often due to misinformation, multidisciplinary care centers were started all over Europe a few years ago. The aim of our study was to prospectively identify the factors associated with the acceptance of diagnosis and management satisfaction of patients, and to assess the concordance of the medical health assessment between physicians and patients 12 months after their management at our multidisciplinary center.MethodsWe included all adults who were admitted to the Tick-Borne Diseases Reference Center of Paris and the Northern Region (TBD-RC) (2017–2020). A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains and 13 items rated between 0 (lowest) and 10 (highest grade): (1)Reception; (2)Care and quality of management; (3)Information/explanations given to the patients; (4)Current medical condition and acceptance of the final diagnosis; (5)Overall appreciation. Factors associated with diagnosis acceptance and management satisfaction at 12 months were identified using logistic regression models. The concordance of the health status as assessed by doctors and patients was calculated using a Cohen’s kappa test.ResultsOf the 569 patients who consulted, 349 (61.3%) answered the questionnaire. Overall appreciation had a median rating of 9 [8;10] and 280/349 (80.2%) accepted their diagnoses. Patients who were “very satisfied” with their care paths at TBD-RC (OR = 4.64;CI95%[1.52–14.16]) had higher odds of diagnosis acceptance. Well-delivered information was strongly associated with better satisfaction with the management (OR = 23.39;CI95%[3.52–155.54]). The concordance between patients and physicians to assess their health status 12 months after their management at TBD-RC was almost perfect in the groups of those with confirmed and possible LB (κ = 0.99), and moderate in the group with other diagnoses (κ = 0.43).ConclusionPatients seemed to approve of this multidisciplinary care organization for suspected LB. It helped them to accept their final diagnoses and enabled a high level of satisfaction with the information given by the doctors, confirming the importance of shared medical decisions, which may help to reduce health misinformation. This type of structure may be useful for any disease with a complex and controversial diagnosis.

Evaluation of Low-Traffic Neighborhoods and Scale Effects: The Paris Case Study

This paper investigates the socio-economic impacts of the driving restriction zone policy for the Paris region, using the multi-agent transport simulation MATSim. Based on a previous work which has calibrated a first instantiation of the mobility model to the Paris region, we extend it by modeling and simulating two forms of intermodality: Park-and-Walk and Park-and-Ride. After re-calibrating the model, we evaluate two policy scenarios featuring different scales of the restriction zone, using indicators related to mobility, traffic emissions, and social cost. The analysis puts special attention on how modal shift and emissions vary across space, that is, inside and outside the policy zone. We find that the small-scale scenario with a restriction zone limited to the Paris center leads to very limited modal shift, whereas the larger-scale policy scenario encompassing the whole of Paris shifts significantly more trips (about 1.4% of total trips) from cars to public transport and other modes. In both scenarios, traffic emissions decline in the restriction zone and its near surroundings. Far from the restriction zone, however, emissions increase in the small-scale scenario but decrease in the large-scale scenario. These differences are caused by the traffic detour, modal shift, and rebound effects, the magnitudes of which vary depending on the scale of the restriction zone. The driving restrictions also cause the social cost to increase by around 10% in both scenarios. This ultimately implies a trade-off between reducing emissions and increasing user costs, with a substantially greater efficiency (larger reduction for similar cost) in the large-scale policy scenario.

Le 190 a treize ans : l’expérience du premier centre de santé sexuelle français

Le 190 is a sexual health center in Paris founded in 2010. Its initial objective is to reduce the HIV/AIDS epidemic locally among men who have sex with men (MSM) through multidisciplinary support rooted in the reality of the sexuality and affective life of HIV-positive and HIV-negative MSM. Because of its constant concern for overall gay health and its community character, its activity has diversified and has enabled it to be a forerunner in both care and care pathways, on both the medical and regulatory aspects. Mental health and the complications of chemsex are taking an increasingly important place in the demand for care and the support has been adapted and perfected with the patients. Today, Le 190 is considered a model by many community actors and health professionals and is celebrating its 13th anniversary, an opportunity to share its experience and reaffirm its demonstrated benefit for public health and universal care. The major innovations of the center as well as the limitations and difficulties it has encountered will allow for a better understanding of community health in practice and more specifically gay health.