Poitiers University Research Articles

In vitro activity of delafloxacin against clinical levofloxacin-resistant Helicobacter pylori isolates.

Increasing antibiotic resistance in Helicobacter pylori necessitates research on new active molecules. In 2017, delafloxacin, a new fluoroquinolone with chemical properties of activity under acidic conditions, was approved for treatment of community-acquired bacterial pneumonia and acute bacterial skin and soft-tissue infections. Mutations in gyrA are responsible for fluoroquinolone resistance, but certain clinical isolates of H. pylori appear to display a dual phenotype: resistance to levofloxacin associated with very low delafloxacin MICs. To estimate epidemiological cut-off (ECOFF) values and to identify mutations in the gyrA gene, specific to FQ resistance, without increasing the MICs of delafloxacin. Clinical strains (n = 231) were collected in the bacteriology laboratory of Poitiers University Hospital over a 2 year period to determine the ECOFF of delafloxacin. Retrospectively, 101 clinical strains with an levofloxacin-resistant phenotype (MIC > 1 mg/L) were selected from 2018 to 2022 for delafloxacin MIC determination and QRDR (gyrA) sequencing. The estimated ECOFF of delafloxacin was ≤0.125 mg/L. No H. pylori isolate showed a levofloxacin-sensitive phenotype with a delafloxacin MIC of >0.125 mg/L. Among the levofloxacin-resistant H. pylori isolates, 53.5% had delafloxacin MICs of ≤0.125 mg/L. The N87I mutation was associated with dual levofloxacin/delafloxacin resistance (P < 0.001) in contrast to the N87K and D91N mutations (P > 0.05). Mutations D91G and D91Y were not associated with a delafloxacin resistance phenotype (P > 0.05). Delafloxacin seems to be a therapeutic alternative for levofloxacin-resistant strains with greater in vitro activity. However, further clinical/biological investigations are required to determine its efficacy in H. pylori eradication.

Care pathways in childhood neurodevelopmental disorders: Toward greater awareness of KBG syndrome among pediatricians

IntroductionKBG syndrome is an autosomal dominant, polymalformative genetic syndrome that is mainly associated with neurodevelopmental and learning disorders, intellectual disability, behavioral disorders, and epilepsy as well as characteristic dysmorphic features, short stature, and ENT (ear, nose, and throat) abnormalities. However, the diagnostic pathway of these individuals is an element that has not been broadly evaluated. The main aim of this study was therefore to characterize the diagnostic pathway for these individuals, by assessing the different healthcare professionals involved and the main referral elements. MethodThis was a multicenter, retrospective, descriptive study. A cohort of 30 individuals with KBG syndrome who were followed up at Poitiers University Hospital and Bordeaux University Hospital we recruited. ResultsPediatricians were the main healthcare professionals who referred individuals for genetic consultation, and the main reason for referral was an assessment of learning delays or intellectual disability, in association with other abnormalities. ConclusionPediatricians play a crucial role in the diagnostic guidance of individuals with KBG syndrome, and the main reason for referral remains the assessment of a learning delay or intellectual disability. Healthcare professionals must therefore remain attentive to the child's development and the various anomalies associated with it, in particular characteristic dysmorphic features, behavioral disorders, and statural growth.

Analysis of the obstetrician's posture and movements during a simulated forceps delivery

BackgroundThe objective of this study was to identify and qualify, by means of a three-dimensional kinematic analysis, the postures and movements of obstetricians during a simulated forceps birth, and then to study the association of the obstetricians’ experience with the technique adopted.MethodFifty-seven volunteer obstetricians, 20 from the Limoges and 37 from the Poitiers University hospitals, were included in this multi-centric study. They were classified into 3 groups: beginners, intermediates, and experts, beginners having performed fewer than 10 forceps deliveries in real conditions, intermediates between 10 and 100, and experts more than 100. The posture and movements of the obstetricians were recorded between December 2020 and March 2021 using an optoelectronic motion capture system during simulated forceps births. Joint angles qualifying these postures and movements were analysed between the three phases of the foetal traction. These phases were defined by the passage of a virtual point associated with the forceps blade through two anatomical planes: the mid-pelvis and the pelvic outlet. Then, a consolidated ascending hierarchical classification (AHC) was applied to these data in order to objectify the existence of groups of similar behaviours.ResultsThe AHC distinguished four different postures adopted when crossing the first plane and three different traction techniques. 48% of the beginners adopted one of the two raised posture, 22% being raised without trunk flexion and 26% raised with trunk flexion. Conversely, 58% of the experts positioned themselves in a “chevalier servant” posture (going down on one knee) and 25% in a “squatting” posture before initiating traction. The results also show that the joint movement amplitude tends to reduce with the level of expertise.ConclusionForceps delivery was performed in different ways, with the experienced obstetricians favouring postures that enabled observation at the level of the maternal perineum and techniques reducing movement amplitude. The first perspective of this work is to relate these different techniques to the traction force generated. The results of these studies have the potential to contribute to the training of obstetricians in forceps delivery, and to improve the safety of women and newborns.

Correlation Between Sleep Continuity and Patient-Reported Sleep Quality in Conscious Critically Ill Patients at High Risk of Reintubation: A Pilot Study.

It is well-established that sleep quality of ICU patients is poor, with sleep being highly fragmented by multiple awakenings. These sleep disruptions are associated with poor outcomes such as prolonged weaning duration from mechanical ventilation. Polysomnography can measure sleep continuity, a parameter associated positively with outcomes in patients treated with noninvasive ventilation, but polysomnography is not routinely available in all ICUs, and simple means to assess sleep quality are needed. The Richards-Campbell sleep questionnaire (RCSQ) assesses sleep quality in ICU patients but is difficult to administrate in patients who are not fully awake, and a simpler sleep numeric rating scale (sleep-NRS) has been proposed as an alternative. We here investigated the relationships between sleep continuity and patients-reported sleep quality. Single-center retrospective study. Medical ICU of Poitiers University Hospital. Seventy-two patients were extubated from mechanical ventilation and at high risk of reintubation. None. We analyzed 52 previously recorded polysomnographies in nonsedated and conscious ICU patients. Sleep was recorded the night after extubation. Sleep continuity was measured using an automated scoring algorithm from one electroencephalogram (EEG) channel of the polysomnography. Patient-reported sleep quality was assessed using RCSQ and sleep-NRS. Sleep continuity could be calculated on 45 polysomnographies (age: 68 [58-77], median [25th-75th]) RCSQ (62 [48-72]) and sleep-NRS (6.0 [5.0-7.0]) were obtained in 21 patients and 34 patients, respectively. Our results show a significant correlation between sleep continuity and sleep-NRS (p = 0.0037; ρ = 0.4844; n = 34) but not with RCSQ score (p = 0.6732; ρ = 0.1005; n = 20). Sleep continuity correlates with patient-reported sleep quality assessed using sleep-NRS and may capture the refreshing part of sleep. Sleep-NRS can be easily administered in ICU patients. Sleep continuity and sleep-NRS are simple tools that may prove useful to evaluate sleep quality in ICU patients.

Maternal, Fetal and Neonatal Outcomes Related to Recreational Cannabis Use during Pregnancy: Analysis of a Real-World Clinical Data Warehouse between 2010 and 2019.

Cannabis is the main illicit psychoactive substance used in French childbearing women and very few data are available about adverse events (AEs) related to its use during pregnancy. The aim of this study was to evaluate the association between recreational cannabis use during pregnancy and adverse outcomes from a real-world clinical data warehouse. Data from the Poitiers University Hospital warehouse were analyzed between 1 January 2010 and 31 December 2019. Logistic regression models were used to evaluate associations between outcomes in three prenatal user groups: cannabis alone ± tobacco (C ± T) (n = 123), tobacco alone (T) (n = 191) and controls (CTRL) (n = 355). Pregnant women in the C ± T group were younger (mean age: 25.5 ± 5.7 years), had lower pre-pregnancy body mass index (22.8 ± 5.5 kg/m2), more psychiatric history (17.5%) and were more likely to benefit from universal free health-care coverage (18.2%) than those in the T and CTRL groups. Cannabis use increases the occurrence of voluntary interruption of pregnancy, at least one AE during pregnancy, at least one neonatal AE, the composite adverse pregnancy outcome over 28, prematurity and small for gestational age. Given the trivialization of recreational cannabis use during pregnancy, there is an urgent need to communicate on AEs of cannabis use during pregnancy.

Severity of kidney involvement as predictor of death, severe heart failure and renal events in patients with type 2 diabetes: Data from a prospective cohort

Type 2 diabetes is associated with an increased risk for end-stage renal disease and heart failure, contributing to premature death. All these 3 events are inter-related, suggesting common risk factors and/or pathophysiological pathways. The SURDIAGENE (SUrvie Rénale DIAbète et GENEtique) cohort is a single center hospital-based cohort of persons living with type 2 diabetes, recruiting participants at Poitiers university hospital, France, from 2002 to 2011 with further follow-up till 2015. Here, we describe the cumulative prevalence of hard renal events (sustained doubling of serum creatinine and/or renal replacement therapy), heart failure leading to hospitalization (HFH) and all-cause death, according to the KDIGO classification, which considers CKD stages according to CKD EPI equation [1–5] and albuminuria (A1, A2, A3) according to albumin/creatinine ratio with thresholds at 30 and 300 mg/g. We considered 1450 participants with KDIGO stage available at baseline. Considering a cumulated follow-up duration of 10,667 patient.years with 100 renal events, 247 HFH and 527 deaths, our study showed that the more severe the KDIGO stage, the higher the incidence rate not only for renal event, but also for HFH and for all-cause death. For instance, in CKD1A1 and CKD4A3 the incidence rates for hard renal events, HFH and death were 0.98 and 140.70, 4.46 and 107.09, 13.64 and 156.56 per 1000 patient.years, respectively. Interestingly, the incidence of renal event was lower than the incidence of all-cause death in all KDIGO stages, at variance with the data from recent renal outcome trials on SGLT2 inhibitors and finerenone. We conclude that KDIGO stages should be considered for renal but also for HFH risk classification. The analysis of the respective incidence of renal events and deaths in observational studies and RCTs deserves further evaluation in type 2 diabetes.

Paving the Way for Personalized Medicine in First Kidney Transplantation: Interest of a Creatininemia Latent Class Analysis in Early Post-transplantation.

Plasma creatinine is a marker of interest in renal transplantation but data on its kinetics in the first days following transplantation are scarce. The aim of this study was to identify clinically relevant subgroups of creatinine trajectories following renal transplantation and to test their association with graft outcome. Among 496 patients with a first kidney transplant included in the French ASTRE cohort at the Poitiers University hospital, 435 patients from donation after brain death were considered in a latent class modeling. Four distinct classes of creatinine trajectories were identified: "poor recovery" (6% of patients), "intermediate recovery" (47%), "good recovery" (10%) and "optimal recovery" (37%). Cold ischemia time was significantly lower in the "optimal recovery" class. Delayed graft function was more frequent and the number of hemodialysis sessions was higher in the "poor recovery" class. Incidence of graft loss was significantly lower in "optimal recovery" patients with an adjusted risk of graft loss 2.42 and 4.06 times higher in "intermediate recovery" and "poor recovery" patients, respectively. Our study highlights substantial heterogeneity in creatinine trajectories following renal transplantation that may help to identify patients who are more likely to experience a graft loss.

A complete pipeline for glioma grading using intelligible AI on multimodal MRI data

1) Objectives: Machine learning for binary glioma grading have been extensively used on anatomical MRI, especially using the BraTS dataset. The relevance of radiomic criteria based on multimodal imaging, including diffusion, perfusion and spectroscopy data is to be explored, as multimodal datasets are scarce, and there is no common benchmark for performance comparison. 2) Material and methods: Poitiers University Hospital provides 123 multimodal patient data. We computed 124 features and let a recursive feature elimination algorithm (RFE) yield a relevant, reduced subset of features. We trained a SVM classifier on this subset. We proposed a method to adapt the BraTS dataset to allow performance comparison with the literature. We got a performance reference point by training on anatomical data only, and showed improvements when multimodalities were added. We explored the feature relevance through the RFE subset. The RFE subset is not constant and induce variability in the performances. To smooth the variability, we applied the RFE algorithm 100 times and incremented the selected features, resulting in a global feature ranking. We also show the best classifier reached on these 100 trainings and its feature subset. 3) Results: The best classifier reached 86.5% accuracy, with a mean accuracy on 100 trainings of 78.6%. The rankings shows that anatomical and perfusion sequences are the most relevant for glioma grading, especially T1 post-gadolinium, cerebral blood volume and flow. Intensity and texture features are frequently selected, while anisotropic diffusion coefficient, time to peak and mean time transit mappings seem irrelevant. 4) Conclusion: Multimodal radiomics improve the classification and are consistent with the radiological analysis.

Prevalence and prognosis of cardiac amyloidosis in patients who underwent diphosphonate scintigraphy for non-cardiological reasons

Transthyretin cardiac amyloidosis is a rare and currently underdiagnosed disease. Untreated, median survival since diagnosis is estimated to be between 3 and 5 years. Diphosphonate scintigraphy is one of the earliest positive examinations well before biological or clinical signs. The objective of this study is to determine the prevalence of cardiac involvement in patients who underwent disphophonate scintigraphy for non-cardiological reasons and to follow their prognosis. Our study is a retrospective, descriptive, monocentric study carried out at the university hospital of Poitiers. Collection of all scintigraphy with Technetium 99m-labelled disodium Hydroxymethylene Diphosphonate (HMDP-99mTc), performed at the Poitiers University Hospital between January 1, 2006 and January 1, 2012. 725 patients were included and all scintigraphy were reanalyzed and we retained only the Perugini 2 and 3 stage for the diagnosis of amyloidosis. The study focuses on the prevalence and the overall and detailed mortality of these patients at 5 years. In all, 20 scintigraphy showed Perugini scores of 2 or 3, i.e., a prevalence of about 1% in the study. The prevalence by age group was also studied: there is an age-related gradient: among patients over 70 years of age, it is calculated at 2.7% (20/725 patients); among patients over 80 years of age, it is calculated at 4.4% (14/316) (Fig. 1); and among patients over 90 years of age, it is calculated at 16.7% (4/24). No fixation was found in patients under 70-years-old. The overall 5-year mortality rate was calculated at 85%, the majority of which was due to cancer. The discovery of Perugini stage 2 and 3 cardiac staining on scintigraphy for non-cardiological reasons among the 725 patients analyzed is uncommon (1%). There is an age-related prevalence gradient (up to 16.7% over 90 years). Radiologists should refer patients to amyloidosis specialists for specific management, which would allow amyloidosis to be managed at an early stage to probably decrease hospitalizations and mortality.

Déclin rapide de la fonction rénale chez les patients diabétiques à Lomé (Togo)

ObjectiveTo determine the hospital frequency of diabetic patients with a rapid decline in their renal function, to look for the associated factors. MethodDescriptive and analytical cross-sectional study carried out over 12 months (May 1, 2019 to April 31, 2020). Were included all patients aged 18 and over, having achieved at least 3 creatinine during the previous 2 years but spaced at least 6 months apart and having an eGFR calculated from their last creatinine greater than 30 mL/min by the formula of CDK-EPI. We evaluated the eGFR by the CDK-EPI formula using the calculator developed by the Poitiers University Hospital and the Inserm unit of the Francophone Diabetes Society. ResultsA total of 80 patients medical files were retained. The rapid decline in renal function was found in 28 patients, either a frequency of 35%. The sex ratio M/F was 1.5. The mean age was 62.93 years (range 18–85 years). Hypertension was the most common comorbidity (92.5%). The very high cardiovascular risk was predominant in 82.5% of cases. The very high renal risk was found in 20 patients, either 25%. Univariate and multivariate analysis showed that the rapid decline in renal function was associated with very high cardiovascular risk (P=0.037) and glomerular filtration rate (P˂0.001). Conclusionthis study showed a high hospital frequency of the rapid decline in renal function in Togo (35%). Our results have identified the very high cardiovascular risk and glomerular filtration rate as risk factors. The originality of our study was the demonstration of the high proportion of very high cardiovascular risk (82.5%) and very high renal risk (25%) in the evaluation of renal and cardiovascular risk.

Increased remission with fewer corticosteroids and more biologics in rheumatoid arthritis at 7-year follow-up in real-life conditions

Remission in rheumatoid arthritis (RA) is an important therapeutic target that is not easy to achieve in real-life conditions. Some prognostic factors have been identified but the literature is variable. The objectives of this study were to evaluate the remission rate and the maintenance of remission in patients with RA over 7 years of follow-up in real-life conditions and to identify prognostic factors of long-term remission. Patients with RA seen at the Poitiers University Hospital were identified and clinical and biological data were collected. Data were analysed after 1 year and 7 years. Twice as many patients were in remission at 7 years than at 1 year of follow-up. 48.6% of patients who were not in remission at 1 year obtained remission at 7 years of follow-up. Patients achieving remission were more often receiving coprescription of csDMARDs and bDMARDs. Patients not in remission at 7 years were given more corticosteroids at higher doses. After 7 years of follow-up, low initial disease activity and use of csDMARDs and bDMARDs appeared to be independent positive predictive factors. Once obtained at one year, remission was maintained for 76% of our patients. As a conclusion, modern management of RA, whatever disease duration, leads to remission rates similar to those of early RA after 7 years of follow-up.

K1 Antigen Is Associated with Different AST Profile in Escherichia coli: A One-Month-Long Pilot Study.

Escherichia coli is responsible for diseases of varying severity. The “K” antigen designates the capsular polysaccharides on the bacterial surface, which are mostly similar to those of highly pathogenic bacteria. The K1 antigen is often found in pathogenic E. coli. Aim: While the published studies on the AST profile of K1-positive E. coli have focused on pregnant women or newborns, this study aimed to characterize the AST profile of K1-positive E. coli independently of the clinical sample of isolation. Over a 4-week-long period, all patients hospitalized/consulting at the Poitiers University Hospital presenting a determined AST on E. coli were prospectively included to define their K1-status (Pastorex Meningitis) and to collect the clinical (age/sex) or biological metadata (AST/MIC). Among the 296 included samples, no differential representation was observed between K1 results regarding sample nature. K1-negative results were associated with multiple antibiotic-resistance (12.3% vs. 33.0%; p < 0.01). AST phenotypes differed between these groups, with a higher proportion of K1-negativity among resistant strains, especially on β-lactams (ureidopenicillin, 25.8% vs. 14.9%; and ampicillin/inhibitor, 50.0% vs. 26.8%; p < 0.05) or quinolone (19.8% vs. 7.0%) and sulfamethoxazole-trimethoprim (30.2% vs. 12.3%) (p < 0.01). This study analyzed E. coli ASTs in clinical samples of all types, regarding their K1-antigen status.

Comparison of the injection of low molecular weight heparin in arterial or venous bloodline for preventing extracorporeal circuit clotting during hemodialysis

Low molecular weight heparins (LMWH) are widely used for preventing clotting during hemodialysis (HD). Although injection in venous bloodline (VBL) is recommended to avoid initial loss of LMWH through the dialyzer, LMWH is still frequently administered in the arterial blood line (ABL) at the start of dialysis. The aim of this study was to compare the efficacy and safety of same enoxaparin dose administered through VBL or ABL. We also evaluated antifactor Xa (aXa) activity according to the injection route and dialysis modalities: high-flux (HF) HD, medium cut-off (MCO) HD and on-line hemodiafiltration (OL-HDF). This open, single-center prospective study was conducted at the Poitiers university Hospital HD unit. Forty-three patients were studied over 18 consecutive dialysis sessions using a fixed enoxaparin dose (20 or 40 mg) first administered through ABL bolus and then through VBL for another 18 sessions. Compared to ABL, VBL bolus resulted in significant increase in median post-dialysis aXa activity: 0.16 (0.1–0.6) IU/mL vs. 0.31 (0.1–1.3) IU/mL, respectively, P = 0.006. After ABL bolus of enoxaparin 40 mg, median post-dialysis aXa activity was significantly lower with OL-HDF compared to HF-HD: 0.14 (0.1–0.35) vs. 0.32 (0.15–0.49), P = 0.02. A trend for lower clotting within lines and bubble trap using VBL bolus was observed. In conclusion, VBL enoxaparin injection is safe in OL-HDF patients. However, in HF-HD and MCO-HD, VBL injection of enoxaparin 40 mg may increase overdosing risk. Thus, aXa activity should be monitored in HF-HD and MCO-HD patients at risk of bleeding and/or on vitamin K antagonists, and careful surveillance is required when administering enoxaparin dose 40 mg through the VBL route.

Drinking during low-risk labor: monocentric randomized clinical trial on patients’ satisfaction, and maternal and neonatal outcomes

Introduction This study aimed to assess satisfaction of patients affected by various fluid regimes during uncomplicated labor; to identify factors possibly associated with the level of satisfaction; to compare obstetrical and neonatal outcomes between the intervention groups. Methods Between October and December 2014, 40 women were included in the study set at the Poitiers University Hospital, France. Women were randomly allocated to two study arms: 20 to strict and 20 to liberal fluid regime group. Women’s satisfaction was assessed using visual analog scale. Categorical obstetrical and neonatal outcomes were analyzed using Chi-squared test and Fischer’s exact test. The between-group difference was assessed with Mann–Whitney U-test. Results Overall satisfaction was higher among women from the liberal fluid regime than from the strict fluid regime group (median score: 88, interquartile range [IQR]: 21 vs. 72, IQR: 21; p = 0.03). The active phase of the second stage of labor was shorter in the liberal fluid regime than in the strict fluid regime group (median 9 min, IQR: 7 vs. 17 min, IQR: 12; p = 0.02). The length of stay in the delivery room was significantly shorter in liberal fluid regime than in strict fluid regime group (median 190 min, IQR: 128 vs. 340 min, IQR: 195, p = 0.04). There were no significant differences in other obstetrical and neonatal outcomes. Conclusion Liberal fluid regime during labor was associated with significantly higher satisfaction of women. The active phase of the second stage of labor and the length of stay in the delivery room were significantly shorter in the liberal fluid regime group.

Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial

Two billion peripheral venous catheters are sold globally each year, but the optimal skin disinfection and types of devices are not well established. We aimed to show the superiority of disinfection with 2% chlorhexidine plus alcohol over 5% povidone iodine plus alcohol in preventing infectious complications, and of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes used in combination (innovation group) over open catheters and three-way stopcocks for treatment administration (standard group) in preventing catheter failure. We did an open-label, randomised-controlled trial with a two-by-two factorial design, for which we enrolled adults (age ≥18 years) visiting the emergency department at the Poitiers University Hospital, France, and requiring one peripheral venous catheter before admission to the medical wards. Before catheter insertion, patients were randomly assigned (1:1:1:1) using a secure web-based random-number generator to one of four treatment groups based on skin preparation and type of devices (innovative devices or standard devices; 2% chlorhexidine plus alcohol or 5% povidone iodine plus alcohol). Primary outcomes were the incidence of infectious complications (local infection, catheter colonisation, or bloodstream infections) and time between catheter insertion and catheter failure (occlusion, dislodgment, infiltration, phlebitis, or infection). This study is registered with ClinicalTrials.gov, NCT03757143. 1000 patients were recruited between Jan 7, and Sept 6, 2019, of whom 500 were assigned to the chlorhexidine plus alcohol group and 500 to the povidone iodine plus alcohol group (250 with innovative solutions and 250 with standard devices in each antiseptic group). No significant interaction was found between the two study interventions. Local infections occurred less frequently with chlorhexidine plus alcohol than with povidone iodine plus alcohol (0 [0%] of 496 patients vs six [1%] of 493 patients) and the same was observed for catheter colonisation (4/431 [1%] vs 70/415 [17%] catheters among the catheters cultured; adjusted subdistribution hazard ratio 0·08 [95% CI 0·02-0·18]). Median time between catheter insertion and catheter failure was longer in the innovation group compared with the standard group (50·4 [IQR 29·6-69·4] h vs 30·0 [16·6-52·6] h; p=0·0017). Minor skin reactions occurred in nine (2%) patients in the chlorhexidine plus alcohol group and seven (1%) patients in the povidone iodine plus alcohol group. For skin antisepsis, chlorhexidine plus alcohol provides greater protection of peripheral venous catheter-related infectious complications than does povidone iodine plus alcohol. Use of innovative devices extends the catheter complication-free dwell time. Becton Dickinson.

Pacemakers capable of monitoring sleep-disordered breathing: impact on sleep apnea detection in real life

Abstract Background Pacemaker recipients are at high-risk of sleep apnea (SA). New generation of pacemakers allow day by day, sleep-disordered breathing (SDB) monitoring. These devices measure variations in thoracic impedance and can detect apnea and hypopnea. Purpose The aim was To compare the rate of SA detection in patients implanted with and without pacemaker capable of monitoring (SDB). Methods This retrospective study included all consecutive patients implanted with a pacemaker between 2013 and 2016 at Poitiers university hospital. Pacemaker recipients allowing SDB monitoring (SDB monitoring group) and pacemaker recipients not allowing SDB monitoring (control group) were compared in terms of SA diagnosis, continuous positive airway pressure (CPAP) therapy initiation, newly AF discovered and stroke occurrence. Results Among the 1442 patients included (mean age 79 years, 39% of women, BMI = 27 kg/m2). 653 were in the SDB monitoring group and 789 in the control group. The 2 groups were not different in terms of age, body mass index, cardiovascular risk factor, cardiac function, and medication. Indication for cardiac pacing was atrioventricular block and sinus dysfunction in 56% and 23% of patients respectively. Mean follow-up was 24.7 months. 40 patients (7.5%) have been diagnosed with SA in the SDB monitoring group and 18 (2.7%) in the control group (p&amp;lt;0.001). CPAP therapy was initiated in 33 (5%) patients in SDB monitoring group and in 16 (2%) patients for the control group (p=0.01). The rate of newly diagnosed AF was 15% in SDB monitoring and 7% in control group (p&amp;lt;0.001). The incidence of stroke was 16 (2.4%) in the SDB monitoring group and 18 (3.4%) in the control group (P=0.45). Conclusion In real life conditions, pacemakers capable of monitoring SDB improve the diagnosis of SA and CPAP therapy rate. Monitoring of sleep apnea after at least Funding Acknowledgement Type of funding source: None

TRIBUTE TO NIEVES LÓPEZ MARTÍNEZ

Nieves was born in Burgos on February 5th, 1949 and passed away, much too soon, on December 15th, 2010. She studied at Madrid’s Complutense University (UCM) from which she graduated with a degree in Biological Science in 1970 and there she met Professor Emiliano Aguirre. When he suggested starting a research project on lagomorphs (pikas, rabbits and hares) from the Spanish fossil record, Nieves threw herself into the job with her characteristic energy and enthusiasm. At a time (1971-1973) when very few scientists travelled abroad, Nieves obtained a Cooperation Grant from the French Government to do her PhD Thesis under the supervision of Dr. Thaler at Montpellier University. Her university teaching career began in 1978 as an Interim Associate Teacher at Madrid’s Autónoma University (UAM). She was an excellent teacher, and the driving force of her professional life was to a great degree her relationship with her students. She was innovative in her teaching, making use of the new technologies (virtual campus, web pages, blogs, etc.) to gain students’ attention and interest. She excelled in her research and was one of the pioneers in directing research projects of the National Plan; she directed numerous field campaigns and excavations in the continental basins of the Iberian Peninsula and participated in the stimulating and arduous campaigns in the Republic of Chad together with her French colleagues under the direction of Dr. Brunet (Poitiers University).

Comparison of conventional, burst and high-frequency spinal cord stimulation on pain relief in refractory failed back surgery syndrome patients: study protocol for a prospective randomized double-blinded cross-over trial (MULTIWAVE study)

BackgroundWhile the evolution of technology provides new opportunities to manage chronic refractory pain using different waveform modalities of spinal cord stimulation in failed back surgery syndrome (FBSS), there is no randomized controlled trial available to compare the efficacy of these different stimulations waveforms to date. MULTIWAVE is a prospective, randomized, double-blinded, crossover trial study designed to compare the clinical efficacy of tonic conventional stimulation (TCS), burst stimulation (BURST) and high-frequency stimulation (HF) in FBSS patients over a 15-month period in SCS implanted patients.Methods/designTwenty-eight patients will be recruited in the Poitiers University Hospital, in Niort and La Rochelle Hospitals in France. Eligible patients with post-operative low back and leg pain with an average visual analog scale (VAS) score ≥ 5 for low back pain are implanted and randomly assigned to one of the six arms (in a 1:1:1:1:1:1 ratio), where they receive a 3-month combination of TCS, BURST and HF including one treatment modality per month and varying the order of the modality received within the six possible combinations. Patients receiving intrathecal drug delivery, peripheral nerve stimulation and back resurgery related to the original back pain complaint and experimental therapies are excluded from this study. Patients included in the spinal cord stimulation group undergo trial stimulation, and they all receive a TCS treatment for 2 months, as the gold standard modality. Thereafter, patients are randomly assigned to one of the six arms for the total duration of 3-month crossover period. Then, patients choose their preferred stimulation modality (TCS, BURST, or HF) for the follow-up period of 12 months. Outcome assessments are performed at baseline (first implant), before randomization (2 months after baseline) and at 1, 2, 3, 6, 9 and 15 months post-randomization. Our primary outcome is the average global VAS of pain over 5-day pain diary period between baseline and after each period of stimulation. Additional outcomes include changes in leg and back pain intensity, functional disability, quality of life, psychological state, paraesthesia intensity perception, patient satisfaction and the number of adverse events.DiscussionRecruitment began in February 2017 and will continue through 2019.Trial registrationClinicaltrials.gov NCT03014583. Registered on 9 January 2017.

Preface

The 20th International Conference of ADRI organized by UniversitasSwadaya Gunung Jati (UGJ) in collaboration with Universitas Pendidikan Indonesia (UPI) was held on 19-20 November 2018 at Prima Hotel Cirebon, Indonesia. As an International Symposium on Sciences, Engineering and Technology (ISSET), the conference promotes its theme “The contribution of cross-disciplinary research to the development of creative and innovative thinking toward millennial generation“. The symposium aims to provide an opportunity for academia, professionals, and practitioners from various fields with cross-disciplinary throughout the world including sciences, engineering, and technology. The symposium is therefore expected to contribute new findings and to empower human resources.It was wonderful to have over 300 speakers and participants representing various universities from Indonesia and other countries. We were very honored to have Dr. KH. Abdul Wahid Maktub as Staff Member of The Ministry of Higher Education Indonesia as the keynote speaker and five invited speakers from different countries with a variety expertise as follows: 1) Dr Achmad Fathoni Rodli from Universitas Maarif Hasyim Latif Surabaya, Indonesia; 2) Professor Khamisah Osman from the National University, Malaysia; 3) Professor Sukree Langputeh from Fatani Univesity, Thailand; 4) Professor Challoner A Matero from San Carlos University, Philipphines and 5) Associate Professor Jean-Marie Pincemin from Poitiers University, France in this conference.List of Conference Chair, Vice Chairperson, Advisory Boards, Scientific Committee, Organizing Committee, CONTACT ISSET 2018 and Conference Photographs are available in this pdf.

Influence of polymer additives on friction in fluid-film bearings: Theoretical view on experimental results by Moritsugu Kasai et al.

The problem of the decrease in power loss due to friction stands permanent. One of the approaches to the solution of the problem is the application of polymer additives in order to modify the rheological properties of oils. The present theoretical work is dedicated to the analysis of experimental results of a study on polymethacrylate additives’ influence on friction that were obtained in the laboratory of Solid Mechanics of the Poitiers University. A simulation model developed in the present paper is based on the generalised Reynolds equation that takes heterogeneity of viscosity properties into account. The Reynolds equation was modified and rewritten in the bicylindrical coordinates. The geometry of the flow region could thus be described more accurately and the numerical solution could be obtained over a grid with an adaptive step. Analysis of numerical results along with experimental results allowed the identification of relationship between contents of polymer-containing oils and the hydrodynamic effect of power loss due to friction decrease as well as determination of possible reasons for contradictions that occurred during the experimental studies that are essentially a significant difference between the results for a Babbitted and a bronze bearing.