Grenoble University Research Articles

COVID-19 lockdowns and incidence of psychoactive substance exposure according to age and sex

Background The lockdown periods imposed in 2020 by governments had deleterious consequences on population mental health. Several studies based on declarative data have suggested that the lockdown periods were associated with changes in psychoactive substance use but few relied on toxicological analyses. Aims We studied the impact of lockdowns on the pattern of routine care toxicological screening performed on patients hospitalized at the emergency ward (EW) and intensive care units (ICU) at the Grenoble University Hospital. Method This was a retrospective, monocentric study comparing routine care toxicology biological tests performed in children older than 12 years of age and adults hospitalized at the ICU and EW in 2018, 2019, and 2020. Alcohol, illicit drugs, and medications were screened. Generalized linear models were generated to evaluate the effect of the lockdown periods on toxicology results, considering age and sex. Results The study included 13,910 samples from 11,786 patients. There was no significant difference in the repartition of sex or age over the three years. The frequency of positive toxicological tests increased during the lockdown periods (adjusted odds ratio (OR) 95% confidence interval (CI): 1.14, (1.01–1.28), p = .026). The frequency of poly-exposures also rose during these periods (OR 1.43 (1.11–1.82), p = .004) mostly among men (OR 1.54 (1.02–2.04), p = .022), 12–25-year-old patients (OR 1.69 (1.07–2.31), p = .016), and seniors (>56 years) (OR 1.54 (1.00–1.97), p = .032). Conclusions This study suggests that lockdown episodes were associated with increased incidence of psychoactive substance poly-exposures, highlighting the need for preventive strategies for high-risk populations.

Natural Language Processing and Computational Linguistics

Natural Language Processing and Computational Linguistics

Diagnostic workup in children with arthrogryposis: description of practices from a single reference centre, comparison with literature and suggestion of recommendations

IntroductionArthrogryposis multiplex congenita (AMC) refers to a clinical presentation of congenital contractures involving two or more body areas. More than 400 distinct conditions may lead to AMC, making the aetiological...

Using promotional discourse analysis and project-based learning to develop Master’s students’ business writing skills

Foreword Caroline Rossi, universite Grenoble Alpes While corpora have been used extensively in translator training for a few decades (Beeby et al. 2009; Zanettin et al. 2013), applications to the English for specific purposes (ESP) classroom have remained relatively scarce. However, a recent meta-analysis into “the effectiveness of using the tools and techniques of corpus linguistics for L2 learning or use” (Boulton & Cobb 2017) has reported effective use of corpora with learners of a foreign...

Using a digital scientific communication genre to improve students’ oral skills

Foreword Marie-Helene Fries, Universite Grenoble-Alpes Could the notion of multimodal literacy inspire teaching in the context of English for specific purposes (ESP)? In science and technology at least, multimodality plays an essential role, as noted by Sionis in this journal, when commenting on presentation design for a scientific conference on mechanical engineering: Their verbal discourse was created and organised to develop and comment on non-verbal materials and not the other way round....

Balloon catheter vs oxytocin alone for induction of labor in women with one previous cesarean section and an unfavorable cervix: a multicenter, retrospective study.

To compare the rate of vaginal birth between double-balloon catheter and oxytocin alone for induction of labor in women with one previous cesarean section and an unfavorable cervix. A retrospective and observational study was conducted from 2013 to 2017, at the Saint-Etienne University Hospital where women received induction with a double-balloon catheter for 12h and at the Grenoble Alpes University Hospital where women received induction with a low-dose oxytocin infusion. Primary outcome was the rate of vaginal birth. Out of 1920 women eligible for attempting a vaginal birth after one previous cesarean section, 501 had a labor induction. Among women with an unfavorable cervix, 160 received a double-balloon catheter in Saint Etienne and 152 received oxytocin alone in Grenoble. The vaginal birth rate was higher in the double-balloon catheter group (61% versus 47% in the oxytocin group). An induction of labor with oxytocin alone reduced chances of vaginal birth (aOR 0.38 CI-95% [0.22-0.66]) compared to cervical ripening with double-balloon catheter. The perinatal morbidity was similar in the two groups. There was, however, 3.9% uterine rupture in the oxytocin group versus 0.6% in the double-balloon group (p = 0.11). For induction of labor in women with one previous cesarean section and with unfavorable cervix, cervical ripening with a double-balloon catheter increases the rate of vaginal birth without increased risk of uterine rupture.

Complement Alternative and Mannose-Binding Lectin Pathway Activation Is Associated With COVID-19 Mortality.

BackgroundThe SARS-CoV-2 infection triggers excessive immune response resulting in increased levels of pro-inflammatory cytokines, endothelial injury, and intravascular coagulopathy. The complement system (CS) activation participates to this hyperinflammatory response. However, it is still unclear which activation pathways (classical, alternative, or lectin pathway) pilots the effector mechanisms that contribute to critical illness. To better understand the immune correlates of disease severity, we performed an analysis of CS activation pathways and components in samples collected from COVID-19 patients hospitalized in Grenoble Alpes University Hospital between 1 and 30 April 2020 and of their relationship with the clinical outcomes.MethodsWe conducted a retrospective, single-center study cohort in 74 hospitalized patients with RT-PCR-proven COVID-19. The functional activities of classical, alternative, and mannose-binding lectin (MBL) pathways and the antigenic levels of the individual components C1q, C4, C3, C5, Factor B, and MBL were measured in patients’ samples during hospital admission. Hierarchical clustering with the Ward method was performed in order to identify clusters of patients with similar characteristics of complement markers. Age was included in the model. Then, the clusters were compared with the patient clinical features: rate of intensive care unit (ICU) admission, corticoid treatment, oxygen requirement, and mortality.ResultsFour clusters were identified according to complement parameters. Among them, two clusters revealed remarkable profiles: in one cluster (n = 15), patients exhibited activation of alternative and lectin pathways and low antigenic levels of MBL, C4, C3, Factor B, and C5 compared to all the other clusters; this cluster had the higher proportion of patients who died (27%) and required oxygen support (80%) or ICU care (53%). In contrast, the second cluster (n = 19) presented inflammatory profile with high classical pathway activity and antigenic levels of complement components; a low proportion of patients required ICU care (26%) and no patient died in this group.ConclusionThese findings argue in favor of prominent activation of the alternative and MBL complement pathways in severe COVID-19, but the spectrum of complement involvement seems to be heterogeneous requiring larger studies.

Image-based river discharge estimation by merging heterogeneous data with information entropy theory

An information entropy based approach for the discharge measurements is evaluated for the gaging of the Isère river at the Grenoble university campus. Over a four month period, six discharge measurements were made using a vessel-mounted aDcp. Simultaneously, particle tracking velocimetry (PTV) from video images was used to estimate surface velocities. The surface velocities are projected along the regularly surveyed river section of the Isère-Campus gaging station. The vertical velocity profile at each stream-wise location is approximated by a 1D entropy profile. Information entropy 1D velocity vertical profile depends on two parameters which are fitted using aDcp and surface velocity measurements. The inclusion of the surface velocities reduces the dispersion of the estimated entropy parameters. The measurements show that the two parameters are linearly related with a slope that is stage dependent and thus, surface velocity dependent. From there, the information entropy theory for 1D velocity distribution offers a protocol by which surface velocities only are used to compute the discharges. The protocol is calibrated with both aDcp and surface velocity measurements. It is finally validated with several events during which only surface velocities are measured. For the high water flood event the estimated discharge falls within 2% of the one estimated with the rating curve of the gaging station.

SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study

BackgroundIn healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures.MethodsWe conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period.ResultsAmong 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12–42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively.ConclusionsThe number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected.Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).

Science in your summer garden

Flowers that form fractals Romanesco cauliflower is mesmerizing. Unlike the boring old regular white cauliflower, romanesco’s buds spiral out in a distinctive fractal pattern. But how this pattern comes about is something biologists have been asking for a long time. A recent study suggests that the pattern may be related to the dynamics of how the florets grow ( Science 2021, DOI: 10.1126/science.abg5999 ). Through a combination of computer modeling and genetic experiments, Christophe Godin , a computational scientist at France’s National Institute for Research in Digital Science and Technology and the University of Lyon, and François Parcy , a plant geneticist at the French National Center for Scientific Research and Grenoble Alpes University, mutated the model plant Arabidopsis thaliana to grow in a romanesco-esque flowering pattern. The team found that this change in flowering shape was caused by only one genetic tweak to a cauliflower mutant of the Arabidopsis

Continuous positive airway pressure adherence trajectories in sleep apnea: Clustering with summed discrete Fréchet and dynamic time warping dissimilarities.

Obstructive sleep apnea (OSA) is a chronic disease characterized by recurrent pharyngeal collapses during sleep. In most severe cases, continuous positive airway pressure (CPAP) consists in keeping the airways open by administering mild air pressure. This treatment faces adherence issues. Eight hundred and forty-eight subjects were equipped with CPAP prescribed at the Grenoble University Hospital between 2016 and 2018. Their daily CPAP uses have been recorded during the first 3 months. Our aim is to cluster these adherence time series. With hierarchical agglomerative clustering, we focused on the choices of the dissimilarity measure and the internal cluster validation index (CVI). The Euclidean distance, the dynamic time warping (DTW) and the generalized summed discrete Fréchet dissimilarity were implemented with three linkage strategies ("average," "complete," and "Ward"). The performances of each method (dissimilarity and linkage) were evaluated on a simulation study through the adjusted Rand index (ARI). The Ward linkage with DTW dissimilarity provided the best ARI. Then six different internal CVIs (Silhouette, Calinski Harabasz, Davies Bouldin, Modified Davies Bouldin, Dunn, and COP) were compared on their ability to choose the best number of clusters. The Dunn index beat the others. CPAP data were clustered with the Ward linkage, the DTW dissimilarity and the Dunn index. It identified six clusters, from a cluster of patients (N = 29 subjects) whose stopped the therapy early on to a cluster (N = 105) with increasing adherence over time. Other clusters were extremely good users (N = 151), good users (N = 150), moderate users (N = 235), and poor adherers (N = 178).

Risk factors of BK viral hemorrhagic cystitis in allogenic hematopoietic stem cell transplantation.

Reactivation of BK virus (BKV) can occur during intensive immunosuppression such as in allogenic hematopoietic stem cell transplant (AHSCT) recipients for whom a systematic PCR urine test for BKV will be positive in 50% to 100% of patients. Only 5% to 40% will develop BKV hemorrhagic cystitis (HC). Thus, BKV PCR testing is useful to confirm a diagnosis of BKV-HC but not to predict its occurrence. The aim of this retrospective study was to ascertain the risk factors of developing BKV HC, mostly in patients receiving posttransplant cyclophosphamide. The study looked at data from Grenoble Alpes University Hospital included in the national retrospective register ProMISe, administered by the "Société Francophone de Greffe de Moelle et de Thérapie Cellulaire". Urine BKV PCR was performed when patients presented grade≥2 hematuria with clinical symptoms of cystitis. BKV-HC was defined as an association of clinical symptoms of cystitis, grade≥2 hematuria and BKV viruria>7 log10 copies/ml. From January 2014 to January 2018, 168 AHSCTs were considered for analysis, of which 43 (25.6%) developed BKV-HC and 44.9% of the subgroup that received posttransplant cyclophosphamide. After logistic regression, the risk factors associated with BKV-HC were reduced to posttransplantation exposure to cyclophosphamide (OR 4.25, [1.66; 10.87], P=.02), age<40y (OR 3.85 [1.51; 9.80], P=.005) and corticosteroid therapy (OR 3.86, [1.59; 9.36], P=.003). Exposure to cyclophosphamide, younger age (<40) and corticosteroid therapy are potential risk factors for BKV-HC.

Identification of a predictive metabolic signature of response to immune checkpoint inhibitors in non-small cell lung cancer: METABO-ICI clinical study protocol

BackgroundImmune checkpoints inhibitors (ICI) are becoming new standards of care for the treatment of non-small cell lung cancer (NSCLC), both as first (alone or in association with chemotherapy) and second line. However, no powerful predictive biomarker of therapeutic response to ICI has been found to date. It has been recently shown that microbiota composition could influence the ability of patients to respond to ICI. Indeed, the microbiota produces circulating metabolites that will subsequently act on immune system, the investigators hypothesized that plasma metabolic signature, reflecting a global microbiota function, could represent a predictive biomarker of response to ICI. MethodsMonocentric prospective study. Primary objective is to identify baseline metabolic signature (metabolomics analysis by mass spectrometry) associated to ICI response. Secondary objectives are to link metabolic signature with microbiota composition (metagenomics analysis RNA 16S) and immune profile, and altogether with clinic response to ICI. The study will include 60 NSCLC patients treated by ICI in 1st, 2nd or 3rd line of treatment at the Grenoble Alpes University hospital (CHUGA) in 18 months. Patients that have received antibiotic or steroid treatment, 2 or 4 weeks before ICI initiation, respectively, will be excluded. Blood and feces will be collected prior to, at 2 months after ICI treatment initiation, and at 6 months or at progression. Expected resultsWe expect to highlight a metabolic profile predictive of response to ICI. By identifying factors associated with early progression, we could avoid to treat potential non-responding patients. Moreover, by restoring a favorable microbiota, patients’ ability to respond to these treatments might be restored.

Efficacy of Omalizumab in a series of 23 patients suffering from mast cell activating disorders

Omalizumab, an anti-IgE antibody, is an efficient treatment for chronic spontaneous urticaria (CSU) and asthma. Moreover, Omalizumab has demonstrated efficacy in treating allergic rhinitis, atopic dermatitis and, more recently,in nasal polyps. So we could suppose that it could be efficient in other mast cell activating disorders (MCAD) as mast cell activation syndrome (MCAS), indolent systemic mastocytosis (ISM) and extracutaneous signs of CSU (CSU + ). We report the evolution of extracutaneous symptoms in CSU + MCAS and ISM patients treated with Omalizumab. We retrospectively collected data from all ISM, MCAS or CSU+ patients treated with Omalizumab and followed by the Department of clinical immunology of Grenoble-Alpes University Hospital, France. Since 2014, 23 patients were included in our study : 8 ISM, 2 MCAS and 13 CSU+. Oral consent from all patient was collected. The median age of our cohort was 48 years (17–81). The majority of the patients were women (65.2 %). The median age of patients having their first symptoms was 33 years (range : 6–68) and when the diagnosis was made was 45 years (range : 13–77). Before Omalizumab therapy, the major debilitating symptoms are angioedema (70 %), urticaria (83 %), gastro-intestinal (GI) symptoms (70 %) and recurrent anaphylactic reaction (35 %). All patients received concomitantly Venom Immunotherapy (IT), H1-antihistamines, H2-antihistamines, anti-leukotriene, Cromolyn sodium treatments. Among patients, 5 (23 %) were treated with a median dose of 300 mg/3 weeks, 11 (50 %) received a dose of 300 mg/month and 6 a dose of 300 mg/15 days (27 %). The injections were mainly delivered at home (70 %). The median age of patients on the first injection was 46 years (range : 14–77). For our available data, extracutaneous symptoms were improved for all patients except for one. The improvement appeared 3 months post-treatment (range 1–12). Patients also noticed an asthenia improvement (31 %). The majority of patient with anaphylactic reactions did not present anaphylactic attack during venom immunotherapy or during follow-ups. One patient had an ISM with vesical-, GI-, skin-symptoms and POTS (postural orthostatic tachycardia syndrome). Skin symptoms (urticaria) improved but not the extracutaneous ones. Omalizumab was given during a median period of 17 months (range : 5–62) with no severe or serious adverse events. The most common drug side effects were local swelling at the site of injection (4 %), transient asthenia (30 %), fainting attack (13 %), arthralgia (8 %). Two patients noticed exacerbation after first injections (8 %). One patient noticed a hair loss. Other than that, no long-term side effect was observed. In conclusion, MCAD are relatively rare and heterogeneous diseases with poor therapeutic option. Omalizumab, an anti-IgE Ab, seems to be safe and efficient in several symptoms. It also seems to be efficient in CSU+ extracutaneous symptoms.

Sarcopenia diagnosis: comparison of automated with manual computed tomography segmentation in clinical routine

AbstractBackgroundCross‐sectional muscle area (CSMA) at the mid third lumbar vertebra (L3) can be used for sarcopenia diagnosis. The measurement of CSMA is time‐consuming and thus restricted to clinical research. We aimed to compare the automatic module ABACS (Automatic Body composition Analyser using Computed tomography image Segmentation software) with manual segmentation for CSMA assessment into clinical routine.MethodsThe study population was screened retrospectively from a computed tomography‐scan (CT‐scan) database. All consecutive participants, hospitalized at the Grenoble University Hospital (CHU Grenoble Alpes) between January and May 2018, and with an abdominal CT‐scan including sagittal reconstruction were included. The software SliceOmatic complemented with the module ABACS (ABACS‐SliceOmatic) was compared with the software ImageJ. Their agreement was determined using Lin's concordance correlation coefficient and visualized in Bland–Altman plots for the CSMA measurement or with Cohen's kappa coefficient (κ) for sarcopenia status.ResultsData from 680 participants were analysed (mean age 59 ± 19 years, %females: 45.7). The concordance correlation coefficient between both types of software was 0.93 (CI95%: 0.92 to 0.94). Mean CSMA was significantly higher with ABACS‐SliceOmatic (mean difference: 6.51 ± 10.50 cm2; P &lt; 0.001). Kappa agreement for sarcopenia diagnosis was moderate: 0.68 (CI95%: 0.62–0.74) and 0.71 (CI95%: 0.65–0.76) for Prado's and Derstine's definitions, respectively.ConclusionsABACS‐SliceOmatic has moderate agreement with the manual software ImageJ in a routine clinical database. Our work suggests that ABACS‐SliceOmatic should be used with caution in clinical practice. To improve its reliability, we suggest to manually validate the automatic segmentation.

A randomized sham-controlled trial on the effect of continuous positive airway pressure treatment on gait control in severe obstructive sleep apnea patients

To determine the effect of continuous positive airway pressure (CPAP), the gold standard treatment for obstructive sleep apnea syndrome (OSAS), on gait control in severe OSAS patients. We conducted a randomized, double-blind, parallel-group, sham-controlled monocentric study in Grenoble Alpes University Hospital, France. Gait parameters were recorded under single and dual-task conditions using a visuo-verbal cognitive task (Stroop test), before and after the 8-week intervention period. Stride-time variability, a marker of gait control, was the primary study endpoint. Changes in the determinants of gait control were the main secondary outcomes. ClinicalTrials.gov Identifier: (NCT02345694). 24 patients [median (Q1; Q3)]: age: 59.5 (46.3; 66.8) years, 87.5% male, body mass index: 28.2 (24.7; 29.8) kg. m−2, apnea–hypopnea index: 51.6 (35.0; 61.4) events/h were randomized to be treated by effective CPAP (n = 12) or by sham-CPAP (n = 12). A complete case analysis was performed, using a mixed linear regression model. CPAP elicited no significant improvement in stride-time variability compared to sham-CPAP. No difference was found regarding the determinants of gait control. This study is the first RCT to investigate the effects of CPAP on gait control. Eight weeks of CPAP treatment did not improve gait control in severe non-obese OSAS patients. These results substantiate the complex OSAS-neurocognitive function relationship.

Hidden Markov Model Segmentation to Demarcate Trajectories of Residual Apnoea-Hypopnoea Index in CPAP-Treated Sleep Apnoea Patients: The New Concept of a Telemonitogram

Background: Continuous positive airway pressure (CPAP), the reference treatment for obstructive sleep apnoea (OSA), is used by millions of individuals worldwide with remote telemonitoring providing daily information on CPAP usage and efficacy, a currently underused resource. Here, we aimed to implement state-of-the-art data science methods to describe heterogeneity and diversity of time-series of residual apnoea-hypopnoea indexes (rAHI) from CPAP telemonitoring. Methods: We analysed a CPAP telemonitoring database to model and cluster rAHI trajectories. Our primary objective was to use Hidden Markov models (HMMs) as a probabilistic model-based approach to extract features from rAHI time-series. Secondary goals were to identify clusters of rAHI trajectories and their relation to CPAP treatment outcomes, adherence and leaks. Findings: From telemonitoring records of 2,860 CPAP-treated patients (age: 66·31 ± 12·92 years, 69·9% male), HMM modelling revealed three states differing in variability within a given state and probability of shifting from one state to another. Six clusters of rAHI trajectories were identified ranging from well controlled CPAP-treated patients (Cluster 0: 669 (23%); mean rAHI 0·58 ± 0·59 events/hour) to the most unstable (Cluster 5: 470 (16%); mean rAHI 9·62 ± 5·62 events/hour). CPAP adherence was 30 minutes higher in cluster 0 compared to clusters 4 and 5 (p-value <0·01). Leaks were significantly more frequent in cluster 5. Interpretation: This new approach based on HMM might constitute the backbone for deployment of digital health solutions improving the interpretation of telemonitoring data from CPAP-treated patients. Funding Information: JLP, SB, and RT are supported by the French National Research Agency in the framework of the Investissements d’avenir” program (ANR-15-IDEX-02) and the “e-health and integrated care and trajectories medicine and MIAI artificial intelligence” Chairs of excellence from the Grenoble Alpes University Foundation (ANR-19-P3IA-0003). AM is supported by Probayes and MIAI in the framework of a “Convention Industrielle de Formation par la Recherche” (CIFRE) PhD. The PhD is also supported by the French National Research Agency (grant 2020/0007). Declaration of Interests: JLP reports grants from Air Liquide Foundation, grants and personal fees from Agiradom, grants and personal fees from AstraZeneca, grants from Fisher and Paykel, grants from Mutualia, grants and personal fees from Philips, grants and personal fees from Resmed, grants from Vitalaire, grants from Boehringer Ingelheim, grants from Jazz Pharmaceuticals, grants from Night Balance, grants from Sefam, outside the submitted work; JCB is employee of AGiR-a-dom, a French home-care provider; RT reports other from AGiR-a-dom, grants from Resmed, outside the submitted work; AM, RLH and MCS report other from AGiR-a-dom, and SB have no conflict of interest directly related to this work. Ethics Approval Statement: We analysed a CPAP telemonitoring database [registered and ethically approved by the French C.C.T.I.R.S: N°15.925bis and ethics regulations MR003 N° 1996650v0] to model and cluster patients’ rAHI trajectories.

Evaluation of socio-economic insecurity in peripheral artery disease patients.

The social and economic environment has become a major determinant of cardiovascular health. The objective of our study was to assess socio-economic insecurity in patients with symptomatic PAD. The PRECAR study was a non-interventional prospective cohort study. Patients were recruited from the Vascular Medicine and Surgery Departments of Grenoble-Alpes University Hospital or during a consultation as part of the therapeutic education program "On the move! Better understanding and better living with arterial disease". The analysis of socio-economic and environmental data was based on the EPICES score (a reliable index used to measure individual deprivation) and INSEE parameters (level of education and socio-professional category). Cardiovascular risk factors were also recorded. 150 patients with symptomatic PAD were included between November 2017 and June 2018. 84% were men. In our population 54% (CI95% 45.7 - 62.1) were in a precarious situation compared to 40% (CI95% 39.8 - 40.2) in the general population, according to the EPICES score (P<0.001). Levels of education were low and patients with a baccalaureate or higher education degree were under-represented. Executives, intellectuals and intermediate professions were also under-represented in the PAD population. This data opens new perspectives on the social characterisation of patients that may contribute to improving the outcomes of patients with peripheral vascular disease.

ECMO pour choc cardiogénique réfractaire post cardiotomie : expérience du service de chirurgie cardiaque du CHU de Grenoble Alpes

ObjectiveThe objective of our study is to detail our experience relating to ECMO implantations for post-cardiotomy refractory shock, by analyzing the pre-ECMO factors (history, type of surgery, LVEF), factors relating to ECMO (implantation time, duration) and post-ECMO factors (weaning, complications) in order to highlight those possibly associated with high mortality. MethodsThis is a univariate and multivariate retrospective study of ECMO data implemented between 2011 and 2019 at the Grenoble Alpes University Hospital Center following cardiac surgery. The time to implantation of ECMO was less than 3hours (intraoperative) between 3 and 24hours (early postoperative) and between 24 and 48hours after aortic unclamping (late postoperative). Preoperative or postoperative intra-aortic balloon counterpulsation (CPBIA) could be associated. Results114 veino-arterial ECMOs were implanted for refractory cardiogenic shock after 5702 cardiac surgeries (1.9%) with a survival rate of 30.7%. The mean age of the patients was 68.6+- 10.5 years. The implantation of ECMO was performed intraoperatively in 71 patients (62.2%), early postoperatively in 22 patients (19.2%) and late postoperatively in 21 patients (18.4%). The duration of assistance was less than 48hours in 27 patients (23.6%), between 48hours and one week in 58 patients (50.9%) and more than one week in 29 patients (25.5%). Univariate analysis revealed a statistically significant association between mortality rate and male sex (P=0.002), association absent with other preoperative characteristics, delay in implantation of ECMO, installation of CPBIA, post-operative characteristics and resuscitation suites. Multivariate analysis of the entire study population demonstrated that the use of ECMO for cardio-respiratory arrest was the only independent risk factor for mortality (OR=7.57 [1.41-40, 62]). After multivariate reanalysis excluding patients with ECMO placement for cardio respiratory arrest, age, preoperative renal failure, type of procedure and EuroSCORE II were risk factors for mortality. ConclusionIn this study, male gender, type of intervention, occurrence of cardiac arrest were significantly associated with the death rate. A study of greater power, multicentric, and with a larger sample, will have to be carried out to reach significance.

Revised biostratigraphy and regional correlations of the Urgonian southern Vercors carbonate platform, southeast France

The Subalpine Urgonian platform provides seismic-scale outcrops of interest to constrain the depositional organisation of Lower Cretaceous carbonate systems. Revising the biostratigraphy using ammonites, rudists, calcareous algae and orbitolinids and establishing regional stratigraphic correlations between the Gresse-en-Vercors cliff and the Plateau de Glandasse provide a new vision regarding the Urgonian platform stratigraphic architecture of the southern Vercors. The rudist-dominated inner-platform series cropping out in the northern Gresse-en-Vercors cliff grades laterally southward into the bioclastic-dominated Glandasse Formation (defined in the Plateau de Glandasse series). Our new correlations contradict with the Grenoble University's conceptual platform model which considered the Glandasse Formation as rudist-poor lowstand deposits formed in the southern Vercors and sealed by the transgressive Urgonian limestones formation. Our interpretation better conforms to the Geneva University's conceptual model, suggesting that the Glandasse and Urgonian limestones formations should be regarded as stratigraphic equivalents. Further investigations are needed to address the stratigraphic evolution and controlling mechanisms of the regional Urgonian system at the regional scale.