Anxiété postnatale chez des femmes primipares ayant vécu au moins un avortement spontané

L’avortement spontané (AS) représente 15 à 25 % des grossesses, ce qui en fait la complication en contexte de grossesse la plus fréquente (Brier, 2008). Cette perte périnatale et le deuil qui en découle sont souvent des épreuves douloureuses ayant des impacts psychologiques pour la mère (Séjourné et al., 2008). Des études ont mis en lumière la présence d’un lien entre vivre un AS et la présence d’anxiété, mais les résultats sur les liens entre vivre un AS et l’anxiété à long terme sont limités, semblent se contredirent ou découlent d’études sur différents types de perte. Les études diffèrent quant aux mesures et aux construits d’anxiété et plusieurs portent sur des échantillons relativement modestes et sans groupe contrôle. L’objectif général de cette étude corrélationnelle transversale consiste à poursuivre l’étude du lien entre le fait d’avoir vécu au moins un AS et l’anxiété suivant un premier accouchement d’un enfant en santé, en considérant aussi les symptômes du trouble d’anxiété généralisée (TAG) qui sont les plus répandus en périnatalité, de même que certains facteurs associés (sociodémographiques et psychologiques). Quelques recherches soulignent le rôle central de l’intolérance à l’incertitude dans l’apparition et le maintien des inquiétudes excessives ou de l’anxiété en périnatalité et qu’elle semble exacerbée par des événements stressants. À titre exploratoire, le lien entre les AS et l’intolérance à l’incertitude est donc aussi étudié. Ceci est fait en contrôlant pour des facteurs s’étant déjà montrés liés aux AS. L’échantillon recruté, issu de la population générale, comporte 135 mères primipares ayant vécu au moins un AS comparé à 455 femmes n’en ayant pas vécu. Il repose sur l’utilisation de données des participants volontaires qui ont été recrutés de façon non aléatoire dans une étude corrélationnelle plus vaste explorant les facteurs explicatifs de l’anxiété chez les nouveaux parents. Les participantes ont répondu à un sondage en ligne évaluant diverses variables. En plus du fait d’avoir vécu ou non un AS, plusieurs composantes de l’anxiété étaient mesurées, soit l’anxiété d’état et de trait, les symptômes du TAG, la tendance à s’inquiéter en général et sur la parentalité ainsi que l’intolérance à l’incertitude. Les données ont été soumises à des analyses descriptives, comparatives et corrélationnelles. Les résultats mettent en lumière que sur le plan des symptômes anxieux, les femmes ayant vécu au moins un AS rapportent plus de symptômes de TAG, une plus grande tendance à s’inquiéter en général et une plus grande tendance à s’inquiéter sur la parentalité. Sur le plan de l’intolérance à l’incertitude, les femmes ayant vécu au moins un AS rapportent être plus intolérantes à l’incertitude et présentent davantage de manifestations cognitives et comportementales traduisant cette intolérance. Sur le plan théorique, les résultats amènent un éclairage nouveau et plus précis, en complémentarité aux résultats des études antérieures sur les liens entre les AS et les différentes composantes de l’anxiété. La mise en relation de l’intolérance à l’incertitude pave la voie à de nouvelles études qui permettraient d’accéder à une meilleure compréhension et explication de ce lien. Sur le plan clinique, cette recherche pourrait aiguiller les cliniciens quant à l’importance d’évaluer systématiquement l’historique des pertes périnatales en tant que prédicteur du risque d’anxiété post-partum et en tant que marqueur possible d’une intervention. La nature corrélationnelle de cette étude justifie une prudence quant à l’attribution causale des phénomènes étudiés et elle préconise de mener d’autres travaux sur le sujet

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

OBJECTIVE: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES: Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS: Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS: In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012002780

Multifocal Metachronous Giant Cell Tumor: Case Report and Review of the Literature

Introduction. Giant cell tumors (GCTs) of bone are known for their local aggressiveness and high recurrence rate. There are rare cases of multicentric GCT and most are synchronous. We herein review metachronous multicentric GCT reported in the literature. Material and Methods. A MEDLINE, Cochrane, and Google Scholar search was done to collect all cases of multicentric metachronous GCT specifying the clinical, radiological, and histological characteristics of each location and its treatment. Results. A total of 37 multifocal giant cell tumors were found in the literature. 68% of cases of multicentric giant cell tumors occur in less than 4 years following treatment of the first lesion. Thirty-seven cases of multifocal metachronous GCT were identified in the literature until 2012. Patients with multicentric GCT tend to be younger averaging 23. There is a slight female predominance in metachronous GCT. The most common site of the primary GCT is around the knee followed by wrist and hand and feet. Recurrence rate of multicentric GCT is 28.5%. Conclusion. Multicentric giant cell tumor is rare. The correct diagnosis relies on correlation of clinical and radiographic findings with confirmation of the diagnosis by histopathologic examination

Robust wetting and drying with discontinuous Galerkin flood model on unstructured triangular meshes

Godunov-based finite volume (FV) methods are widely employed to numerically solve the Shallow-Water Equations (SWEs) with application to simulate flood inundation over irregular geometries and real-field, where unstructured triangular meshing is favored. Second-order extensions have been devised, mostly on the MUSCL reconstruction and the discontinuous Galerkin (DG) approaches. In this paper, we introduce a novel second-order Runge–Kutta discontinuous Galerkin (RKDG) solver for flood modeling, specifically addressing positivity preservation and wetting and drying on unstructured triangular meshes. To enhance the RKDG model, we adapt and refine positivity-preserving and wetting and drying techniques originally developed for the MUSCL-based finite volume (FV) scheme, ensuring its effective integration within the RKDG framework. Two analytical test problems are considered first to validate the proposed model and assess its performance in comparison with the MUSCL formulation. The performance of the model is further explored in real flooding scenarios involving irregular topographies. Our findings indicate that the added complexity of the RKDG model is justified, as it delivers higher-quality results even on very coarse meshes. This reveals that there is a promise in deploying RKDG-based flood models in real-scale applications, in particular when field data are sparse or of limited resolution

Does increasing packing density using larger caliber coils improve angiographic results of embolization of intracranial aneurysms at 1 year: A randomized trial

© 2020 American Society of Neuroradiology. All rights reserved. BACKGROUND AND PURPOSE: The impact of increased aneurysm packing density on angiographic outcomes has not been studied in a randomized trial. We sought to determine the potential for larger caliber coils to achieve higher packing densities and to improve the angiographic results of embolization of intracranial aneurysms at 1 year. MATERIALS AND METHODS: Does Embolization with Larger Coils Lead to Better Treatment of Aneurysms (DELTA) was an investigator-initiated multicenter prospective, parallel, randomized, controlled clinical trial. Patients had 4- to 12-mm unruptured aneurysms. Treatment allocation to either 15- (experimental) or 10-caliber coils (control group) was randomized 1:1 using a Web-based platform. The primary efficacy outcome was a major recurrence or a residual aneurysm at follow-up angiography at 12 6 2 months adjudicated by an independent core lab blinded to the treatment allocation. Secondary outcomes included indices of treatment success and standard safety outcomes. Recruitment of 564 patients was judged necessary to show a decrease in poor outcomes from 33% to 20% with 15-caliber coils. RESULTS: Funding was interrupted and the trial was stopped after 210 patients were recruited between November 2013 and June 2017. On an intent-to-treat analysis, the primary outcome was reached in 37 patients allocated to 15-caliber coils and 36 patients allocated to 10-caliber coils (OR = 0.931; 95% CI, 0.528–1.644; P = .885). Safety and other clinical outcomes were similar. The 15-caliber coil group had a higher mean packing density (37.0% versus 26.9%, P = .0001). Packing density had no effect on the primary outcome when adjusted for initial angiographic results (OR = 1.001; 95% CI, 0.981–1.022; P = .879). CONCLUSIONS: Coiling of aneurysms randomized to 15-caliber coils achieved higher packing densities compared with 10-caliber coils, but this had no impact on the angiographic outcomes at 1 year, which were primarily driven by aneurysm size and initial angiographic results

Intracranial Myeloid Sarcoma Metastasis Mimicking Acute Subdural Hematoma

Myeloid sarcoma, a rare consequence of myeloproliferative disorders, is rarely seen in the central nervous system, most commonly in the pediatric population. Although there are a handful of case reports detailing initial presentation of CNS myeloid sarcoma in the adult population, we have been unable to find any reports of CNS myeloid sarcoma presenting as a large mass lesion in a herniating patient. Here, we present the case of a patient transferred to our facility for a very large subdural hematoma. Based on imaging characteristics, it was felt to be a spontaneous hematoma secondary to coagulopathy. No coagulopathy was found. Interestingly, he did have a history of acute myeloid leukemia (AML) diagnosed 2 months previously, and intraoperatively he was found to have a confluent white mass invading both the subdural and subarachnoid spaces. There was minimal associated hemorrhage and final pathology showed myeloid sarcoma. This is the first report we are aware of in which CNS myeloid sarcoma presented as a subdural metastasis and also the first report in which we are aware of this etiology causing a herniation syndrome secondary to mass effect

Management Strategies and Outcomes for VHL-related Craniospinal Hemangioblastomas

Hemangioblastomas are rare and benign tumors accounting for less than 2% of all central nervous system (CNS) tumors. The vast majority of hemangioblastomas occur sporadically, whereas a small number of cases, especially in younger patients, are associated with Von Hippel–Lindau (VHL) syndrome. It is thought that loss of tumor suppressor function of the VHL gene results in stabilization of hypoxia-inducible factor alpha with downstream activation of cellular proliferative and angiogenic genes that promote tumorigenesis. VHL-related hemangioblastomas predominantly occur in the cerebellum and spine. Lesions are often diagnosed on contrast-enhanced craniospinal MRIs, and the diagnosis of VHL occurs through assessment for germline VHL mutations. Surgical resection remains the primary treatment modality for symptomatic or worrisome lesions, with excellent local control rates and neurological outcomes. Stereotactic radiotherapy can be employed in patients who are deemed high risk for surgery, have multiple lesions, or have non-resectable lesions. Given the tendency for development of either new or multiple lesions, close radiographic surveillance is often recommended for asymptomatic lesions