Bulletin De L Academie Nationale De Medecine最新文献

英文中文

Quelle place reste-t-il pour les antivitamines K ? 抗维生素K还有什么空间？

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.12.006

Bernard Iung

For more than 50 years, vitamin K antagonists (VKAs) were the only oral anticoagulant therapy available. Despite efficacy, VKAs use is made difficult due to the variability of anticoagulant activity requiring regular blood samples to assess haemostasis, at least monthly. Since the 2010's, direct anticoagulants (DOACs) have rapidly prevailed over VKA, due to the lack of blood controls, and because numerous randomized trials have demonstrated at least equivalent efficacy and safety to VKAs in most indications of long-term anticoagulant therapy. According to current international guidelines, DOACs are now recommended as first-line treatment in most presentations of venous thromboembolism and atrial fibrillation. VKAs remain indicated in vascular complications of antiphopholipid syndrome. In atrial fibrillation, it is now clear that DOACs can be used in patients with native valve disease, except rheumatic mitral stenosis, and after valve replacement using a bioprosthesis. VKAs remain indicated in patients with rheumatic mitral stenosis associated with atrial fibrillation and after heart valve replacement using a mechanical prosthesis. VKAs are also indicated in case of terminal renal failure. When VKAs are required, their prescription should be associated with patient education and, if possible, international normalized ratio self-monitoring to improve patient adherence and reduce the risk of complications.

50多年来，维生素K拮抗剂（VKAs）是唯一可用的口服抗凝治疗。尽管有疗效，但由于抗凝血活性的可变性，vka的使用变得困难，需要定期采集血液样本来评估止血情况，至少每月一次。自2010年以来，由于缺乏血液控制，直接抗凝剂（DOACs）迅速取代了VKA，因为许多随机试验已经证明，在大多数长期抗凝治疗适应症中，直接抗凝剂（DOACs）的疗效和安全性至少与VKA相当。根据目前的国际指南，DOACs现在被推荐作为大多数静脉血栓栓塞和房颤的一线治疗。抗磷脂综合征血管并发症中仍存在vka。在房颤中，除了风湿性二尖瓣狭窄外，DOACs可以用于先天性瓣膜疾病患者和使用生物假体瓣膜置换术后。vka仍然适用于风湿性二尖瓣狭窄合并心房颤动患者和使用机械假体心脏瓣膜置换术后。vka也适用于晚期肾功能衰竭。当需要vka时，其处方应与患者教育相结合，并在可能的情况下进行国际标准化比例自我监测，以提高患者的依从性并降低并发症的风险。

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引用次数: 0

La théorie des trois nez à l’usage du clinicien 临床医生的三个鼻子理论

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.11.006

Roger Jankowski

In the evo-devo concept on the origin of the nose, anterior skull base and midface, the centro-facial air cavities do not correspond to a single organ but result from the physiological and anatomical assembly of the organs of olfaction and respiration to which the paranasal sinuses are added after birth. Establishing that the ethmoid is not a sinus makes it possible to individualize nasal polyposis as a specific pathology of the olfactory nose and to formalize its surgery. Giving its entity to the respiratory nose makes it possible to individualize monosymptomatic nasal obstruction and chronic respiratory rhinitis (CRR), which includes allergic rhinitis. Knowing the CT and endoscopic semiology of CRR refines the allergological diagnosis and the therapeutic management of CND. The paranasal sinus organ, which, through its uninterrupted production of nitric oxide and its bolus release thanks to the ostial sphincter contributes to the asepsis of the centrofacial and broncho-pulmonary air cavities and to the oxygenation of the pulmonary arterial blood, deserves new clinical attention. The theory of the three noses offers the clinician an original diagnostic and therapeutic approach to the pathology of the nose and sinuses.

在关于鼻子、前颅底和中脸起源的进化概念中，面中央空腔并不对应于一个单一的器官，而是嗅觉和呼吸器官的生理和解剖组合的结果，鼻窦是在出生后添加的。确定筛窦不是鼻窦使得将鼻息肉病个体化作为嗅觉鼻的一种特殊病理并使其手术正规化成为可能。将其实体赋予呼吸性鼻使单症状性鼻塞和慢性呼吸性鼻炎（CRR）（包括过敏性鼻炎）的个体化成为可能。了解CRR的CT和内窥镜符号学可以改善CND的过敏诊断和治疗管理。鼻副窦器官通过其不间断的一氧化氮的产生和通过口括约肌的大量释放，有助于中央面和支气管肺腔的无菌和肺动脉血的氧合，值得临床新的关注。三鼻理论为临床医生提供了鼻窦病理的原始诊断和治疗方法。

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引用次数: 0

Communiqué. Zones à faible émission (ZFE) : ne pas oublier l’impact sur la santé 公报。低排放区对健康的影响

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.12.019

Académie nationale de médecine

引用次数: 0

L’eau, l’air et les émergences épidémiques 水、空气和流行病爆发

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.12.008

Antoine Flahault

引用次数: 0

Reste-t-il une place pour les digitaliques dans le traitement de l’insuffisance cardiaque ? 数字技术在治疗心力衰竭方面还有一席之地吗？

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.11.004

Damien Logeart

Digitalis glycosides are the oldest class of drugs used to treat heart failure (HF). Their efficacy in patients with HF and reduced left ventricular ejection fraction (LVEF), and sinus rhythm, has been evaluated in two randomized, placebo-controlled trials. The DIG trial, which involved 6800 patients with LVEF ≤ 45% and was published in the late 1990s, showed that digoxin had no effect on mortality, but reduced hospitalizations by 18% (relative risk reduction (RRR): 0.72; 95% confidence interval (95% CI): 0.66–0.79, P = 0.006). More recently, the DIGIT-HF trial (1212 patients with LVEF ≤ 40% and NYHA class III or IV, or LVEF ≤ 30% and NYHA class II) demonstrated that digitoxin significantly reduced the primary endpoint of death or hospitalization for HF by 18% (HR: 0.82; 95% CI: 0.69 to 0.98; P = 0.03). This beneficial effect, in addition to the recommended quadruple therapy, was driven solely by the reduction in hospitalizations. In addition to this statistically significant but relatively modest benefit, the use of digitalis is complicated by a narrow therapeutic margin (target digoxin level 0.5–0.9 ng/mL) with a risk of serious adverse cardiac effects if digoxin levels exceed 1.2 ng/mL. In 2021 and 2022, respectively, European and North American cardiology societies considered that digoxin could be prescribed to HF patients with reduced LVEF and sinus rhythm who are symptomatic despite optimized treatment (class IIb recommendation). Digoxin is also indicated for controlling heart rate in patients with permanent atrial fibrillation, particularly in cases of HF.

洋地黄苷是最古老的一类用于治疗心力衰竭的药物。在两项随机安慰剂对照试验中，他们对HF、左室射血分数（LVEF）降低和窦性心律患者的疗效进行了评估。在20世纪90年代末发表的涉及6800例LVEF≤45%的患者的DIG试验显示地高辛对死亡率没有影响，但住院率降低了18%(相对风险降低率（RRR）： 0.72；95%置信区间（95% CI）： 0.66-0.79, P = 0.006)。最近，DIGIT-HF试验（1212例LVEF≤40%且NYHA为III或IV级，或LVEF≤30%且NYHA为II级的患者）表明，地黄素显著降低了HF的主要终点死亡或住院率18% （HR: 0.82; 95% CI: 0.69至0.98;P = 0.03）。除了推荐的四联疗法外，这种有益效果完全是由于住院率的减少。除了这一具有统计学意义但相对适度的益处外，使用洋地黄的治疗范围很窄（目标地高辛水平为0.5-0.9 ng/mL），如果地高辛水平超过1.2 ng/mL，则有严重心脏不良反应的风险。分别在2021年和2022年，欧洲和北美心脏病学会认为地高辛可用于LVEF降低和窦性心律降低的HF患者，尽管优化了治疗，但仍有症状（IIb类推荐）。地高辛也适用于控制永久性房颤患者的心率，特别是HF患者。

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引用次数: 0

Complications neurologiques des immunothérapies anti-cancéreuses 抗癌免疫疗法的神经并发症

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.12.009

Bastien Joubert

Anti-cancer immunotherapies primarily include chimeric antigen receptor T cells (CAR-T cells) and immune checkpoint inhibitors (ICIs). Each of these therapeutic classes is associated with its own spectrum of neurological toxicities. CAR-T cells induce immune effector cell-associated neurotoxicity syndrome (ICANS) in 40–60% of treated patients, which manifests as encephalopathy of varying severity and resolves with treatment in over 90% of cases. Late-onset toxicities presenting as parkinsonian syndrome are by contrast rare (< 1% of patients). ICIs cause immune-mediated neurological toxicities in 1–8% of patients, with a wide variability in manifestations. The most frequent complications include myositis, acute demyelinating polyradiculoneuropathy, and encephalitis. The latter can be divided into two subgroups with distinct clinical, biological, and prognostic features: focal encephalitis, which mimics the clinical presentation of paraneoplastic encephalitis and is often -refractory to treatment; and meningoencephalitis, which typically responds well to corticosteroids. Diagnosis of ICI-related adverse effects relies on the temporal association with ICI treatment, syndromic identification of the neurological disorder, exclusion of alternative diagnoses, and detection of nervous system inflammation markers, including anti-neuronal antibodies. Treatment is not well standardized and typically involves corticosteroids, intravenous immunoglobulins, and immunosuppressants, with prognosis varying significantly depending on the type of neurological involvement.

抗癌免疫疗法主要包括嵌合抗原受体T细胞（CAR-T细胞）和免疫检查点抑制剂（ICIs）。这些治疗类别中的每一种都有其自身的神经毒性谱。CAR-T细胞在40-60%的治疗患者中诱导免疫效应细胞相关神经毒性综合征（ICANS），其表现为不同严重程度的脑病，并在90%以上的病例中治疗后消退。相比之下，表现为帕金森综合征的迟发性毒性非常罕见（占患者的1%）。ICIs在1-8%的患者中引起免疫介导的神经毒性，表现差异很大。最常见的并发症包括肌炎、急性脱髓鞘性多根神经病变和脑炎。后者可分为两个亚组，具有不同的临床、生物学和预后特征：局灶性脑炎，模仿副肿瘤脑炎的临床表现，通常难以治疗；脑膜脑炎，通常对皮质类固醇反应良好。ICI相关不良反应的诊断依赖于与ICI治疗的时间相关性、神经系统疾病的综合征识别、排除替代诊断以及神经系统炎症标志物（包括抗神经元抗体）的检测。治疗没有很好的标准化，通常包括皮质类固醇、静脉注射免疫球蛋白和免疫抑制剂，预后因神经系统受累类型而有很大差异。

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引用次数: 0

Discussion à propos de la communication : « Envenimation ophidienne : le retour des antidotes ? » 关于交流的讨论：“奥菲迪亚中毒：解毒剂的回归？”»

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.12.024

Jean-Philippe Chippaux

引用次数: 0

Physiopathologie de la zone épileptogène : décharge de haute fréquence et inhibition 癫痫源区生理病理学：高频放电与抑制

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.06.013

Patrick Chauvel

Surgery for drug-resistant epilepsy relies on the precise localization of the epileptogenic zone (EZ). Stereo-electroencephalography (SEEG), developed in France and later adopted internationally, allows the direct recording of seizures within the brain. Unlike electrocorticography (ECoG), SEEG reveals high-frequency oscillations (HFOs, 80–200 Hz) at seizure onset, particularly in neocortical epilepsies (e.g., focal cortical dysplasias). These high-frequency discharges are now considered a marker of the EZ. However, pathological HFOs (linked to epilepsy) are difficult to distinguish from physiological HFOs (related to cognitive activity). The EZ is defined by the initial synchronization of fast discharges, often preceded by pre-ictal spikes and accompanied by a flattening of the SEEG signal (suppression of low frequencies). A characteristic time-frequency pattern of the EZ has been identified, combining: (i) pre-ictal spikes, (ii) narrowband fast activity (high gamma, 80–150 Hz), and (iii) suppression of low frequencies. This pattern is consistent across different etiologies and correlates with surgical success. A novel pathophysiological hypothesis suggests a key role of inhibition. The fast discharges may reflect the synchronized activity of perisomatic GABAergic inhibitory interneurons, leading to hyperpolarization of pyramidal cells (explaining the suppression of low frequencies). The end of the fast discharge is followed by an excitatory post-inhibitory rebound (PIR). This hypothesis has recently received clinical confirmation in motor cortex seizures and is supported by computational models, as well as microelectrode recordings in animals and humans.

手术治疗耐药癫痫依赖于致痫区（EZ）的精确定位。立体脑电图（SEEG）由法国开发，后来在国际上采用，可以直接记录大脑内的癫痫发作。与皮质电图（ECoG）不同，SEEG显示癫痫发作时的高频振荡（HFOs, 80-200 Hz），特别是在新皮质癫痫（如局灶性皮质发育不良）中。这些高频放电现在被认为是EZ的标志。然而，病理性hfo（与癫痫有关）很难与生理性hfo（与认知活动有关）区分。EZ是由快速放电的初始同步定义的，通常在临界点前尖峰之前，伴随着SEEG信号的平坦化（低频抑制）。已经确定了EZ的特征时频模式，结合了：(i)临界点前尖峰，（ii）窄带快速活动（高伽马，80-150 Hz）和（iii）低频抑制。这种模式在不同的病因中是一致的，并与手术成功相关。一种新的病理生理学假说提出了抑制的关键作用。快速放电可能反映了细胞周围gaba能抑制性中间神经元的同步活动，导致锥体细胞的超极化（解释低频抑制）。快速放电结束后会出现兴奋性抑制后反弹（PIR）。这一假设最近在运动皮层癫痫发作中得到了临床证实，并得到了计算模型以及动物和人类微电极记录的支持。

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引用次数: 0

Nouvelles perspectives thérapeutiques des glioblastomes 胶质母细胞瘤的新治疗前景

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.04.029

Caroline Zerbib , Elizabeth Cohen-Jonathan Moyal

Glioblastoma, the most common and aggressive primary brain tumor, has a highly unfavorable prognosis, with an estimated 5-year survival rate of just 7%. Standard treatment includes surgery, radiotherapy and chemotherapy with Temozolomide. Recently, the addition of low-intensity electric fields (TTFields) has improved overall survival; however, local recurrences remain nearly inevitable. Tumor heterogeneity, particularly due to the presence of highly aggressive and radio-resistant glioblastoma stem cells, plays a key role in these recurrences, posing a major therapeutic challenge. Efforts to optimize treatment strategies focus on adjusting irradiation doses and volumes, enhancing the prediction of therapeutic response through biomarkers, and utilizing advanced multimodal imaging to detect recurrence at an early stage. Additionally, combination approaches – such as integrating TTFields with radiotherapy and immunotherapy – are opening new therapeutic avenues. The development of molecular, immunological, and radiological biomarkers holds promise for more personalized treatment, reducing variability in patient responses. Furthermore, artificial intelligence (AI), through the analysis of multidimensional data, could play a crucial role in predicting treatment outcomes. The integration of these technologies has the potential to revolutionize glioblastoma management by optimizing treatment strategies and identifying patients most likely to benefit from targeted therapies.

胶质母细胞瘤是最常见和侵袭性的原发性脑肿瘤，预后非常不利，估计5年生存率仅为7%。标准治疗包括手术、放疗和替莫唑胺化疗。最近，低强度电场（TTFields）的加入提高了总体存活率；然而，局部复发几乎是不可避免的。肿瘤的异质性，特别是由于高侵袭性和放射抗性胶质母细胞瘤干细胞的存在，在这些复发中起着关键作用，提出了主要的治疗挑战。优化治疗策略的努力集中在调整照射剂量和体积，通过生物标志物增强治疗反应的预测，以及利用先进的多模态成像在早期发现复发。此外，联合疗法——例如将TTFields与放疗和免疫疗法相结合——正在开辟新的治疗途径。分子、免疫学和放射学生物标志物的发展为更个性化的治疗带来了希望，减少了患者反应的可变性。此外，人工智能（AI）通过对多维数据的分析，可以在预测治疗结果方面发挥关键作用。这些技术的整合有可能通过优化治疗策略和确定最有可能从靶向治疗中受益的患者来彻底改变胶质母细胞瘤的治疗。

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引用次数: 0

Communiqué. La prévention des commotions cérébrales liées aux pratiques sportives doit être renforcée 公报。加强预防运动引起的脑损伤

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-02-01 DOI: 10.1016/j.banm.2025.12.021

Académie nationale de médecine

引用次数: 0

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