Bulletin De L Academie Nationale De Medecine最新文献

英文中文

Hypothyroïdie congénitale et pollution : comment l’IA et le Big Data transforment la détection des signaux épidémiques 先天性甲状腺功能减退和污染：人工智能和大数据如何改变流行病信号检测

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/j.banm.2025.09.006

Olivier Jardé , Abdallah Al-Salameh , Léa Leroy , Rachel Desailloud , Sylvain Chamot

Objective

To investigate how the integration of massive health data (French National Health Data System, SNDS, and data from Regional Neonatal Screening Centers, CRDN) and environmental data (Information System on Health and Environment for Water, SISE-Eaux, and the Air Quality Cartography from INERIS) can be used to explore associations between environmental pollution and congenital hypothyroidism (CH), and to enable early detection of large-scale epidemic signals.

Methods

This synthesis is based on three peer-reviewed articles published by our team. The first study analyzes spatial and temporal trends in the incidence of congenital and acquired hypothyroidism in France from 2014 to 2019 using the SNDS, a medico-administrative database covering the entire French population. The second study, conducted at the regional level (Picardy), assesses the association between neonatal TSH concentrations and prenatal exposure to various air and water pollutants by linking neonatal screening data with local environmental data. The third study examines, at the national level, the relationship between prenatal exposure to specific pollutants (perchlorate, nitrates, particulate matter) and the incidence of CH, based on a national cohort derived from the SNDS.

Results

The analyses reveal associations between several environmental pollutants and alterations in neonatal thyroid function. The combined use of SNDS and large-scale environmental data enables fine-grained detection of emerging epidemic signals across the country.

Conclusions

Integrating massive health and environmental datasets opens new avenues for automated epidemiological surveillance and for better understanding the environmental determinants of thyroid diseases.

目的探讨如何将大量健康数据（法国国家卫生数据系统SNDS和区域新生儿筛查中心CRDN数据）与环境数据（法国国家卫生数据系统SISE-Eaux数据和inris空气质量制图）整合在一起，探索环境污染与先天性甲状腺功能减退症（CH）之间的关系，并尽早发现大范围的流行病信号。方法本综合基于我们团队发表的三篇同行评议的文章。第一项研究使用覆盖整个法国人口的医疗管理数据库SNDS分析了2014年至2019年法国先天性和获得性甲状腺功能减退症发病率的时空趋势。第二项研究在区域一级进行（Picardy），通过将新生儿筛查数据与当地环境数据联系起来，评估新生儿TSH浓度与产前暴露于各种空气和水污染物之间的关系。第三项研究在国家一级检查了产前暴露于特定污染物（高氯酸盐、硝酸盐、颗粒物质）与CH发病率之间的关系，该研究基于来自SNDS的国家队列。结果分析揭示了几种环境污染物与新生儿甲状腺功能改变之间的关系。综合使用SNDS和大规模环境数据，可以对全国各地新出现的流行病信号进行细粒度检测。结论整合大量健康和环境数据集为自动化流行病学监测和更好地了解甲状腺疾病的环境决定因素开辟了新的途径。

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引用次数: 0

Rapport 25-12. Intelligence artificielle et responsabilité médicale. Quels enjeux ? 25-12报告。人工智能与医疗责任。什么是危险的？

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/j.banm.2025.12.002

Dominique Lecomte, Christian-François Roques-Latrille, groupe de travail de la commission 5 de l’Académie nationale de médecine

Artificial intelligence (AI) is revolutionizing medicine, offering undeniable advances in diagnosis, treatment, and patient monitoring. Professional practice is highly regulated to ensure the quality and safety of care. This report presents the consequences of the use of AI by doctors on their professional liability. New obligations arise from French legislation: the Public Health Code, the Code of Medical Ethics, the “Informatique et Libertés” law (LIL, 1978), the law on bioethics of August 3, 2021, to which is added the transposition into French law of European Union (EU) regulations, in particular, the “General Data Protection Regulation” (GDPR, 2018), the European regulation on AI (RIA) (“EU AI ACT”) adopted on June 13, 2024 by the European Parliament. This latest text emphasizes the respective obligations and the potential sharing of liability between the “supplier” of the device using AI (developer, designer, manufacturer, etc.) and the “deployer”, who is the healthcare professional facing the “affected person” (the patient) who is questioning the consequences of the use of AI. Information from the physician to the patient and the relationship that develops between them in the context of the use of these new technologies is the cornerstone of medical liability (Article L-4001-3 of the French Public Health Code). No court decision concerning the use of AI in the medical field currently exists (judicial, administrative, disciplinary, or amicable settlement commission jurisdictions). However, the ongoing implementation of both European and French regulations will undoubtedly lead to changes in the legislation. The RIA will fully enter into force on August 2, 2027.

人工智能（AI）正在彻底改变医学，在诊断、治疗和患者监测方面取得了不可否认的进步。专业实践受到严格监管，以确保护理的质量和安全。本报告介绍了医生使用人工智能对其职业责任的影响。法国立法产生了新的义务：《公共卫生法》、《医学伦理准则》、《信息与自由法》（LIL, 1978）、2021年8月3日的生物伦理学法，其中增加了欧盟（EU）法规在法国法律中的转换，特别是《一般数据保护条例》（GDPR, 2018）、欧洲议会于2024年6月13日通过的《欧洲人工智能条例》（RIA）（“EU AI ACT”）。这一最新文本强调了使用人工智能设备的“供应商”（开发商、设计师、制造商等）和“部署者”（即面对质疑使用人工智能后果的“受影响者”（患者）的医疗保健专业人员）之间各自的义务和潜在的责任分担。在使用这些新技术的背景下，医生向患者提供的信息以及他们之间发展的关系是医疗责任的基石（《法国公共卫生法》第L-4001-3条）。目前没有关于在医疗领域使用人工智能的法院裁决（司法、行政、纪律或和解委员会管辖）。然而，欧洲和法国法规的持续实施无疑将导致立法的变化。RIA将于2027年8月2日全面生效。

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Pénurie d’organes : État des lieux et estimation des besoins à venir 器官短缺：现状和对未来需求的估计

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/j.banm.2025.11.003

Régis Bronchard, Michel Tsimaratos

Organ shortage is a major challenge for healthcare systems worldwide. In France, despite significant efforts to improve organ donation and transplantation, a persistent gap between supply and demand remains. This article explores current trends and projections of organ needs for the next five years, based on recent data and prospective analysis. The main factors influencing this shortage, as well as potential strategies to address it, are discussed, integrating the objectives of the Organ and Tissue Transplant Plan 2022–2026.

器官短缺是全球卫生保健系统面临的主要挑战。在法国，尽管在改善器官捐赠和移植方面做出了重大努力，但供需之间仍然存在持续的差距。本文基于最近的数据和前瞻性分析，探讨了未来五年器官需求的当前趋势和预测。结合2022-2026年器官和组织移植计划的目标，讨论了影响这一短缺的主要因素以及解决这一短缺的潜在战略。

引用次数: 0

Problématiques et avancées de la xénotransplantation 异种移植的问题和进展

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/j.banm.2025.11.002

Gilles Blancho

Xenotransplantation, from the beginning of the 20th century, was the first proof of concept for the technical feasibility of organ transplantation, through the development of vascular anastomoses. But until recently, it has, of course, always faced the problem of species discordances leading to immediate or very early rejection. A better understanding of the phenomena involved, combined on the one hand with access to genetic modification techniques in large animals, particularly pigs, and on the other hand with new immunosuppression, has made it possible to take new steps in preclinical pig models on non-human primates with prolonged survival, such that the major advance in the transition to humans has occurred since 2021. At this stage, human experiments remain exceptional and pilot, mainly in the USA and to a lesser extent in China, and observing their results will be very instructive. They certainly show the way for restarting other dynamics, particularly in France and Europe.

异种移植，从20世纪初开始，通过血管吻合的发展，首次证明了器官移植技术可行性的概念。当然，直到最近，它一直面临着物种不协调导致立即或很早就被排斥的问题。更好地理解所涉及的现象，一方面与大型动物（特别是猪）的基因改造技术相结合，另一方面与新的免疫抑制相结合，使得有可能在非人类灵长类动物的临床前猪模型中采取新的步骤，从而使向人类过渡的重大进展发生在2021年。在这个阶段，人体实验仍然是特殊的和试点的，主要是在美国，在较小程度上在中国，观察他们的结果将是非常有益的。它们无疑为重启其他动态指明了道路，尤其是在法国和欧洲。

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Sommaire 摘要

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/S0001-4079(25)00382-6

引用次数: 0

Remerciements aux experts 感谢专家

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/S0001-4079(25)00376-0

引用次数: 0

Envenimation ophidienne : le retour des antidotes ? 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 : 2026-01-01 DOI: 10.1016/j.banm.2025.09.007

Jean-Philippe Chippaux

There are an estimated 5 million snakebites worldwide every year, resulting in 3.5 million snakebite envenomations (SBE), 150,000 deaths and an equal number of cases of permanent disability. There are four clinical syndromes of SBE: inflammatory, hemorrhagic, neurotoxic, and necrotic. The latter can cause severe permanent disabilities. Venom disappears from the body spontaneously within five to seven days. However, inflammation, coagulopathy, and necrosis are sustained by the innate immune response, even after the venom has been eliminated. SBE management consists of neutralizing the venom and addressing the symptoms. Antivenom is currently the only etiological treatment. It eliminates the venom, stopping its harmful effects. Although it is not very effective against edema, it stops bleeding and neurotoxic effects within two to 12 hours in most patients. Researchers are developing more accessible and easier-to-administer antidotes. These include inhibitors of enzymes present in venom and metallic ion chelators. Some of these inhibitors are already on the market, such as varespladib and marimastat, and are being repositioned for SBE treatment. Symptomatic treatment, the second component of care, has not been studied enough. Respiratory paralysis is treated with assisted ventilation. There is no standardized protocol for managing inflammation and coagulopathy. The clinical benefit of diuretics on edema has not been evaluated. Blood substitutes, such as transfusions and fresh frozen plasma, are not readily available. Antihemorrhagic agents have not been proven clinically useful.

据估计，全世界每年有500万起蛇咬伤事件，造成350万起蛇咬伤中毒，15万人死亡，以及同等数量的永久性残疾病例。SBE的临床表现有炎症、出血性、神经毒性和坏死四种。后者可导致严重的永久性残疾。毒液会在5到7天内自动从体内消失。然而，炎症、凝血功能障碍和坏死是由先天免疫反应维持的，即使在毒液被清除后也是如此。SBE管理包括中和毒液和处理症状。抗蛇毒血清是目前唯一的病因治疗方法。它可以消除毒液，阻止它的有害影响。虽然它对水肿不是很有效，但对大多数患者来说，它在2到12小时内止血和神经毒性作用。研究人员正在开发更容易获得和更容易管理的解毒剂。这些包括存在于毒液中的酶抑制剂和金属离子螯合剂。其中一些抑制剂已经上市，如varespladib和marimastat，并正在重新定位用于SBE治疗。对症治疗，护理的第二个组成部分，还没有得到足够的研究。呼吸麻痹用辅助通气治疗。治疗炎症和凝血功能障碍没有标准化的方案。利尿剂治疗水肿的临床疗效尚未得到评价。血液替代品，如输血和新鲜冷冻血浆，并不容易获得。抗出血性药物尚未被证明在临床上有用。

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引用次数: 0

Cannabis et mort inattendue du nourrisson : que révèlent les cheveux ? 大麻和婴儿的意外死亡：头发揭示了什么？

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/j.banm.2025.07.011

N. Arbouche , M. Baudry , A. Blanchot , A. Walch , L. Berthelon , A. Farrugia , L. Gheddar , A. Ameline , J.S. Raul , P. Kintz

Objective

Sudden Infant Death Syndrome (SIDS) remains a major cause of infant mortality. This study explores the presence of cannabinoids in the hair of infants who died suddenly and unexpectedly, in order to assess potential cannabis exposure. Hair analysis is a valuable tool for detecting chronic exposure and provides essential information about the child's toxicological environment.

Methods

A toxicological hair analysis was conducted on 15 children (aged 27 days to 24 months) who died in a SIDS context between 2017 and 2025. When available, blood, urine, and gastric content samples were also analyzed. After decontamination, cannabis markers (THC, CBN, CBD) were screened in the hair samples.

Results

14 of the 15 children had detectable concentrations of cannabinoids in their hair: THC (< 5 to 9097 pg/mg), CBN (13 to 1348 pg/mg), and CBD (< 5 to 2800 pg/mg). Blood, urine, and gastric content analyses were all negative. These results confirm a high prevalence of cannabis exposure in this context. However, discriminating between systemic absorption, external contamination, and prenatal exposure remains difficult, notably due to the large porosity of very young children's hair and biological variations specific for this population.

Conclusion

The study highlights cannabis exposure in children who died in a SIDS context, emphasizing the importance of the domestic environment as a risk factor. The complexity of toxicological interpretation of hair in very young children requires caution when interpreting results, especially regarding forensic implication.

目的婴儿猝死综合征（SIDS）仍然是婴儿死亡的主要原因。本研究探讨了突然意外死亡的婴儿头发中大麻素的存在，以评估潜在的大麻暴露。毛发分析是检测慢性暴露的一种有价值的工具，并提供有关儿童毒理学环境的重要信息。方法对2017年至2025年期间在小岛屿发展中国家死亡的15名儿童（27天至24个月）进行头发毒理学分析。如有可能，还对血液、尿液和胃内容物样本进行分析。去污后，在头发样本中筛选大麻标志物（四氢大麻酚，CBN， CBD）。结果15名儿童中有14名在他们的头发中检测到大麻素浓度：THC(5至9097 pg/mg)， CBN（13至1348 pg/mg）和CBD（5至2800 pg/mg）。血液、尿液和胃内容物分析均为阴性。这些结果证实，在这种情况下，大麻暴露率很高。然而，区分全身吸收、外部污染和产前暴露仍然很困难，特别是由于非常年幼的儿童的头发有很大的孔隙，以及这一人群特有的生物变异。结论：该研究强调了小岛屿发展中国家死亡儿童的大麻暴露，强调了家庭环境作为一个风险因素的重要性。非常年幼的儿童头发的毒理学解释的复杂性要求在解释结果时谨慎，特别是关于法医含义。

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引用次数: 0

Discussion à propos de la communication : « Enjeux de santé publique du vieillissement de la population : les nonagénaires » 关于传播的讨论：“人口老龄化对公共卫生的挑战：90岁以上人口”

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/j.banm.2025.12.004

Joël Ankri

引用次数: 0

L’information en santé est la meilleure arme pour lutter contre la désinformation 健康信息是打击虚假信息的最佳武器

IF 0.2 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Bulletin De L Academie Nationale De Medecine

Pub Date : 2026-01-01 DOI: 10.1016/j.banm.2025.09.005

Hervé Maisonneuve , Loïc Guillevin , Mathieu Molimard

The manipulation of opinion is a long-standing power issue; misinformation in healthcare is exacerbated by social networks and the lack of scientific education, leading to dangerous behaviour. We need to distinguish between mis-information (false, unintentional), dis-information (false, intentional, used to manipulate) and mal-information (true but used to harm). This information runs counter to scientific evidence. According to the Global Risks Report, misinformation is the world's biggest risk until 2027. Its motivations are complex, ranging from financial gain to the erosion of trust in institutions. To counter this phenomenon, the D.E.F.I.S. approach is proposed: (1) detection and diagnosis: the need for tools to anticipate misinformation, with active monitoring and content moderation, notably via the Digital Services Act. Generative artificial intelligence poses new challenges for the dissemination of reliable information; (2) education: improve health literacy and critical thinking from a very early age, by learning to distinguish between facts and opinions and to manage the emotions that can impair judgement; (3) training (formation): develop the skills of healthcare professionals and researchers in popularising and communicating science; (4) information: disseminate reliable and accessible information from official sources such as sante.fr or learned societies, while understanding the psychological mechanisms involved in accepting or rejecting information; (5) sanctions: strengthen the application of existing laws against quackery and make digital platforms more accountable. As inaction is not an option, greater coordination and visibility of the many existing initiatives are imperative to effectively combat misinformation.

舆论操纵是一个长期存在的权力问题；社交网络和缺乏科学教育加剧了医疗保健领域的错误信息，导致了危险的行为。我们需要区分错误信息（虚假的，无意的），虚假信息（虚假的，故意的，用来操纵的）和错误信息（真实的，但用来伤害的）。这一信息与科学证据背道而驰。根据《全球风险报告》，在2027年之前，虚假信息是世界上最大的风险。它的动机很复杂，从经济利益到对机构信任的侵蚀。为了应对这一现象，D.E.F.I.S.的方法被提出：(1)检测和诊断：需要工具来预测错误信息，积极监控和内容审核，特别是通过数字服务法案。生成式人工智能对可靠信息的传播提出了新的挑战；(2)教育：通过学习区分事实和意见以及管理可能损害判断的情绪，从很小的时候就提高卫生素养和批判性思维；(3)培训（形成）：发展卫生保健专业人员和研究人员在普及和传播科学方面的技能；(4)信息：传播来自官方来源（如sante.fr或学术团体）的可靠和可访问的信息，同时了解接受或拒绝信息所涉及的心理机制；(5)制裁：加强现行法律对江湖骗术的适用，加强对数字平台的问责。由于不作为不是一种选择，因此必须加强许多现有举措的协调和可见性，以有效地打击错误信息。

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