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[Chronic respiratory failure]. 慢性呼吸衰竭。
Pub Date : 2025-11-01
Kinan El Husseini, Hervé Mal
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引用次数: 0
[Contributions of molecular biology to sarcomas]. [分子生物学对肉瘤的贡献]。
Pub Date : 2025-11-01
Sarah Watson
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引用次数: 0
[Microangiopathies thrombotiques]. [Microangiopathies thrombotiques]。
Pub Date : 2025-11-01
Léo Guénnoun, Adrien Picod, Paul Coppo

THROMBOTIC MICROANGIOPATHIES. The syndrome of thrombotic microangiopathy (TMA) is defined by the combination of mechanical hemolytic anemia, consumptive thrombocytopenia, and organ failure secondary to microvascular obstruction by microthrombi. TMAs include thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome and require specific therapies that have significantly improved the prognosis ; post-infectious HUS (including shigatoxin-associated HUS), and secondary TMAs that occur in specific contexts (infection, neoplasia, transplantation, autoimmune disease, medication or toxin exposure, severe hypertension, etc.). The main etiological entities, their pathophysiology, clinical phenotypes, and appropriate management, are reviewed below, with a focus on situations requiring specific and urgent treatment.

血栓性微血管病。血栓性微血管病(TMA)综合征的定义是机械性溶血性贫血、消耗性血小板减少症和微血栓引起的微血管阻塞继发器官衰竭的结合。tma包括血栓性血小板减少性紫癜和非典型溶血性尿毒症综合征,需要特异性治疗,可显著改善预后;感染后溶血性尿毒综合征(包括志贺毒素相关溶血性尿毒综合征),以及在特定情况下发生的继发性TMAs(感染、肿瘤、移植、自身免疫性疾病、药物或毒素暴露、严重高血压等)。主要的病因实体、病理生理、临床表型和适当的管理,将在下面进行回顾,重点是需要特殊和紧急治疗的情况。
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引用次数: 0
[What are the key takeaways from the HAS recommendations regarding special populations (elderly populations and pregnancy or planning to become pregnant) ?] [关于特殊人群(老年人群、怀孕或计划怀孕),卫生保健建议的主要结论是什么?]]
Pub Date : 2025-11-01
Lyse Bordier

WHAT ARE THE KEY TAKEAWAYS FROM THE HAS RECOMMENDATIONS REGARDING SPECIAL POPULATIONS (ELDERLY POPULATIONS AND PREGNANCY OR PLANNING TO BECOME PREGNANT) ? Type 2 diabetes in elderly patients is a common reason for consultation in general practice. Its management is challenging due to the heterogeneity of this particular population, which often combines age-related and diabetes-related complications. A geriatric assessment is necessary to set glycemic targets and define the therapeutic strategy. Therapeutic means are based on lifestyle modifications combined with medical treatment with particular attention to the risk of hypoglycemia and malnutrition. The indications for cardio- and nephroprotective treatments are the same as for younger subjects. Regular reassessment of health status is necessary and therapeutic deintensification should be considered when appropriate.

关于特殊人群(老年人群和怀孕或计划怀孕)的建议的主要结论是什么?2型糖尿病是老年患者就诊的常见原因。由于这一特殊人群的异质性,其管理具有挑战性,通常合并了年龄相关和糖尿病相关的并发症。老年评估对于设定血糖目标和确定治疗策略是必要的。治疗手段以改变生活方式为基础,结合药物治疗,特别注意低血糖和营养不良的风险。心脏和肾脏保护治疗的适应症与年轻患者相同。定期重新评估健康状况是必要的,适当时应考虑治疗性去强化。
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引用次数: 0
[Giant lobar emphysema in a newborn]. [新生儿巨大肺气肿]。
Pub Date : 2025-11-01
Khalil Chafi, Lina Belkouchi, Habib Bellamlih, Amine Bentaher, Nazik Allali, Latifa Chat
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引用次数: 0
[Sarcoma: 10 key messages]. [肉瘤:10个关键信息]。
Pub Date : 2025-11-01
Mehdi Brahmi
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引用次数: 0
[Pharmacological management of non-insulin-treated type 2 diabetes: practical implementation of HAS guidelines]. [非胰岛素治疗2型糖尿病的药理管理:HAS指南的实际实施]。
Pub Date : 2025-11-01
Hadjadj Hadjadj

PHARMACOLOGICAL MANAGEMENT OF NON-INSULIN-TREATED TYPE 2 DIABETES: PRACTICAL IMPLEMENTATION OF HAS GUIDELINES. French health authorities' guidelines for type 2 diabetes were updated in May 2024. These guidelines provide a framework for the appropriate positioning of various therapeutic options in the management of type 2 diabetes. Lifestyle modifications and metformin remain the first-line treatment. A paradigm shift introduced by these new recommendations emphasizes the need to prioritize cardiovascular and renal status over glycemic control when initiating therapy. Consequently, these guidelines recommend early use of SGLT2 inhibitors (sodium-glucose co-transporter 2 inhibitors) or GLP-1 receptor agonists in patients requiring secondary cardiovascular prevention. In cases of chronic kidney disease or heart failure, SGLT2 inhibitors are preferred, followed by GLP-1 receptor agonists.

非胰岛素治疗2型糖尿病的药理学管理:指南的实际实施。法国卫生当局于2024年5月更新了2型糖尿病指南。这些指南为2型糖尿病管理中各种治疗方案的适当定位提供了一个框架。生活方式改变和二甲双胍仍然是一线治疗方法。这些新建议带来的范式转变强调在开始治疗时需要优先考虑心血管和肾脏状况而不是血糖控制。因此,这些指南建议在需要二级心血管预防的患者中早期使用SGLT2抑制剂(钠-葡萄糖共转运蛋白2抑制剂)或GLP-1受体激动剂。在慢性肾脏疾病或心力衰竭的情况下,首选SGLT2抑制剂,其次是GLP-1受体激动剂。
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引用次数: 0
[Systemic treatment of bone sarcoma, soft tissue sarcoma, GIST]. 【骨肉瘤、软组织肉瘤、GIST的全身治疗】。
Pub Date : 2025-11-01
Nathalie Gaspar, Armelle Dufresne, Benjamin Verret

SYSTEMIC TREATMENT OF BONE SARCOMA, SOFT TISSUE SARCOMA, GIST. In osteosarcomas and Ewing sarcomas, the interest of systemic treatments is established in neo-adjuvant and adjuvant setting. Effective molecules are doxorubicin, alkyls, vinca-alkaloids and etoposide in Ewing's sarcomas, and methotrexate, doxorubicin, cisplatin, ifosfamide and etoposide in osteosarcoma. Several ongoing clinical studies raise the question of the value of maintenance treatment, including anti-angiogenic tyrosine kinase inhibitors. In soft tissue sarcomas, anthracyclines remain the reference molecules, either in the adjuvant (neo) or metastatic setting. Other anti-angiogenic chemotherapy molecules or tyrosine kinase inhibitors are authorized whose effectiveness differs depending on the histological subtype. In the adjuvant setting, many questions remain about the optimal use of chemotherapy and the selection of patients who could benefit from such a strategy. In high-risk gastro intestinal stromal tumor (GIST), the standard is 3 years adjuvant treatment with imatinib; a recent study asks whether treatment should continue for up to 6 years. In metastatic GIST, patients are treated with 4 successive lines of more or less specific tyrosine kinase inhibitors: imatinib, sunitinib, regorafenib, riprenib.

全身治疗骨肉瘤,软组织肉瘤,要点。在骨肉瘤和尤文氏肉瘤中,系统治疗的兴趣建立在新辅助和辅助设置上。在尤文氏肉瘤中的有效分子是阿霉素、烷基、生物碱和依托泊苷,在骨肉瘤中的有效分子是甲氨蝶呤、阿霉素、顺铂、异环磷酰胺和依托泊苷。一些正在进行的临床研究提出了维持治疗的价值的问题,包括抗血管生成酪氨酸激酶抑制剂。在软组织肉瘤中,蒽环类药物仍然是参考分子,无论是在辅助(新)或转移设置。其他抗血管生成化疗分子或酪氨酸激酶抑制剂被批准,其有效性取决于组织学亚型。在辅助治疗方面,关于化疗的最佳使用和选择可以从这种策略中受益的患者,仍然存在许多问题。高危胃肠道间质瘤(GIST)的标准是3年伊马替尼辅助治疗;最近的一项研究询问治疗是否应该持续长达6年。在转移性GIST中,患者接受4种或多或少特异性酪氨酸激酶抑制剂的连续治疗:伊马替尼、舒尼替尼、瑞非尼、利普尼。
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引用次数: 0
[Sarcoma: a plural entity]. [肉瘤:复数实体]。
Pub Date : 2025-11-01
Thibaud Valentin, Nicolas Penel, Maud Toulmonde

Sarcoma: A PLURAL ENTITY. Sarcoma are a heterogeneous group of 150 different histopathological entities, developed from soft tissues or bone of any anatomical location.Their estimated incidence is around 70 cases for 100 000 people. They can occur in patients of any age, including children, the median age of onset being around 60 years. Most sarcomas are sporadic, since predisposing factors are rare. In France, the treatment of patiens with sarcomas must be carried out, within a center belonging to Netsarc+ networt as soon as a diagnosis is suspected, to offer them a better prognosis, mostly explained by the quality of the surgery, a major prognostic factor in these diseases.

肉瘤:一种复数实体。肉瘤是由150种不同的组织病理实体组成的异质组,发生于软组织或骨骼的任何解剖位置。估计发病率约为每10万人70例。它们可以发生在任何年龄的患者中,包括儿童,发病的中位年龄约为60岁。大多数肉瘤是散发性的,因为诱发因素很少。在法国,一旦怀疑诊断,必须在属于Netsarc+网络的中心内对肉瘤患者进行治疗,以便为他们提供更好的预后,这主要是由于手术质量,这是这些疾病的主要预后因素。
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引用次数: 0
[Lifestyle modifications in type 2 diabetes: yes, but how ?] 2型糖尿病的生活方式改变:是的,但如何改变呢?]
Pub Date : 2025-11-01
Emmanuelle Lecornet Sokol

LIFESTYLE MODIFICATIONS IN TYPE 2 DIABETES: YES, BUT HOW ? Management of type 2 diabetes relies above all on sustainable lifestyle changes, including physical activity, diet, therapeutic education and psychological support. These approaches must be personalized and integrated into a comprehensive treatment plan. Adapted physical activity, a real treatment, requires prior assessment and can be prescribed within a structured framework. Dieticians must provide individualized support for diets, avoiding restrictive diets. Therapeutic patient education, although sometimes difficult to access, encourages autonomy and commitment. Digital tools, local resources and professionals trained in education can make this possible. Psychological support, though often neglected, is essential. To be effective, this strategy requires going beyond theoretical discourse and proposing concrete solutions, adapted to the realities of each patient, by mobilizing available local resources.

2型糖尿病患者生活方式的改变:是的,但如何改变呢?2型糖尿病的管理首先依赖于可持续的生活方式改变,包括身体活动、饮食、治疗性教育和心理支持。这些方法必须个性化,并整合到一个全面的治疗计划中。适应的身体活动是一种真正的治疗方法,需要事先评估,并可以在一个结构化的框架内规定。营养师必须提供个性化的饮食支持,避免限制性饮食。治疗性患者教育,虽然有时很难获得,鼓励自主和承诺。数字工具、当地资源和受过教育培训的专业人员可以实现这一目标。心理支持虽然经常被忽视,但却是必不可少的。为了有效,这一战略需要超越理论论述,并通过调动现有的当地资源,提出具体的解决方案,适应每个病人的实际情况。
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引用次数: 0
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