Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes.

BACKGROUND: Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear. OBJECTIVES: The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization. METHODS: Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold. RESULTS: A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief. CONCLUSIONS: FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy.

Prise en charge des endométriomes et de l'endométriose recto-vaginate et vésicate [Management of endometrioma, recto-vaginal and bladder endometriosis].

Endometriosis is a frequent, benign, chronic disease associated with pain and/or infertility. Classically the lesions are found on the pelvic peritoneum, ovary (endometrioma), rectovaginal septum and bladder. Management of endometrioma has evolved over the last few years to individualised treatment. Indeed endometrioma cystectomy can decrease pain and the risk of recurrence but is also associated with a decrease in ovarian reserve. A multi-disciplinary team should manage recto-vaginal or bladder endometriosis. Surgical resection of these lesions must be as complete as possible and can be complex.

Médaille commémorant l'arrivée des cendres de Napoléon Ier sur le territoire français / F. Galle

Ancien possesseur : Labrouste, Henri (1801-1875)

[Agrandissement de l'avers du jeton de présence de la Société centrale des Architectes]

Ancien possesseur : Labrouste, Henri (1801-1875)

Médaille commémorant la cérémonie du retour des cendres de Napoléon Ier à Paris, le 15 décembre 1840 / Barre

Ancien possesseur : Labrouste, Henri (1801-1875)

Médaille commémorant la construction de la cathédrale de Marseille / E.A. Oudiné

Ancien possesseur : Labrouste, Henri (1801-1875)

Médaille décernée à Henri Labrouste, à l'école des Beaux-Arts, en 1823 / E. Gatteaux

Ancien possesseur : Labrouste, Henri (1801-1875)

Geomorphological heritage, conservation and promotion in high-alpine protected areas

In recent decades, recognition of both cultural and natural heritage has grown in the Alps. This tendency illustrates a collective identity building (local, national, alpine), but it also highlights, in the current context of global change, a renewed reflection of man's relationship with the environment. Thus, a fundamental and scientific intrinsic value (as a part of wilderness) tends to be recognized in the natural heritage as a whole. However, geoheritage (and geodiversity) is still often perceived as a secondary natural component, compared with bioheritage (and biodiversity). In this context, we study the geomorphological heritage (landforms and the processes that shape them) of Les Contamines-Montjoie Natural Reserve. Indeed, despite the high geomorphological richness (especially glacial) of the reserve, which covers more than 4000 ha of the Mont-Blanc Massif, local recognition of this heritage is still limited. In order to recognize and protect it, and starting with a scientific study, this research identifies the main local richness and assesses the geotourist and educational potentials. Finally, several tools to educate and promote geoheritage (educational paths and website) are proposed.

Médaille de la Société de prévoyance et de secours mutuels de la Maison Leclaire décernée à Henri Labrouste en 1869 / Barre

Ancien possesseur : Labrouste, Henri (1801-1875)

[Médaille commémorant l'exposition universelle de Paris en 1867] / H. Ponscarme f.

Ancien possesseur : Labrouste, Henri (1801-1875)

[Médaille décernée à Henri Labrouste, à l'école des Beaux-Arts, en 1820] / Andrieu f., Puymaurin d.

Ancien possesseur : Labrouste, Henri (1801-1875)

[Médaille de la Commission impériale commémorant l'exposition universelle de Paris en 1867] / H. Ponscarme f.

Ancien possesseur : Labrouste, Henri (1801-1875)

[Médaille commémorant la construction du marché aux bestiaux et des abattoirs généraux de La Villette] / Louis Merley

Ancien possesseur : Labrouste, Henri (1801-1875)

[Médaille commémorant l'érection de l'obélisque de Louqsor] / Barre Ft.

Ancien possesseur : Labrouste, Henri (1801-1875)

[Médaille décernée à Henri Labrouste au collège Sainte-Barbe]

Ancien possesseur : Labrouste, Henri (1801-1875)