69 results on '"Sauleau EA"'
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2. Risk for non Hodgkin's lymphoma in the vicinity of French municipal solid waste incinerators.
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Viel JF, Daniau C, Goria S, Fabre P, de Crouy-Chanel P, Sauleau EA, Empereur-Bissonnet P, Viel, Jean-François, Daniau, Côme, Goria, Sarah, Fabre, Pascal, de Crouy-Chanel, Perrine, Sauleau, Erik-André, and Empereur-Bissonnet, Pascal
- Abstract
Background: Dioxin emissions from municipal solid waste incinerators are one of the major sources of dioxins and therefore are an exposure source of public concern. There is growing epidemiologic evidence of an increased risk for non-Hodgkin's lymphoma (NHL) in the vicinity of some municipal solid waste incinerators with high dioxin emission levels. The purpose of this study was to examine this association on a larger population scale.Methods: The study area consisted of four French administrative departments, comprising a total of 2270 block groups. NHL cases that had been diagnosed during the period 1990-1999, and were aged 15 years and over, were considered. Each case was assigned a block group by residential address geocoding. Atmospheric Dispersion Model System software was used to estimate immissions in the surroundings of 13 incinerators which operated in the study area. Then, cumulative ground-level dioxin concentrations were calculated for each block group. Poisson multiple regression models, incorporating penalized regression splines to control for covariates and dealing with Poisson overdispersion, were used. Five confounding factors were considered: population density, urbanisation, socio-economic level, airborne traffic pollution, and industrial pollution.Results: A total of 3974 NHL incident cases was observed (2147 among males, and 1827 among females) during the 1990-1999 time period. A statistically significant relationship was found at the block group level between risk for NHL and dioxin exposure, with a relative risk (RR) of 1.120 (95% confidence interval [CI] 1.002 - 1.251) for persons living in highly exposed census blocks compared to those living in slightly exposed block groups. Population density appeared positively linked both to risk for NHL and dioxin exposure. Subgroup multivariate analyses per gender yielded a significant RR for females only (RR = 1.178, 95% CI 1.013 - 1.369).Conclusion: This study, in line with previous results obtained in the vicinity of the incinerator located in Besançon (France), adds further evidence to the link between NHL incidence and exposure to dioxins emitted by municipal solid waste incinerators. However, the findings of this study cannot be extrapolated to current incinerators, which emit lower amounts of pollutants. [ABSTRACT FROM AUTHOR]- Published
- 2008
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3. Diagnostic performance of coronary calcifications on CT to rule out acute coronary syndrome in the emergency department.
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Sentagne JP, Ohana M, Severac F, Le Borgne P, Sauleau EA, Bilbault P, and Kepka S
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- Humans, Female, Male, Retrospective Studies, Middle Aged, Aged, Troponin blood, Chest Pain etiology, Chest Pain diagnostic imaging, France, Sensitivity and Specificity, Calcinosis diagnostic imaging, Vascular Calcification diagnostic imaging, Acute Coronary Syndrome diagnostic imaging, Acute Coronary Syndrome diagnosis, Emergency Service, Hospital, Electrocardiography, Tomography, X-Ray Computed
- Abstract
Background: At present, the diagnosis of acute coronary syndrome (ACS) can be made by emergency physicians using the usual complementary tests, since the current troponin and electrocardiogram (ECG) protocols have been extensively tested for their safety. However, the detection of coronary calcifications on CT associated with coronary obstruction may be of interest for the diagnostic strategy in the emergency department (ED). The aim of this study was to evaluate a strategy combining a non-ischemic ECG with an initial normal troponin assay and the diagnostic accuracy of chest CT in detecting coronary calcifications to rule out the presence of an acute coronary event in patients presenting with chest pain in the ED., Methods: This was a retrospective, single-center study carried out in an ED in France and included all patients over 18 years of age presenting with chest pain between 1 June 2021 and 31 December 2021 with a non-ischemic ECG and a negative first troponin assay. The primary endpoint was the diagnostic performance of the combing strategy in ruling out ACS. The secondary endpoints were the sensitivity and specificity of calcifications in acute coronary syndrome, comparison with the diagnostic performance of a second troponin assay and the rate of reconsultation, rehospitalisation and investigations within 2 months of the ED., Results: Of the 280 patients included, 141 didn't have calcifications. A total of 14 events were found with a negative predictive value for the combining strategy of 99.8% [95%CI: 98.2 - 100]. Sensitivity and specificity were 98.4% [95%CI: 83.8 - 100] and 53% [95%CI: 47 - 58.9], respectively. Among patients with no calcification, 8.2% were admitted to hospital and none suffered an acute coronary event. A total of 36 patients (12.8%) consulted a doctor within 2 months, with 23 investigations, all of which were negative in the non-calcification group., Conclusions: A strategy combining the detection of coronary calcifications on chest CT in patients with a non-ischemic ECG and a single troponin assay is effective to rule out ACS in the ED, and may perform better then ECG and troponin alone., (© 2024. The Author(s).)
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- 2024
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4. Using machine learning or deep learning models in a hospital setting to detect inappropriate prescriptions: a systematic review.
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Johns E, Alkanj A, Beck M, Dal Mas L, Gourieux B, Sauleau EA, and Michel B
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- Humans, Pharmacists standards, Deep Learning, Pharmacy Service, Hospital methods, Pharmacy Service, Hospital standards, Inappropriate Prescribing prevention & control, Machine Learning
- Abstract
Objectives: The emergence of artificial intelligence (AI) is catching the interest of hospital pharmacists. A massive collection of health data is now available to train AI models and hold the promise of disrupting codes and practices. The objective of this systematic review was to examine the state of the art of machine learning or deep learning models that detect inappropriate hospital medication orders., Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE and Embase databases were searched from inception to May 2023. Studies were included if they reported and described an AI model intended for use by clinical pharmacists in hospitals. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST)., Results: 13 articles were selected after review: 12 studies were judged to have high risk of bias; 11 studies were published between 2020 and 2023; 8 were conducted in North America and Asia; 6 analysed orders and detected inappropriate prescriptions according to patient profiles and medication orders; and 7 detected specific inappropriate prescriptions, such as detecting antibiotic resistance, dosage abnormality in prescriptions, high alert drugs errors from prescriptions or predicting the risk of adverse drug events. Various AI models were used, mainly supervised learning techniques. The training datasets used were very heterogeneous; the length of study varied from 2 weeks to 7 years and the number of prescription orders analysed went from 31 to 5 804 192., Conclusions: This systematic review points out that, to date, few original research studies report AI tools based on machine or deep learning in the field of hospital clinical pharmacy. However, these original articles, while preliminary, highlighted the potential value of integrating AI into clinical hospital pharmacy practice., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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5. Can Lumbopelvic Parameters Be Used to Predict Thoracic Kyphosis at all Ages? A National Cross-Sectional Study.
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Solla F, Ilharreborde B, Blondel B, Prost S, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Lamas V, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Kerckhove MV, Lebhar J, Giorgi H, Faure A, Sauleau EA, Pesenti S, and Charles YP
- Abstract
Study Design: National cross-sectional study., Objective: Thoracic kyphosis (TK) is related to sagittal parameters as pelvic tilt (PT), lumbar lordosis (LL) and pelvic incidence (PI). The equation TK = 2 (PT+LL-PI) was validated for adolescents. The purpose of this study was to investigate if this equation correctly predicts TK regardless of age., Methods: Sagittal alignment parameters were assessed on full spine radiographs of 2599 individuals without spine pathology (1488 females, 1111 males). Calculated TK (CTK) = 2 (PT+LL-PI) and measured TK (MTK) were compared by calculating the gap and using a linear regression between both parameters. Subgroup analyses were performed for gender, age, TK groups (≤20°, 21°-40°, 41°-60°, >60°), and PI groups (<45°, 45°-60°, >60°)., Results: Average values in the total population were: MTK 45.0°, CTK 36.9°. Average TK gap was 8.1°, 5.2° in females (intercept 11.7, slope .61) and 11.9° in males (intercept 7.1, slope .58). The mean gap was 3.6° for 15-34 years, 5.7° under 15 years and it increased progressively after 35 years with a maximum of 19.9° over 80 years. The gap also increased with the amount of MTK: -3.5° for TK<20° up to 17.3° for TK >60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI <45° and TK ≤20°., Conclusion: The formula TK=2 (PT+LL-PI) yielded moderate accuracy for adolescents and young adults, but did not fit for over 35 years and under 15. The amount and variance in TK increased in elderly subjects, which made the formula less accurate.
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- 2024
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6. Do Age-Related Variations Of Sagittal Alignment Rely On SpinoPelvic Organization? An Observational Study Of 1540 Subjects.
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Prost S, Blondel B, Bauduin E, Pesenti S, Ilharreborde B, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, and Charles YP
- Abstract
Study Design: Descriptive radiographic analysis of a prospective multi-center database., Objective: This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity., Methods: After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45°, intermediate PI 45-60°, high PI > 60°, and then stratified by age (20-34, 35-49, 50-64, > 65 Y.O). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation., Results: Mean age was 53.5 years (845 females, 695 males, range 20-93 years).In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups.In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects.For all subjects, kyphosis and pelvic tilt (PT) increased with age.There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT., Conclusion: This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.
- Published
- 2023
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7. Variation of cervical sagittal alignment parameters according to age and pelvic incidence in degenerative spinal deformity patients.
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Lamas V, Chapon R, Prost S, Blondel B, Fuentes S, Sauleau EA, and Charles YP
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- Adult, Male, Female, Humans, Middle Aged, Retrospective Studies, Bayes Theorem, Thoracic Vertebrae, Cervical Vertebrae diagnostic imaging, Lordosis diagnostic imaging, Kyphosis diagnostic imaging
- Abstract
Introduction: In asymptomatic subjects, variations of cervical sagittal alignment parameters according to age and spinopelvic organization have been reported. A large range of compensation phenomena has been observed in degenerative spinal deformity in order to maintain horizontal gaze, but it remains unclear how age and spinopelvic morphology could additionally influence cervical alignment. The aim of this observational retrospective study was to describe the distribution of cervical sagittal alignment parameters according to age and pelvic incidence in subjects with and without degenerative spinal deformity in order to precisely evaluate cervical compensation phenomena in adult spinal deformity (ASD)., Material and Methods: Radiographs of 478 subjects (327 females and 151 males) were distributed into 235 asymptomatic and 243 deformed subjects. Occipito-cervical parameters were McGregor-C1, McGregor-C2, C1-C2 and occipito-C2 angles. The cervicothoracic inflection point (CTIP) was determined. Caudal cervical sagittal alignment parameters were: C2-C7 lordosis, C2-apex (superior arch), apex-CTIP (inferior arch), occipito-C3 and occipito-C4 angles, C7-slope and T1-slope. The distribution of parameters was analyzed using a Bayesian inference (significant when Pr > 0.975 or Pr < 0.025). Comparisons between asymptomatic and deformed subjects were done after matching on age (40-60 years; > 60 years) and on PI (< 45°; 45-60°; > 60°)., Results: Among occipito-cervical parameters, there was no significant change in McGregor-C1 angle. However, McGregor-C2 angle was significantly higher in the ASD group (Pr = 0.0029), with influence of age (Pr = 0.023), but PI influence. C1-C2 lordosis was significantly higher in the ASD group compared to the asymptomatic group (Pr < 0.0007), without influence of age or PI noticed. C2-C7 lordosis was also higher in the ASD group (Pr < 0.025) with a role of age and PI (Pr < 0.025). Cervical lordosis in the superior arch was significantly higher in the ASD group (Pr > 0.999), without influence of age or PI. In the inferior arch, the lordosis angle was not modified according to the group, but there was an influence of age (Pr < 0.0007). C7-slope and T1-slope were higher according the age group (Pr < 0.0012), without influence of the group or PI., Conclusion: This observational study highlights cervical sagittal alignment adaptations in degenerative spinal deformity, matched on age and pelvic incidence. The inferior cervical spine seemed to be modified with a higher lordosis, increasing with age responding to the age-related thoracic kyphosis increase. In addition to that, the superior cervical spine hyperextends more in adult degenerative deformity to maintain horizontal gaze., Level of Evidence: III., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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8. Proximal and distal mechanical repercussions of instrumentation by double rods and interbody grafts in adult scoliosis.
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Saad M, Arfa M, Attia A, Lamas V, Sauleau EA, and Charles YP
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- Animals, Humans, Adult, Middle Aged, Bayes Theorem, Treatment Outcome, Retrospective Studies, Postoperative Complications epidemiology, Postoperative Complications etiology, Scoliosis surgery, Pseudarthrosis complications, Spinal Fusion adverse effects, Kyphosis diagnostic imaging, Kyphosis surgery, Fractures, Bone complications
- Abstract
Introduction: Correction of adult scoliosis by instrumentation with double rods and interbody grafts aims to reduce the risk of pseudarthrosis with rod fracture. An increase in instrumentation rigidity can lead to an increase in stresses at the proximal and distal ends of the construct. The aim of this study was to analyze the incidence and clinical repercussions of proximal junctional kyphosis (PJK), proximal junctional failure (PJF) and iliac screw loosening., Materiel and Methods: An analysis of patients operated on for adult scoliosis with instrumentation to the pelvis using 4 rods and interbody cages was carried out from a prospective register. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Scoliosis Research Society 22 (SRS-22) clinical scores and radiological parameters were collected preoperatively, postoperatively at 3 months, 1 year and 2 years. The appearance of PJK, PJF or distal screw loosening was sought; the clinical impact and the risk factors were analyzed by Bayesian inference., Results: Fifty-one patients with a mean age of 64.5 years were included. The clinical scores improved significantly (Pr>0.95) at 2 years: VAS back 6.9 versus 2.6, VAS leg 4.9 versus 2.5, ODI 48.2 versus 25.4, SRS-22 2.4 versus 3.5. The radiological parameters were corrected (Pr>0.95): Cobb angle 63.9° versus 22.8°, spinosacral angle (SSA) 112.4° versus 118.8°, T1-pelvic angle (TPA) 24, 8° versus 20.8°, lumbar lordosis 43.8° versus 51.0°, thoracic kyphosis 45.2° versus 53.6°. Thirteen patients (25.5%) presented with PJK and 11 (21.6%) with PJF. Seven patients (13.7%) presented with iliac screw loosening. None of these complications was associated with a significant deterioration in clinical scores. Cranial migration of the lumbar apex increased the risk of distal screw loosening: Odds-Ratio 10.31 (Pr>0.999). Two patients were re-operated on for PJF and one patient for iliac screw loosening (5.9%). No rod fracture with pseudarthrosis was found., Conclusion: Instrumentation with double rods and interbody grafts was associated with a rate of 47.1% of mechanical repercussions at the extremity of the construct. However, these complications were not associated with a significant deterioration in clinical scores., Level of Evidence: III., (Copyright © 2023. Published by Elsevier Masson SAS.)
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- 2023
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9. Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis.
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Kepka S, Heimann C, Severac F, Hoffbeck L, Le Borgne P, Bayle E, Ruch Y, Muller J, Roy C, Sauleau EA, Andres E, Ohana M, and Bilbault P
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- Male, Humans, Aged, Female, Retrospective Studies, Radiography, Emergency Service, Hospital, Tomography, X-Ray Computed, Pneumonia diagnostic imaging
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Background and Objectives: Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT). However, although ULD CT appears to be an attractive alternative to radiography, its organizational impact in ED remains unknown. Our objective was to compare the relevant timepoints in ED management of CT and chest radiography. Materials and Methods: We conducted a retrospective study in two ED of a University Hospital including consecutive patients consulting for a CAP between 1 March 2019 and 29 February 2020 to assess the organizational benefits of ULD chest CT and chest radiography (length of stay (LOS) in the ED, time of clinical decision after imaging). Overlap weights (OW) were used to reduce covariate imbalance between groups. Results: Chest radiography was performed for 1476 patients (mean age: 76 years [63; 86]; 55% men) and ULD chest CT for 133 patients (mean age: 71 [57; 83]; 53% men). In the weighted population with OW, ULD chest CT did not significantly alter the ED LOS compared with chest radiography (11.7 to 12.2; MR 0.96 [0.85; 1.09]), although it did significantly reduce clinical decision time (6.9 and 9.5 h; MR 0.73 [0.59; 0.89]). Conclusion: There is real-life evidence that a strategy with ULD chest CT can be considered to be a relevant approach to replace chest radiography as part of the diagnostic workup for CAP in the ED without increasing ED LOS.
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- 2023
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10. Evaluating the Portability of Rheumatoid Arthritis Phenotyping Algorithms: A Case Study on French EHRs.
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Fabacher T, Sauleau EA, Leclerc Du Sablon N, Bergier H, Gottenberg JE, Coulet A, and Névéol A
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- Humans, Algorithms, Machine Learning, Natural Language Processing, Electronic Health Records, Arthritis, Rheumatoid diagnosis
- Abstract
Previous work has successfully used machine learning and natural language processing for the phenotyping of Rheumatoid Arthritis (RA) patients in hospitals within the United States and France. Our goal is to evaluate the adaptability of RA phenotyping algorithms to a new hospital, both at the patient and encounter levels. Two algorithms are adapted and evaluated with a newly developed RA gold standard corpus, including annotations at the encounter level. The adapted algorithms offer comparably good performance for patient-level phenotyping on the new corpus (F1 0.68 to 0.82), but lower performance for encounter-level (F1 0.54). Regarding adaptation feasibility and cost, the first algorithm incurred a heavier adaptation burden because it required manual feature engineering. However, it is less computationally intensive than the second, semi-supervised, algorithm.
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- 2023
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11. Psychopathological profile and sagittal alignment in low-back pain.
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Collinet A, Ntilikina Y, Romani A, Schuller S, Sauleau EA, and Charles YP
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- Humans, Middle Aged, Cervical Vertebrae, Lumbar Vertebrae pathology, Lordosis, Kyphosis, Low Back Pain diagnostic imaging, Mental Disorders
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Introduction: Low-back pain requires comprehensive care using a biopsychosocial model. The psychologic dimension plays an important role, but the link between sagittal alignment and a given psychopathological profile is little studied. The aim of this study was to analyze the psychopathological profiles and sagittal parameters of a population with low-back pain and to assess the link., Material and Methods: 205 patients, with a mean age of 49.6 years (range, 18-70 years), presenting chronic common low-back pain without radicular involvement, were included prospectively. Mood scores comprised: the self-administered "Hospital Anxiety and Depression Scale" (HAD), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D) and Young Mania Rating Scale (YMRS). Radiological parameters, measured on lateral full-spine radiographs, included: L1-S1 lordosis, T1-T12 kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 slope, and Roussouly type., Results: Mean HAM-A score was 16.1; 54% of patients had scores ≥14, indicating anxiety disorder. Mean HAM-D score was 10.8; 55% of patients had scores ≥10, indicating depressive disorder. Mean YMRS score was 2.6; only 1 patient had a score ≥20, indicating manic disorder. The 112 patients with HAM-A score >14 showed mean 51.6° L1-S1 lordosis (p=0.356), 48.3° T1-T12 kyphosis (p=0.590), -4.3mm C7 SVA (p=0.900), and 29.3° T1 slope (p=0.451). In case of HAM-A <14, there were no significant differences. The 113 patients with HAM-D score >10 showed significant differences in T1-T12 kyphosis (mean 49.0°; p<0.05) and T1 slope (30.2°; p<0.05); mean L1-S1 lordosis was 50.5° (p=0.861) and C7 SVA 1.6mm (p=0.462). In case of HAM-D <10, T1-T12 kyphosis was 45.5° (p<0.05) and T1 slope 26.2° (p<0.05); mean lordosis was 50.9° (p=0.861) and mean C7 SVA -7.1mm (p=0.259). Multivariate analysis found no significant link between Roussouly type and psychiatric scores: HAD (p=0.715), HAM-A (p=0.652), and HAM-D (p=0.902)., Conclusion: More than 50% of patients with common low-back pain presented a mood disorder. Depressive disorder was associated with greater T1-T12 kyphosis and T1 slope. There was no relationship between psychiatric scores and overall sagittal alignment., Level of Evidence: II., (Copyright © 2022. Published by Elsevier Masson SAS.)
- Published
- 2023
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12. Comparison of Spinopelvic Configuration and Roussouly Alignment Types Between Pediatric and Adult Populations.
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Charles YP, Lamas V, Ilharreborde B, Blondel B, Prost S, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Lebhar J, Giorgi H, Faure A, Sauleau EA, and Pesenti S
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- Adolescent, Adult, Bayes Theorem, Child, Cross-Sectional Studies, Humans, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae pathology, Retrospective Studies, Kyphosis pathology, Lordosis diagnostic imaging, Lordosis pathology
- Abstract
Study Design: Retrospective cross-sectional study., Objective: The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations., Summary of Background Data: The Roussouly classification was validated for adults. Alignment types may vary during growth., Materials and Methods: Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression., Results: The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age., Conclusion: Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4., Level of Evidence: Level III., Competing Interests: Y.P.C. is consultant for Stryker, Clariance, SpineVision, Philips and Ceraver; he received royalties and grants unrelated to this study from Stryker and Clariance. B.I. is consultant for Zimmer Biomet, Medtronic and Implanet. B.B. is associate editor for OTSR Elsevier-Masson and consultant for Medicrea, Medtronic, Implanet, Vexim Stryker, and 3M. F.L. is consultant for Spineart and SMAIO. Guillaume Riouallon is consultant for Medtronic, Stryker and NewClip; he received royalties from Euros. V.C. is shareholder of Follow Health SA and consultant for Clariance. I.O. is consultant for Medtronic and Depuy Synthes; he received grants from DePuy Synthes unrelated to this study and royalties from Clariance, Alphatec and Spineart. L.B.is consultant for Neo and Euros; he received grants from DePuy Synthes unrelated to this study. F.S. received funding to attend meetings from Medicrea, Medtronic and Euros. J.-C.L.H. is consultant for Medtronic and BD Bard; he received royalties and grants unrelated to this study from Medtronic. V.F. is consultant for Clariance; he received royalties Medicrea and Clariance. A.F. is consultant for OSD. The remaining authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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13. Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo.
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Mandja BA, Handschumacher P, Bompangue D, Gonzalez JP, Muyembe JJ, Sauleau EA, and Mauny F
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- Animals, Bayes Theorem, Democratic Republic of the Congo epidemiology, Humans, Monkeypox virus, Zoonoses epidemiology, Mpox (monkeypox) epidemiology
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Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC). While the number of cases has increased steadily in the DRC over the last 30 years, the environmental risk factors that drive the spatiotemporal dynamics of MPX transmission remain poorly understood. This study aimed to investigate the spatiotemporal associations between environmental risk factors and annual MPX incidence in the DRC. All MPX cases reported weekly at the health zone level over a 16-year period (2000-2015) were analyzed. A Bayesian hierarchical generalized linear mixed model was conducted to identify the spatiotemporal associations between annual MPX incidence and three types of environmental risk factors illustrating environment as a system resulting from physical, social and cultural interactions Primary forest (IRR 1.034 [1.029-1.040]), economic well-being (IRR 1.038 [1.031-1.047]), and temperature (IRR 1.143 [1.028-1.261]) were positively associated with annual MPX incidence. Our study shows that physical environmental risk factors alone cannot explain the emergence of MPX outbreaks in the DRC. Economic level and cultural practices participate from environment as a whole and thus, must be considered to understand exposure to MPX risk Future studies should examine the impact of these factors in greater detail., (© 2022. EcoHealth Alliance.)
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- 2022
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14. Variation of Global Sagittal Alignment Parameters According to Gender, Pelvic Incidence, and Age.
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Charles YP, Bauduin E, Pesenti S, Ilharreborde B, Prost S, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, and Blondel B
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- Adult, Bayes Theorem, Cross-Sectional Studies, Humans, Male, Radiography, Retrospective Studies, Lordosis diagnostic imaging, Posture
- Abstract
Study Design: Retrospective cross-sectional study., Objective: The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI)., Summary of Background Data: Variability with age has been reported. It remains unclear how gender and spinopelvic morphology could additionally influence global alignment parameters., Materials and Methods: Radiographs of 2599 individuals (5-93 y) were analyzed. Translation parameters were: Sagittal Vertical Axis (SVA)-C7, SVA-C2, SVA-Center Acoustic Meatus (CAM), C7/Sacrofemoral Distance (SFD) ratio. Inclination parameters were: C7-Vertical Tilt (VT), T1-VT and T9-VT, Odontoid-Hip Axis (OD-HA), OD-CAM. Pelvic compensation parameters were: T1-Pelvic Angle (TPA), Global Tilt (GT), Spino-Sacral Angle (SSA). Global sagittal alignment (GSA) was considered among formulae. The distribution of parameters was analyzed using a Bayesian inference. Correlations with spinopelvic parameters were investigated., Results: SVA-C7, SVA-C2, SVA-CAM were larger in males and high PI, and increased significantly after 50 years (Pr>0.9999). C7/SFD decreased during growth and was larger in low PI (Pr=0.951). There was no correlation with spinopelvic parameters. Age-related variations of inclination parameters were nonsignificant. T1-VT and T9-VT increased with PI and were significantly larger in high PI (Pr>0.95). C7-VT was significantly larger in low PI (Pr>0.9999). OD-HA and OD-CAM were constant and increased after 80 years. TPA and GT increased with PI (Pr>0.9999) and age after 35 years (Pr>0.9999). SSA decreased nonsignificantly after 50 years. TPA correlated with PI (ρ=0.6130) and pelvic tilt (PT) (ρ=0.8375). GT correlated with PI (ρ=0.5961) and PT (ρ=0.8996). SSA correlated with sacral slope (ρ=0.9026). GSA was larger in high PI (Pr>0.9999) and increased after 35 years (Pr>0.9999). GSA correlated with PT (ρ=0.7732)., Conclusion: Translation parameters increase with age, more prominently in males and high PI. Variations of inclination parameters are smaller. Pelvic compensation parameters and GSA increase with age and are closely related to PT and spinopelvic morphology., Level of Evidence: Level III., Competing Interests: Y.P.C. is consultant for Stryker, Clariance, Philips and Ceraver; he received royalties and grants unrelated to this study from Stryker and Clariance. B.I. is consultant for Zimmer Biomet, Medtronic and Implanet. F.L. is consultant for Spineart and SMAIO. G.R. is consultant for Medtronic, Stryker and NewClip; he received royalties from Euros. V.C. is shareholder of Follow Health SA and consultant for Clariance. I.O. is consultant for Medtronic and Depuy Synthes; he received grants from DePuy Synthes unrelated to this study and royalties from Clariance, Alphatec and Spineart. L.B. is consultant for Neo and Euros; he received grants from DePuy Synthes unrelated to this study. F.S. received funding to attend meetings from Medicrea, Medtronic, and Euros. J.-C.L.H. is consultant for Medtronic and BD Bard; he received royalties and grants unrelated to this study from Medtronic. V.F. is consultant for Clariance; he received royalties Medicrea and Clariance. A.F. is consultant for OSD. B.B. is associate editor for OTSR Elsevier-Masson and consultant for Medicrea, Medtronic, Implanet, Vexim Stryker, and 3M. The remaining authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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15. Activation of 20-HETE Synthase Triggers Oxidative Injury and Peripheral Nerve Damage in Type 2 Diabetic Mice.
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Haddad M, Eid S, Harb F, Massry MEL, Azar S, Sauleau EA, and Eid AA
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- Animals, Mice, AMP-Activated Protein Kinases metabolism, Hydroxyeicosatetraenoic Acids, Metformin pharmacology, Oxidative Stress, Peripheral Nerves, Reactive Oxygen Species metabolism, Cytochrome P-450 CYP4A metabolism, Diabetes Mellitus, Experimental complications, Diabetes Mellitus, Experimental metabolism, Diabetes Mellitus, Type 2 complications, Diabetic Neuropathies complications, Peripheral Nerve Injuries complications
- Abstract
Diabetic Peripheral Neuropathy (DPN), highly prevalent among patients with diabetes, is characterized by peripheral nerve dysfunction. Reactive Oxygen Species (ROS) overproduction has been suggested to orchestrate diabetic complications including DPN. Untargeted antioxidant therapy has exhibited limited efficacy, highlighting a critical need to explore ROS sources altered in a cell-specific manner in DPN. Cytochromes P450 (CYP) enzymes are prominent sources of ROS. Particularly, the 20-HETE synthase, CYP4A, is reported to mediate diabetes-induced renal, retinal, and cardiovascular injuries. This work investigates the role of CYP4A/20-HETE in DPN and their mechanisms of action. Non-obese type 2 Diabetic mice (MKR) were used and treated with a CYP4A-inhibitor (HET0016) or AMPK-activator (Metformin). Peripheral nerves of MKR mice reflect increased CYP4A and 20-HETE levels, concurrent with altered myelin proteins and sensorimotor deficits. This was associated with increased ROS production and altered Beclin-1 and LC3 protein levels, indicative of disrupted autophagic responses in tandem with AMPK inactivation. AMPK activation via Metformin restored nerve integrity, reduced ROS production, and regulated autophagy. Interestingly, similar outcomes were revealed upon HET0016 treatment whereby ROS production, autophagic responses, and AMPK signaling were normalized in diabetic mice. Altogether, the results highlight hyperglycemia-mediated oxidative injury in DPN through a novel CYP4A/20-HETE/AMPK pathological axis. PERSPECTIVE: To our knowledge, this is the first study to highlight the role of CYPs/20-HETE-induced oxidative injury in the pathogenesis of diabetic peripheral neuropathy. Targeting the identified pathological axis CYP4A/20-HETE/AMPK may be of clinical potential in predicting and alleviating peripheral nerve injury in patients with Type 2 Diabetes Mellitus., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2022
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16. Correction to: Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age.
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, and Blondel B
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- 2022
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17. Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age.
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, and Blondel B
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- Bayes Theorem, Cervical Vertebrae diagnostic imaging, Humans, Male, Thoracic Vertebrae diagnostic imaging, Kyphosis diagnostic imaging, Kyphosis epidemiology, Lordosis diagnostic imaging, Lordosis epidemiology
- Abstract
Purpose: The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment., Methods: A total of 2599 individuals (5-93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1-C2 lordosis. Caudal cervical parameters were: C2-C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated., Results: Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1-C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2-C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2-C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95)., Conclusion: Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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18. Effect of emergency start and central venous catheter on outcomes in incident hemodialysis patients: a prospective observational cohort.
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Alizada U, Sauleau EA, Krummel T, Moranne O, Kazes I, Couchoud C, and Hannedouche T
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- Aged, Cohort Studies, Humans, Middle Aged, Nephrologists, Renal Dialysis methods, Survival Rate, Arteriovenous Shunt, Surgical adverse effects, Central Venous Catheters, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic etiology, Kidney Failure, Chronic therapy
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Background: Unfavorable conditions at hemodialysis inception reduce the survival rate. However, the relative contribution to outcomes of predialysis follow-up, symptoms, emergency start or central venous catheter (CVC) is unknown., Methods: We analyzed the determinants of survival according to dialysis initiation conditions in the nationwide REIN registry, using two methods based either on clinical classification or data mining. We divided patients into four groups according to dialysis initiation (emergency vs planned, symptoms or not, previous follow-up). "Followed planned starters" began dialysis as outpatients and with an arteriovenous fistula (AVF). "Followed symptomatic non-urgent starters" were patients who started earlier because of any non-urgent symptomatic event. "Followed urgent starters" had seen a nephrologist before inception but started dialysis in an emergency condition. "Unknown urgent starters" were patients without any follow-up and who had a CVC at inception., Results: "Followed urgent" starters had the lowest 2-year survival rate (66.8%) compared to "followed planned" (77.3%), "followed symptomatic non urgent" (79.2%), and "unknown urgent" (71.7%). Compared to other groups, the risk of mortality was lower in followed symptomatic non urgent (HR 0.86 95% CI 0.75-0.99) and higher in followed urgent starters (HR 1.05 (95% CI 0.94-1.18). In data mining Classification And Regression Tree regrouping in five categories, the lowest 2-year survival (52.3%) was in over 70-year-old starters with a CVC. The survival was 93.2% in under 57-year-old patients without active cancer, 82.5% in 57-70-year-old individuals without cancer, 72.4% in over 70-year-old patients without CVC and 61.4% in under 70-year-old subjects with cancer. The hazard ratio of data mining categories varied between 2.12 (95% CI 1.73-2.60) in 57-70-year-old subjects without cancer and 4.42 (95% CI 3.64-5.37) in over 70-year-old patients with CVC. Therefore, regrouping incident patients into five data mining categories, identified by age, cancer, and CVC use, could discriminate the 2-year survival in patients starting hemodialysis., Conclusions: Although each classification captured different prognosis information, both analyses showed that starting hemodialysis on a CVC has more dramatic outcomes than emergency start per se., (© 2021. Italian Society of Nephrology.)
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- 2022
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19. Cognitive reserve as one of the determinants of the progression of Alzheimer disease.
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Albrecht P, Perisse J, Sauleau EA, and Blanc F
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To assess the validity of Yaakov Stern's theory, which postulates that the first cognitive deficits of Alzheimer disease are delayed in patients with high cognitive reserve, compared to those with low cognitive reserve, but this is subsequently associated with faster cognitive decline when cerebral lesions have reached a certain degree of severity. A retrospective study of 318 patients with Alzheimer disease without associated cerebral disorders, was performed at the Memory Clinic of the University Hospital of Strasbourg. The patients were divided into five groups according to their degree of cognitive reserve, as assessed by their level of education (primary, middle school, intermediate, high school and higher education). Cognitive status was assessed by scores on the Mini Mental Status Examination (MMSE) at the first examination and during follow-up lasting four years or longer. Slopes of cognitive decline were computed and compared between groups using ß linear regression. Patients in the higher education group had higher MMSE scores than those in the other groups at the first consultation, but a statistically significant steeper slope during the follow-up. Our results are consistent with Stern's theoretical model, which assumes that high cognitive reserve is accompanied by compensation mechanisms which hinder the onset of clinical cognitive decline in patients with Alzheimer disease, but that is then associated with a faster decline at a later stage when the reserve is exhausted.
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- 2022
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20. COVID-19 Impact on Stroke Admissions during France's First Epidemic Peak: An Exhaustive, Nationwide, Observational Study.
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Risser C, Tran Ba Loc P, Binder-Foucard F, Fabacher T, Lefèvre H, Sauvage C, Sauleau EA, and Wolff V
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- Bayes Theorem, Cohort Studies, Communicable Disease Control, Hospitalization, Humans, Pandemics, COVID-19 epidemiology, Stroke diagnosis, Stroke epidemiology, Stroke therapy
- Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic continues to have great impacts on the care of non-COVID-19 patients. This was especially true during the first epidemic peak in France, which coincided with the national lockdown. The aim of this study was to identify whether a decrease in stroke admissions occurred in spring 2020, by analyzing the evolution of all stroke admissions in France from January 2019 to June 2020., Methods: We conducted a nationwide cohort study using the French national database of hospital admissions (Information Systems Medicalization Program) to extract exhaustive data on all hospitalizations in France with at least one stroke diagnosis between January 1, 2019, and June 30, 2020. The primary endpoint was the difference in the slope gradients of stroke hospitalizations between pre-epidemic, epidemic peak, and post-epidemic peak phases. Modeling was carried out using Bayesian techniques., Results: Stroke hospitalizations dropped from March 10, 2020 (slope gradient: -11.70), and began to rise again from March 22 (slope gradient: 2.090) to May 7. In total, there were 23,873 stroke admissions during the period March-April 2020, compared to 29,263 at the same period in 2019, representing a decrease of 18.42%. The percentage change was -15.63%, -25.19%, -18.62% for ischemic strokes, transient ischemic attacks, and hemorrhagic strokes, respectively., Discussion/conclusion: Stroke hospitalizations in France experienced a decline during the first lockdown period, which cannot be explained by a sudden change in stroke incidence. This decline is therefore likely to be a direct, or indirect, result of the COVID-19 pandemic., (© 2022 S. Karger AG, Basel.)
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- 2022
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21. Simulation on synthetic bone: A tool for teaching thoracolumbar pedicle screw placement.
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Saur M, Guillard B, Collinet A, Schmitz A, Sauleau EA, Clavert P, Koch G, Vidailhet P, Gasia V, and Charles YP
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- Computer Simulation, Humans, Orthopedics education, Pedicle Screws, Spinal Fusion methods, Surgery, Computer-Assisted
- Abstract
Introduction: Simulation workshops for surgical training of residents are becoming popular. The gold standard for teaching thoracolumbar pedicle screw placement are cadaver labs; however, the availability of human bodies is limited. The primary objective of this study was to determine if training on a synthetic bone model improves the apprenticeship of accurate pedicle screw placement. The secondary objective was to check the influence of residents' previous experience in spine surgery., Hypothesis: The main hypothesis was that theoretical learning with practical application on synthetic bone was superior to theoretical learning alone., Methods: Twenty-three orthopedic residents were taught about free-hand pedicle screw placement using a theoretical presentation. Six residents had previous experience with screwing techniques. After randomization in two groups, 11 residents (group 1) participated in a workshop on synthetic bone, whereas 12 residents received only theoretical instruction (group 2). Each resident was asked to place two thoracic screws (T7-T11) and two lumbar screws (L1-L5) on a cadaver. Screw placement accuracy was analyzed using the Gertzbein classification on computed tomography (grades 0 and 1=accurate positioning; grades 2 and 3=malposition>2mm)., Results: Rates of accurate screw positioning were 64.0% and 62.5% for thoracic levels, and 72.7% and 66.6% for lumbar levels in group 1 and 2, respectively. There was no significant difference in malposition rates on cadavers between the groups (p=0.1809). A resident who was first trained by simulation had a chance of decreasing the Gertzbein score with an odds-ratio of 1.7714 [0.7710-4.1515]. The odds ratio was 4.5188 [0.0456-0.8451] when comparing residents with previous experience in spinal surgery to novice residents., Discussion: Theoretical teaching associated with a simulation model is relevant for learning a surgical technique. A single simulation workshop on synthetic bone seems insufficient to improve pedicle screw placement accuracy compared to theoretical teaching alone. Progressive experience and the repetition of technical gestures during hands-on supervised learning in spine surgery with a senior surgeon had an influence on the accuracy of pedicle screw placement., Level of Evidence: II., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
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- 2021
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22. Analysis of factors associated with sagittal alignment deterioration after correction of degenerative scoliosis by in situ contouring.
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Baldairon F, Charles YP, Eichler D, Ntilikina Y, Sauleau EA, and Steib JP
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- Bayes Theorem, Humans, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae surgery, Middle Aged, Retrospective Studies, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae surgery, Kyphosis diagnostic imaging, Kyphosis etiology, Kyphosis surgery, Lordosis diagnostic imaging, Lordosis surgery, Scoliosis diagnostic imaging, Scoliosis surgery
- Abstract
Introduction: In situ contouring is one of the surgical techniques used for scoliosis reduction. The initial correction could change over time, with deterioration of the sagittal balance. The purpose of this study was to analyze the loss of correction after degenerative lumbar scoliosis surgery using in situ contouring., Materials and Methods: Full spine radiographs of 73 patients (mean age 63.3 years, mean follow-up 27 months) were analyzed before surgery, after surgery, and at the final follow-up. The following radiographic parameters were measured: C2-C7 lordosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic tilt, pelvic incidence, sacral slope, SVA C7, SVA C2, Cobb angle. Bayesian inference was used to compare the changes in these parameters. A probability>0.95 was considered as a significant change., Results: After surgery, lumbar lordosis increased from -28.4° to -37.8° (probability 0.999), then decreased to -32.1° at the final follow-up (probability 0.953). Thoracic kyphosis increased from 29.6° to 37.4° after surgery (probability 1.00) and continued to increase to 41.6° at the final follow-up (probability 0.999). SVA C7 increased from 38.5mm to 62.3mm (probability 0.999) and pelvic tilt from 19.4° to 25.1° (probability 1.00) during the follow-up period. Ten patients had to be reoperated because of a surgical site infection. Infection (14%) was associated with an increase of SVA C7 (probability 0.989) and thoracic kyphosis (probability 0.987). Nonunion (16%) was associated with a decrease in lumbar lordosis (probability 0.756)., Conclusion: Correction of degenerative lumbar scoliosis by in situ contouring resulted in sagittal balance correction; however, some of this correction was lost during the follow-up period. The main risk factors were deep wound infection and nonunion., Level of Evidence: IV, Retrospective study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
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- 2021
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23. Fine-scale geographic variations of rates of renal replacement therapy in northeastern France: Association with the socioeconomic context and accessibility to care.
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Desmarets M, Ayav C, Diallo K, Bayer F, Imbert F, Sauleau EA, and Monnet E
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- Aged, Bayes Theorem, Female, France, Humans, Kidney Failure, Chronic therapy, Male, Spatial Analysis, Geography, Health Services Accessibility statistics & numerical data, Renal Replacement Therapy statistics & numerical data, Socioeconomic Factors
- Abstract
Background: The strong geographic variations in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease are not solely related to variations in the population's needs, such as the prevalence of diabetes or the deprivation level. Inequitable geographic access to health services has been involved in different countries but never in France, a country with a generous supply of health services and where the effect of the variability of medical practices was highlighted in an analysis conducted at the geographic scale of districts. Our ecological study, performed at the finer scale of townships in a French area of 8,370,616 inhabitants, investigated the association between RRT incidence rates, socioeconomic environment and geographic accessibility to healthcare while adjusting for morbidity level and medical practice patterns., Methods: Using data from the Renal Epidemiology and Information Network registry, we estimated age-adjusted RRT incidence rates during 2010-2014 for the 282 townships of the area. A hierarchical Bayesian Poisson model was used to examine the association between incidence rates and 18 contextual variables describing population health status, socioeconomic level and health services characteristics. Relative risks (RRs) and 95% credible intervals (95% CrIs) for each variable were estimated for a 1-SD increase in incidence rate., Results: During 2010-2014, 6,835 new patients ≥18 years old (4231 men, 2604 women) living in the study area started RRT; the RRT incidence rates by townships ranged from 21 to 499 per million inhabitants. In multivariate analysis, rates were related to the prevalence of diabetes [RR (95% CrI): 1.05 (1.04-1.11)], the median estimated glomerular filtration rate at dialysis initiation [1.14 (1.08-1.20)], and the proportion of incident patients ≥ 85 years old [1.08 (1.03-1.14)]. After adjusting for these factors, rates in townships increased with increasing French deprivation index [1.05 (1.01-1.08)] and decreased with increasing mean travel time to reach the closest nephrologist [0.92 (0.89-0.95])., Conclusion: These data confirm the influence of deprivation level, the prevalence of diabetes and medical practices on RRT incidence rates across a large French area. For the first time, an association was found with the distance to nephrology services. These data suggest possible inequitable geographic access to RRT within the French health system., Competing Interests: The authors have declared that no competing interests exist.
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- 2020
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24. PoleSat's Modelling a Reorganization of Vascular Catheterization Provision at the Territorial Hospital Grouping Level.
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Quesnel-Barbet A, Soula J, Sauleau EA, Parrend P, Bazile P, Dufossez F, Maignant G, Staccini P, Albert F, and Hansske A
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- Prospective Studies, Catheterization, Hospitals, Public
- Abstract
Since a French organization (2016) has defined "the territorial hospital groupings", public hospitals must share medical-economic knowledge and decision-makers expect prospective analyses. PoleSat aims, quick hospital-catchment area modellings, completed by population analyses. Modellings are based on "diagnostic and interventional vascular catheterizations" acts and Nouvelle-Aquitaine, and they are carried out 3 times, through the graphical user interface's main-setting values, coupled with 3 activity-scenarios. Scenario results cannot confirm the NA02-Atlantique's H0. The experts have approved PoleSat's method as a robust help-tool; therefore they project to repeat its usages.
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- 2020
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25. A Brain Imaging-Based Diagnostic Biomarker for Periodic Catatonia: Preliminary Evidence Using a Bayesian Approach.
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Foucher JR, de Billy C, Jeanjean LC, Obrecht A, Mainberger O, Clauss JME, Schorr B, Lupu MC, de Sousa PL, Lamy J, Noblet V, Sauleau EA, Landré L, and Berna F
- Subjects
- Adult, Bayes Theorem, Biomarkers, Female, Humans, Male, Middle Aged, Proof of Concept Study, Sensitivity and Specificity, Young Adult, Catatonia diagnostic imaging, Catatonia physiopathology, Cerebrovascular Circulation physiology, Functional Neuroimaging standards, Magnetic Resonance Imaging standards
- Abstract
Periodic catatonia (PC) is a psychomotor phenotype with a progressive-remitting course. While it can fit any disorder diagnosis of the schizoaffective spectrum, its core features consist of a mix of hypo- and hyperkinesias resulting in distortions of expressive movements such as grimacing and parakinesias. The replication of cerebral blood flow (CBF) increases in the left supplementary motor area (L-SMA) and lateral premotor cortex (L-LPM) in acute and remitting PC patients indicates that these increases could be used as diagnostic biomarkers. In this proof-of-concept study, 2 different MRI sequences were repeated on 3 separate days to get reliable measurement values of CBF in 9 PC and 26 non-PC patients during different cognitive tasks. Each patient was compared to 37 controls. In L-SMA [-9; +10; +60] and L-LPM [-46; -12; +43], a test was positive if the t value was >2.02 (α < 0.05; two tailed). The measurements had good analytical performance. Regarding the tests, their sensitivities and specificities were significantly different from the chance level on both measures, except for L-SMA sensitivities. When combining all the tests, among regions and methods, sensitivity was 98% (95% credible interval [CI] 76-100%) and specificity 88% (72-97%). Bayesian inferences of its negative predictive values for PC were >95% regardless of the context, while its positive predictive values reached 94% but only when used in combination with clinical criteria. The case-by-case analysis suggests that non-PC patients with neurological motor deficits are at risk to be false positive., (© 2019 S. Karger AG, Basel.)
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- 2020
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26. Unmasking the interplay between mTOR and Nox4: novel insights into the mechanism connecting diabetes and cancer.
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Mroueh FM, Noureldein M, Zeidan YH, Boutary S, Irani SAM, Eid S, Haddad M, Barakat R, Harb F, Costantine J, Kanj R, Sauleau EA, Ouhtit A, Azar ST, Eid AH, and Eid AA
- Subjects
- AMP-Activated Protein Kinases antagonists & inhibitors, Animals, Antibiotics, Antineoplastic pharmacology, Blood Glucose, Caco-2 Cells, DNA Damage, Diabetes Mellitus, Experimental, Gene Expression Regulation, Neoplastic drug effects, HT29 Cells, Humans, Hypoglycemic Agents pharmacology, Male, Metformin pharmacology, Mice, Mice, Inbred C57BL, Mice, Transgenic, NADPH Oxidase 4 genetics, Sirolimus pharmacology, TOR Serine-Threonine Kinases antagonists & inhibitors, TOR Serine-Threonine Kinases genetics, Up-Regulation, NADPH Oxidase 4 metabolism, TOR Serine-Threonine Kinases metabolism
- Abstract
Cancer was recently annexed to diabetic complications. Furthermore, recent studies suggest that cancer can increase the risk of diabetes. Consequently, diabetes and cancer share many risk factors, but the cellular and molecular pathways correlating diabetes and colon and rectal cancer (CRC) remain far from understood. In this study, we assess the effect of hyperglycemia on cancer cell aggressiveness in human colon epithelial adenocarcinoma cells in vitro and in an experimental animal model of CRC. Our results show that Nox (NADPH oxidase enzyme) 4-induced reactive oxygen species (ROS) production is deregulated in both diabetes and CRC. This is paralleled by inactivation of the AMPK and activation of the mammalian target of rapamycin (mTOR) C1 signaling pathways, resulting in 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) accumulation, induction of DNA damage, and exacerbation of cancer cell aggressiveness, thus contributing to the genomic instability and predisposition to increased tumorigenesis in the diabetic milieu. Pharmacologic activation of AMPK, inhibition of mTORC1, or blockade of Nox4 reduce ROS production, restore the homeostatic signaling of 8-oxoguanine DNA glycosylase/8-oxodG, and lessen the progression of CRC malignancy in a diabetic milieu. Taken together, our results identify the AMPK/mTORC1/Nox4 signaling axis as a molecular switch correlating diabetes and CRC. Modulating this pathway may be a strategic target of therapeutic potential aimed at reversing or slowing the progression of CRC in patients with or without diabetes.-Mroueh, F. M., Noureldein, M., Zeidan, Y. H., Boutary, S., Irani, S. A. M., Eid, S., Haddad, M., Barakat, R., Harb, F., Costantine, J., Kanj, R., Sauleau, E.-A., Ouhtit, A., Azar, S. T., Eid, A. H., Eid, A. A. Unmasking the interplay between mTOR and Nox4: novel insights into the mechanism connecting diabetes and cancer.
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- 2019
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27. Safety and efficacy of percutaneous instrumentation combined with antibiotic treatment in spondylodiscitis.
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Lambert A, Charles YP, Ntilikina Y, Lefebvre N, Hansmann Y, Sauleau EA, and Steib JP
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- Adult, Aged, Aged, 80 and over, Back Pain diagnosis, Back Pain etiology, Discitis complications, Discitis diagnosis, Female, Humans, Lumbar Vertebrae diagnostic imaging, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Thoracic Vertebrae diagnostic imaging, Tomography, X-Ray Computed, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Back Pain therapy, Braces, Discitis therapy, Lumbar Vertebrae surgery, Spinal Fusion instrumentation, Thoracic Vertebrae surgery
- Abstract
Background: Patients with spondylodiscitis are treated with antibiotics and braces for 6 to 12 weeks. Braces aim to decrease pain and prevent kyphotic deformity due to vertebral body collapse. Percutaneous instrumentation could be an alternative to influence pain and patient's autonomy., Purpose: The purpose of this study was to analyze back pain, quality of life, sagittal deformity, and complications after percutaneous instrumentation in spondylodiscitis., Patients and Methods: VAS for back pain, EQ-5D, radiographic sagittal index were assessed retrospectively for 28 patients who had a standardized follow-up at 5 days, 6 weeks, 3 months, 1 and 2 years. Probabilities>0.95 indicated significant changes (Bayesian model)., Results: VAS was 7.0 preoperatively, 3.2 (day 5), 2.2 (6 weeks), 1.9 (3 months), 1.6 (1 year), 1.4 (2 years): probabilities>0.95 within 6 weeks. EQ-5D was 0.229 preoperatively, 0.563 (6 weeks), 0.687 (3 months), 0.755 (1 year), 0.787 (2 years): probabilities>0.95 within 1 year. Sagittal index was 15.1° preoperatively, 9.6° postoperatively: probability>0.95. Inter-body fusion was: complete 60.7%, partial 17.9%, and nonunion 21.4%. Antibiotic treatment was stopped at 6 weeks in 82.1%, at 3 months in 17.9%, without septic complication., Conclusion: Percutaneous instrumentation improved pain control, quality of life and prevented kyphosis. Antibiotic treatment was not influenced. Septic complications were not observed., Level of Evidence: IV., (Copyright © 2019. Published by Elsevier Masson SAS.)
- Published
- 2019
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28. Polesat-Web-2018: A Simulation IT Tool with Immediate Prospective and Strategic Views of Hospital Spatial Planning.
- Author
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Quesnel-Barbet A, Soula J, Sauleau EA, Parrend P, Bazile P, Dufossez F, and Hansske A
- Subjects
- Internet, Prospective Studies, Software, Geographic Information Systems, Hospital Design and Construction
- Abstract
Medical geo-informatics allows the Health world to address major challenges thanks to attractive concepts, methods and user-friendly IT. PoleSat-web-2018 presents a decision support system - a modelling "variable geometry" IT tool for simulation of hospital spatial planning. The outputs enable quasi-instantaneous analytic visualization at several geographic levels. PoleSat-web-2018 provides prospective views of hospital catchments (by grouping, closing) and proves to be relevant for the French planners of the Ministry of Health.
- Published
- 2019
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29. Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy.
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Eichler D, Charles YP, Baldairon F, Ntilikina Y, Sauleau EA, and Steib JP
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- Humans, Middle Aged, Radiography, Recurrence, Retrospective Studies, Osteotomy adverse effects, Osteotomy methods, Osteotomy statistics & numerical data, Spinal Curvatures diagnostic imaging, Spinal Curvatures pathology, Spinal Curvatures surgery, Spine diagnostic imaging, Spine pathology, Spine surgery
- Abstract
Purpose: This retrospective study investigates sagittal alignment after pedicle subtraction osteotomy (PSO). The purpose was to investigate factors associated with malalignment recurrence., Methods: Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measurements were taken preoperatively, 3 months postoperatively, at follow-up: SVA C2 and C7, C2-C7 lordosis, T4-T12 kyphosis, L1-S1 lordosis, PSO lordosis, pelvic incidence, pelvic tilt, sacral slope. Follow-up CTs were screened for pseudarthrosis and gas in sacroiliac joints., Results: PSO lordosis increased from 11.8° to 40.8° (p < 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° (p < 0.0001) and decreased to 49.7° (p = 0.0008). Pelvic tilt decreased from 29.2° to 16.5° (p < 0.0001) and increased to 22.5° (p < 0.0001). SVA C7 decreased from 105.1 to 35.5 mm (p < 0.0001) and increased to 64.8 mm (p = 0.0005). Twenty-eight patients (42%) had an SVA C7 increase of more than 70 mm in the postoperative course: recurrence group. These patients were older: 62.8 years versus 52.3 years (p = 0.0031). Loss of lordosis was 11.9° (recurrence group) versus 5.0° (non-recurrence group). Eleven patients (17%) had pseudarthrosis. Pelvic incidence increased by 9.3° (recurrence group) versus 3.8° (non-recurrence group). In 23 patients (35%), pelvic incidence increased > 10°. Gas was evidenced in sacroiliac joints in 22 patients (33%)., Conclusion: Postoperative anterior malalignment recurrence may occur after PSO. Elderly patients were at risk of recurrence. Loss of lumbar lordosis linked to pseudarthrosis represented another factor. With malalignment recurrence, anterior trunk rotation and pelvic retroversion might additionally have augmented moments across sacroiliac joints with subsequent ligament laxity and pelvic incidence increase. These slides can be retrieved under Electronic Supplementary Material.
- Published
- 2019
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30. PoleSat_2018: A Strategic IT Tool for Spatial Simulation Modelling of Hospital Planning.
- Author
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Quesnel-Barbet A, Soula J, Bazile P, Sauleau EA, and Parrend P
- Subjects
- Geographic Information Systems, Hospitals, Medical Informatics, Prospective Studies, Computer Simulation, Hospital Planning
- Abstract
Geomatics becomes a major field of science facing challenges to assist medical informatics and health decision makers thanks to attractive concepts, methods and easy, user-friendly-way IT technologies. PoleSat_2018 presents a web-based graphical user interface with an embedded optimized and automated algorithm. It is primarily geared for geomatics non-specialists and allows computer simulations by modelling scenarios of hospital grouping and/or closure. The consultation, reflection, prospective views, offered in a very short time to policy makers will find a successful support for health planning strategic decisions.
- Published
- 2019
31. Survival advantage of planned haemodialysis over peritoneal dialysis: a cohort study.
- Author
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Thiery A, Séverac F, Hannedouche T, Couchoud C, Do VH, Tiple A, Béchade C, Sauleau EA, and Krummel T
- Subjects
- Aged, Female, Follow-Up Studies, France epidemiology, Humans, Kidney Failure, Chronic mortality, Male, Middle Aged, Propensity Score, Survival Rate trends, Kidney Failure, Chronic therapy, Peritoneal Dialysis methods, Registries, Renal Dialysis methods
- Abstract
Background: Previous studies comparing the outcomes in haemodialysis (HD) with those in peritoneal dialysis (PD) have yielded conflicting results., Methods: The aim of the study was to compare the survival of planned HD versus PD patients in a cohort of adult incident patients who started renal replacement therapy (RRT) between 2006 and 2008 in the nationwide REIN registry (Réseau Epidémiologie et Information en Néphrologie). Patients who started RRT in emergency or stopped RRT within 2 months were excluded. Adjusted Cox models, propensity score matching and marginal structural models (MSMs) were used to compensate for the lack of randomization and provide causal inference from longitudinal data with time-dependent treatments and confounders including transplant censorship, modality change over time and time-varying covariates., Results: Among a total of 13 767 dialysis patients, 13% were on PD at initiation of RRT and 87% were on HD. The median survival times were 53.5 months or 4.45 years and 38.6 months or 3.21 years for patients starting on HD and PD, respectively. Regardless of the model used, there was a consistent advantage in terms of survival for HD patients: hazard ratio (HR) 0.76 [95% confidence interval (95% CI) 0.69-0.84] with the Cox model using propensity score; HR 0.67 (95% CI 0.62-0.73) in the Cox model with censorship for each treatment change; and HR 0.82 (95% CI 0.69-0.97) with MSMs. However, MSMs tended to reduce the survival gap between PD and HD patients., Conclusion: This large cohort study using various statistical methods to minimize the bias appears to demonstrate a better survival in planned HD than in PD.
- Published
- 2018
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32. Multilocus sequence typing of clinical Borreliella afzelii strains: population structure and differential ability to disseminate in humans.
- Author
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Gallais F, De Martino SJ, Sauleau EA, Hansmann Y, Lipsker D, Lenormand C, Talagrand-Reboul E, Boyer PH, Boulanger N, Jaulhac B, and Schramm F
- Subjects
- Animals, Borrelia burgdorferi genetics, Borrelia burgdorferi isolation & purification, Borrelia burgdorferi Group isolation & purification, Europe epidemiology, Genetic Variation, Humans, Ixodes parasitology, Lyme Disease epidemiology, Lyme Disease transmission, Multilocus Sequence Typing methods, Phylogeny, Borrelia burgdorferi Group classification, Borrelia burgdorferi Group genetics, Genotype, Lyme Disease parasitology
- Abstract
Background: Lyme borreliosis in humans results in a range of clinical manifestations, thought to be partly due to differences in the pathogenicity of the infecting strain. This study compared European human clinical strains of Borreliella afzelii (previously named Borrelia afzelii) using multilocus sequence typing (MLST) to determine their spatial distribution across Europe and to establish whether there are associations between B. afzelii genotypes and specific clinical manifestations of Lyme borreliosis. For this purpose, typing was performed on 63 strains, and data on a further 245 strains were accessed from the literature., Results: All 308 strains were categorized into 149 sequence types (STs), 27 of which are described here for the first time. Phylogenetic and goeBURST analyses showed short evolutionary distances between strains. Although the main STs differed among the countries with the largest number of strains of interest (Germany, the Netherlands, France and Slovenia), the B. afzelii clinical strains were less genetically structured than those previously observed in the European tick population. Two STs were found significantly more frequently in strains associated with clinical manifestations involving erythema migrans, whereas another ST was found significantly more frequently in strains associated with disseminated manifestations, especially neuroborreliosis., Conclusions: The MLST profiles showed low genetic differentiation between B. afzelii strains isolated from patients with Lyme borreliosis in Europe. Also, clinical data analysis suggests the existence of lineages with differential dissemination properties in humans.
- Published
- 2018
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33. Long-term cognitive outcome of Alzheimer's disease and dementia with Lewy bodies: dual disease is worse.
- Author
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Blanc F, Mahmoudi R, Jonveaux T, Galmiche J, Chopard G, Cretin B, Demuynck C, Martin-Hunyadi C, Philippi N, Sellal F, Michel JM, Tio G, Stackfleth M, Vandel P, Magnin E, Novella JL, Kaltenbach G, Benetos A, and Sauleau EA
- Subjects
- Aged, Causality, Comorbidity, Female, France epidemiology, Humans, Longitudinal Studies, Male, Prevalence, Prognosis, Risk Factors, Alzheimer Disease diagnosis, Alzheimer Disease epidemiology, Cognitive Dysfunction diagnosis, Cognitive Dysfunction epidemiology, Lewy Body Disease diagnosis, Lewy Body Disease epidemiology
- Abstract
Background: Longitudinal studies of dementia with Lewy bodies (DLB) are rare. Clinically, DLB is usually considered to worsen into Alzheimer's disease (AD). The aim of our study was to compare the rate of the cognitive decline in DLB, AD, and the association of the two diseases (AD + DLB)., Methods: Using the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment database, which includes all the patients seen at all memory clinics (medical consultation and day hospitals) in four French regions, and beta regression, we compared the longitudinal the Mini-Mental State Examination scores of 1159 patients with AD (n = 1000), DLB (n = 131) and AD + DLB (association of the two) (n = 28) during follow-up of at least 4 years., Results: The mean follow-up of the patients was 5.88 years. Using beta regression without propensity scores, the comparison of the decline of patients with AD and patients with DLB did not show a significant difference, but the decline of patients with AD + DLB was worse than that of either patients with DLB (P = 0.006) or patients with AD (P < 0.001). Using beta regression weighted by a propensity score, comparison of patients with AD and patients with DLB showed a faster decline for patients with DLB (P < 0.001). The comparison of the decline of patients with AD + DLB with that of patients with DLB (P < 0.001) and patients with AD (P < 0.001) showed that the decline was clearly worse in the patients with dual disease., Conclusions: Whatever the analysis, the rate of decline is faster in patients with AD + DLB dual disease. The identification of such patients is important to enable clinicians to optimise treatment and care and to better inform and help patients and caregivers.
- Published
- 2017
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34. NMDAR antibodies in first episode psychosis: conclusions too inflammatory given results?
- Author
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Berna F, Séverac F, Sauleau EA, Meyer N, and Weibel S
- Subjects
- Antibodies, Case-Control Studies, Humans, Prevalence, Receptors, N-Methyl-D-Aspartate, Psychotic Disorders
- Published
- 2017
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35. Reliability, factor analysis and internal consistency calculation of the Insomnia Severity Index (ISI) in French and in English among Lebanese adolescents.
- Author
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Chahoud M, Chahine R, Salameh P, and Sauleau EA
- Abstract
Objectives: Our goal is to validate and to verify the reliability of the French and English versions of the Insomnia Severity Index (ISI) in Lebanese adolescents., Study Design: A cross-sectional study was implemented., Methods: 104 Lebanese students aged between 14 and 19 years participated in the study. The English version of the questionnaire was distributed to English-speaking students and the French version was administered to French-speaking students. A scale (1 to 7 with 1 = very well understood and 7 = not at all) was used to identify the level of the students' understanding of each instruction, question and answer of the ISI. The scale's structural validity was assessed. The factor structure of ISI was evaluated by principal component analysis. The internal consistency of this scale was evaluated by Cronbach's alpha. To assess test-retest reliability the intraclass correlation coefficient (ICC) was used., Results: The principal component analysis confirmed the presence of a two-component factor structure in the English version and a three-component factor structure in the French version with eigenvalues > 1. The English version of the ISI had an excellent internal consistency (α = 0.90), while the French version had a good internal consistency (α = 0.70). The ICC presented an excellent agreement in the French version (ICC = 0.914, CI = 0.856-0.949) and a good agreement in the English one (ICC = 0.762, CI = 0.481-890). The Bland-Altman plots of the two versions of the ISI showed that the responses over two weeks' were comparable and very few outliers were detected., Conclusion: The results of our analyses reveal that both English and French versions of the ISI scale have good internal consistency and are reproducible and reliable. Therefore, it can be used to assess the prevalence of insomnia in Lebanese adolescents.
- Published
- 2017
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36. Cervical sagittal alignment in adult hyperkyphosis treated by posterior instrumentation and in situ bending.
- Author
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Paternostre F, Charles YP, Sauleau EA, and Steib JP
- Subjects
- Adaptation, Physiological, Adult, Female, Follow-Up Studies, Humans, Kyphosis diagnostic imaging, Lordosis diagnostic imaging, Lumbar Vertebrae diagnostic imaging, Male, Pelvic Bones diagnostic imaging, Postoperative Period, Posture, Radiography, Range of Motion, Articular, Retrospective Studies, Sacrum diagnostic imaging, Thoracic Vertebrae diagnostic imaging, Young Adult, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae physiopathology, Kyphosis surgery, Lordosis surgery, Thoracic Vertebrae surgery
- Abstract
Background: In the normal adult spine, a link between thoracolumbar and cervical sagittal alignment exists, suggesting adaptive cervical positional changes allowing horizontal gaze. In patients with thoracic hyperkyphosis, cervical adaptation to sagittal global alignment might be different from healthy individuals. However, this relationship has not clearly been reported in hyperkyphotic deformity., Purpose: The purpose of this study was to identify cervical sagittal alignment types observed on radiographs in young adults with thoracic hyperkyphosis. The relationship between cervical and thoracolumbar alignment as well as the effect of posterior instrumentation and adaptive positional changes of the mobile cervical segment were retrospectively analyzed., Patients and Methods: Twenty-three patients (32.7 years; 5-year follow-up) were included. Full spine radiographic measurements were: T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, SVA C7, SVA C2, lordosis between C0-C2, C2-C7, C2-C4 and C4-C7. A Bayesian model and Spearman correlation were used., Results: Two alignment types existed: cervical lordosis (group A) and cervical kyphosis (group B). Preoperatively, T4-T12 kyphosis and L1-S1 lordosis were significantly higher in group A: 76.6° versus 59.4° and -72.8° versus -65.8° (probability of>5° difference P (β>5)>0.95). Pelvic incidence was higher in group A (49.8° versus 44.2°) and C0-C2 lordosis in group B (-29.4° versus -21.6°). A significant correlation existed between: T4-T12 kyphosis and C2-C7 lordosis, L1-S1 lordosis and pelvic incidence, C2-C7 lordosis and T1 slope, C2-C7 lordosis and T1-T4 kyphosis. Postoperatively, T4-T12 kyphosis decreased by 33.1° P (β>5)=0.9995), L1-S1 lordosis decreased by 17.7° (P (β>5)=0.961), T1-T4 kyphosis increased by 14.1° (P (β>5)=0.973). SVA C2 (translation) increased by 13.8mm. C0-C2 lordosis (head rotation) remained unchanged. Six patients changed cervical alignment. PJK occurred in 15 patients, unrelated to cervical alignment or proximal instrumentation level., Discussion: Two cervical alignment types, lordotic or kyphotic, were observed thoracic hyperkyphosis patients. This alignment was mainly triggered by the amount of thoracic kyphosis and lumbar lordosis, linked to pelvic incidence. Moreover, the inclination of the C7-T1 junctional area plays a key role in the amount of cervical lordosis. The correction of T4-T12 kyphosis induced compensatory modifications at adjacent segments: T1-T4 kyphosis increase (PJK) and L1-S1 lordosis decrease. Global spino-pelvic alignment and head position did not change in the sagittal plane. The cervical spine tented to keep in its preoperative position in most patients., Level of Evidence: Level IV., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
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37. Tailored telephone counselling to increase participation of underusers in a population-based colorectal cancer-screening programme with faecal occult blood test: A randomized controlled trial.
- Author
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Denis B, Broc G, Sauleau EA, Gendre I, Gana K, and Perrin P
- Subjects
- Aged, Colorectal Neoplasms epidemiology, Early Detection of Cancer methods, Female, France epidemiology, Humans, Male, Mass Screening methods, Mass Screening statistics & numerical data, Middle Aged, Precision Medicine methods, Colorectal Neoplasms diagnosis, Counseling methods, Early Detection of Cancer statistics & numerical data, Occult Blood, Patient Participation statistics & numerical data, Telephone
- Abstract
Background: Despite the involvement of general practitioners, the mailing of several recall letters and of the faecal occult blood test (FOBT) kit, the uptake remains insufficient in the French colorectal cancer-screening programme. Some studies have demonstrated a greater efficacy of tailored telephone counselling over usual care, untailored invitation mailing and FOBT kit mailing. We evaluated the feasibility and the effectiveness of telephone counselling on participation in the population-based FOBT colorectal cancer-screening programme implemented in Alsace (France)., Methods: Underusers were randomized into a control group with untailored invitation and FOBT kit mailing (n=19,756) and two intervention groups for either a computer-assisted telephone interview (n=9367), system for tailored promotion of colorectal cancer screening, or a telephone-based motivational interview (n=9374)., Results: Only 5691 (19.9%) people were actually counseled, so that there was no difference in participation between the intervention groups taken together (13.9%, 95% confidence interval [CI] [13.5-14.4]) and the control group (13.9%, 95% CI [13.4-14.4]) (P=1.0) in intent-to-treat analysis. However, in per-protocol analysis, participation was significantly higher in the two intervention groups than in the control group (12.9%, 95% CI [12.6-13.2]) (P<0.01), with no difference between computer-assisted telephone interview (24.6%, 95% CI [22.7-26.4]) and motivational interview (23.6%, 95% CI [21.8-25.4]) (P=0.44)., Conclusion: There was no difference of effectiveness between tailored telephone counselling and untailored invitation and FOBT kit mailing on participation of underusers in an organized population-based colorectal cancer screening programme. A greater efficacy of telephone counselling, around twice that of invitation and FOBT kit mailing, was observed only in people who could actually be counseled, without difference between computer-assisted telephone interview and motivational interview. However, technical failures hampered telephone counselling, so that there was no difference in intent-to-treat analysis. The rate of technical success of telephone interviews should be evaluated, and enhanced if insufficient, before implementation of telephone counselling in population-based cancer screening programmes., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
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38. Small-area geographic and socioeconomic inequalities in colorectal tumour detection in France.
- Author
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Fournel I, Bourredjem A, Sauleau EA, Cottet V, Dejardin O, Bouvier AM, Launoy G, and Bonithon-Kopp C
- Subjects
- Aged, Bayes Theorem, Female, Follow-Up Studies, France epidemiology, Humans, Incidence, Male, Middle Aged, Prognosis, Registries, Risk Factors, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Health Status Disparities, Mass Screening statistics & numerical data, Population Surveillance, Socioeconomic Factors
- Abstract
The aim of this study was to assess the impact of area deprivation and primary care facilities on colorectal adenoma detection and on colorectal cancer (CRC) incidence in a French well-defined population before mass screening implementation. The study population included all patients aged 20 years or more living in Côte d'Or (France) with either colorectal adenoma or invasive CRC first diagnosed between 1995 and 2002 and who were identified from the Burgundy Digestive Cancer Registry and the Côte d'Or Polyp Registry. Area deprivation was assessed using the European deprivation index on the basis of the smallest French area available (Ilots Regroupés pour l'Information Statistique). Healthcare access was assessed using medical density of general practitioners (GPs) and road distance to the nearest GP and gastroenterologist. Bayesian regression analyses were used to estimate influential covariates on adenoma detection and CRC incidence rates. The results were expressed as relative risks (RRs) with their 95% credibility interval. In total, 5399 patients were diagnosed with at least one colorectal adenoma and 2125 with invasive incident CRC during the study period. Remoteness from GP [RR=0.71 (0.61-0.83)] and area deprivation [RR=0.98 (0.96-1.00)] independently reduced the probability of adenoma detection. CRC incidence was only slightly affected by GP medical density [RR=1.05 (1.01-1.08)] without any area deprivation effect [RR=0.99 (0.96-1.02)]. Distance to gastroenterologist had no impact on the rates of adenoma detection or CRC incidence. This study highlighted the prominent role of access to GPs in the detection of both colorectal adenomas and overall cancers. Deprivation had an impact only on adenoma detection.
- Published
- 2016
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39. Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study.
- Author
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Charles YP, Pelletier H, Hydier P, Schuller S, Garnon J, Sauleau EA, Steib JP, and Clavert P
- Subjects
- Aged, Aged, 80 and over, Cadaver, Female, Humans, Lumbar Vertebrae surgery, Male, Polymethyl Methacrylate, Prosthesis Failure, Bone Cements, Materials Testing, Pedicle Screws, Vertebroplasty methods
- Abstract
Background: Vertebroplasty prefilling or fenestrated pedicle screw augmentation can be used to enhance pullout resistance in elderly patients. It is not clear which method offers the most reliable fixation strength if axial pullout and a bending moment is applied. The purpose of this study is to validate a new in vitro model aimed to reproduce a cut out mechanism of lumbar pedicle screws, to compare fixation strength in elderly spines with different cement augmentation techniques and to analyze factors that might influence the failure pattern., Materials and Methods: Six human specimens (82-100 years) were instrumented percutaneously at L2, L3 and L4 by non-augmented screws, vertebroplasty augmentation and fenestrated screws. Cement distribution (2 ml PMMA) was analyzed on CT. Vertebral endplates and the rod were oriented at 45° to the horizontal plane. The vertebral body was held by resin in a cylinder, linked to an unconstrained pivot, on which traction (10 N/s) was applied until rupture. Load-displacement curves were compared to simultaneous video recordings., Results: Median pullout forces were 488.5 N (195-500) for non-augmented screws, 643.5 N (270-1050) for vertebroplasty augmentation and 943.5 N (750-1084) for fenestrated screws. Cement augmentation through fenestrated screws led to significantly higher rupture forces compared to non-augmented screws (P=0.0039). The pullout force after vertebroplasty was variable and linked to cement distribution. A cement bolus around the distal screw tip led to pullout forces similar to non-augmented screws. A proximal cement bolus, as it was observed in fenestrated screws, led to higher pullout resistance. This cement distribution led to vertebral body fractures prior to screw pullout., Conclusion: The experimental setup tended to reproduce a pullout mechanism observed on radiographs, combining axial pullout and a bending moment. Cement augmentation with fenestrated screws increased pullout resistance significantly, whereas the fixation strength with the vertebroplasty prefilling method was linked to the cement distribution., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)
- Published
- 2015
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40. Non-redundant association rules between diseases and medications: an automated method for knowledge base construction.
- Author
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Séverac F, Sauleau EA, Meyer N, Lefèvre H, Nisand G, and Jay N
- Subjects
- Humans, Cardiovascular Diseases drug therapy, Data Mining methods, Electronic Health Records, Knowledge Bases, Natural Language Processing
- Abstract
Background: The widespread use of electronic health records (EHRs) has generated massive clinical data storage. Association rules mining is a feasible technique to convert this large amount of data into usable knowledge for clinical decision making, research or billing. We present a data driven method to create a knowledge base linking medications to pathological conditions through their therapeutic indications from elements within the EHRs., Methods: Association rules were created from the data of patients hospitalised between May 2012 and May 2013 in the department of Cardiology at the University Hospital of Strasbourg. Medications were extracted from the medication list, and the pathological conditions were extracted from the discharge summaries using a natural language processing tool. Association rules were generated along with different interestingness measures: chi square, lift, conviction, dependency, novelty and satisfaction. All medication-disease pairs were compared to the Summary of Product Characteristics, which is the gold standard. A score based on the other interestingness measures was created to filter the best rules, and the indices were calculated for the different interestingness measures., Results: After the evaluation against the gold standard, a list of accurate association rules was successfully retrieved. Dependency represents the best recall (0.76). Our score exhibited higher exactness (0.84) and precision (0.27) than all of the others interestingness measures. Further reductions in noise produced by this method must be performed to improve the classification precision., Conclusions: Association rules mining using the unstructured elements of the EHR is a feasible technique to identify clinically accurate associations between medications and pathological conditions.
- Published
- 2015
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41. Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending.
- Author
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Charles YP, Sfeir G, Matter-Parrat V, Sauleau EA, and Steib JP
- Subjects
- Adolescent, Adult, Biomechanical Phenomena, Bone Nails, Bone Screws, Cervical Vertebrae diagnostic imaging, Female, Follow-Up Studies, Humans, Incidence, Kyphosis diagnostic imaging, Kyphosis epidemiology, Lordosis diagnostic imaging, Lordosis epidemiology, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae surgery, Male, Middle Aged, Radiography, Retrospective Studies, Scoliosis diagnostic imaging, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae surgery, Treatment Outcome, Young Adult, Cervical Vertebrae surgery, Kyphosis prevention & control, Lordosis prevention & control, Orthopedic Procedures instrumentation, Orthopedic Procedures methods, Scoliosis surgery
- Abstract
Study Design: Retrospective radiographical analysis of cervical and thoracolumbar sagittal alignment in young adults with idiopathic scoliosis., Objective: To analyze cervical alignment types, the relationship between cervical and thoracolumbar alignment and the effect of posterior instrumentation., Summary of Background Data: Thoracic scoliosis with hypokyphosis may decrease cervical lordosis. Additional adaptive positional changes of the mobile cervical segment may exist, because sigmoid cervical patterns are observed. Sagittal alignment of the instrumented thoracolumbar spine may influence cervical alignment., Methods: Pre- and postoperative full-spine radiographs of 52 patients were analyzed at 8-year average follow-up. Sagittal thoracolumbar measurements were T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA) C7, and SVA C2. Cervical measurements were C0-C2, C2-C6, C2-C4, C4-C6, and C2-T1 lordosis, chin-brow vertical angle., Results: Five cervical alignment types were identified: lordotic, hypolordotic, kyphotic, sigmoid with cranial lordosis, and sigmoid with cranial kyphosis. Spinopelvic parameters and global thoracolumbar balance remained unchanged postoperatively. The average C2-C6 lordosis increased by 6.4° (P < 0.0001). Twenty-seven of the 52 patients changed cervical alignment postoperatively. SVA C2-C7 difference changed in this subgroup (P = 0.0159). In 21 of the 27 patients, SVA changed more than 5 mm at C2 (P = 0.0029), and in 25 of the 27 patients at C7 (P < 0.0001). A correlation existed between T4-T12 kyphosis and L1-S1 lordosis, C2-C4 and L1-S1 lordosis, L1-S1 lordosis, and pelvic tilt. T1-T4 kyphosis and T1 slope correlated with C2-T1 lordosis, but proximal junctional kyphosis was not linked to a specific cervical alignment type., Conclusion: Postoperative adaptive changes occurred at C7 and C2 by shifting anteriorly or posteriorly, resulting in different radiographical cervical shapes. The amount of lumbar lordosis may influence cervical lordosis, which needs to be considered for surgical correction. Adaptive hip movements may influence thoracolumbar and cervical alignment. The amount of proximal thoracic kyphosis influenced cervical lordosis. Global thoracic hypokyphosis might influence cervical alignment, but it was not evidenced., Level of Evidence: 4.
- Published
- 2015
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42. The effect of posterior non-fusion instrumentation on segmental shear loading of the lumbar spine.
- Author
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Charles YP, Persohn S, Rouch P, Steib JP, Sauleau EA, and Skalli W
- Subjects
- Aged, Aged, 80 and over, Cadaver, Female, Humans, Laminectomy, Lumbar Vertebrae surgery, Male, Materials Testing, Middle Aged, Spondylolisthesis surgery, Zygapophyseal Joint surgery, Lumbar Vertebrae physiopathology, Prostheses and Implants, Spondylolisthesis physiopathology, Weight-Bearing physiology
- Abstract
Background: Lumbar stenosis and facet osteoarthritis represent indications for decompression and instrumentation. It is unclear if degenerative spondylolisthesis grade I with a remaining disc height could be an indication for non-fusion instrumentation. The purpose of this study was to determine the influence of a mobile pedicle screw based device on lumbar segmental shear loading, thus simulating the condition of spondylolisthesis., Materials and Methods: Six human cadaver specimens were tested in 3 configurations: intact L4-L5 segment, then facetectomy plus undercutting laminectomy, then instrumentation with lesion. A static axial compression of 400 N was applied to the lumbar segment and anterior displacements of L4 on L5 were measured for posterior-anterior shear forces from 0 to 200 N. The slope of the loading curve was assessed to determine shear stiffness., Results: Homogenous load-displacement curves were obtained for all specimens. The average intact anterior displacement was 1.2 mm. After lesion, the displacement increased by 0.6mm compared to intact (P=0.032). The instrumentation decreased the displacement by 0.5 mm compared to lesion (P=0.046). The stiffness's were: 162 N/mm for intact, 106 N/mm for lesion, 148 N/mm for instrumentation. The difference was not significant between instrumented and intact segments (P=0.591)., Conclusions: Facetectomy plus undercutting laminectomy decreases segmental shear stiffness and increases anterior translational L4-L5 displacement. Shear stiffness of the instrumented segment is higher with the device and anterior displacements under shear loading are similar to the intact spine. This condition could theoretically be interesting for the simulation of non-fusion instrumentation in degenerative spondylolisthesis., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)
- Published
- 2014
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43. Age and stage at diagnosis: a hospital series of 11 women with intellectual disability and breast carcinoma.
- Author
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Satgé D, Sauleau EA, Jacot W, Raffi F, Azéma B, Bouyat JC, and El Hage Assaf N
- Subjects
- Adult, Age Factors, Aged, Breast Neoplasms diagnosis, Case-Control Studies, Delayed Diagnosis, Female, Humans, Intellectual Disability diagnosis, Middle Aged, Neoplasm Grading, Neoplasm Metastasis, Neoplasm Staging, Odds Ratio, Tumor Burden, Breast Neoplasms complications, Breast Neoplasms pathology, Intellectual Disability complications
- Abstract
Background: Breast cancer has been poorly studied in women with intellectual disability (ID), which makes designing a policy for screening the nearly 70 million women with ID in the world difficult. As no data is available in the literature, we evaluated breast cancer at diagnosis in women with ID., Methods: Women with ID were searched retrospectively among all women treated for invasive breast cancer in a single hospital over 18 years. Age at diagnosis was compared among the whole group of women. Tumor size, lymph node involvement, SBR grade, TNM classification, and AJCC stage were compared to controls matched for age and period of diagnosis using conditional logistic regression., Results: Among 484 women with invasive breast cancer, 11 had ID. The mean age at diagnosis was 55.6 years in women with ID and 62.4 years in the other women. The mean tumor size in women with ID was 3.53 cm, compared to 1.80 cm in 44 random controls from among the 473 women without ID. Lymph node involvement was observed in 9 of the 11 women with ID compared to 12 of the controls (OR = 11.53, p = 0.002), and metastases were found in 3 of the 11 women with ID compared to 1 of the 44 controls (OR = 12.00, p = 0.031). The AJCC stage was higher in women with ID compared to controls (OR = 3.19, p = 0.010)., Conclusions: Women with ID presented at an earlier age with tumors of a higher AJCC stage than controls despite no significant differences in tumor grade and histological type. Thus, delayed diagnosis may be responsible for the differences between disabled and non-disabled women.
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- 2014
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44. The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy: a population-based cohort study.
- Author
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Denis B, Sauleau EA, Gendre I, Exbrayat C, Piette C, Dancourt V, Foll Y, Ait Hadad H, Bailly L, and Perrin P
- Subjects
- Adenoma pathology, Aged, Benchmarking, Carcinoma pathology, Carcinoma in Situ pathology, Cohort Studies, Colonic Polyps pathology, Colorectal Neoplasms pathology, Female, France, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Quality Improvement, Retrospective Studies, Adenoma diagnosis, Carcinoma diagnosis, Carcinoma in Situ diagnosis, Colonic Polyps diagnosis, Colonoscopy standards, Colorectal Neoplasms diagnosis, Early Detection of Cancer standards, Occult Blood
- Abstract
Background: Measuring adenoma detection is a priority in the quality improvement process for colonoscopy. Our aim was (1) to determine the most appropriate quality indicators to assess the neoplasia yield of colonoscopy and (2) to establish benchmark rates for the French colorectal cancer screening programme., Methods: Retrospective study of all colonoscopies performed in average-risk asymptomatic people aged 50-74 years after a positive guaiac faecal occult blood test in eight administrative areas of the French population-based programme., Results: We analysed 42,817 colonoscopies performed by 316 gastroenterologists. Endoscopists who had an adenoma detection rate around the benchmark of 35% had a mean number of adenomas per colonoscopy varying between 0.36 and 0.98. 13.9% of endoscopists had a mean number of adenomas above the benchmark of 0.6 and an adenoma detection rate below the benchmark of 35%, or inversely. Correlation was excellent between mean numbers of adenomas and polyps per colonoscopy (Pearson coefficient r=0.90, p<0.0001), better than correlation between mean number of adenomas and adenoma detection rate (r=0.84, p=0.01)., Conclusion: The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy. Benchmark could be established at 0.6 in the French programme., (Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
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- 2014
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45. How to interpret and choose a Bayesian spatial model and a Poisson regression model in the context of describing small area cancer risks variations.
- Author
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Colonna M and Sauleau EA
- Subjects
- Bayes Theorem, Data Interpretation, Statistical, Female, France, Humans, Male, Poisson Distribution, Registries statistics & numerical data, Regression Analysis, Risk Factors, Neoplasms epidemiology, Small-Area Analysis
- Abstract
Background: The statistical Bayesian approach is widely used in disease mapping and Poisson regression. Results differ depending on the underlying hypothesis. Our objective is to give a comprehensive presentation of the tools that can be used to interpret results and choose between the different hypotheses. Data from the Isere cancer registry (France) illustrate this presentation., Method: We consider, first, Bayesian models for disease mapping. Classic heterogeneity (Potthoff-Whithinghill statistic) and spatial autocorrelation tests (Moran statistic) of the SIRs, the DIC criteria of the different Bayesian models and finally the comparison of the empirical variance of the unstructured and structured heterogeneity components of the BYM model are considered. The last two criteria are considered for Bayesian Poisson regression including a covariate. Mapping the components of the BYM model with a covariate is also considered., Results: Four cancer sites (prostate, lung, colon-rectum and bladder) in men diagnosed during the 1998-2007 period are used to illustrate our presentation. We show that the different criteria used to interpret and to choose a model give coherent results., Conclusion: A relevant interpretation of results is a necessary step in choosing the best-adapted Bayesian model. This choice is easy to make with criteria such as the DIC. The comparison of the empirical variance of the unstructured and structured heterogeneity components of the BYM model is also informative., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)
- Published
- 2013
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46. Harms of colonoscopy in a colorectal cancer screening programme with faecal occult blood test: a population-based cohort study.
- Author
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Denis B, Gendre I, Sauleau EA, Lacroute J, and Perrin P
- Subjects
- Aged, Cohort Studies, Colon, Colonoscopy statistics & numerical data, Colorectal Neoplasms prevention & control, Female, France, Hemorrhage etiology, Humans, Intestinal Perforation etiology, Male, Middle Aged, Prospective Studies, Randomized Controlled Trials as Topic, Retrospective Studies, Surveys and Questionnaires, Colonoscopy adverse effects, Colorectal Neoplasms diagnosis, Mass Screening statistics & numerical data, Occult Blood
- Abstract
Background and Aims: To assess the harms of colonoscopy in a real world colorectal cancer screening programme with faecal occult blood test., Methods: Retrospective cohort study of all colonoscopies performed in patients aged 50-74 for a positive guaiac-based faecal occult blood test between September 2003 and February 2010 within the screening programme in progress in Alsace (France). Adverse events were recorded through prospective voluntary reporting by gastroenterologists and retrospective postal surveys addressed to persons screened and their general practitioners., Results: Of 10,277 colonoscopies, 250 adverse events were recorded, 48 (4.7 ‰, 95% CI 3.4-6.0) of them being moderate or severe, mainly 10 (1.0 ‰, 95% CI 0.4-1.6) perforations and 31 (3.0 ‰, 95% CI 2.0-4.1) bleeding. 91.7% of moderate and severe adverse events were the result of a therapeutic procedure. Of 103 serious adverse events, eight (7.8%) were considered preventable. Gastroenterologists reported 52.2% of moderate and severe adverse events. A mild adverse event or an incident was reported in up to 97.0 ‰ (95% CI 83.2-110.7) colonoscopies., Conclusion: The harms of colonoscopy were underestimated in all randomized controlled trials on colorectal cancer screening with faecal occult blood test. They are greater in a real world programme, estimated at 7.5 major and 100 minor adverse events per 1000 colonoscopies., (Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2013
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47. Cancer incidence and survival in adolescents and young adults in France, 2000-2008.
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Desandes E, Lacour B, Belot A, Molinie F, Delafosse P, Tretarre B, Velten M, Sauleau EA, Woronoff AS, Guizard AV, Ganry O, Bara S, Grosclaude P, Troussard X, Bouvier V, Brugieres L, and Clavel J
- Subjects
- Adolescent, Adult, Female, France epidemiology, Humans, Incidence, Male, Neoplasms mortality, Time Factors, Young Adult, Neoplasms epidemiology
- Abstract
This study aimed to describe cancer incidence (2000-2008) and survival (2000-2004) in France in adolescents and young adults (AYA). All cases of cancer diagnosed in 15-24 years, recorded by all French population-based registries (14% of the French population), over the 2000-2008 period, were included. Incidence change over time was described with the conventional annual percentage change (cAPC). The survival of cases diagnosed (2000-2004) was estimated using Kaplan-Meier method. A total of 1022 in adolescents and 1396 in young adults were diagnosed. Overall incidence rates were 219.4/10(6) in 15-19 year olds and 293.1/10(6) in 20-24 year olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors and Hodgkin's disease, and were melanoma, thyroid carcinoma, and Hodgkin's disease in females. The age-standardized rates appeared stable over time in AYA, with a cAPC of +2.0% (P = 0.68). The 5-year overall survival for all cancers was different between genders and age groups, with 78.8% (95%CI: 75.6-82.0) for males and 85.2% (95%CI: 82.2-88.1) for females (P = 0.01), and 78.5% (95%CI: 75.0-82.1) in 15-19 year olds and 84.3% (95% CI: 81.6-87.0) in 20-24 year olds (P = 0.02). Noteworthy, the frequency and the distribution of tumor types in AYA are unique and different from the observed at any other age group. Survival in French AYA has improved over time. Epidemiological data might reflect major trends in the risk factors and preventive interventions. Thus, further research into etiology of cancers affecting AYA should become key priorities for cancer control among AYA.
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- 2013
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48. Obstetric and neonatal outcomes in a home-like birth centre: a case-control study.
- Author
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Gaudineau A, Sauleau EA, Nisand I, and Langer B
- Subjects
- Adult, Apgar Score, Bayes Theorem, Case-Control Studies, Delivery, Obstetric statistics & numerical data, Female, France, Humans, Infant, Newborn, Infant, Newborn, Diseases epidemiology, Infant, Newborn, Diseases etiology, Linear Models, Logistic Models, Multivariate Analysis, Natural Childbirth statistics & numerical data, Obstetric Labor Complications epidemiology, Obstetric Labor Complications etiology, Patient Transfer statistics & numerical data, Pregnancy, Retrospective Studies, Delivery Rooms organization & administration, Infant, Newborn, Diseases prevention & control, Natural Childbirth methods, Obstetric Labor Complications prevention & control
- Abstract
Purpose: To compare the intervention rates associated with labor in low-risk women who began their labor in the "home-like birth centre" (HLBC) and the traditional labor ward (TLW)., Methods: This retrospective study used data that were collected from January 2005 to June 2008, from women admitted to the HLBC (n = 316) and compared to a group of randomly selected low-risk women admitted to the TLW (n = 890) using the Baysian information criterion to select the best predictive model., Results: Women in the HLBC had spontaneous vaginal deliveries more often (88.6 vs. 82.8 %, p value 0.034) and perineal lesions less often (60.1 vs. 62.5 %, p value 0.013). The frequency of adverse neonatal outcomes did not differ statistically between the two groups, although the mean clamped at birth umbilical arterial pH level was higher in the HLBC group. The transfer rate from HLBC to TLW was 31.3 % of which 75.8 % were nulliparae., Conclusions: It appears that women could benefit from HLBC care in settings such as the one studied. Larger observational studies are warranted to validate these results.
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- 2013
- Full Text
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49. Resources allocation in healthcare for cancer: a case study using generalised additive mixed models.
- Author
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Musio M, Sauleau EA, and Augustin NH
- Subjects
- Adult, Age Distribution, Aged, Aging, Female, France epidemiology, Health Care Rationing standards, Health Priorities standards, Health Services for the Aged standards, Humans, Incidence, Male, Middle Aged, Neoplasms epidemiology, Poisson Distribution, Population Dynamics trends, Registries, Resource Allocation methods, Resource Allocation standards, Space-Time Clustering, Young Adult, Health Care Rationing economics, Health Priorities economics, Health Services for the Aged economics, Neoplasms economics
- Abstract
Our aim is to develop a method for helping resources re-allocation in healthcare linked to cancer, in order to replan the allocation of providers. Ageing of the population has a considerable impact on the use of health resources because aged people require more specialised medical care due notably to cancer. We propose a method useful to monitor changes of cancer incidence in space and time taking into account two age categories, according to healthcar general organisation. We use generalised additive mixed models with a Poisson response, according to the methodology presented in Wood, Generalised additive models: an introduction with R. Chapman and Hall/CRC, 2006. Besides one-dimensional smooth functions accounting for non-linear effects of covariates, the space-time interaction can be modelled using scale invariant smoothers. Incidence data collected by a general cancer registry between 1992 and 2007 in a specific area of France is studied. Our best model exhibits a strong increase of the incidence of cancer along time and an obvious spatial pattern for people more than 70 years with a higher incidence in the central band of the region. This is a strong argument for re-allocating resources for old people cancer care in this sub-region.
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- 2012
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50. Sagittal balance correction of idiopathic scoliosis using the in situ contouring technique.
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Charles YP, Bouchaïb J, Walter A, Schuller S, Sauleau EA, and Steib JP
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- Adult, Female, Follow-Up Studies, Humans, Male, Surgery, Computer-Assisted, Young Adult, Radiographic Image Interpretation, Computer-Assisted methods, Scoliosis diagnostic imaging, Scoliosis surgery
- Abstract
Purpose: Idiopathic scoliosis can lead to sagittal imbalance. The relationship between thoracic hyper- and hypo-kyphotic segments, vertebral rotation and coronal curve was determined. The effect of segmental sagittal correction by in situ contouring was analyzed., Methods: Pre- and post-operative radiographs of 54 scoliosis patients (Lenke 1 and 3) were analyzed at 8 years follow-up. Cobb angles and vertebral rotation were determined. Sagittal measurements were: kyphosis T4-T12, T4-T8 and T9-T12, lordosis L1-S1, T12-L2 and L3-S1, pelvic incidence, pelvic tilt, sacral slope, T1 and T9 tilt., Results: Thoracic and lumbar curves were significantly reduced (p = 0.0001). Spino-pelvic parameters, T1 and T9 tilt were not modified. The global T4-T12 kyphosis decreased by 2.1° on average (p = 0.066). Segmental analysis evidenced a significant decrease of T4-T8 hyperkyphosis by 6.6° (p = 0.0001) and an increase of segmental hypokyphosis T9-T12 by 5.0° (p = 0.0001). Maximal vertebral rotation was located at T7, T8 or T9 and correlated (r = 0.422) with the cranial level of the hypokyphotic zone (p = 0.003). This vertebra or its adjacent levels corresponded to the coronal apex in 79.6 % of thoracic curves., Conclusions: Lenke 1 and 3 curves can show normal global kyphosis, divided in cranial hyperkyphosis and caudal hypokyphosis. The cranial end of hypokyphosis corresponds to maximal rotation. These vertebrae have most migrated anteriorly and laterally. The sagittal apex between segmental hypo- and hyper-kyphosis corresponds to the coronal thoracic apex. A segmental sagittal imbalance correction is achieved by in situ contouring. The concept of segmental imbalance is useful when determining the levels on which surgical detorsion may be focused.
- Published
- 2012
- Full Text
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