Author: "CIC - Poitiers" - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"CIC - Poitiers"' showing total 328 results

Start Over Author "CIC - Poitiers"

328 results on '"CIC - Poitiers"'

101. Personality dimensions are associated with quality of life in fluctuating Parkinson's disease patients (PSYCHO-STIM)

Author: Elodie Hainque, Solène Ansquer, Tiphaine Rouaud, Vanessa Rousseau, Olivier Rascol, Teodor Danaila, Fabienne Ory-Magne, Marie Bonnet, Mylène Meyer, Christophe Arbus, Christine Brefel-Courbon, Claire Marsé, Mélissa Tir, David Devos, Mathilde Boussac, Caroline Moreau, Estelle Harroch, Lhaouas Belamri, Christine Tranchant, Béchir Jarraya, Jean-François Houvenaghel, David Maltête, A. Marques, Julia Dupouy, Alexandre Eusebio, Toulouse Neuro Imaging Center (ToNIC), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre d'investigation clinique de Toulouse (CIC 1436), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Pôle Santé publique et médecine publique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Différenciation et communication neuronale et neuroendocrine (DC2N), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinique neurologique, Hôpital Laennec, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pontchaillou [Rennes], Comportement et noyaux gris centraux = Behavior and Basal Ganglia [Rennes], Université de Rennes (UR)-Université européenne de Bretagne - European University of Brittany (UEB)-CHU Pontchaillou [Rennes]-Institut des Neurosciences Cliniques de Rennes = Institute of Clinical Neurosciences of Rennes (INCR), Centre Hospitalier Universitaire de Nice (CHU Nice), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Strasbourg, Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Neuroimagerie cognitive - Psychologie cognitive expérimentale (UNICOG-U992), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux (NPsy-Sydo), CHU Clermont-Ferrand-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Université Clermont Auvergne (UCA), Hospices Civils de Lyon (HCL), Institut de Neurosciences de la Timone (INT), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), CHU Casselardit - Junod, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], CHU Toulouse [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université européenne de Bretagne - European University of Brittany (UEB)-CHU Pontchaillou [Rennes]-Institut des Neurosciences Cliniques de Rennes (INCR), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris Saclay (COmUE)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)
Subjects: 0301 basic medicine, Male, Character, Parkinson's disease, media_common.quotation_subject, Deep Brain Stimulation, [SDV]Life Sciences [q-bio], Disease, Cohort Studies, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Quality of life, Subthalamic Nucleus, medicine, Personality, Humans, 10. No inequality, media_common, business.industry, Parkinson Disease, temperament, Middle Aged, medicine.disease, humanities, 030104 developmental biology, quality of life, personality, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Parkinson’s disease, Harm avoidance, Temperament and Character Inventory, Temperament, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Cohort study, Clinical psychology
Abstract: International audience; Background:Parkinson’s disease (PD) negatively affects patients’ Quality of Life (QoL) which depends on both objective criteria such as physical health and subjective ones such as worries and norms according to personal believes. Therefore, QoL could be also associated to personality dimensions in chronic neurological diseases such as PD. Objective:Our objective was thus to study the potential association between personality dimensions and QoL in PD patients with motor fluctuations before Deep Brain Stimulation of the Sub-Thalamic Nucleus (DBS-STN). Methods:Data were obtained from the French multicentric cohort study Predi-Stim. All PD patients awaiting DBS-STN and responding to the inclusion criteria at the time of the study were included. All participants answered the “Temperament and Character Inventory” (TCI) and the PDQ-39 before surgery. Analyses were made using adjusted univariate generalized linear regression models to evaluate a potential association between TCI dimensions and PDQ-39 scores. Results:Three hundred thirty-three consecutive patients were included. The temperament Harm Avoidance was negatively associated with QoL (p = 1e-4, R2= 0.33), whereas the character Self-Directedness was positively associated with mental component of QoL (p = 2e-4, R2= 0.33) in PD patients with motor fluctuations awaiting DBS-STN. Conclusions:PD patients with motor fluctuations, with lower Harm Avoidance and higher Self-Directedness scores have the best QoL mainly at an emotional and social level. Therapeutic education of these PD patients focusing on their personal resources may thus be important to improve their well-being.
Published: 2020

102. COVID-19 impact assessment on the French radiological centers: a nationwide survey

Author: Isabelle Fitton, Olivier Boumendil, Jean Pierre Tasu, Jean-Yves Gaubert, Jules Gregory, Jean-Paul Beregi, Rémy Guillevin, Nicolas Sans, Madeleine Cavet, Violaine Flory, Kathia Chaumoitre, Mathieu Naudin, Mathilde Wagner, Cornelia Anna Freitag, Lucie Cassagnes, Pierre-Jean Saulnier, Philippe Feuerstein, G. Herpe, Mathieu Lederlin, Hubert Nivet, Isabelle Petit, Jean-Michel Bartoli, Farida Enikeeva, Mickaël Ohana, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Mathématiques et Applications (LMA-Poitiers), Université de Poitiers-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Département de Radiologie [Rennes], Université de Rennes (UR), CHU Clermont-Ferrand, Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Pasteur [Nice] (CHU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Département de Radiologie adultes [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Lorraine (UL), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Hôpital Purpan [Toulouse], and CHU Toulouse [Toulouse]
Subjects: Adult, Male, medicine.medical_specialty, Cross-sectional study, [SDV]Life Sciences [q-bio], Pneumonia, Viral, Context (language use), 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Computed Tomography, Epidemiology, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Prospective cohort study, Pandemics, Tomography, ComputingMilieux_MISCELLANEOUS, Neuroradiology, medicine.diagnostic_test, business.industry, SARS-CoV-2, COVID-19, Interventional radiology, General Medicine, Middle Aged, Triage, 3. Good health, Prospective, Cross-Sectional Studies, Radiology Nuclear Medicine and imaging, 030220 oncology & carcinogenesis, Radiological weapon, X-Ray computed, Female, Radiology, France, business, Coronavirus Infections, Tomography, X-Ray Computed, Surveys and questionnaires
Abstract: To determine the impact of the COVID-19 on the CT activities in French radiological centers during the epidemic peak. A cross-sectional prospective CT scan survey was conducted between March 16 and April 12, 2020, in accordance with the local IRB. Seven hundred nine radiology centers were invited to participate in a weekly online survey. Numbers of CT examinations related to COVID-19 including at least chest (CTcovid) and whole chest CT scan activities (CTchest) were recorded each week. A sub-analysis on French departments was performed during the 4 weeks of the study. The impact of the number of RT-PCRs (reverse transcriptase polymerase chain reactions) on the CT workflow was tested using two-sample t test and Pearson’s test. Five hundred seventy-seven structures finally registered (78%) with mean response numbers of 336 ± 18.9 (323; 351). Mean CTchest activity per radiologic structure ranged from 75.8 ± 133 (0–1444) on week 12 to 99.3 ± 138.6 (0–1147) on week 13. Mean ratio of CTcovid on CTchest varied from 0.36 to 0.59 on week 12 and week 14 respectively. There was a significant relationship between the number of RT-PCR performed and the number of CTcovid (r = 0.73, p = 3.10−16) but no link with the number of positive RT-PCR results. In case of local high density COVID-19, CT workflow is strongly modified and redirected to the management of these specific patients. • Over the 4-week survey period, 117,686 chest CT (CT total ) were performed among the responding centers, including 61,784 (52%) CT performed for COVID-19 (CT covid ). • Across the country, the ratio CT covid /CT total varied from 0.36 to 0.59 and depended significantly on the local epidemic density (p = 0.003). • In clinical practice, in a context of growing epidemic, in France, chest CT was used as a surrogate to RT-PCR for patient triage.
Published: 2020

103. Safety of immune checkpoint inhibitor rechallenge after discontinuation for grade ≥2 immune-related adverse events in patients with cancer

Author: Marion Allouchery, Ghada Miremont-Salamé, Franck Rouby, Mathieu Puyade, Celia Bertin, Thomas Lombard, Marion Sassier, Mickael Martin, Marie-Christine Perault-Pochat, Marina Atzenhoffer, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre régional de pharmacovigilance de Marseille Provence Corse [CHU de Marseille] (CRPV-Marseille), Assistance Publique - Hôpitaux de Marseille (APHM)-CHU Marseille, Centre régional de pharmacovigilance de Caen Basse-Normandie (CRPV), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Henri Mondor, Hospices Civils de Lyon (HCL), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], Laboratoire de neurosciences expérimentales et cliniques (LNEC), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Otten, Lisa
Subjects: Male, Cancer Research, medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, medicine.medical_treatment, Immunology, 03 medical and health sciences, 0302 clinical medicine, Immune system, Internal medicine, Neoplasms, Pharmacovigilance, medicine, Immunology and Allergy, Humans, 030212 general & internal medicine, Adverse effect, Prospective cohort study, Immune Checkpoint Inhibitors, RC254-282, Aged, Pharmacology, business.industry, Melanoma, [SCCO.NEUR]Cognitive science/Neuroscience, autoimmunity, [SCCO.NEUR] Cognitive science/Neuroscience, Cancer, Correction, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Immunotherapy, Middle Aged, medicine.disease, Discontinuation, Oncology, 030220 oncology & carcinogenesis, Molecular Medicine, Female, immunotherapy, business, hormones, hormone substitutes, and hormone antagonists
Abstract: BackgroundSafety of rechallenge of immune checkpoint inhibitor (ICI) after grade ≥2 immune-related adverse events (irAEs) leading to ICI discontinuation remains unclear.MethodsAll adverse drug reactions involving at least one ICI reported up to December 31, 2019 were extracted from the French pharmacovigilance database. Patients were included if they experienced at least one grade ≥2 irAE resulting in ICI discontinuation, with subsequent ICI rechallenge. The primary outcome was the recurrence of at least one grade ≥2 irAE in these patients after ICI rechallenge.ResultsWe included 180 patients: 61.1% were men (median age of 66 years), 43.9% had melanoma and 78.9% were receiving anti-programmed cell death 1. First ICI discontinuation was related to 191 irAEs. After ICI rechallenge, 38.9% of the patients experienced at least one grade ≥2 irAE. Among them, 70.0% experienced the same irAE, 25.7% a distinct irAE, and 4.3% both the same and a distinct irAE. Lower recurrence rates of irAEs were associated with rechallenge with the same ICI treatment (p=0.02) or first endocrine irAEs (p=0.003). Gastrointestinal irAEs were more likely to recur (p=0.007). The median duration from ICI discontinuation to rechallenge and the severity of the initial irAE did not predict recurrent irAEs after ICI rechallenge (p=0.53 and p=0.40, respectively).ConclusionsIn this study, 61.1% of the patients who discontinued ICI treatment for grade ≥2 irAEs experienced no recurrent grade ≥2 irAEs after ICI rechallenge. Although ICI rechallenge appears to be safe under close monitoring, it should always be discussed balancing usefulness of rechallenge, patient comorbidities and risk of recurrence of first irAE(s). Due to inherent bias associated with pharmacovigilance studies, further prospective studies are needed to assess risk factors that may influence patient outcomes after ICI rechallenge.
Published: 2020

104. Analysis of a cohort of 279 patients with hairy-cell leukemia (HCL): 10 years of follow-up

Author: Xavier Troussard, Agnès Olivrie, Gandhi Damaj, Stephanie Noel, Jean-Claude Eisenmann, Olivier Hermine, Jérémie Riou, Sandrine Vaudaux, Patricia Validire-Charpy, Jean Gutnecht, Alain Devidas, Charlotte Petitdidier-Lionnet, Mohamed Touati, Stephanie Haiat, Vincent Levy, Fabienne Huysman, Eric Lippert, Aline Tanguy-Schmidt, Jehan Dupuis, Olivier Lambotte, Clara Mariette, Marouane Boubaya, Edouard Cornet, Pierre Feugier, Mathilde Hunault-Berger, Bertrand Joly, Stéphane Leprêtre, Jérôme Paillassa, Cécile Tomowiak, Kamel Ghomari, Willy Vaillant, Catherine Thieblemont, Mario Ojeda Uribe, Didier Decaudin, Bernard Drenou, Jean-Michel Karsenti, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques (GPMCND), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Henri Mondor, Centre Hospitalier Sud Francilien [Corbeil-Essonnes] (CH Sud Francilien), Centre Hospitalier Universitaire [Grenoble] (CHU), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Curie [Paris], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), CHU Limoges, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), CHU Necker - Enfants Malades [AP-HP], Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier d'Auch (CH Auch), Centre Hospitalier Intercommunal Fréjus - St Raphaël (CHI Fréjus - St Raphaël), CHRU Brest - Service d'Hématologie (CHU-Brest-Hemato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CH Beauvais, Hôpital Avicenne [AP-HP], Micro et Nanomédecines Translationnelles (MINT), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Innate Immunity and Immunotherapy (CRCINA-ÉQUIPE 7), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Fédération Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), and Bernardo, Elizabeth
Subjects: Adult, Male, medicine.medical_specialty, Disease-free survival, medicine.medical_treatment, Antineoplastic Agents, [SDV.CAN]Life Sciences [q-bio]/Cancer, lcsh:RC254-282, Gastroenterology, Article, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Humans, Chemotherapy, Hairy cell leukemia, Risk factor, Adverse effect, Cladribine, Aged, Aged, 80 and over, Hairy cell leukaemia, Leukemia, Hairy Cell, Adverse effects, business.industry, Incidence (epidemiology), Hematology, Middle Aged, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, 3. Good health, Leukemia, Treatment Outcome, Risk factors, Oncology, 030220 oncology & carcinogenesis, Cohort, Female, business, Pentostatin, Follow-Up Studies, 030215 immunology, medicine.drug
Abstract: In total, 279 patients with hairy-cell leukemia (HCL) were analyzed, with a median follow-up of 10 years. Data were collected up to June 2018. We analyzed responses to treatment, relapses, survival, and the occurrence of second malignancies during follow-up. The median age was 59 years. In total, 208 patients (75%) were treated with purine analogs (PNAs), either cladribine (159) or pentosatin (49), as the first-line therapy. After a median follow-up of 127 months, the median overall survival was 27 years, and the median relapse-free survival (RFS) was 11 years. The cumulative 10-year relapse incidence was 39%. In patients receiving second-line therapy, the median RFS was 7 years. For the second-line therapy, using the same or another PNA was equivalent. We identified 68 second malignancies in 59 patients: 49 solid cancers and 19 hematological malignancies. The 10-year cumulative incidences of cancers, solid tumors, and hematological malignancies were 15%, 11%, and 5.0%, respectively, and the standardized incidence ratios were 2.22, 1.81, and 6.67, respectively. In multivariate analysis, PNA was not a risk factor for second malignancies. HCL patients have a good long-term prognosis. PNAs are the first-line treatment. HCL patients require long-term follow-up because of their relatively increased risk of second malignancies.
Published: 2020

105. Cancer Among Adolescents and Young Adults Between 2000 and 2016 in France: Incidence and Improved Survival

Author: Laetitia Daubisse-Marliac, Brigitte Lacour, Tania d'Almeida, Karima Hammas, Olivier Ganry, Alain Monnereau, Emmanuel Desandes, Nicolas Boissel, Brigitte Trétarre, Isabelle Baldi, Anne-Valérie Guizard, Anne Cowppli-Bony, Patricia Delafosse, Thomas Raze, Jacqueline Clavel, G. Coureau, Michel Velten, Sandrine Plouvier, Gautier Defossez, Xavier Troussard, Simona Bara, Véronique Bouvier, Anne-Sophie Woronoff, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Registre National des Tumeurs Solides de l'Enfant (RNTSE), Equipe 7 : EPICEA - Epidémiologie des cancers de l'enfant et de l'adolescent (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Registre National des Cancers de l'Enfant - National Registry of Childhood Cancers [Villejuif & CHU Nancy] (RNCE), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), French network of cancer registries [Toulouse] (Francim), Registre des cancers de Loire‐Atlantique et Vendée, Imaging and Longitudinal Investigations to Ameliorate Decision-making [Nantes] (ILIAD), Site de Recherche Intégrée sur le Cancer [Nantes] (SIRIC), Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre hospitalier universitaire de Nantes (CHU Nantes), FRANCIM, Réseau des registres français du cancer, Registre des cancers de l’Isère [CHU de Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU)-Université Grenoble Alpes (UGA), CRLCC Paul Strauss, Registre des Tumeurs de l'Hérault, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Registre des tumeurs du Doubs et du Territoire de Belfort [CHRU Besançon], Pôle cancérologie (CHRU Besançon), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CHU Amiens-Picardie, CHirurgie, IMagerie et REgénération tissulaire de l’extrémité céphalique - Caractérisation morphologique et fonctionnelle - UR UPJV 7516 (CHIMERE), Université de Picardie Jules Verne (UPJV), Registre général des cancers de Lille et de sa région (GCS-C2RC), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Hôpital Albert Calmette [Lille], Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Registre Général des Tumeurs du Calvados, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-UNICANCER, Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers (ANTICIPE), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)-Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM), Registre des cancers de la Manche [CHPC - Site Louis Pasteur], Site Louis Pasteur [CHPC], CH Centre Hospitalier Public du Cotentin (CHPC)-CH Centre Hospitalier Public du Cotentin (CHPC), A&O (Apprentissage et Optimisation) (A&O), Laboratoire Interdisciplinaire des Sciences du Numérique (LISN), Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS)-Science des Données (SDD), Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS)-Algorithmes, Apprentissage et Calcul (AAC), Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Université Sorbonne Paris Nord, Cancer environnement (EPICENE ), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Registre National des Hémopathies malignes de l'Enfant (RNHE), and Institut de Veille Sanitaire (INVS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Pediatrics, medicine.medical_specialty, Survival, Adolescent, Lymphoma, [SDV]Life Sciences [q-bio], Population, Improved survival, Adolescents, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Neoplasms, Medicine, Humans, 030212 general & internal medicine, Registries, Young adult, education, Melanoma, Cancer, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Cancer survival, Neoplasms, Germ Cell and Embryonal, medicine.disease, humanities, Young Adults, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Female, France, Trends, business
Abstract: International audience; Purpose: This study was undertaken to determine cancer survival and describe the spectrum of cancers diagnosed among French adolescent and young adult (AYA) population.Methods: All cases of cancer diagnosed in 15-24 years, recorded by all French population-based registries (18% of the French population), over the 2000-2016 period, were included. Age-standardized incidences rates (ASR), conventional annual percentage change (cAPC) of incidence over time, and 5-year overall survival (5yOS) were calculated.Results: We analyzed 2,734 cancer diagnoses in adolescents and 4,199 in young adults. Overall incidence rates were 231.9/106 in 15-19 year olds and 354.0/106 in 20-24 year olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors (GCT), Hodgkin lymphoma (HL), and malignant melanoma, and were HL, thyroid carcinoma, and malignant melanoma in females. Cancer incidence was stable over time with a cAPC of 0.8% (p=0.72). For all cancers combined, 5yOS was 86.6% (95%CI: 85.8-87.4), greater than 85% for HL, non-Hodgkin lymphomas (NHL), GCT, thyroid carcinomas, and malignant melanomas, and around 60% and lower for osteosarcomas, Ewing tumors, hepatic carcinomas, and rhabdomyosarcomas. The 5yOS has significantly improved from 2000-2007 to 2008-2015 for all cancers pooled, with a substantial gain of 4% for 15-19 year-olds, and 3% for 20-24 year-olds.Conclusion: Notwithstanding the encouraging results for some cancers, and overall, persistent poorer survivals in AYA were shown compared to children for acute lymphoblastic leukemia, osteosarcoma, Ewing tumor, rhabdomyosarcoma and malignant hepatic tumors. These disparities require further investigation to identify and address the causes of these inferior outcomes.
Published: 2020

106. Comparison of a new versus standard removable offloading device in patients with neuropathic diabetic foot ulcers: a French national, multicentre, open-label randomized, controlled trial

Author: Maud François, L Bordier, Teresa Crea Avila, Abdelkader Chibani, Louis Potier, Laurence Baillet-Blanco, Narimène Belhatem, Roxane Ducloux, Manuel Dolz, Dured Dardari, Vincent Rigalleau, Ronan Roussel, Estelle Nobecourt-Dupuy, Dominique Malgrange, Ariane Sultan, Dominique-François Eveno, Jean-Claude Dupré, Quentin Pellenc, Marilyne Feron, Michel Marre, Pierre-Jean Saulnier, Gilberto Velho, Elise Gand, Kamel Mohammedi, Service d'endocrinologie, diabétologie et nutrition [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Centre Hospitalier Universitaire de la Réunion, Saint Denis de la Réunion, Hôpital d'Instruction des Armées Begin, Service de Santé des Armées, Hôpital Corentin Celton [Issy-les-Moulineaux], Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Gonesse, Centre Hospitalier La Tourmaline, La Tourmaline, Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Service d'Endocrinologie (BORDEAUX - Endocrino), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre de Recherche des Cordeliers, Paris, Service d'Endocrinologie - Diabète - Nutrition [Reims], Université de Reims Champagne-Ardenne (URCA)-Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), and MORNET, Dominique
Subjects: Adult, Male, medicine.medical_specialty, randomized clinical trials, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, [SDV]Life Sciences [q-bio], off-loading devices, 030209 endocrinology & metabolism, Clinical Care/Education/Nutrition, Sudden death, Diseases of the endocrine glands. Clinical endocrinology, Amputation, Surgical, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Adverse effect, ComputingMilieux_MISCELLANEOUS, Aged, Wound Healing, business.industry, Middle Aged, RC648-665, medicine.disease, Diabetic foot, Diabetic Foot, foot ulcer, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Diabetic foot ulcer, medicine.anatomical_structure, Amputation, Ankle, business
Abstract: IntroductionThe offloading is crucial to heal neuropathic diabetic foot ulcer (DFU). Removable offloading are the most used devices. Orthèse diabète is a new customized removable knee-high offloading device immobilizing foot and ankle joints, with some specific and innovative features that may improve offloading. We aimed to evaluate the efficiency of this device in DFU healing.Research, design and methodsThe evaluation of Offloading using a new removable ORTHOsis in DIABetic foot study is a French multicenter (13 centers) randomized controlled trial with blinded end points evaluation. Adults with neuropathic DFU were randomly assigned to either Orthèse Diabète (experimental device), or any type of conventional (usually used in France) removable offloading devices (control group). The primary outcome was the 3-month proportion of patients with fully healed DFU.ResultsAmong 112 randomized patients (men 78%, age 62±10 years), the primary outcome occurred in 19 (33%) participants using conventional device vs 19 (35%) Orthèse Diabète users (p=0.79). Study groups were also comparable in terms of prespecified secondary end points including occurrence of new DFU (25% vs 27% in conventional and experimental groups), ipsilateral lower-limb amputation (4% vs 10%) or infectious complications (14% vs 13%) (p>0.05 for all). Adverse events were comparable between groups, including 4 deaths unrelated to study allocation (1 sudden death, 2 ventricular arrhythmias and 1 pancreatic cancer). Adverse events believed to be related to the device were higher in the Orthèse Diabète group than in the control group (15% vs 4%). Orthèse Diabète was less frequently worn than conventional devices (46% vs 66%, p=0.04).ConclusionsOrthèse Diabète, a new removable offloading orthosis immobilizing foot and ankle joints did not show superiority compared with conventional removable devices in neuropathic DFU healing and cannot be recommended to heal DFU.Trial registration numberNCT01956162.
Published: 2020

107. The Characteristics of Care Provided to Population(s) in Precarious Situations in 2015. A Preliminary Study on the Universal Health Cover in France

Author: Philippe Boutin, Emilie Bouquet, Marie-Christine Pérault-Pochat, François Birault, Bérangère Thirioux, Nicole Caunes, Stéphanie Mignot, Pinet, Nicolas, Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Pôle de Santé Des Couronneries, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Henri Laborit (CHL)
Subjects: Chronic bronchitis, medicine.medical_specialty, Inequality, Health, Toxicology and Mutagenesis, media_common.quotation_subject, Population, lcsh:Medicine, Burnout, Drug Prescriptions, Vulnerable Populations, Article, 03 medical and health sciences, reimbursed drugs prescriptions, 0302 clinical medicine, General Practitioners, Universal Health Insurance, Environmental health, Health care, Epidemiology, medicine, Humans, 030212 general & internal medicine, education, Reimbursement, media_common, Retrospective Studies, universal health cover, general practice, education.field_of_study, Physician-Patient Relations, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, lcsh:R, Public Health, Environmental and Occupational Health, 3. Good health, Defined daily dose, 030221 ophthalmology & optometry, precarious populations, France, business, Delivery of Health Care, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background: The French Universal Health Cover (CMU) aims to compensate for inequalities between precarious and non-precarious populations, enabling the former to access to free healthcare. These measures rely on the principle that precarious populations&rsquo, health improves if healthcare is free. We designed a study to examine whether CMU fails to compensate for inequalities in reimbursed drugs prescriptions in precarious populations. Material and method: This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by general practitioners (GPs) to precarious and non-precarious patients in France in 2015. Data were analysed using Mann&ndash, Whitney tests. Findings: 6 out of 20 molecules were significantly under-reimbursed in precarious populations. 2 were over-reimbursed. The 12 remaining molecules did not differ between groups. Interpretation: The under-reimbursement of atorvastatin, rosuvastatin, tamsulosine and timolol reflects well-documented epidemiological differences between these populations. In contrast, the equal reimbursement of amoxicillin, pyostacine, ivermectin, salbutamol and tiopropium is likely an effect of lack of compensation for inequalities. Precarious patients are more affected by diseases that these molecules target (e.g., chronic bronchitis, bacterial pneumonia, cutaneous infections). This could also be the case for the equal and under-reimbursement of insulin glargine and metformin (targeting diabetes), respectively, although this has to be considered with caution. In conclusion, the French free healthcare cover does not fail to compensate for all but only for some selective inequalities in access to reimbursed drugs prescriptions. These results are discussed with respect to the interaction of the doctor&ndash, patient relationship and the holistic nature of primary care, potentially triggering burnout and empathy decrease and negatively impacting the quality of care in precarious populations.
Published: 2020

108. Cancer risk in dialyzed patients with and without diabetes

Author: Cécile Vigneau, Mathilde Lassalle, Guillaume Bouzillé, Adélaïde Pladys, Pierre Lemordant, Pierre Ingrand, Christian Jacquelinet, Pascal Van Hille, Marc Cuggia, Christine Riou, Sahar Bayat, Gautier Defossez, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence de la biomédecine [Saint-Denis la Plaine], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), French National Research Agency funded this work inside the Integrating and Sharing Health Data for Research Project (Grant No. ANR-15-CE19-0024)., ANR-15-CE19-0024,INSHARE,Contribution pour l'intégration et le partage des données de santé pour une recherche collaborative(2015), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Jonchère, Laurent, and Contribution pour l'intégration et le partage des données de santé pour une recherche collaborative - - INSHARE2015 - ANR-15-CE19-0024 - AAPG2015 - VALID
Subjects: Male, Cancer Research, medicine.medical_specialty, Epidemiology, medicine.medical_treatment, REIN registry, [SDV]Life Sciences [q-bio], Population, End stage renal disease, Diabetes Complications, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Risk Factors, Neoplasms, Internal medicine, Diabetes mellitus, medicine, Humans, Registries, 030212 general & internal medicine, education, Cancer occurrence, INSHARE platform, Dialysis, Aged, education.field_of_study, business.industry, Diabetes, Cancer, Cancer registry, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Oncology, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 030220 oncology & carcinogenesis, Kidney Failure, Chronic, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Cancer risk, business
Abstract: Background The risk of cancer is higher in patients with renal diseases and diabetes compared with the general population. The aim of this study was to assess in dialyzed patients, the association between diabetes and the risk to develop a cancer after dialysis start. Methods All patients who started dialysis in the French region of Poitou-Charentes between 2008 and 2015 were included. Their baseline characteristics were extracted from the French Renal Epidemiology and Information Network and were linked to data relative to cancer occurrence from the Poitou-Charentes General Cancer Registry using a procedure developed by the INSHARE platform. The association between diabetes and the risk of cancer was assessed using the Fine & Gray model that takes into account the competing risk of death. Results Among the 1634 patients included, 591 (36.2 %) had diabetes and 91 (5.6 %) patients developed a cancer (n = 24 before or at dialysis start, and n = 67 after dialysis start). The risk to develop a cancer after dialysis initiation was lower in dialyzed patients with diabetes than without diabetes (SHR = 0.54; 95 %CI: 0.32-0.91). Moreover, compared with the general population, the cancer risk was higher in dialyzed patients without diabetes, but not in those with diabetes. Conclusion The risk of developing a cancer in the region of Poitou-Charentes is higher in dialyzed patients without diabetes than with diabetes.
Published: 2020

109. Intégrité scientifique et éthique – Questions soulevées par les dépistages organisés

Author: Pr P Ingrand, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité d'épidémiologie, biostatistique et registre des cancers [Poitou-Charentes], and CCSD, Accord Elsevier
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Health Policy, [SHS] Humanities and Social Sciences, 030212 general & internal medicine, [SHS]Humanities and Social Sciences
Abstract: International audience
Published: 2020

110. Simultaneous determination of bisphenol A and its chlorinated derivatives in human plasma: Development, validation and application of a UHPLC–MS/MS method

Author: Antoine Dupuis, M. Albouy-Llaty, Sylvie Rabouan, Virginie Migeot, Nicolas Venisse, Guillaume Binson, Guillaume Cambien, Sarah Ayraud-Thevenot, Mohamed Belmouaz, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, and Université de Poitiers
Subjects: endocrine system, Bioanalysis, Bisphenol A, Environmental Engineering, Halogenation, Health, Toxicology and Mutagenesis, 0208 environmental biotechnology, 02 engineering and technology, Endocrine Disruptors, 010501 environmental sciences, Mass spectrometry, 01 natural sciences, Uhplc ms ms, Matrix (chemical analysis), chemistry.chemical_compound, Phenols, Tandem Mass Spectrometry, Biomonitoring, Humans, Environmental Chemistry, Benzhydryl Compounds, Chromatography, High Pressure Liquid, 0105 earth and related environmental sciences, Chromatography, Public Health, Environmental and Occupational Health, General Medicine, General Chemistry, Pollution, 020801 environmental engineering, 3. Good health, chemistry, Endocrine disruptor, Human plasma, [SDE]Environmental Sciences, Chlorine
Abstract: Bisphenol A (BPA) is a well-known ubiquitous chemical found in polycarbonate, polysulfone and epoxy resins, used in mass production for many consumer products. BPA exhibits endocrine disruptor properties that can potentially induce adverse health effects. In aquatic environments, it can react with chlorine to produce chlorinated derivatives (ClxBPAs). ClxBPAs exhibit oestrogenic activity 10 to 105 times higher than BPA itself. Assessing human exposure to endocrine disrupting chemicals is mandatory to assess health risk. Blood, as well as urine matrix, are commonly used to perform human biomonitoring. We therefore developed, fully validated and applied a method based on Ultra High Performance Liquid Chromatography couples to a Triple Quad Mass Spectrometer to determine BPA, monochlorobisphenol A (MCBPA), dichlorobisphenol A (DCBPA), trichlorobisphenol A (TCBPA) and tetrachlorobisphenol A (TTCBPA) in human blood plasma. The European Medicines Agency guidelines for bioanalytical method validation have been applied. Precision and trueness of the method were15% at medium and high levels of quality control and20% at the limits of quantification (LOQs). The LOQs were settled at 0.1 ng/mL for BPA, 0.02 ng/mL for TTCBPA and 0.005 ng/mL for MCBPA, DCBPA, and TCBPA. The analytical method was applied to ten patients suffering from end stage renal disease. BPA was quantified in all ten patients while MCBPA, DCBPA and TTCBPA were determined in three and TCBPA in four. In conclusion, we have successfully developed a highly sensitive method to determine BPA and ClxBPAs in human plasma. Thanks to this method, for the first time, we could demonstrate ClxBPAs occurrence in human blood.
Published: 2020

111. Intérêt de l’éducation périnéale en rééducation périnéale chez la femme

Author: Xavier Fritel, F. Bruyère, V. Blanchard, K. Nyangoh Timoh, Anne-Cécile Pizzoferrato, Service d'anatomie et cytologie pathologiques [Rennes] = Anatomy and Cytopathology [Rennes], CHU Pontchaillou [Rennes], Université Francois Rabelais [Tours], CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie-Obstétrique et Médecine de la Reproduction [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, and Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)
Subjects: medicine.medical_specialty, Pelvic floor, business.industry, Urology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Visual feedback, Pelvic Floor Muscle, Re education, Pelvic Floor Disorders, body regions, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Quality of life, Female patient, Physical therapy, Medicine, Independent practice, business
Abstract: AIM Evaluate the impact of pelvic floor education on the symptoms of female patients referred for pelvic floor muscle training (PFMT). METHODS Forty female patients suffering from pelvic floor disorders and referred to independent practice for PFME between February and May 2019 answered a survey on symptoms and quality of life before PFME, after four sessions of pelvic floor education and at the end of PFME. The ICIQ-SF, USP, Contilife, PDFI 20, Kess, and Wexner scores were used to evaluate the results. The protocol consisted in four initial sessions of pelvic floor education including information on each field of perineology ; the fifth session was dedicated to visual feedback using a mirror ; the following five sessions were tailored according to the care objectives established based on the initial assessment. RESULTS The scores were significantly improved after the four initial sessions of pelvic floor education. The improvement was significant at the end of the re-education program. The PFDI-20 score dropped from 66,9 to 20,9 (P=0,002), the ICIQ-SF score from 8,4 to 1,5 (P
Published: 2020

112. Supplementary material: Plasma Trimethylamine N-oxide and risk of cardiovascular events in patients with type 2 diabetes

Author: Croyal, Mikael, Saulnier, Pierre-Jean, Aguesse, Audrey, Gand, Elise, Ragot, Stéphanie, Roussel, Ronan, Halimi, Jean-Michel, Ducrocq, Grégory, Cariou, Bertrand, Montaigne, David, Wargny, Matthieu, Krempf, Michel, Hadjadj, Samy, Nutrition périnatale [Nantes] (Centres de Recherche en Nutrition Humaine - CRNH), Centre de Recherche en Nutrition Humaine - Ouest, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d' investigation clinique-plurithématique du CHU de Poitiers, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre de Recherche des Cordeliers (CRC), Université Pierre et Marie Curie - Paris 6 (UPMC)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de néphrologie, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de cardiologie, Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Service Endocrinologue, Centre hospitalier universitaire de Nantes (CHU Nantes), Ischémie - Reperfusion en transplatation rénale, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers, Physiologie des Adaptations Nutritionnelles [UMR_A1280] (PhAN), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Université Paris Diderot - Paris 7 (UPD7)-École pratique des hautes études (EPHE)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Récepteurs nucléaires, maladies cardiovasculaires et diabète (EGID), Université de Lille, Droit et Santé-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM CIC 0802 (INSERM - CHU de Poitiers), Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 (UPMC)-École Pratique des Hautes Études (EPHE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Unité de recherche de l'institut du thorax (ITX-lab), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Paris Diderot - Paris 7 (UPD7)-École pratique des hautes études (EPHE), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: risk factor, trimethylamine N-oxide, [SDV]Life Sciences [q-bio], TMAO, SURDIAGENE cohort, type 2 diabetes, ComputingMilieux_MISCELLANEOUS, cardiovascular diseases
Abstract: International audience
Published: 2020

113. Regulation of Protein Synthesis and Apoptosis in Lymphocytes of Parkinson Patients: The Effect of Dopaminergic Treatment

Author: Julie Deguil, Stéphanie Ragot, Pauline Barraud, Stéphanie Pain, Jeremie Belin, Jean-Luc Houeto, Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie [Poitiers], and Centre hospitalier universitaire de Poitiers (CHU Poitiers)
Subjects: Male, Dopamine Agents, Substantia nigra, Apoptosis, Peripheral blood mononuclear cell, Antiparkinson Agents, Levodopa, eIF-2 Kinase, Humans, Medicine, Lymphocytes, Protein kinase A, Dopaminergic treatment, PI3K/AKT/mTOR pathway, Kinase, business.industry, TOR Serine-Threonine Kinases, Dopaminergic, Middle Aged, Protein kinase R, 3. Good health, Parkinson disease, Neurology, Cancer research, Female, Neurology (clinical), business, Protein synthesis, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background: Parkinson disease (PD) is a neurodegenerative disorder characterized by progressive degeneration of the dopaminergic neurons in the substantia nigra, presumably due to increased apoptosis. In previous studies, we showed altered expression of proteins involved in mammalian target of rapamycin (mTOR) antiapoptotic and double-stranded RNA-dependent protein kinase (PKR) apoptotic pathways of translational control in experimental cellular and animal models of PD. Results: In this work, our results showed clear modifications in the expression of kinases involved in mTOR and PKR apoptosis pathways, in lymphocytes of PD patients treated or not with anti-PD treatment (levodopa), which confirmed the role played by apoptosis in the pathogenesis of this disease and the positive effect of treatment with medication on this parameter. Others proteins involved in apoptosis were also evaluated in lymphocytes of patients as the expression of the peripheral benzodiazepine receptor and caspase-3. Conclusion: Translational control is altered in PD and hence its evaluation in peripheral blood mononuclear cells may serve as an early marker of apoptosis and indicate the efficacy of the dopaminergic treatment.
Published: 2020

114. Ponatinib in childhood Philadelphia chromosome-positive leukaemias: an international registry of childhood chronic myeloid leukaemia study

Author: Brigitte Nelken, Yves Bertrand, Krzysztof Kałwak, Frédéric Millot, André Baruchel, Meinolf Suttorp, A. B. Versluys, Stéphane Ducassou, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Technische Universität Dresden = Dresden University of Technology (TU Dresden), Princess Máxima Center for Pediatric Oncology [Utrecht, Netherlands], Wroclaw Medical University [Wrocław, Pologne] (WMU), CHU Lille, CHU Bordeaux [Bordeaux], Institut d'hématologie et d'oncologie pédiatrique [CHU - HCL] (IHOPe), Hospices Civils de Lyon (HCL), Hôpital Robert Debré, Wrocław Medical University, and CCSD, Accord Elsevier
Subjects: 0301 basic medicine, Oncology, Male, Cancer Research, medicine.medical_treatment, [SDV]Life Sciences [q-bio], International Cooperation, Fusion Proteins, bcr-abl, Disease, Tyrosine-kinase inhibitor, chemistry.chemical_compound, 0302 clinical medicine, hemic and lymphatic diseases, Medicine, Philadelphia Chromosome, Registries, Age of Onset, Child, Children, Philadelphia Chromosome Positive, Ponatinib, Imidazoles, Treatment options, 3. Good health, [SDV] Life Sciences [q-bio], Pyridazines, Treatment Outcome, 030220 oncology & carcinogenesis, Child, Preschool, Cohort, Female, medicine.medical_specialty, Adolescent, medicine.drug_class, Chronic myeloid leukaemia, Philadelphia chromosome–positive acute lymphoblastic leukaemia, 03 medical and health sciences, Internal medicine, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Humans, Retrospective Studies, Chemotherapy, business.industry, Survival Analysis, 030104 developmental biology, chemistry, business
Abstract: Background Ponatinib is effective in adults with Philadelphia chromosome–positive (Ph+) leukaemias, but scant data are available regarding the use of this tyrosine kinase inhibitor in children. Aims The aim of this study isto describe the tolerance and efficacy of compassionate use of ponatinib in a paediatric cohort of patients with Ph+ leukaemias. Methods Data from 11 children with chronic myeloid leukaemia (CML) registered to the international registry of childhood chronic myeloid leukaemia and from 3 children with Ph+ acute lymphoblastic leukaemia (Ph+ ALL) treated with ponatinib were collected retrospectively. Results In 11 girls and 3 boys (median age 14 years), ponatinib was used as a second- to eighth-line treatment. Ponatinib was administered as single therapy (9 patients) or in combination with chemotherapy (8 patients). The status of the disease when ponatinib was started was as follows: CML in advanced phases (n = 8), CML in chronic phase without achievement of molecular response (n = 2) or presence of T315I mutation (n = 1) and Ph + ALL in molecular (n = 1) or marrow (n = 2) relapses. The median dose administered was 21.4 mg/m2 and median duration of ponatinib was 2.5 months. Ponatinib alone or in combination with chemotherapy administered on 16 occasions led to achievement of major molecular response in 50% of cases. Ponatinib was used as a bridge to transplant in 4 cases. Among the 9 patients treated with ponatinib alone, toxicity grade III–IV (2 patients) was exclusively haematologic. No vascular events related to ponatinib were observed. Conclusion Ponatinib may be a reasonable additional treatment option for children with Ph+ leukaemias who have failed several lines of therapy.
Published: 2020

115. Innate T-αβ lymphocytes as new immunological components of anti-tumoral 'off-target' effects of the tyrosine kinase inhibitor dasatinib

Author: Alice Barbarin, Jean-Marc Gombert, André Herbelin, Nathalie Piccirilli, Lydia Roy, Myriam Abdallah, Lucie Lefèvre, Emilie Cayssials, Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service d'Oncologie Hématologique et de Thérapie Cellulaire [Poitiers], CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers, Service Clinique d'Hématologie [Créteil], Hôpital Henri Mondor, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Immunologie et Inflammation [Poitiers], This study was supported by INSERM, CHU de Poitiers, Université de Poitiers, Ligue contre le Cancer du Grand Ouest (Comités départementaux de la Vienne, de la Charente, de la Charente Maritime et des Deux-Sèvres), Association pour la Recherche en Immunologie-Poitou-Charentes (ARIM-PC), Cancéropôle Grand Sud-Ouest, Groupement Interrégional de Recherche Clinique et d’Innovation Sud-Ouest Outre-Mer (API-K 2017), Association Laurette Fugain (ALF 2015/10, ALF 2019/10) and INCa-DGOS 8658 (PRT-K 2015-052). A.B. was supported by fellowships provided by Fondation Brystol-Meyers Squibb and Région Nouvelle Aquitaine and E.C. by a Sport & Collection fellowship., and Bodescot, Myriam
Subjects: 0301 basic medicine, Receptors, Antigen, T-Cell, alpha-beta, Cell, Dasatinib, lcsh:Medicine, Lymphocyte Activation, Tyrosine-kinase inhibitor, 0302 clinical medicine, hemic and lymphatic diseases, CD8-positive T cells, lcsh:Science, Mice, Inbred BALB C, Multidisciplinary, Kinase, 3. Good health, NKT cells, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Medicine, Female, [SDV.IMM.IMM] Life Sciences [q-bio]/Immunology/Immunotherapy, medicine.drug, medicine.drug_class, Science, T cell, Immunology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Biology, Article, Interferon-gamma, 03 medical and health sciences, Immune system, [SDV.CAN] Life Sciences [q-bio]/Cancer, Antigen, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, medicine, Animals, Humans, Protein Kinase Inhibitors, lcsh:R, [SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy, Th1 Cells, Immunity, Innate, Mice, Inbred C57BL, 030104 developmental biology, Cancer research, Natural Killer T-Cells, lcsh:Q, Immunologic Memory, CD8
Abstract: Kinase inhibitors hold great potential as targeted therapy against malignant cells. Among them, the tyrosine kinase inhibitor dasatinib is known for a number of clinically relevant off-target actions, attributed in part to effects on components of the immune system, especially conventional T-cells and natural killer (NK)-cells. Here, we have hypothesized that dasatinib also influences non-conventional T-αβ cell subsets known for their potential anti-tumoral properties, namely iNKT cells and the distinct new innate CD8 T-cell subset. In mice, where the two subsets were originally characterized, an activated state of iNKT cells associated with a shift toward an iNKT cell Th1-phenotype was observed after dasatinib treatment in vivo. Despite decreased frequency of the total memory CD8 T-cell compartment, the proportion of innate-memory CD8 T-cells and their IFNγ expression in response to an innate-like stimulation increased in response to dasatinib. Lastly, in patients administered with dasatinib for the treatment of BCR-ABL-positive leukemias, we provided the proof of concept that the kinase inhibitor also influences the two innate T-cell subsets in humans, as attested by their increased frequency in the peripheral blood. These data highlight the potential immunostimulatory capacity of dasatinib on innate T-αβ cells, thereby opening new opportunities for chemoimmunotherapy.
Published: 2020

116. Association between sleep disturbances, fear of hypoglycemia and psychological well-being in adults with type 1 diabetes mellitus, data from cross-sectional VARDIA study

Author: Séverine Dubois, Claire Briet, Ingrid Allix, Matthieu Pichelin, Lucy Chaillous, Pierre-Jean Saulnier, A.M. Leguerrier, Matthieu Wargny, Valentine Suteau, Fabrice Bonnet, Pierre-Henri Ducluzeau, Véronique Kerlan, Stéphanie Ragot, Bertrand Cariou, Gerard Fradet, D. Gouet, Elise Gand, Caroline Perlemoine, Samy Hadjadj, Ingrid Delcourt Crespin, Linda Gonder-Frederick, MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Institut du thorax, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Virginia, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Stress Oxydant et Pathologies Métaboliques (SOPAM), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], CH Départemental Vendée, Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), CH La Rochelle, CH Bretagne Sud, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CCSD, Accord Elsevier, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Clinique d'Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital Laennec, Service d'Endocrinologie (CHRU - Endocrino), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hopital saint louis (LA ROCHELLE - Hôpital Saint Louis), CHRU de Tours, Service de Médecine Interne Nutrition, Immunologie antivirale systémique et cérébrale, Université Paris-Sud - Paris 11 (UP11)-IFR93-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Nantes (UN), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)
Subjects: Adult, Male, Sleep Wake Disorders, medicine.medical_specialty, [SDV.BA] Life Sciences [q-bio]/Animal biology, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], 030209 endocrinology & metabolism, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, Hypoglycemia, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, 030212 general & internal medicine, [SDV.BC] Life Sciences [q-bio]/Cellular Biology, ComputingMilieux_MISCELLANEOUS, Glycemic, Type 1 diabetes, business.industry, [SDV.BA]Life Sciences [q-bio]/Animal biology, General Medicine, Fear, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, medicine.disease, Sleep in non-human animals, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Psychological well-being, Female, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract: International audience; Aim: To assess the relationship between sleep quality, fear of hypoglycemia, glycemic variability and psychological well-being in type 1 diabetes mellitus.Methods: Our data were provided by the VARDIA Study, a multicentric cross-sectional study conducted between June and December 2015. Sleep characteristics were assessed by the Pittsburgh Sleep Quality Index (PSQI). Fear of hypoglycemia and psychological well-being were measured with the Hypoglycemia Fear Survey version II (HFS-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Glycemic variability (GV) was determined using the CV of three 7-point self-monitoring blood glucose profiles and the mean amplitude of glycemic excursion (MAGE).Results: 315 patients were eligible for PSQI questionnaire analysis: 54% women, mean age 47 ± 15, mean diabetes duration of 24 ± 13 years, HbA1c of 7.6 ± 0.9% (60 ± 7,5mmol/mol). Average PSQI score was 6.0 ± 3.3 and 59.8% of the patients had a PSQI score > 5. HFS-II score and HADS were significantly higher among "poor" sleepers (p < 0.0001) and PSQI score was positively associated with HADS (β = 0.22; 95% CI = 0.08;0.35). GV evaluated by CV or MAGE did not differ between "poor" and "good" sleepers (p = 0.28 and 0.54, respectively).Conclusions: Adult patients with type 1 diabetes have sleep disturbances which correlate with psychological well-being. This study suggests that psychological management can be a target to improve sleep quality in adults with type 1 diabetes mellitus.
Published: 2020

117. Acute Clostridioides difficile Infection in Hospitalized Persons Aged 75 and Older: 30-Day Prognosis and Risk Factors for Mortality

Author: Marc Paccalin, Isabelle Ingrand, Pierre Ingrand, Gaëtan Gavazzi, A. Caupenne, Claire Roubaud-Baudron, Emmanuel Forestier, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Grenoble, Centre Hospitalier Métropole Savoie [Chambéry], Hôpital Xavier Arnozan - CHU de Bordeaux, Université Victor Segalen - Bordeaux 2, and CCSD, Accord Elsevier
Subjects: medicine.medical_specialty, recurrence, [SDV]Life Sciences [q-bio], Population, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Clostridioides, Risk Factors, Internal medicine, Medicine, Humans, Decompensation, Medical history, 030212 general & internal medicine, Prospective Studies, Older adult, education, General Nursing, Aged, Geriatrics, Aged, 80 and over, education.field_of_study, business.industry, Clostridioides difficile, Health Policy, Mortality rate, Hazard ratio, General Medicine, Prognosis, mortality, infection, Confidence interval, 3. Good health, [SDV] Life Sciences [q-bio], Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, Cohort study
Abstract: Objectives To assess the 30-day mortality predictive markers in the oldest patients with Clostridioides difficile infection (CDI) and to analyze the accuracy of the European severity risk markers in this population. Design Observational prospective multicenter cohort study conducted by the French Infectious Diseases Society and Geriatrics Society networks. An electronic questionnaire was sent to members of both societies regarding their participation. Each investigator used an online survey to gather the data. Setting and participants Patients aged ≥75 years hospitalized in French geriatric or infectious wards with confirmed diagnosis of CDI between March 1, 2016 and May 1, 2017. Methods Clinical and laboratory parameters included medical history and comorbidities with the Cumulative Illness Rating Scale (CIRS). Criteria increasing the risk of severe disease were recorded as listed in the European guidelines. Therapeutic management, recurrence, and mortality rates were assessed at day 30 after diagnosis. Results Included patients numbered 247; mean age was 87.2 years (SD 5.4). Most of the CDI incidences (66.4%) were health care–associated infections, with 81% diagnosed within 30 days of hospitalization; CIRS mean score was 16.6 (SD 6.6). Markers of severity ≥3 included 97 patients (39.3%). Metronidazole was the main initial treatment (51.0%). C difficile infection in the older adult was associated with a 30-day mortality of 12.6%. Multivariate analysis showed that baseline CIRS score [hazard ratio (HR) 1.06 per 1-point increase, 95% confidence interval (CI) 1.00-1.12] and evidence of cardiac, respiratory, or renal decompensation (HR 3.04, 95% CI 1.40-6.59) were significantly associated with mortality. Conclusions and implications European severity markers are adequate in the oldest old. Organ failure and comorbidities appeared to be the main markers of prognosis, and these should raise the awareness of practitioners. Although antibiotic treatment was not predictive of mortality, our results point out the lack of adherence to current guidelines in this population.
Published: 2020

118. Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19

Author: Anne Dutour, Matthieu Wargny, Michael Joubert, D. Gouet, Thierry Duriez, Rachel Desailloud, Gaëtan Prévost, Pierre Gourdy, Bertrand Cariou, Matthieu Pichelin, Christelle Raffaitin-Cardin, Thomas Goronflot, Frédérique Olivier, Ingrid Julier, Céline Gonfroy, Ingrid Allix, Laurent Meyer, Etienne Larger, Coralie Amadou, Lucien Marchand, Dominique Seret-Bégué, Pierre-Jean Saulnier, Charles Thivolet, Abdallah Al-Salameh, Camille Vatier, Olivier Bourron, Ronan Roussel, Samy Hadjadj, Jean-François Gautier, Nicolas Wiernsperger, Pascale Quiniou, Jean-Daniel Lalau, Michel Marre, CHU Amiens-Picardie, Université de Picardie Jules Verne (UPJV), Périnatalité et Risques Toxiques - UMR INERIS_I 1 (PERITOX), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie-Institut National de l'Environnement Industriel et des Risques, Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Association REMEDES [Ville-sur-Jarnioux], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Centre Hospitalier de Cholet (CHC), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Nord [CHU - APHM], Centre Hospitalier René Dubos [Pontoise], Centre Hospitalier de La Rochelle (CHR), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Alès-Cévennes (CHAC), Hôpital Cochin [AP-HP], Centre Hospitalier Saint Joseph (CH St Joseph), Hôpital Ambroise Paré [AP-HP], Les Hôptaux universitaires de Strasbourg (HUS), CHU Strasbourg, Centre hospitalier de Cahors, Département d'Endocrinologie, Diabète et Maladies Métaboliques [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre Hospitalier Libourne, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Gonesse (CHU Gonesse), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Centre National de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité [CHu Saint-Antoine] (PRISIS), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de l'Environnement Industriel et des Risques (INERIS)-Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and CarMeN, laboratoire
Subjects: Male, medicine.medical_specialty, endocrine system diseases, Propensity score, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], 030209 endocrinology & metabolism, Type 2 diabetes, 030204 cardiovascular system & hematology, Lower risk, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Mechanical ventilation, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Clinical endpoint, Humans, Hypoglycemic Agents, Survival analysis, Aged, Aged, 80 and over, business.industry, Mortality rate, General Medicine, Middle Aged, medicine.disease, Respiration, Artificial, Metformin, 3. Good health, [SDV] Life Sciences [q-bio], Hospitalization, Death, Diabetes Mellitus, Type 2, Propensity score matching, Original Article, Female, business, Covid-19, medicine.drug
Abstract: International audience; AIMS: Metformin exerts anti-inflammatory and immunosuppressive effects. We addressed the impact of prior metformin use on prognosis in patients with type 2 diabetes hospitalised for COVID-19. METHODS: CORONADO is a nationwide observational study that included patients with diabetes hospitalised for COVID-19 between March 10 and April 10, 2020 in 68 French centres. The primary outcome combined tracheal intubation and/or death within 7 days of admission. A Kaplan-Meier survival curve was reported for death up to day 28. The association between metformin use and outcomes was then estimated in a logistic regression analysis after applying a propensity score inverse probability of treatment weighting approach. RESULTS: Among the 2449 patients included, 1496 were metformin users and 953 were not. Compared with non-users, metformin users were younger with a lower prevalence of diabetic complications, but had more severe features of COVID-19 on admission. The primary endpoint occurred in 28.0% of metformin users (vs 29.0% in non-users, P = 0.6134) on day 7 and in 32.6% (vs 38.7%, P = 0.0023) on day 28. The mortality rate was lower in metformin users on day 7 (8.2 vs 16.1%, P \textless 0.0001) and on day 28 (16.0 vs 28.6%, P \textless 0.0001). After propensity score weighting was applied, the odds ratios for primary outcome and death (OR [95%CI], metformin users vs non-users) were 0.838 [0.649-1.082] and 0.688 [0.470-1.007] on day 7, then 0.783 [0.615-0.996] and 0.710 [0.537-0.938] on day 28, respectively. CONCLUSION: Metformin use appeared to be associated with a lower risk of death in patients with diabetes hospitalised for COVID-19.
Published: 2020

119. Toxicities associated with chemotherapy regimens containing a fluoropyrimidine: A real-life evaluation in France

Author: Claire Lafay-Chebassier, Marie-Christine Pérault-Pochat, Chantal Barin-Le Guellec, Pierre Ingrand, Jean-François Tournamille, Adeline Boudet, Mary-Christine Lanoue, Gautier Defossez, Marie-Christine Etienne-Grimaldi, Isabelle Ingrand, Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), and CCSD, Accord Elsevier
Subjects: Male, 0301 basic medicine, Cancer Research, medicine.medical_specialty, Organoplatinum Compounds, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Medication Adherence, Capecitabine, 03 medical and health sciences, Pharmacovigilance, 0302 clinical medicine, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, Dihydropyrimidine dehydrogenase, Humans, Medicine, Adverse effect, Dihydrouracil Dehydrogenase (NADP), Toxic death, Chemotherapy, Public health, business.industry, Adverse effects, Incidence (epidemiology), Confidence interval, 5 Fluorouracil, 3. Good health, [SDV] Life Sciences [q-bio], 030104 developmental biology, Oncology, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, 030220 oncology & carcinogenesis, Cohort, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Female, Fluorouracil, France, business, Fluoropyrimidine, medicine.drug
Abstract: International audience; AIMS: Despite fluoropyrimidines (FPs) constituting the main component of the chemotherapy combination protocols in 50% of chemotherapies for solid tumour treatments, incidence data for FP-related toxicity are poorly documented in real life. This study evaluated the number of patients receiving FP-based chemotherapies in France, along with the true incidence of FP-related serious adverse effects (SAEs) before the recent mandatory dihydropyrimidine dehydrogenase (DPD)-screening was introduced by French health authorities, DPD being the rate-limiting enzyme of 5-fluorouracil (5-FU) catabolism.METHODS: Exhaustive data on the number of patients treated with FP-based chemotherapy in 2013-2014 were collected in the Centre-Val de Loire region of France. True incidence of SAEs was extracted from a cohort of 513 patients with incident solid tumours receiving first-line FP-based chemotherapy.RESULTS: After extrapolation at national level, we estimated that 76,200 patients are currently treated annually with 5FU (53,100 patients, 62% digestive system-related versus 26% breast cancers versus 12% head and neck cancers) or capecitabine (23,100 patients, 45% digestive system-related versus 37% breast cancers versus 18% non-documented). Earlier (in the first two cycles) the SAE incidence rate was 19.3% (95% confidence interval (CI) 16-23%) including one toxic death (0.2%, 95%CI 0-1%). SAE incidence rate was 32.2% (95%CI 28-36%) over the first 6 months of treatment. Incidence of death, life-threatening prognosis or incapacity/disability was 1.4% (95%CI 0.4-2.4%) and 1.6% (95%CI 0.5-2.6%) during first two cycles and first 6 months, respectively.CONCLUSION: These data highlight the significant public health issue related to FP toxicity, with around 1200 patients developing FP-related life-threatening prognosis or incapacity/disability annually in France, including 150 toxic deaths. It is hoped that DPD-deficiency screening will reduce such iatrogenic events and eradicate toxic deaths.
Published: 2020

120. Hypnosis Versus Placebo During Atrial Flutter Ablation The PAINLESS Study: A Randomized Controlled Trial

Author: Garcia, Rodrigue, Bouleti, Claire, Li, Anthony, Frasca, Denis, El Harrouchi, Sophia, Marechal, Julien, Roumegou, Pierre, Corbi, Pierre, Christiaens, Luc, Le Gal, François, Degand, Bruno, CCSD, Accord Elsevier, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and St George's, University of London
Subjects: Male, [SDV]Life Sciences [q-bio], morphine, Analgesics, Opioid, [SDV] Life Sciences [q-bio], atrial flutter, quality of care, hypnotic therapy, Catheter Ablation, randomized trial, Humans, Female, pain, Hypnosis, Aged
Abstract: International audience; Objectives: The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation.Background: AFL ablation commonly requires intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with rising interest, but robust data in electrophysiological procedures are lacking.Methods: This single center, randomized controlled trial compared hypnosis and placebo during AFl ablation. In addition to the randomized intervention, all patients were treated according to the institution's standard of care analgesia protocol (administration of 1 mg of intravenous morphine in case of self-reported pain ≥5 on an 11-point numeric rating scale or on demand). The primary endpoint was perceived pain quantified by patients using a visual analog scale.Results: Between October 2017 and September 2019, 113 patients (mean age 70 ± 12 years, 21% women) were randomized to hypnosis (n = 56) or placebo (n = 57). Mean pain score was 4.0 ± 2.2 in the hypnosis group versus 5.5 ± 1.8 in the placebo group (p < 0.001). Pain perception, assessed every 5 min during the whole procedure, was consistently lower in the hypnosis group. Patients' sedation scores were also better in the hypnosis group than in the placebo group (8.3 ± 2.2 vs. 5.4 ± 2.5; p < 0.001). Finally, morphine requirements were significantly lower in the hypnosis group (1.3 ± 1.3 mg) compared with the placebo group (3.6 ± 1.8 mg; p < 0.001).Conclusions: In this first randomized trial, hypnosis during AFL ablation was superior to placebo for alleviating pain and reducing morphine consumption.
Published: 2020

121. Recommandations pour la pratique clinique du CNGOF : il est temps d’évoluer !

Author: L, Sentilhes, M-V, Senat, T, Schmitz, A, Fauconnier, X, Fritel, HAL UVSQ, Équipe, Pôle d'Obstétrique Reproduction Gynécologie Centre Aliénor d'Aquitaine, Hôpital Pellegrin, Bordeaux, France., Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Research Center of Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, and Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Obstetrics, [SDV] Life Sciences [q-bio], [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Gynecology, [SDV]Life Sciences [q-bio], Practice Guidelines as Topic, Humans, CNGOF, Female, France, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2020

122. Disseminated invasive aspergillosis in patients with severe influenza infection

Author: René Robert, Faustine Reynaud, Delphine Chatellier, Florence Boissier, Grégoire Monseau, Jean-Pierre Frat, Anne Veinstein, Arnaud W. Thille, Damien Marie, Marie Flores, Kevin Brunet, Mathilde Wairy, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CCSD, Accord Elsevier
Subjects: 0301 basic medicine, medicine.medical_specialty, ARDS, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030106 microbiology, Infectious and parasitic diseases, RC109-216, Acute respiratory distress, Severe influenza, Aspergillosis, Revascularization, Article, 03 medical and health sciences, 0302 clinical medicine, medicine, In patient, 030212 general & internal medicine, business.industry, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, medicine.disease, Refractory shock, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Infectious Diseases, Coronary occlusion, Emergency medicine, business
Abstract: International audience; A female 66 year-old patient, not immunocompromised, was admitted in ICU for severe influenza complicated by severe acute respiratory distress syndrome (ARDS) leading to extra-corporeal membrane oxygenation (ECMO). During ICU hospitalization, she developed a disseminated invasive aspergillosis with cerebral access and coronary occlusion which lead to cardiac arrest. Despite a successful revascularization procedure, the patient died of refractory shock.
Published: 2020

123. In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study

Author: Bertrand Gachon, Antoine Nordez, Fabrice Pierre, Xavier Fritel, Nantes Université, Bibliothèque universitaire, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN), Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), and Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Le Mans Université (UM)
Subjects: lcsh:Diseases of the musculoskeletal system, External anal sphincter, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, [SDV]Life Sciences [q-bio], Anal Canal, 02 engineering and technology, Perineum, Biceps, Study Protocol, 0302 clinical medicine, Pregnancy, Anal sphincter, Perineal tear, Valsalva maneuver, Orthopedics and Sports Medicine, Prospective Studies, Perineal trauma, 2. Zero hunger, 030219 obstetrics & reproductive medicine, Pelvic floor, Ultrasound, Obstetric anal sphincter injury, Prenatal Care, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, Research Design, Childbirth, Elasticity Imaging Techniques, Female, medicine.medical_specialty, 0206 medical engineering, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Pelvic Floor Muscle, 03 medical and health sciences, Rheumatology, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Levator ani muscle, business.industry, Parturition, Pelvic Floor, Delivery, Obstetric, 020601 biomedical engineering, Surgery, body regions, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Levator ani, MESH: Adult Elasticity / physiology* Elasticity Imaging Techniques / methods* Feasibility Studies Female Humans Longitudinal Studies Pelvic Floor / diagnostic imaging* Pelvic Floor / physiology Prospective Studies Valsalva Maneuver / physiology, Shear wave elastography, lcsh:RC925-935, business
Abstract: Background Animal studies have reported an increase in pelvic floor muscle stiffness during pregnancy, which might be a protective process against perineal trauma at delivery. Our main objective is to describe the changes in the elastic properties of the pelvic floor muscles (levator ani, external anal sphincter) during human pregnancy using shear wave elastography (SWE) technology. Secondary objectives are as follows: i) to look for specific changes of the pelvic floor muscles compared to peripheral muscles; ii) to determine whether an association between the elastic properties of the levator ani and perineal clinical and B-mode ultrasound measures exists; and iii) to provide explorative data about an association between pelvic floor muscle characteristics and the risk of perineal tears. Methods Our prospective monocentric study will involve three visits (14–18, 24–28, and 34–38 weeks of pregnancy) and include nulliparous women older than 18 years, with a normal pregnancy and a body mass index (BMI) lower than 35 kg.m− 2. Each visit will consist of a clinical pelvic floor assessment (using the Pelvic Organ Prolapse Quantification system), an ultrasound perineal measure of the anteroposterior hiatal diameter and SWE assessment of the levator ani and the external anal sphincter muscles (at rest, during the Valsalva maneuver and during pelvic floor contraction), and SWE assessment of both the biceps brachii and the gastrocnemius medialis (at rest, extension and contraction). We will collect data about the mode of delivery and the occurrence of perineal tears. We will investigate changes in continuous variables collected using the Friedman test. We will look for an association between the elastic properties of the levator ani muscle and clinical / ultrasound measures using a Spearman test at each trimester. We will investigate the association between the elastic properties of the pelvic floor muscles and perineal tear occurrence using a multivariate analysis with logistic regression. Discussion This study will provide original in vivo human data about the biomechanical changes of pregnant women’s pelvic floor. The results may lead to an individualized risk assessment of perineal trauma at childbirth. Trial registration This study was registered on https://clinicaltrials.gov on July 26, 2018 (NCT03602196).
Published: 2020

124. Concerns about pharmacokinetic (PK) and pharmacokinetic-pharmacodynamic (PK-PD) studies in the new therapeutic area of COVID-19 infection

Author: Venisse, N., Peytavin, G., Bouchet, Stéphane, Gagnieu, M. C., Garraffo, R., Guilhaumou, R., Solas, C., Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, CHU Bordeaux [Bordeaux], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Nice (CHU Nice), Université Côte d'Azur (UCA), Institut de Neurosciences des Systèmes (INS), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique - Hôpitaux de Marseille (APHM), Unité des Virus Emergents (UVE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Hôpital de la Timone [CHU - APHM] (TIMONE)
Subjects: PharmacoEpi-Drugs, Pharmacodynamics, PK-PD, COVID-19, Pharmacokinetics, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract: International audience; In the context of the COVID-19 pandemic, several drugs have been repurposed as potential candidates for the treatment of COVID-19 infection. While preliminary choices were essentially based on in vitro potency, clinical translation into effective therapies may be challenging due to unfavorable in vivo pharmacokinetic properties at the doses chosen for this new indication of COVID-19 infection. However, available pharmacokinetic and pharmacokinetic-pharmacodynamic studies suffer from severe limitations leading to unreliable conclusions, especially in term of dosing optimization.In this paper we propose to highlight these limitations and to identify some of the major requirements that need to be addressed in designing PK and PK-PD studies in this era of COVID. A special attention should be paid to pre-analytical and analytical requirements and to the proper collection of covariates affecting dose-exposure relationships (co-medications, use of specific organ support techniques and other clinical and para-clinical data). We also promote the development of population PK and PK-PD models specifically dedicated to COVID-19 patients since those previously developed for other diseases (SEL, malaria, HIV) and clinical situations (steady-state, non-ICU patients) are not representative of severe patients.Therefore, implementation of well-designed PK and PD studies targeted to COVID-19 patients is urgently needed. For that purpose we call for multi-institutional collaborative work and involvement of clinical pharmacologists in multidisciplinary research consortia.
Published: 2020

125. Pneumococcal purpura fulminans in asplenic or hyposplenic patients: a French multicenter exposed-unexposed retrospective cohort study

Author: Jean-Marc Tadié, Armand Mekontso Dessap, Martin Cour, Damien Contou, Nicolas de Prost, Rémi Coudroy, Romain Sonneville, Gwenhael Colin, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Jonchère, Laurent, Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Asplenia, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Splenectomy, Bacteremia, Critical Care and Intensive Care Medicine, Amputation, Surgical, Pneumococcal Infections, 03 medical and health sciences, Overwhelming post-splenectomy infection, 0302 clinical medicine, Patient Admission, Sepsis, medicine, Humans, 030212 general & internal medicine, 030304 developmental biology, Aged, Retrospective Studies, 0303 health sciences, Purpura fulminans, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Retrospective cohort study, lcsh:RC86-88.9, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Pneumococcal infections, Intensive Care Units, Streptococcus pneumoniae, Pneumococcal vaccine, SAPS II, Female, business
Abstract: Background Pneumococcal infections remain the main cause of overwhelming post-splenectomy infections, and purpura fulminans may develop in almost 20% of patients with overwhelming post-splenectomy infection. We aimed at describing the impact of asplenia/hyposplenia on the clinical features and the outcomes of adult patients admitted to the intensive care unit (ICU) for pneumococcal purpura fulminans. Methods A 17-year national multicenter retrospective cohort study included adult patients admitted to 55 French ICUs for an infectious purpura fulminans from 2000 to 2016. Patients with pneumococcal purpura fulminans were analyzed according to the absence or presence of asplenia/hyposplenia. Results Among the 306 patients admitted to the ICU for purpura fulminans, 67 (22%) had a pneumococcal purpura fulminans, of whom 34 (51%) had asplenia (n = 29/34, 85%) or hyposplenia (n = 5/34, 15%) and 33 (49%) had eusplenia. The prevalence of pneumococcal purpura fulminans was seven times higher in asplenic/hyposplenic patients compared to eusplenic patients with purpura fulminans (n = 34/39, 87% vs. n = 33/267, 12%; p n = 25/34, 73% vs. n = 13/33, 39%; p = 0.01). The rate of bacteremia did not differ between asplenic/hyposplenic and eusplenic patients (n = 31/34, 91% vs n = 27/33, 82%; p = 0.261). SAPS II (60 ± 14 vs. 60 ± 18; p = 0.244) and SOFA (13 [1–5] vs. 14 [1–4, 6]; p = 0.48) scores did not differ between asplenic/hyposplenic and eusplenic patients. There were no significant differences between asplenic/hyposplenic and eusplenic patients regarding the rate of limb amputation (n = 9/34, 26% vs. 15/33, 45%; p = 0.11) and hospital mortality (n = 20/34, 59% vs. n = 15/33, 45%; p = 0.27). Conclusions Half of pneumococcal purpura fulminans episodes occurred in asplenic or hyposplenic patients. Pneumococcal vaccine coverage was reported in one third of asplenic/hyposplenic patients. Half of pneumococcal purpura fulminans episodes occurred more than 20 years after splenectomy. Outcomes of pneumococcal purpura fulminans did not show significant differences between patients with or without asplenia or hyposplenia, although the small number of patients included limited our power to detect potential differences between groups.
Published: 2020

126. Comprehensive assessment of ventilator supports in Emergency Medicine

Author: Marjanovic, Nicolas, STAR, ABES, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers, Arnaud Thille, and Olivier Mimoz
Subjects: [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, High flow nasal cannula oxygen therapy, Oxygen inhalation therapy, Ventilation mécanique, Ventilation non invasive, Étude clinique, Non-Invasive ventilation, Acute respiratory failure, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Bench test, Invasive ventilation, Clinical study, Oxygénothérapie, Mechanical ventilation, Oxygénothérapie nasale à haut-Débit, Banc test, Insuffisance respiratoire aigüe, Emergency medicine, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Ventilation invasive, Médecine d'urgence, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Acute respiratory failure is a common complaint of patients visiting the Emergency Department and conventional oxygen therapy is its first-line treatment. Ventilatory support is required when nasal oxygen therapy is not enough or as a first-line treatment in the most severe cases. Ventilatory supports include high-flow and humidified nasal cannula oxygen (HNFO) and mechanical ventilation. Data assessing their values in Emergency Departments (EDs) mainly come from research conducted in Intensive Care Units. In addition, a comprehensive approach of their application and their results in Emergency Departments has never been conducted.The aim of this research is to provide a comprehensive assessment of ventilatory supports in EDs by assessing the place of HFNO, introducing recently in this setting, and the practice of noninvasive and invasive mechanical ventilation in EDs. We assessed first the clinical and biological impact of HFNO in patients admitting to an ED for de novo acute hypoxemic respiratory failure, then in patients admitting for acute hypercapnic respiratory failure secondary to acute heart failure, through two prospective studies. In addition, we provided a matching of data issued from all prospective trials conducted in the EDs. We aimed to determine if early application of HFNO in patients with acute respiratory failure improves outcome. We found HFNO applied early was associated with an improvement in clinical and biological patterns in patients admitted for de novo acute hypoxemic respiratory failure, and similarly in patients admitted for acute hypercapnic respiratory failure due to acute heart failure. However, HFNO was not associated with a reduction of mechanical ventilation requirements or in mortality. In addition, we assessed mechanical ventilation in the ED by analysing three determinants that may influence patient’s outcome. First, we conducted a large bench test assessing performance and usability of all emergency ventilators marketed in Europe or North America and assessing through two distinct studies. Then, we assessed the mechanical ventilation practice in six French EDs and measured the association between mechanical ventilation settings and patients’ outcome. Performance of recent emergency ventilator were closes to ICU ventilators due to high technological improvements in the last decades. These improvements were associated with an increase of their complexity without impairment of their usability. Finally, in six French EDs, most of the patients were treated with a low tidal volume (between 6 and 8 mL/kg of predicted body weight) as recommend by scientific societies. However, a low tidal volume strategy was not associated with a reduction in the acute respiratory distress incidence as well as in mortality. These studies provided a comprehensive assessment of the ventilator support in the ED, including invasive and noninvasive ventilation, through a clinical and technological approach, and an emerging treatment, HFNO, by its clinical, biological and prognostic impact., L’insuffisance respiratoire aiguë est un motif fréquent de consultation dans un service d’urgences. Le traitement de première intention repose sur l’oxygénothérapie conventionnelle. En cas d’échec ou d’emblée en cas d’urgence vitale immédiate, le recours à un support ventilatoire devient nécessaire. Les supports ventilatoires englobent l’oxygénothérapie à haut-débit nasal humidifiée (OHD) et la ventilation mécanique qui peut être invasive ou non-invasive. Les données concernant l’intérêt du support ventilatoire en médecine d’urgence sont issues pour l’essentiel de travaux conduits en réanimation, et une approche globale de leur place en médecine d’urgence n’a jamais été réalisé.L’objectif de ce travail est de proposer une évaluation globale du support ventilatoire en médecine d’urgence, en analysant l’intérêt de l’OHD, d’introduction récente aux urgences, et la pratique aux urgences de la ventilation mécanique non-invasive et invasive.Nous avons dans un premier temps évalué les effets cliniques et gazométriques de l’OHD au cours de l’insuffisance respiratoire aiguë hypoxémique de novo, puis au cours de l’insuffisance respiratoire aiguë hypercapnique secondaire à un OAP cardiogénique, aux travers de deux études prospectives. Puis, nous avons réalisé une compilation des données de l’ensemble des études prospectives réalisés aux urgences pour déterminé si la mise en place précoce de l’OHD au cours des détresses respiratoires aiguës sans cause spécifique était susceptible d’améliorer le devenir des patients. Nous avons constaté qu’une mise en place précoce de l’OHD, dès l’admission du patient aux urgences, était associée à une amélioration des paramètres cliniques et gazométriques en cas d’insuffisance respiratoire aiguë de novo comparativement à l’oxygénothérapie conventionnelle, et de manière similaire à la ventilation non-invasive en cas d’insuffisance respiratoire aiguë hypercapnique secondaire à un OAP. En revanche, au cours des détresses respiratoires aiguës admises aux urgences, quelle qu’en soit la cause, l’OHD n’a pas été associé à une diminution au recours à la ventilation mécanique, ni à une diminution de la mortalité.Parallèlement, nous avons réalisé une évaluation des pratiques de la ventilation mécanique aux urgences, en analysant, indépendamment de l’indication de la ventilation mécanique, trois déterminants susceptibles d’influer le pronostic des patients. Nous avons dans un premier temps conduit un banc d’essai de l’ensemble des ventilateurs mécaniques de médecine d’urgence commercialisés en Europe et en Amérique du Nord pour évaluer leur performance et leur utilisabilité aux travers de deux études. Puis, nous avons réalisé une évaluation des pratiques de la ventilation mécanique, et mesuré l’association entre les paramètres réglés (notamment la ventilation à faible volume) et le pronostic du patient. Nous avons mis en évidence que les ventilateurs de médecine d’urgence récents ont une performance technique proche des ventilateurs de réanimation en raison des évolutions technologiques et de l’émergence des ventilateurs à turbine. L’augmentation de leurs performances et de leur complexité n’a pas été associée à une dégradation de leur utilisabilité. Enfin, dans les 6 services d’urgences participants, la majorité des patients ont bénéficié d’une ventilation mécanique à faible volume courant (entre 6 et 8 mL/kg de poids idéal théorique), répondant ainsi aux recommandations des sociétés savantes. En revanche, une ventilation à faible volume courant n’a pas été associée à une diminution de l’incidence du syndrome de détresse respiratoire aigu ou une diminution du taux de mortalité.Ces études permettent une évaluation globale du support ventilatoire aux urgences, intégrant la ventilation mécanique invasive et non-invasive, par son approche clinique et technologique, et un traitement émergent, l’OHD, par son impact clinique, gazométrique et pronostique aux urgences.
Published: 2020

127. Relationship between obesity and severe COVID ‐19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

Author: Sara Barraud, Anne Dorange, Bertrand Cariou, Louis Potier, Christine Coffin-Boutreux, Natacha Germain, Coralie Amadou, Patrice Winiszewski, Bénédicte Gaborit, Camille Vatier, Blandine Tramunt, Pierre-Jean Saulnier, Stéphanie Laugier-Robiolle, Deborah Ancelle, Etienne Larger, Bénédicte Fremy, Pierre Gourdy, Bruno Vergès, Matthieu Pichelin, Isabelle Moura, Dominique Seret-Bégué, Matthieu Wargny, Olivier Bourron, Arnaud Monier, Samy Hadjadj, Laurent Meyer, Leila Ait Bachir, Cyrielle Caussy, Nadia Sabbah, Jean-François Gautier, Sarra Smati, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Assistance Publique-Hôpitaux de Marseille (AP-HM), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Pathologies biliaires, fibrose et cancer du foie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Monod, Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Institut hospitalier Franco-Britannique [Levallois-Perret], Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de Cardiométabolisme et Nutrition - Institute of Cardiometabolism and Nutrition, Centre Hospitalier Perigueux, Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier d'Agen, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Complications vasculaires du diabète (CRC - Inserm U1138), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Service de diabétologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Centre Hospitalier d'Auch (CH Auch), Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Louis Pasteur [Chartres], Centre Hospitalier d 'Albi, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Université de Guyane (UG), Centre Hospitalier de Gonesse (CHU Gonesse), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Air Liquide Health Care international AstraZeneca Fondation Francophone pour la Recherche sur le Diabete Hospitalization and Care Organization Division (DHOS) 20-0138Sanofi Societe Francophone du Diabete, Barraud, Sara, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance Publique - Hôpitaux de Marseille (APHM), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Pathologies biliaires, fibrose et cancer du foie [CRSA], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Centre Hospitalier d'Albi, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)
Subjects: Male, obesity, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Type 2 diabetes, 030204 cardiovascular system & hematology, Overweight, Body Mass Index, 0302 clinical medicine, Endocrinology, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, [SDV.MHEP.EM] Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, 2. Zero hunger, education.field_of_study, Middle Aged, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Patient Discharge, 3. Good health, COVID‐19, elderly, mechanical ventilation, obesity, prognosis, type 2 diabetes, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Original Article, Female, type 2 diabetes, medicine.symptom, medicine.medical_specialty, Population, 030209 endocrinology & metabolism, mechanical ventilation, elderly, 03 medical and health sciences, Class I obesity, Internal medicine, Diabetes mellitus, Internal Medicine, Humans, education, Aged, Retrospective Studies, Mechanical ventilation, Inpatients, business.industry, SARS-CoV-2, COVID-19, Original Articles, medicine.disease, Obesity, Respiration, Artificial, Logistic Models, Diabetes Mellitus, Type 2, prognosis, business, Body mass index
Abstract: International audience; Aim: To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D).Methods: From th e CORONAvirus-SARS-CoV-2 and Diabetes Outcomes(CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19–related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status.Results: Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m2, reference group), 726 (36.9%) overweight (25-29.9 kg/m2) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m2) and 314 (16.0%) with class II/III obesity (≥35 kg/m2). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years.Conclusions: Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.
Published: 2020

128. Recommandations pour la pratique clinique du CNGOF : révision méthodologique du processus d’élaboration

Author: Thomas Schmitz, Loïc Sentilhes, Elie Azria, M.-V. Senat, Arnaud Fauconnier, Xavier Fritel, Cyrille Huchon, Nicolas Bourdel, Catherine Deneux-Tharaux, Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and HAL UVSQ, Équipe
Subjects: GRADE system, 030219 obstetrics & reproductive medicine, [SDV]Life Sciences [q-bio], Grade system, Obstetrics and Gynecology, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 3. Good health, Clinical Practice, [SDV] Life Sciences [q-bio], 03 medical and health sciences, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 0302 clinical medicine, Reproductive Medicine, Political science, PICO question, AGREE II consortium, 030212 general & internal medicine, Clinical practice guidelines, Humanities
Abstract: Resume Objectifs Reviser l’organisation et la methodologie des recommandations pour la pratique clinique (RPC) du College national des gynecologues et obstetriciens francais (CNGOF). Methodes Les differentes methodes d’organisation et de cotation de la preuve scientifique ont ete consultees apres recherche dans la base de donnees Medline. Resultats Le groupe RPC du CNGOF a decide d’adopter une organisation des RPC basee sur les 23 criteres AGREE II (pour Appraisal of Guidelines for REsearch and Evaluation) et de coter la preuve scientifique selon la methode GRADE (pour Grading of Recommendation Assessment, Development, and Evaluation). Conclusion En adoptant les criteres du consortium AGREE II et la cotation de la preuve selon la methode GRADE, le CNGOF augmentera la qualite de l’ensemble du processus, delivrera des messages plus cibles et facilement assimilables, pour faciliter mieux encore les prises de decisions des professionnels, au benefice espere de la sante des femmes et de leurs enfants.
Published: 2020

129. Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period

Author: Chaudhuri, Dipayan, Granton, David, Wang, Dominic Xiang, Einav, Sharon, Helviz, Yigal, Mauri, Tommaso, Ricard, Jean-Damien, Mancebo, Jordi, Frat, Jean-Pierre, Jog, Sameer, Hernández, Gonzalo, Maggiore, Salvatore, Hodgson, Carol, Jaber, Samir, Brochard, Laurent, Burns, Karen, Rochwerg, Bram, McMaster University [Hamilton, Ontario], Università degli Studi di Milano [Milano] (UNIMI), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), McMaster University, Hamilton, ON, Canada., Schulich School of Medicine, Western University, London, ON, Canada, Hebrew University Faculty of Medicine, Jerusalem, General Intensive Care Unit of the Shaare Zedek Medical Center, Jerusalem, Israel., Dipartimento dei trapianti, Università degli Studi di Milano, Milan, Italy., Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Nord, Hôpital Louis-Mourier, Colombes, France., Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain, CIC-1402, équipe ALIVE, Poitiers, France, Department of Intensive Care Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, India., Hospital Infanta Sofía, Madrid, Spain, Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, AND Department of Anesthesiology and Critical Care, SS. Annunziata Hospital, Chieti, Italy, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia., Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada, and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
Subjects: systematic review, hypoxia, [SDV]Life Sciences [q-bio], digestive, oral, and skin physiology, otorhinolaryngologic diseases, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], noninvasive ventilation, artificial respiration, oxygen inhalation therapy, intubation
Abstract: International audience; Objective: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period.Data Sources: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).Study Selection: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period.Data Extraction: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, Pao2 before and after intubation, Paco2 after intubation, ICU length of stay, and short-term mortality.Data Synthesis: We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68–1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71–1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), Pao2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or Pao2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation Paco2, ICU length of stay, or 28-day mortality.Conclusions: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.
Published: 2020

130. Cancer, diabète et complications vasculaires : approche épidémiologique de cohortes oncogériatrique et diabétique

Author: Liuu, Evelyne, STAR, ABES, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers, Samy Hadjadj, and Marc Paccalin
Subjects: Complications vasculaires, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, [SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Vascular complications, Type 2 diabetes, Onco-Gériatrie, Diabète de type 2, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Âge, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Neoplasm, Geriatric oncology, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Aged, Cancer
Abstract: Increases of cancer incidence and mortality are a major public health issue, accentuated by population aging. Among the age-related comorbidities, we wanted to specify the burden of diabetes, in particular type 2 (T2D) due to, like cancer, its high prevalence in older population and its multi-system consequences. This work explores the relationship between diabetes, its vascular complications (VC) and cancer, with a particular interest in the geriatric setting. This thesis is based on several finalized and ongoing publications:Article 1: Comprehensive geriatric assessment in older patients with cancer: an external validation of the multidimensional prognostic index in a French prospective cohort study. BMC Geriatr. 2020; 20: 295. doi: 10.1186 / s12877-020-01692-8Heterogeneity of health status in older age claims for the identification of frailty factors influencing life expectancy during oncological diagnosis and follow-up. The geriatric oncology assessment identifies frailty of older patient with cancer. We evaluated the impact of co-morbidities on life expectancy. This geriatric oncology study involved 433 patients included for two years (42% women; mean age 83 ± 5 years). It highlighted a significant association between comorbidities score (assessed by the Cumulative Illness Rating Scale for Geriatrics as part of the MPI Multidimensional Prognostic Index) and 12-month mortality. Compared to group 1, MPI groups 2 and 3 individuals have a higher risk of death (adjusted HR 1.56 [95% CI 1.70–2.09] and 1.72 [1.33–2.22], respectively).Article 2: Frailty and diabetes status in older patients with cancer: impact on mortality in the ANCRAGE cohort. Aging Clin Exp Res. 2020. doi: 10.1007 / s40520-019-01362-9.What is the relationship between diabetes, geriatric oncology frailty and mortality in older cancer patients? In the single-center ANCRAGE cohort, we analyzed the prognostic factors in 1092 elderly subjects with cancer (47% women, mean age 82 ± 5 years), with 20% of diabetic. Frailty prevalence was high in this cohort (84%). During follow-up (median: 15 months [6-29], death in 60%), risk of mortality was higher in patients with diabetes vascular complications (aHR 1.75 [1.15-2.66]), compared to non-diabetic counterparts and whose with diabetes but no VC.Article 3: Diabetes phenotypic characteristics and incident cancer: A cohort approach in French patients with type 2 diabetes - The SURDIAGENE study (manuscript in preparation)Vascular complications increase the progression of cancer and mortality. Yet the relationship between death and diabetes VC has never been explored before in an oncological setting. We focused on the relationship between diabetes VC and cancer: incidence, progression, death. This study in the local SURDIAGENE cohort included 1468 diabetes patients (42% women, mean age 65 ± 11 years, 8% prevalent cancer, 14% incident cancer during the mean follow-up of 7 ± 4 years). Our results confirmed the increased risk of overall mortality in diabetes patients with a past or current history of cancer (n = 313), which was all the more marked in presence of VC (HR 1.73 [1.25-2.38]). Our analyses did not reveal any association between diabetes VC and cancer (prevalent and incident), lymph node and / or metastatic progression, and cancer-related death. There was no relationship between cancer and several plasma biomarkers of metabolic pathways involved in the development of CV: oxidative stress and systemic inflammation.Our results pave the way for improving cancer care in older people with diabetes., L’augmentation de l’incidence des cancers et la mortalité qui en résulte sont un enjeu de santé publique, accentuées par le vieillissement de la population. Parmi les comorbidités liées au vieillissement, nous avons souhaité préciser le poids du diabète, en particulier de type 2 (DT2) en raison, comme le cancer, de sa forte prévalence en population âgée et de ses conséquences multi-systémiques. Ce travail explore la relation entre le diabète, ses complications vasculaires (CV) et le cancer, avec un intérêt particulier pour la situation gériatrique. Cette thèse s’appuie sur plusieurs publications finalisées et en cours :Article 1 : Comprehensive geriatric assessment in older patients with cancer: an external validation of the multidimensional prognostic index in a French prospective cohort study. BMC Geriatr. 2020;20:295. doi: 10.1186/s12877-020-01692-8L’hétérogénéité de l’état de santé des personnes âgées appelle à l’identification des facteurs de fragilité influençant l’espérance de vie lors du diagnostic oncologique et du suivi. L’évaluation onco-gériatrique permet d’identifier la fragilité du patient âgé cancéreux. Cette étude onco-gériatrique portait sur 433 patients inclus pendant deux ans (femmes 42% ; âge moyen 83±5 ans). Elle a mis en exergue une association entre le score de comorbidités (exploré par le Cumulative Illness Rating Scale for Geriatrics dans le cadre de l’index gériatrique multidimensionnel MPI Multidimensional Prognostic Index) et la mortalité à 12 mois. Par rapport au groupe 1, les sujets des groupes MPI 2 et 3 avaient un risque de mortalité plus élevé (HR ajusté 1,56 [IC à 95% 1,70–2,09] et 1,72 [1,33–2,22], respectivement).Article 2 : Frailty and diabetes status in older patients with cancer : impact on mortality in the ANCRAGE cohort. Aging Clin Exp Res. 2020. doi: 10.1007/s40520-019-01362-9. Quelle est la relation entre diabète, fragilité onco-gériatrique et mortalité chez des patients âgés atteints de cancer ? Dans la cohorte monocentrique ANCRAGE, nous avons analysé les facteurs associés au pronostic chez 1092 sujets âgés atteints de cancer (47% femmes, âge moyen 82±5 ans) dont 20 % étaient diabétiques. La prévalence de la fragilité est élevée dans cette cohorte onco-gériatrique (84 %). Au cours du suivi (médiane 15 mois [6-29], 60% décès), le risque de mortalité était plus élevé chez les patients diabétiques présentant des complications vasculaires (aHR 1,75 [1,15-2,66]), en comparaison avec les sujets non diabétiques et diabétiques sans complication vasculaire.Article 3 : Diabetes phenotypic characteristics and incident cancer: A cohort approach in French patients with type 2 diabetes - The SURDIAGENE study (manuscrit en cours de préparation)Les complications vasculaires (CV) majorent l’évolution de la maladie cancéreuse et la mortalité. Pourtant la relation entre le décès et les CV du DT2 n’a jamais été explorée dans un contexte oncologique. Nous nous sommes focalisés sur la relation entre CV du DT2 et cancer : incidence, progression, décès. Cette étude de la cohorte locale SURDIAGENE incluait 1468 patients diabétiques (42% femmes, âge moyen 65±11 ans, 8% cancer prévalent, 14% cancer incident au cours du suivi moyen de 7±4 ans). Nos résultats confirmaient le sur-risque de mortalité globale chez les patients diabétiques avec une histoire ancienne ou actuelle de cancer (n=313), d’autant plus marqué en présence de CV (HR 1,73 [1,25-2,38]). Nos analyses n’identifiaient pas d’association entre les CV du DT2 et cancer (prévalent et incident), la progression ganglionnaire et/ou métastatique, et le décès lié au cancer. Il n’existait pas non plus de relation entre le cancer et plusieurs biomarqueurs plasmatiques de voies métaboliques impliquées dans l’apparition des CV : le stress oxydant et l’inflammation systémique. Nos résultats ouvrent des pistes pour une amélioration de la prise en charge oncologique des personnes âgées avec diabète.
Published: 2020

131. Skin inflammatory response and efficacy of anti-epidermal growth factor receptor therapy in metastatic colorectal cancer (CUTACETUX)

Author: David Tougeron, Sheik Emambux, Laure Favot, Thierry Lecomte, Ewa Wierzbicka-Hainaut, Mahtab Samimi, Eric Frouin, Nicolas Azzopardi, Jocelyn Chevrier, Laura Serres, Julie Godet, Pierre Levillain, Gilles Paintaud, Aurélie Ferru, Laetitia Rouleau, Adriana Delwail, Christine Silvain, Jean-Pierre Tasu, Franck Morel, Stéphanie Ragot, Jean-Claude Lecron, Service de Gastroentérologie, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Laboratoire Inflammation, Tissus épithéliaux et Cytokines (LITEC), Université de Poitiers, Service d'Oncologie Médicale, Service de Gastroentérologie [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), GICC EA 7501, PATCH (Pharmacologie des anticorps thérapeutiques chez l'Homme) (PATCH), Groupe innovation et ciblage cellulaire (GICC), EA 7501 [2018-...] (GICC EA 7501), Université de Tours (UT)-Université de Tours (UT), Département de Dermatologie [CHU Poitiers], Service de dermatologie (CHRU de Tours), Infectiologie et Santé Publique (UMR ISP), Université de Tours (UT)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Service de Pathologie [CHU Poitiers], Service de pharmacologie, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, ImageUP (Plateforme d'Imagerie de l'Université de Poitiers), Signalisation et Transports Ioniques Membranaires (STIM), Université de Poitiers-Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS), Service de Radiologie (POITIERS - Radio), Laboratoire de Traitement de l'Information Medicale (LaTIM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Immunologie/Inflammation [CHU Poitiers], Ligue contre le Cancer (départements de la Vienne, des Deux-Sèvres, de la Charente et de la Charente-Maritime), fondation 'Sport et Collection', Institut de Recherche des Maladies de l'Appareil Digestif (IRMAD) grant from Societe Nationale Francaise de Gastro-Enterologie (SNFGE) and Merck Sante SAS (Lyon, France)., Chanteloup, Nathalie Katy, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique (IMT Atlantique), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Tours-Université de Tours, Université de Tours-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Poitiers-Université de Tours-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), and Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM)
Subjects: [SDV]Life Sciences [q-bio], Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Antibodies, Monoclonal, Antineoplastic Agents, [SDV.CAN]Life Sciences [q-bio]/Cancer, Skin toxicity, RC581-607, cytokines, [SDV] Life Sciences [q-bio], ErbB Receptors, inflammatory factors, [SDV.CAN] Life Sciences [q-bio]/Cancer, cetuximab, Humans, Prospective Studies, monoclonal antibodies, Immunologic diseases. Allergy, Colorectal Neoplasms, RC254-282, Research Article, Original Research
Abstract: International audience; Anti-epidermal growth factor receptor (EGFR) monoclonal antibody is a standard treatment of metastatic colorectal cancer (mCRC) and its most common adverse effect is a papulopustular acneiform rash. The aim of the CUTACETUX study was to characterize the skin inflammatory response associated with this rash and its relation to treatment efficacy.This prospective study included patients with mCRC treated with first-line chemotherapy plus cetuximab. Patients underwent skin biopsies before the initiation of cetuximab (D0) and before the third infusion (D28), one in a rash zone and one in an unaffected zone. Expression of Th17-related cytokines (IL-17A, IL-21, IL-22), antimicrobial peptides (S100A7 and BD-2), innate response-related cytokines (IL-1 beta, IL-6, TNF-alpha and OSM), T-reg-related cytokines (IL-10 and TGF-beta), Th1-related cytokine (IFN-gamma), Th2-related cytokine (IL-4), Thymic stromal lymphopoietin and keratinocyte-derived cytokines (IL-8, IL-23 and CCL20) were determined by RT-PCR.Twenty-seven patients were included. Levels of most of the cytokines increased at D28 in the rash zone compared to D0. No significant association was observed between variations of cytokines levels and treatment response in the rash zone and only the increase of IL-4 (p = .04) and IL-23 (p = .02) levels between D0 and D28 in the unaffected zone was significantly associated with treatment response. Increased levels of IL-8 (p = .02), BD-2 (p = .02), IL-1 beta (p = .004) and OSM (p = .02) in the rash zone were associated with longer progression-free survival.Expression of Th2-related and keratinocyte-derived cytokines in the skin was associated with anti-EGFR efficacy. If this inflammatory signature can explain the rash, the exact mechanism by which these cytokines are involved in anti-EGFR tumor response remains to be studied.
Published: 2020

132. Postpartum psychological distress associated with anal incontinence in the EDEN mother–child cohort: Postpartum psychological distress and anal incontinence

Author: Marie Aline Charles, Jonathan Bernard, Regis HANKARD, Blandine De Lauzon-Guillain, Xavier FRITEL, Marie-Josephe Saurel-Cubizolles, Johanna Lepeule, Barbara Heude, Patricia Dargent-Molina, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), We acknowledge all funding sources for the EDEN study: FRM (Fondation pour la Recherche Médicale), INSERM, Ministère de la Recherche, Université Paris Sud (XI), ANR (Agence Nationale de la Recherche), IRESP (Institut de Recherche en Santé Publique), AFSSET (Agence Française pour la Surveillance et la Sécurité de l’Environnement et du Travail), Santé Publique France (Institut National Pour l’Education et la Santé, Institut National de Veille Sanitaire), DGS (Direction Générale de la Santé), ALFEDIAM (Association de Langue Française pour l'Etude du Diabète et du Métabolisme), MGEN (Mutuelle générale de l’Education Nationale), Nestlé., EDEN Mother-Child Cohort Study Group : Collaborators (27) Annesi-Maesano I, Bernard JY, Botton J, Charles MA, Dargent-Molina P, de Lauzon-Guillain B, Ducimetière P, de Agostini M, Foliguet B, Forhan A, Fritel X, Germa A, Goua V, Hankard R, Heude B, Kaminski M, Larroque B, Lelong N, Lepeule J, Magnin G, Marchand L, Nabet C, Pierre F, Slama R, Saurel-Cubizolles MJ, Schweitzer M, Thiebaugeorges O., Service de gynécologie et obstétrique [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), and EDEN Mother-Child Cohort Study Group : Annesi-Maesano I, Bernard JY, Botton J, Charles MA, Dargent-Molina P, de Lauzon-Guillain B, Ducimetière P, de Agostini M, Foliguet B, Forhan A, Fritel X, Germa A, Goua V, Hankard R, Heude B, Kaminski M, Larroque B, Lelong N, Lepeule J, Magnin G, Marchand L, Nabet C, Pierre F, Slama R, Saurel-Cubizolles MJ, Schweitzer M, Thiebaugeorges O.
Subjects: Adult, Postpartum depression, medicine.medical_specialty, Population, Breastfeeding, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Psychological Distress, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, medicine, cohort study, Flatulence, Humans, postpartum, education, Depression (differential diagnoses), education.field_of_study, Pregnancy, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, anal incontinence, Obstetrics and Gynecology, Puerperal Disorders, medicine.disease, Mental health, Antidepressive Agents, 3. Good health, Breast Feeding, Multivariate Analysis, Cohort, depression, Female, France, business, Fecal Incontinence, Cohort study
Abstract: Objective To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors and to analyse the association between anal incontinence and psychological distress over the first year postpartum. Design Cohort study from pregnancy to 12 months postpartum. Setting Two university hospital maternity wards in France. Population A total of 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence were available for the 1632 women who comprise the sample for analysis. Methods Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum. Main outcome measures Anal (flatus-only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self-rated mental health. Results At 4 months postpartum, the prevalence for flatus-only incontinence was 14.4% and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR = 2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus-only incontinence and only 14.8% of the continent women. Conclusion Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered. Tweetable abstract Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered.
Published: 2019

133. Postpartum psychological distress associated with anal incontinence in the EDEN mother–child cohort

Author: Fritel, Xavier, Gachon, Bertrand, Mj, Saurel-Cubizolles, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), We acknowledge all funding sources for the EDEN study: FRM (Fondation pour la Recherche Médicale), INSERM, Ministère de la Recherche, Université Paris Sud (XI), ANR (Agence Nationale de la Recherche), IRESP (Institut de Recherche en Santé Publique), AFSSET (Agence Française pour la Surveillance et la Sécurité de l’Environnement et du Travail), Santé Publique France (Institut National Pour l’Education et la Santé, Institut National de Veille Sanitaire), DGS (Direction Générale de la Santé), ALFEDIAM (Association de Langue Française pour l'Etude du Diabète et du Métabolisme), MGEN (Mutuelle générale de l’Education Nationale), Nestlé., EDEN Mother-Child Cohort Study Group : Collaborators (27) Annesi-Maesano I, Bernard JY, Botton J, Charles MA, Dargent-Molina P, de Lauzon-Guillain B, Ducimetière P, de Agostini M, Foliguet B, Forhan A, Fritel X, Germa A, Goua V, Hankard R, Heude B, Kaminski M, Larroque B, Lelong N, Lepeule J, Magnin G, Marchand L, Nabet C, Pierre F, Slama R, Saurel-Cubizolles MJ, Schweitzer M, Thiebaugeorges O., and Fritel, Xavier
Subjects: [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, anal incontinence, depression, cohort study, postpartum, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics
Abstract: International audience; OBJECTIVE:To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors, and to analyse the association between anal incontinence and psychological distress over the first 1 year postpartum.DESIGN:Cohort study from pregnancy to 12 months postpartum SETTING: Two university hospital maternity wards in France POPULATION: 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence was available for the 1632 women who comprise the sample for analysis.METHODS:Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum.MAIN OUTCOME MEASURES:Anal (flatus-only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self-rated mental health.RESULTS:At 4 months postpartum, the prevalence for flatus-only incontinence was 14.4%and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR=2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥ 10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus-only incontinence, and only 14.8% of the continent women.CONCLUSION:Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered.
Published: 2019

134. J Am Med Dir Assoc

Author: Tristan Ferry, Virgilio Hernández-Ruiz, Emmanuel Forestier, Sylvain Goutelle, Gaëtan Gavazzi, Claire Roubaud-Baudron, Dominique Breilh, Marc Paccalin, Nicolas Grégoire, GInGer (Groupe Infectio-Gériatrie), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán - National Institute of Medical Science and Nutrition Salvador Zubiran [Mexico], CHU Bordeaux [Bordeaux], Centre Hospitalier Métropole Savoie [Chambéry], Groupe de Recherche et d'Etude du Processus Inflammatoire (GREPI), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), CHU Grenoble, Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux et antibiorésistance (PHAR2), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), HCL Groupement Hospitalier Nord [Lyon], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Bordeaux Research In Translational Oncology [Bordeaux] (BaRITOn), and Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, medicine.drug_class, Injections, Subcutaneous, Antibiotics, subcutaneously administered, MEDLINE, antibiotics, antimicrobials, 03 medical and health sciences, 0302 clinical medicine, Ambulatory care, Antibiotic therapy, medicine, Humans, 030212 general & internal medicine, Risks and benefits, Intensive care medicine, General Nursing, business.industry, Health Policy, Swallowing Disorders, Subcutaneous, General Medicine, 3. Good health, Anti-Bacterial Agents, Tolerability, Pharmaceutical Preparations, Electronic database, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Objectives To describe the rationale for subcutaneous (SC) administration of antibiotics from available published data and to make propositions to help clinicians in daily practice. Design Narrative review. Setting and Participants Hospitalized patients, persons in long-term care facilities and ambulatory care. Methods We searched the MEDLINE/PubMed electronic database for evidence supporting SC administration of antibiotics up to September 2019; the results of this primary search were supplemented by searching the references of the identified articles, as well as by searching in Google Scholar. Results Regarding tolerability, efficacy, and pharmacokinetic/pharmacodynamic profiles, most studies suggest that the SC route could be an alternative to the intravenous route, particularly for time-dependent antibiotics and among certain patient populations, such as patients with poor venous access, swallowing disorders, or behavioral disturbance. However, clinical evidence of the benefits and risks of SC antibiotic administration is still scarce and of low level. Conclusions and Implications SC administration of antibiotics may be useful in various settings such as in hospitalized patients and among those in long-term care facilities or being cared for at home. However, further clinical studies are needed to assess the pharmacokinetic/pharmacodynamic properties, as well as the risks and benefits of SC administration of antibiotics. In this review, we highlight the potential benefits of SC administration of antibiotics and address practical recommendations for its use. This information will enable improvement of treatment strategies and present the SC route as a potential option in specific situations.
Published: 2019

135. Stratégies d'oxygénation non invasives dans l'insuffisance respiratoire aiguë hypoxémique des patients immunodéprimés

Author: Coudroy, Rémi, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers, and Arnaud Thille
Subjects: Clinical study, Immunodépression, High-Flow nasal cannula oxygen therapy, Ventilation non invasive, Étude clinique, Insuffisance respiratoire aiguë, Oxygénothérapie nasale à haut débit, Acute respiratory failure, Noninvasive ventilation, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Immunosuppression, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Acute respiratory failure is the leading cause of intensive care unit admission in immunocompromised patients. Despite therapeutic progresses, their mortality rate remains intolerably high when invasive mechanical ventilation is needed. Noninvasive ventilation (NIV) is currently recommended as first-line treatment in this setting given the mortality reduction reported in old randomized trials. Recently, benefits of NIV have been challenged by large sample sized trials. However, NIV settings may have been suboptimal in these studies and consequently dampened its efficacy. Moreover, high-flow nasal cannula oxygen therapy (HFOT), a more recent oxygenation technique, was associated with promising results in various clinical settings. This project aims at conducting a randomized multicenter controlled trial comparing optimized NIV with HFOT in critically ill immunocompromised patients with acute respiratory failure. First, we validated the research hypothesis, the primary outcome, the sample size calculation and the recruitment rate of the project by means of a pilot retrospective study. Then, the NIV protocol was built based on a systematic review of literature comparing the efficacy of previously published NIV protocols. Afterwards, we identified factors independently associated with NIV failure in hypoxemic patients to identify respiratory parameters to monitor during NIV. Next, we determined mechanisms leading to physiological effects of HFOT in a bench study and a study on healthy volunteers. Last, we chose the most reliable method to estimate inspired oxygen fraction under oxygen mask in a study comparing the different existing methods in order to refine inclusion criteria of the project. All in all, these five above-mentioned preliminary studies enabled to conduct a prospective multicenter randomized trial in 30 centers in France and in Italy aiming at comparing effects of HFOT alone at 60 L/min to its association with optimized NIV (applied at least 12 hours a day with a positive end-expiratory pressure of at least 8 cmH2O and an expired tidal volume lower than 8 ml/kg of predicted body weight) on mortality at day 28 in 300 immunocompromised patients admitted to the ICU for acute respiratory failure.; L’insuffisance respiratoire aiguë est la première cause d’admission en Réanimation des patients immunodéprimés. Malgré les progrès thérapeutiques, leur mortalité reste très élevée en cas de recours à la ventilation mécanique invasive. La ventilation non invasive (VNI) est recommandée comme traitement de première ligne en raison de la diminution de mortalité rapportée dans les études randomisées anciennes. Récemment, ces bénéfices ont été remis en cause par des essais de plus grande ampleur. Toutefois, il est possible que les réglages de la VNI n’aient pas été optimaux dans ces études, diminuant ainsi son efficacité. Par ailleurs, l’oxygénothérapie nasale à haut débit (OHD) est une technique d’oxygénation récente avec des résultats prometteurs dans de nombreuses situations cliniques. L’objectif final de ce projet était de conduire une étude prospective randomisée multicentrique comparant la VNI avec des réglages optimisés à l’OHD chez les patients immunodéprimés admis en Réanimation pour une insuffisance respiratoire aiguë. Nous avons tout d’abord validé l’hypothèse de recherche du projet, son objectif principal, les calculs d’effectif et le taux de recrutement au moyen d’une étude pilote rétrospective. Puis nous avons élaboré le protocole de VNI à partir d’une revue systématique de la littérature comparant l’efficacité des différents protocoles de VNI publiés. Ensuite, nous avons analysé les facteurs de risque d’échec de la VNI chez les patients hypoxémiques afin d’identifier les paramètres physiologiques respiratoires à surveiller chez les patients traités par VNI. En outre, nous avons identifié les mécanismes responsables des effets physiologiques de l’OHD au moyen d’une étude sur banc puis chez des volontaires sains. Enfin, nous avons sélectionné la méthode d’estimation de la fraction inspirée en dioxygène mesurée au masque la plus fiable en comparant les différentes méthodes existantes dans le but d’affiner les critères d’inclusion du projet. Ces cinq études préliminaires nous ont permis de conduire une étude prospective randomisée dans 30 centres en France et en Italie dans le but de comparer les effets de l’OHD seule délivrée à 60 L/min à son association à la VNI intensive (administrée au moins 12 heures par jour avec une pression expiratoire positive d’au moins 8 cmH2O et un volume courant expiré inférieur à 8 ml/kg de poids prédit) sur la mortalité à 28 jours chez 300 patients immunodéprimés admis en Réanimation pour une insuffisance respiratoire aiguë.
Published: 2019

136. Forecasting a Fatal Decision: Direct Replication of the Predictive Validity of the Suicide-Implicit Association Test

Author: Ghina Harika-Germaneau, Nematollah Jaafari, Nina Tello, Wilfried Serra, Armand Chatard, Groupement de recherche en Psychiatrie (GDR Psychiatrie (3557)), Centre National de la Recherche Scientifique (CNRS), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherches sur la Cognition et l'Apprentissage (CeRCA), Université de Poitiers-Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS), and Centre National de la Recherche Scientifique (CNRS)-Université de Tours-Université de Poitiers
Subjects: Predictive validity, Adult, Male, 050103 clinical psychology, medicine.medical_specialty, Attitude to Death, 050109 social psychology, Suicide, Attempted, Neuropsychological Tests, Risk Assessment, Suicidal Ideation, Risk Factors, Replication (statistics), medicine, bepress|Medicine and Health Sciences|Medical Specialties|Psychiatry, Humans, 0501 psychology and cognitive sciences, Psychiatry, General Psychology, ComputingMilieux_MISCELLANEOUS, Suicide attempt, Medical record, 05 social sciences, Implicit-association test, Middle Aged, Confidence interval, Test (assessment), Open data, PsyArXiv|Social and Behavioral Sciences, Suicide, Logistic Models, PsyArXiv|Psychiatry, [SCCO.PSYC]Cognitive science/Psychology, bepress|Social and Behavioral Sciences, Female, France, Self Report, Psychology
Abstract: A previous study by Nock et al. (2010) suggested that people’s implicit identification with “death” or “suicide” can accurately predict whether they will attempt suicide several months in advance. We report the first direct and independent replication of this promising finding. Participants were 165 patients seeking treatment at a psychiatric unit in France. At baseline, patients completed the Suicide–Implicit Association Test (S–IAT), a semistructured interview, and a self-report measure of suicide ideation. Six months later, we contacted participants by phone and examined their hospital medical records to determine whether they had made a new suicide attempt. Results showed that the S–IAT did not distinguish between patients who were admitted to the hospital following suicide attempts and those who were admitted for other reasons. As in the original study, however, the S–IAT predicted suicide attempts within the 6-month follow-up period beyond well-known predictors. The test correctly classified 85% of patients (95% confidence interval = [76.91, 91.53]), supporting its diagnostic value for identifying who will make a suicide attempt.
Published: 2019

137. Implication in vivo des transporteurs pulmonaires sur la pharmacocinétique des anti-infectueux

Author: Carrez, Romain, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers, Sandrine Marchand, and Julien Brillault
Subjects: Poumon, Oseltamivir, Transporteur d'efflux, Pharmacokinetics modeling, Efflux transporters, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Nebulisation, Nébulisation oseltamivir, Lung, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Oxazolidinones, Modélisation pharmacocinétique, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: In the face of the shortage of new anti-infectives and the ever-increasing emergence of multi-resistant infectious agents, it is essential to make better use of the therapeutic arsenal at our disposal. This may involve the use of new routes of administration in order to act more effectively locally. To treat lung infections, inhalation or nebulisation appear to be a good option. It has been shown previously that rather hydrophilic molecules were good candidates for this route of administration because the pulmonary epithelium was not very permeable to them and that the active drug was sequestered in the lung. On the other hand, for lipophilic compounds that diffuse rapidly through the epithelium, pulmonary administration is of little therapeutic interest. The situation becomes more complex in the case of prodrug nebulization and/or when efflux pumps are involved in the pulmonary distribution of anti-infectives. In order to better characterize the role of efflux pumps in the pulmonary distribution of anti-infectives in vitro and their impact in vivo, the pulmonary distribution of several anti-infectives was evaluated according to a standardized protocol in rats, allowing measurement and comparison of free plasma and pulmonary epithelial fluid (ELF) concentrations after systemic and intratracheal administration. The first study focuses on the pulmonary distribution of oseltamivir, an anti-viral active against influenza, which is administered as a prodrug (oseltamivir phosphate (OP)). It has been shown in vitro that OP (non-active) is a substrate for efflux pumps and that this active transport is characterized in vivo by higher local concentrations of OP in ELF than in plasma regardless of the route of administration (intravenous or nebulization). However, these high pulmonary prodrug concentrations have little effect on pulmonary concentrations of the active molecule (oseltamivir carboxylate (OC)), due to low local conversion to the active compound and pulmonary permeability of the OC. The second study presents the case of oxazolidinones (linezolide and tedizolide) used to treat Gram-positive infections for which in vivo studies in humans had previously shown local concentrations (ELF) higher than plasma concentrations after oral administration. These data were found in rats according to our standardized protocol and supplemented with post-nebulization data, suggesting a major role for transporters in the pulmonary diffusion of tedizolide. However, membrane permeability and in vitro inhibition studies conducted in a cellular model (NCI-H441) were unable to demonstrate the role of these efflux transporters on high pulmonary concentrations. Other explanations have been considered such as protein binding in ELF or intracellular penetration of active compound. In conclusion, these in vivo and in vitro studies on 4 active compounds have allowed us to improve our knowledge of the parameters that govern the pulmonary diffusion of anti-infectives such as permeability and affinity for efflux transporters and to show the complexity of extrapolation in vitro/in vivo.; Face à la pénurie de nouveaux anti-infectieux et à l’émergence toujours plus importante d’agents infectieux multi-résistants, il est primordial de mieux utiliser l’arsenal thérapeutique à notre disposition. Cela peut passer par l’utilisation de nouvelles voies d’administration afin d’agir plus efficacement localement. Pour traiter des infections pulmonaires, l’inhalation ou la nébulisation apparaissent comme des voies logiquement intéressantes. Il a été montré précédemment que les molécules plutôt hydrophiles étaient des bonnes candidates à cette voie d’administration car l’épithélium pulmonaire leur était peu perméable et que le principe actif était séquestré au niveau du poumon. A l’inverse, pour les composés lipophiles qui diffusent rapidement à travers l’épithélium, l’administration pulmonaire ne présente que peu d’intérêt thérapeutique. La situation se complexifie dans le cas de la nébulisation de promédicaments et/ou lorsque des pompes d’efflux interviennent dans la distribution pulmonaire des anti-infectieux. Afin de mieux caractériser le rôle des pompes d’efflux dans la distribution pulmonaire des anti-infectieux in vitro et leur impact in vivo, la distribution pulmonaire de plusieurs anti-infectieux a été évaluée selon un protocole standardisé chez le rat, permettant de mesurer et donc de comparer les concentrations libres plasmatiques et dans le liquide épithélial pulmonaire (ELF) après administrations systémique et intratrachéale. Le premier travail porte sur la distribution pulmonaire de l’oseltamivir, un anti-viral actif contre la grippe, qui est administré sous forme de promédicament (oseltamivir phosphate (OP)). Il a été montré in vitro que l’OP (non actif) est substrat de pompes d’efflux et que ce transport actif se caractérise in vivo par des concentrations locales plus élevées d’OP dans l’ELF que dans le plasma quelle que soit la voie d’administration (intraveineuse ou nébulisation). Cependant, ces fortes concentrations pulmonaires en promédicament n’ont que peu d’effet sur les concentrations pulmonaires en molécule active (oseltamivir carboxylate (OC)), du fait d’une faible conversion locale en composé actif et de la perméabilité pulmonaire de l’OC. La deuxième étude présente le cas des oxazolidinones (linézolide et tédizolide) utilisées pour traiter les infections à Gram positif pour lesquels des études in vivo préalablement réalisées chez l’homme avaient montrées des concentrations locales (ELF) supérieures aux concentrations plasmatiques après administration orale. Ces données ont été retrouvées chez le rat selon notre protocole standardisé et complétées avec des données après nébulisation, suggérant un rôle majeur des transporteurs dans ladiffusion pulmonaire notamment du tedizolide. Cependant, les études de perméabilité membranaire et d’inhibition in vitro réalisées sur un modèle cellulaire (NCI-H441) n’ont pas pu mettre en évidence le rôle de ces transporteurs d’efflux sur les concentrations pulmonaires élevées. D’autres explications ont été envisagées comme la liaison à des protéines dans l’ELF ou encore la pénétration intracellulaire des principes actifs. En conclusion, ces études in vivo et in vitro sur 4 composés nous ont permis d’améliorer nos connaissances sur les paramètres qui gouvernent la diffusion pulmonaire des anti-infectieux telles que la perméabilité et l’affinité pour des transporteurs d’efflux et de montrer la complexité d’extrapolation in vitro/in vivo.
Published: 2019

138. Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An 'In Vivo' Innovative Biomechanical Study

Author: Laetitia Fradet, Henri Panjo, David Desseauve, A. Decatoire, Anna Fernandez, Patrick Lacouture, Fabrice Pierre, Robotique, Biomécanique, Sport, Santé (RoBioSS), Département Génie Mécanique et Systèmes Complexes (GMSC), Institut Pprime (PPRIME), Université de Poitiers-ENSMA-Centre National de la Recherche Scientifique (CNRS)-Université de Poitiers-ENSMA-Centre National de la Recherche Scientifique (CNRS)-Institut Pprime (PPRIME), Université de Poitiers-ENSMA-Centre National de la Recherche Scientifique (CNRS)-Université de Poitiers-ENSMA-Centre National de la Recherche Scientifique (CNRS), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: [PHYS.MPHY]Physics [physics]/Mathematical Physics [math-ph], Pelvic inlet, lcsh:Medicine, Thigh, Joint laxity, 0302 clinical medicine, Pregnancy, 030212 general & internal medicine, [PHYS.MECA.MEFL]Physics [physics]/Mechanics [physics]/Fluid mechanics [physics.class-ph], lcsh:Science, Orthodontics, [PHYS.MECA.VIBR]Physics [physics]/Mechanics [physics]/Vibrations [physics.class-ph], education.field_of_study, Lumbar Vertebrae, 030219 obstetrics & reproductive medicine, Multidisciplinary, [SPI.FLUID]Engineering Sciences [physics]/Reactive fluid environment, Biomechanics, [CHIM.MATE]Chemical Sciences/Material chemistry, Biomechanical Phenomena, [PHYS.MECA.ACOU]Physics [physics]/Mechanics [physics]/Acoustics [physics.class-ph], [SPI.ELEC]Engineering Sciences [physics]/Electromagnetism, medicine.anatomical_structure, Female, Hip Joint, Biomedical engineering, musculoskeletal diseases, Posture, Population, Article, Pelvis, [SPI.AUTO]Engineering Sciences [physics]/Automatic, 03 medical and health sciences, Lumbar, [PHYS.QPHY]Physics [physics]/Quantum Physics [quant-ph], medicine, Humans, Body Weights and Measures, [PHYS.MECA.BIOM]Physics [physics]/Mechanics [physics]/Biomechanics [physics.med-ph], education, [SPI.ACOU]Engineering Sciences [physics]/Acoustics [physics.class-ph], business.industry, [SPI.NRJ]Engineering Sciences [physics]/Electric power, lcsh:R, Parturition, Translational research, Lumbar Curve, [PHYS.MECA.MSMECA]Physics [physics]/Mechanics [physics]/Materials and structures in mechanics [physics.class-ph], Delivery, Obstetric, body regions, [CHIM.POLY]Chemical Sciences/Polymers, [PHYS.MECA.THER]Physics [physics]/Mechanics [physics]/Thermics [physics.class-ph], lcsh:Q, business
Abstract: The study aimed to assess the associations between the pelvis orientation, lumbar curve and thigh postures throughout pregnancy in a population of healthy women. Additionally, optimal mechanical birth conditions in terms of the pelvic inlet and lumbar curve were researched. The individuals’ posture was assessed with three-dimensional motion analysis and the lumbar curve with the Epionics SPINE system. The association between the hip joint angles (flexion and abduction), the pelvis external conjugate, and lumbar curve position was assessed with a generalized linear mixed model (GLMM) adjusted to individuals’ characteristics. Joint laxity was assessed with a modified Jobbin’s extensometer. For all of the subjects, hip flexion and hip abduction were significantly associated with the angle between the external conjugate and spine, with higher correlation in the multivariate regression model. The association between hip flexion and the lumbar curve was less significant in multivariate than univariate regression analysis. Optimal birth conditions were never reached. The findings contribute to the understanding of the association between the hip position (flexion and abduction), pelvic orientation, and lumbar curve adjusted for joint laxity in healthy pregnant women. They lay the groundwork for future research in the field of obstetrical biomechanics.
Published: 2019

139. Balloon catheter vs oxytocin alone for induction of labor in women with a previous cesarean section: A randomized controlled trial

Author: Mélie Sarreau, Olivier Morel, Brigitte Fontaine, Pascal Villemonteix, Stéphanie Ragot, Fabrice Pierre, Patrice Poulain, Helene Isly, Pierre Mares, E. Mousty, Alain Godard, Service de gynécologie et obstétrique [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier d'Angoulême (CH Angoulême), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Service d'Obstétrique et de Gynécologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier Nord des Deux Sèvres, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de Gynécologie-obstétrique [CH de Châtellerault], CH de Châtellerault, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-hôpital Sud
Subjects: Adult, medicine.medical_specialty, medicine.medical_treatment, Bishop score, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Oxytocin, law.invention, Catheterization, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Pregnancy, Oxytocics, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Rupture of membranes, Humans, 030212 general & internal medicine, Labor, Induced, Prospective Studies, 10. No inequality, Cervix, ComputingMilieux_MISCELLANEOUS, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Vaginal delivery, Cephalic presentation, Balloon catheter, Obstetrics and Gynecology, General Medicine, Vaginal Birth after Cesarean, 3. Good health, medicine.anatomical_structure, Labor induction, Female, France, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cervical Ripening
Abstract: Introduction The aim of this study was to compare the efficacy and maternal-neonatal morbidity between balloon catheter and oxytocin for induction of labor in women with a previous cesarean section and an unfavorable cervix. Material and methods This open-label randomized controlled trial took place in seven French hospitals. Inclusion criteria were medical indication for labor induction in pregnant women, ≥37 weeks, with lower segment cesarean section, Bishop score ≤4, no pre-labor rupture of membranes, singleton fetus in cephalic presentation. Women were allocated randomly to induction with a 50-mL balloon catheter for 12 hours or a low-dose oxytocin infusion. Primary outcome was the rate of vaginal birth. Secondary outcomes were maternal and neonatal complications. Results The study enrolled 204 women from 26 December 2010 to 31 December 2013: 101 were allocated to receive balloon catheter and 103 to oxytocin. Vaginal birth rate was 50% (n = 51) in the balloon catheter group vs 37% (n = 38) in the oxytocin group (P = 0.050). Maternal and neonatal morbidity did not differ between balloon catheter and oxytocin groups: two uterine dehiscences vs one, one vs four maternal infections, five vs two hemorrhages and 11 vs five neonatal transfers, respectively. Heterogeneity of treatment effect for vaginal delivery was observed across initial Bishop scores. Balloon catheter was more effective for low values of bishop score. Conclusions Balloon catheter tended to be associated with a higher probability of vaginal delivery as compared with low-dose intravenous oxytocin when used for induction of labor in women with a previous cesarean section and low Bishop score at induction.
Published: 2019

140. Ageing stereotypes and prodromal Alzheimer’s disease (AGING): study protocol for an ongoing randomised clinical study

Author: Gauthier, Kim, Morand, Alexandrine, Dutheil, Frederic, Alescio-Lautier, Béatrice, Boucraut, José, Clarys, David, Eustache, Francis, Girard, Nadine, Guedj, Eric, Mazerolle, Marie, Paccalin, Marc, de la Sayette, Vincent, Zaréa, Aline, Huguet, Pascal, Michel, Bernard F, Desgranges, Béatrice, Régner, Isabelle, Laboratoire de psychologie cognitive (LPC), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Neuropsychologie et imagerie de la mémoire humaine (NIMH), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Psychologie Sociale et Cognitive (LAPSCO), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Service Santé Travail Environnement [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Neurosciences sensorielles et cognitives (NSC), Laboratoire d'Immunologie [Hôpital de la Conception - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION)-Centre National de la Recherche Scientifique (CNRS), Institut de Neurosciences de la Timone (INT), Centre de Recherches sur la Cognition et l'Apprentissage (CeRCA), Université de Poitiers-Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS), Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Institut FRESNEL (FRESNEL), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), Imagerie MOléculaire pour applications THéranostiques personnalisées (IMOTHEP), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS)- Hôpital de la Timone [CHU - APHM] (TIMONE), Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (UAR 3124) (MSHE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de Neurologie Comportementale [Hôpital Sainte Marguerite - APHM], Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), This study was supported by a grant from the French National Research Agency (ANR) (grant no. ANR-16-CE36-0005-01)., Collaborators Members of AGING Consortium: Hospitals : José Broucraut, Boris Dufournet, Carine Giallo, Nadine Girard, Eric Guedj, Bernard François Michel, Nathalie Sambuchi (Marseille Public Hospitals, France: central site), Pierre Branger, Julien Cogez, Sabine Fradin, Frédérique Grandhomme, Catherine Lalevée, Nadège Loisel, Olivier Martinaud, Alice Pélerin, Mélissa Pierre, Vincent de La Sayette (Caen University Hospital, France), Alain Manrique (Cyceron Biomedical Imaging Centre, Caen, France), Vanessa Baudifier, Foucaud du Boisgueheneuc, Adrien Julian, Jean-Claude Lecron, Isabelle Merlet, Claudie Ornon, Marc Paccalin (Poitiers University Hospital, France), Sandrine Bioux, Evangeline Bliaux, Didier Hannequin, Véronique Hannier, Maud Loubeyre, Dorothée Pouliquen, Muriel Quillard-Muraine, David Wallon, Aline Zaréa (Rouen University Hospital, France). Laboratories : Kim Gauthier, Isabelle Régner (Cognitive Psychology Laboratory, Aix Marseille Univ, Marseille, France), Béatrice Alescio-Lautier, Véronique Paban, Arnaud Weill (Sensory and Cognitive Neuroscience Laboratory, Aix Marseille Univ ‑ CNRS, Marseille, France), David Clarys, Michel Isingrini, Sandrine Kalenzaga, François Rigalleau (Centre for Research on Cognition and Learning, CNRS ‑ Poitiers University ‑ Tours University, Poitiers, France), Ahmed Abbas, Julien Chavant, Béatrice Desgranges, Francis Eustache, Florence Fraisse, Mickael Laisney, Alexandrine Morand, Shailendra Segobin (Neuropsychology and Human Memory Imaging research unit, Caen University Hospital ‑ Caen Normandy University ‑ PSL Research University ‑ EPHE ‑ INSERM, Caen, France), Pierre Chausse, Frédéric Dutheil, Julien Guegan, Pascal Huguet, Guillaume Vallet (Social and Cognitive Psychology Laboratory, University of Clermont Auvergne ‑ CNRS, Clermont-Ferrand, France), Sophie Blanchet, Pascale Piolino (Memory and Cognition, Institute of Psychology and Centre for Psychiatriy and Neurosciences, INSERM ‑ University of Paris Descartes, Paris, France), Marie Mazerolle (Psychology Department and Laboratory, University of Bourgundy Franche-Comté, France)., ANR-16-CE36-0005,AGING,Impact potentiel des stéréotypes du vieillissement sur l'évaluation des déficits mnésiques et le repérage de l'état prodromal de la maladie d'Alzheimer(2016), Laboratoire de Neurosciences Cognitives [Marseille] (LNC), Département de Médecine Nucléaire [AP-HM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)- Hôpital Nord [CHU - APHM], Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Centre National de la Recherche Scientifique (CNRS)-École Centrale de Marseille (ECM)-Aix Marseille Université (AMU), Centre National de la Recherche Scientifique (CNRS)-École Centrale de Marseille (ECM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-École Centrale de Marseille (ECM)-Aix Marseille Université (AMU)- Hôpital de la Timone [CHU - APHM] (TIMONE), Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (MSHE), Normandie Université (NU)-Normandie Université (NU)-École pratique des hautes études (EPHE), Eustache, Francis, Impact potentiel des stéréotypes du vieillissement sur l'évaluation des déficits mnésiques et le repérage de l'état prodromal de la maladie d'Alzheimer - - AGING2016 - ANR-16-CE36-0005 - AAPG2016 - VALID, Centre National de la Recherche Scientifique (CNRS)-Université de Tours-Université de Poitiers, and Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Aging, Stereotyping, diagnosis, Neuropsychological Tests, aging stereotypes, amyloid PET, [SCCO]Cognitive science, mild cognitive impairment, Neurology, Memory, stereotype threat, Protocol, Humans, Regression Analysis, Cognitive Dysfunction, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Alzheimer disease, Randomized Controlled Trials as Topic
Abstract: International audience; Introduction The number of older people diagnosed with amnestic mild cognitive impairment (aMCI), the prodromal state of Alzheimer's disease (AD), is increasing worldwide. However, some patients with aMCI never convert to the AD type of dementia, with some remaining stable and others reverting to normal. This overdiagnosis bias has been largely overlooked and gone unexplained. There is ample evidence in the laboratory that negative ageing stereotypes (eg, the culturally shared belief that ageing inescapably causes severe cognitive decline) contribute to the deteriorating cognitive performances of healthy older adults, leading them to perform below their true abilities. The study described here is intended to test for the first time whether such stereotypes also impair patients’ cognitive performances during neuropsychological examinations in memory clinics, resulting in overdiagnosis of aMCI. Methods and analysis The ongoing study is a 4-year randomised clinical trial comparing patients’ physiological stress and cognitive performances during neuropsychological testing in memory clinics. A total of 260 patients attending their first cognitive evaluation will be randomised to either a standard condition of test administration, assumed here to implicitly activate negative ageing stereotypes or a reduced-threat instruction condition designed to alleviate the anxiety arising from these stereotypes. Both groups will be tested with the same test battery and stress biomarkers. For 30 patients diagnosed with aMCI in each group (n=60), biomarkers of neurodegeneration and amyloidopathy will be used to distinguish between aMCI with normal versus abnormal AD biomarkers. A 9-month follow-up will be performed on all patients to identify those whose cognitive performances remain stable, deteriorate or improve. Ethics and dissemination This protocol has been approved by the French National Agency for Medicines and Health Products Safety and the Sud-Est I French Ethics Committee (2017-A00946-47). Results will be published in peer-reviewed journals. Trial registration number NCT03138018 .
Published: 2019

141. Comparison of the removal of uraemic toxins with medium cut-off and high-flux dialysers: a randomized clinical trial

Author: Pierre Jamet, Florent Joly, Frank Bridoux, Thierry Hauet, Valentin Bossard, Sandrine Joffrion, Mohamed Belmouaz, Elise Chikhi, Elise Gand, Marc Bauwens, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Département de Néphrologie [CHU Poitiers], Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Service de Néphrologie CHU Poitiers
Subjects: Male, medicine.medical_specialty, Homocysteine, Anemia, medicine.medical_treatment, 030232 urology & nephrology, Nutritional Status, Hemodiafiltration, 030204 cardiovascular system & hematology, Gastroenterology, End stage renal disease, middle-weight uraemic toxins, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Immunoglobulin lambda-Chains, Renal Dialysis, Interquartile range, Internal medicine, medicine, Humans, Prospective Studies, Hypoalbuminemia, Prospective cohort study, albumin, Aged, Toxins, Biological, 2. Zero hunger, Transplantation, Cross-Over Studies, end-stage renal disease, business.industry, Surrogate endpoint, medicine.disease, 3. Good health, chemistry, Nephrology, medium cut-off dialyser, Female, Hemodialysis, expanded haemodialysis, business, Dialysis, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: BackgroundAccumulation of middle-weight uraemic toxins in haemodialysis (HD) patients results in increased morbidity and mortality. Whether medium cut-off HD (MCO-HD) improves removal of middle-weight uraemic toxins remains to be demonstrated.MethodsThis cross-over prospective study included 40 patients randomly assigned to receive either 3 months of MCO-HD followed by 3 months of high-flux HD (HF-HD), or vice versa. The primary endpoint was myoglobin reduction ratio (RR) after 3 months of MCO-HD. Secondary endpoints were the effect of MCO-HD on other middle-weight toxins and protein-bound toxins, and on parameters of nutrition, inflammation, anaemia and oxidative stress.ResultsCompared with HF-HD, MCO-HD provided higher mean RR of myoglobin (36 ± 8 versus 57 ± 13%, P ConclusionsCompared with HF-HD, MCO-HD provides higher myoglobin and other middle molecules RR and is associated with moderate hypoalbuminemia. The potential benefits of this strategy on long-term clinical outcomes deserve further evaluation.
Published: 2019

142. Visual search for verbal material in patients with obsessive–compulsive disorder

Author: Ghina Harika-Germaneau, François Rigalleau, Jean-François Rouet, Mickaël Frasca, Eric Fakra, Florian Ferreri, Fabiano Botta, Christine Ros, Nematollah Jaafari, Nicolas Vibert, Unité de recherche clinique intersectorielle du Centre Hospitalier Henri Laborit, Centre Hospitalier Henri Laborit (CHL), Centre de Recherches sur la Cognition et l'Apprentissage (CeRCA), Centre National de la Recherche Scientifique (CNRS)-Université de Tours-Université de Poitiers, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Département de psychiatrie et d'addictologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne)-Hôpital Nord (Saint Etienne), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Poitiers-Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Male, Obsessive-Compulsive Disorder, medicine.medical_specialty, Adolescent, Eye Movements, genetic structures, Verbal material, Audiology, Obsessive–compulsive disorder, behavioral disciplines and activities, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Word list, Obsessive compulsive, mental disorders, medicine, Humans, Attention, In patient, Biological Psychiatry, Aged, Visual search, Verbal Behavior, Working memory, Subliminal stimuli, Eye movement, Middle Aged, humanities, Semantics, 030227 psychiatry, Psychiatry and Mental health, Reading, [SCCO.PSYC]Cognitive science/Psychology, Visual Perception, Eye tracking, Female, Selective attention, Eye-tracking, Psychology, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, psychological phenomena and processes, 030217 neurology & neurosurgery
Abstract: International audience; This study aimed at investigating attentional mechanisms in obsessive-compulsive disorder (OCD) by analysing how visual search processes are modulated by normal and obsession-related distracting information in OCD patients and whether these modulations differ from those observed in healthy people. OCD patients were asked to search for a target word within distractor words that could be orthographically similar to the target, semantically related to the target, semantically related to the most typical obsessions/compulsions observed in OCD patients, or unrelated to the target. Patients' performance and eye movements were compared with those of individually matched healthy controls. In controls, the distractors that were visually similar to the target mostly captured attention. Conversely, patients' attention was captured equally by all kinds of distractor words, whatever their similarity with the target, except obsession-related distractors that attracted patients' attention less than the other distractors. OCD had a major impact on the mostly subliminal mechanisms that guide attention within the search display, but had much less impact on the distractor rejection processes that take place when a distractor is fixated. Hence, visual search in OCD is characterized by abnormal subliminal, but not supraliminal, processing of obsession-related information and by an impaired ability to inhibit task-irrelevant inputs.
Published: 2018

143. Liver fibrosis is associated with cutaneous inflammation in the imiquimod-induced murine model of psoriasiform dermatitis

Author: N. Venisse, Jiad N. Mcheik, Philippe Vasseur, Christine Silvain, Laure Favot, Jean-Claude Lecron, Mathilde Pohin, Jean-François Jégou, Franck Morel, Laboratoire Inflammation, Tissus épithéliaux et Cytokines (LITEC), Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre hospitalier universitaire de Poitiers (CHU Poitiers)
Subjects: Liver Cirrhosis, Male, 0301 basic medicine, Pathology, medicine.medical_specialty, Interferon Inducers, education, Imiquimod, macromolecular substances, Dermatology, [SDV.IMM.II]Life Sciences [q-bio]/Immunology/Innate immunity, 030207 dermatology & venereal diseases, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Fibrosis, Psoriasis, medicine, Animals, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM], Psoriasiform Dermatitis, Sirius Red, ComputingMilieux_MISCELLANEOUS, health care economics and organizations, Hepatitis, Liver injury, integumentary system, business.industry, medicine.disease, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM], 3. Good health, Mice, Inbred C57BL, Disease Models, Animal, 030104 developmental biology, [SDV.IMM.IA]Life Sciences [q-bio]/Immunology/Adaptive immunology, chemistry, Immunology, Hepatic stellate cell, Drug Eruptions, Chemical and Drug Induced Liver Injury, business, [SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology, medicine.drug
Abstract: SummaryBackground Psoriasis associates several extra-cutaneous manifestations. Little is known about hepatic parameters specifically associated with psoriasis. Objective To study whether psoriasiform dermatitis is associated with liver injury. Methods We studied liver parameters of inflammation and fibrosis in a murine model of psoriasiform dermatitis induced by topical application of imiquimod for nine weeks. Results Topical treatment with imiquimod induced a form of psoriasiform dermatitis reminiscent of the human disorder, characterized by thickened and scaly skin, psoriasiform epidermal hyperplasia, altered keratinocyte differentiation, and cutaneous overexpression of interleukin-17A. Mice with dermatitis displayed hepatitis, as shown by elevation of plasma transaminase levels, as well as portal and periportal hepatitis characterized by T lymphocyte (CD3e+) and polymorphonuclear cell (Gr1+) infiltrates. The hepatitis progressed toward liver fibrogenesis, as shown by excessive Sirius red staining, consistent with the expression of alpha-smooth muscle actin by hepatic stellate cells. Conclusions These results indicate that liver inflammation and fibrosis is associated with experimental psoriasiform dermatitis. Our results suggest that psoriatic inflammation may be associated with specific liver injury. This article is protected by copyright. All rights reserved.
Published: 2018

144. Aggressive primary treatments with favourable 5-year survival for screen-interval breast cancers

Author: Alexandre Quillet, Pierre Ingrand, Gautier Defossez, Registre général des cancers de la région Poitou-Charentes [Poitiers], Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), The present study was funded by The French National Cancer Institute (grant number INCA_6955), which participated in data collection and analysis. The Poitou-Charentes cancer registry is sponsored by the Agence Régionale de Santé Nouvelle-Aquitaine., and Duchange, Nathalie
Subjects: Oncology, Cancer Research, Survival, medicine.medical_treatment, 0302 clinical medicine, Surgical oncology, Risk Factors, 030212 general & internal medicine, Registries, Neoplasm Metastasis, Aged, 80 and over, Middle Aged, Cancer registry, Prognosis, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, 3. Good health, Survival Rate, 030220 oncology & carcinogenesis, Female, France, Mammography, Research Article, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, lcsh:RC254-282, 03 medical and health sciences, Breast cancer, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, Genetics, medicine, Humans, Interval Cancer, Survival rate, Radical mastectomy, Mass screening, Aged, Neoplasm Staging, Proportional Hazards Models, business.industry, Proportional hazards model, Cancer, Data linkage, medicine.disease, Treatment, Neoplasm Grading, Breast neoplasms, business
Abstract: International audience; BACKGROUND:To assess the impact of the participation in screening programme according to the mode of detection on the early diagnosis, treatment, and specific survival outcomes in women with breast cancer.METHODS:Women diagnosed with invasive breast cancer in Poitou-Charentes region (France) between 2008 and 2009 were classified into three groups, using data linkage of cancer registry, vital statistics and French organized screening programme: the screening programme (SP), interval cancer (IC), and non-screening programme detected cancer (NSP) groups. Specific survival rates were analysed using the Kaplan-Meier method and Cox proportional hazard models.RESULTS:Among 1613 patients, 65.7% (n = 1059) participated in a screening programme. The interval cancer rate was 17.1% (n = 181). Tumours in the IC group were diagnosed at a more advanced stage, i.e. with further regional lymph node metastasis or local spread, than those in the SP group (p
Published: 2018

145. Superoxide dismutase 2 (SOD2) contributes to genetic stability of native and T315I-mutated BCR-ABL expressing leukemic cells

Author: Sandrine Girerd, Jean-Claude Chomel, Djamel Aggoune, Annelise Bennaceur-Griscelli, Nathalie Sorel, Lucie Tosca, François Guilhot, Christine Vignon, Fatima Dkhissi, Marie Laure Bonnet, Denis Biard, Gérard Tachdjian, Olivier Herault, Joelle Guilhot, Christophe Desterke, Ali G. Turhan, Service d'histologie, embryologie et cytogénétique [Béclère], Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre National de la Recherche Scientifique (CNRS), TEAM CELLULAR ENGINEERING AND HUMAN SYNDROMES, Commissariat à l’énergie atomique et aux énergies alternatives [Fontenay-aux-Roses] (CEA DSV), INSERM CIC 0802 (INSERM - CHU de Poitiers), Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Institut National de la Santé et de la Recherche Médicale (INSERM), Progression et Dissémination Cérébrales des cellules Tumorales (PRODICET), Université de Poitiers, Université Paris-Sud - Paris 11 (UP11), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Modèles de Cellules Souches Malignes et Thérapeutiques, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Hôpitaux Paris-Sud
Subjects: 0301 basic medicine, Genetic instability, [SDV]Life Sciences [q-bio], Fusion Proteins, bcr-abl, Biophysics, SOD2, Biology, Biochemistry, Cohort Studies, Superoxide dismutase, 03 medical and health sciences, Cell Line, Tumor, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, hemic and lymphatic diseases, Gene expression, Humans, Point Mutation, Gene silencing, Gene Silencing, skin and connective tissue diseases, CML, Molecular Biology, Gene, chemistry.chemical_classification, Reactive oxygen species, Silencing, Gene Expression Regulation, Leukemic, Superoxide Dismutase, Myeloid leukemia, Peroxiredoxins, Cell Biology, 030104 developmental biology, chemistry, Cell culture, Mutation, cardiovascular system, Cancer research, biology.protein
Abstract: International audience; Manganese Superoxide dismutase 2 (SOD2) plays a crucial role in antioxidant defense but there are no data suggesting its role in genetic instability in CML. We evaluated the effects of SOD2 silencing in human UT7 cell line expressing either non-mutated or T315I-mutated BCR-ABL. Array-CGH experiments detected in BCR-ABL-expressing cells silenced for SOD2 a major genetic instability within several chromosomal loci, especially in regions carrying the glypican family (duplicated) and β-defensin genes (deleted). In a large cohort of patients with chronic myeloid leukemia (CML), a significant decrease of SOD2 mRNA was observed. This reduction appeared inversely correlated with leukocytosis and Sokal score, high-risk patients showing lower SOD2 levels. The analysis of anti-oxidant gene expression analysis revealed a specific down-regulation of the expression of PRDX2 in UT7-BCR-ABL and UT7-T315I cells silenced for SOD2 expression. Gene set enrichment analysis performed between the two SOD2-dependent classes of CML patients revealed a significant enrichment of Reactive Oxygen Species (ROS) Pathway. Our data provide the first evidence for a link between SOD2 expression and genetic instability in CML. Consequently, SOD2 mRNA levels should be analyzed in prospective studies as patients with low SOD2 expression could be more prone to develop a mutator phenotype under TKI therapies.
Published: 2018

146. Lack of effects of simvastatin on smoking cessation in humans: A double-blind, randomized, placebo-controlled clinical study

Author: Pierre-Jean Saulnier, Claire Lafay-Chebassier, Marcello Solinas, Isabelle Ingrand, Marie-Christine Perault-Pochat, Emilie Dugast, Pierre Ingrand, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'Épidémiologie et biostatistique [Poitiers], Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers-Université de Poitiers, Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de pharmacologie clinique et de sensibilisation [CHU Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), This study was funded by the Fondation de l’Avenir, the Fondation Cornwell Mann in the framework of the call for project « Sport et Collection » and the INSERM. Te authors are grateful to investigators: Dr B Bareth, Dr F Birault, Dr G Coulombier, Dr X Lemercier, Dr J Marin and Dr M Underner. We thank all the patients participating in the trial, the staf of the Inserm CIC1402, Poitiers, France and the Pharmacy department of the Poitiers University Hospital., and SOLINAS, Marcello
Subjects: Adult, Male, Nicotine, Simvastatin, medicine.medical_specialty, [SDV.SP.MED] Life Sciences [q-bio]/Pharmaceutical sciences/Medication, medicine.medical_treatment, media_common.quotation_subject, lcsh:Medicine, Craving, Placebo, Proof of Concept Study, Article, Double blind, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication, Informed consent, Internal medicine, Tobacco Smoking, Humans, Medicine, 030212 general & internal medicine, lcsh:Science, Smoking Reduction, media_common, Multidisciplinary, business.industry, Smoking, lcsh:R, Tobacco Use Disorder, Middle Aged, Abstinence, 3. Good health, Treatment Outcome, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Smoking cessation, Female, Smoking Cessation, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, lcsh:Q, medicine.symptom, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: International audience; A recent pre-clinical study has shown that brain-penetrating statins can reduce risks of relapse to cocaine and nicotine addiction in rats. Based on this information, we conducted a randomized, double-blind, placebo-controlled, proof-of-concept trial to assess the efficacy of simvastatin in smoking cessation. After informed consent, 118 participants received behavioral cessation support and were randomly assigned to a 3-month treatment with simvastatin or placebo. The primary outcome was biochemically verified abstinence or smoking reduction at 3-month post-target quit date (TQD). Secondary outcomes were abstinence during weeks 9-12 post-TQD, prolonged abstinence or reduction at months 6 and 12 post-TQD, safety and craving assessed at each visit during the 3-month period of treatment. Simvastatin treatment was not associated with higher 3-month abstinence or smoking reduction compared to placebo. There was no significant difference in any of the secondary outcomes. Simvastatin was well tolerated. Over 3 and 9 months follow-up period, 78% simvastatin and 69% placebo participants were retained in the study. At 6 and 12 months, smoking remained significantly reduced from baseline in both groups. Our results demonstrate that a 3-month simvastatin treatment (40 mg/day), added to individual behavioral cessation support, does not improve significantly smoking cessation compared to placebo in humans. According to the World Health Organization, smoking is the largest preventable cause of disease and death in the world 1. Although the prevalence of everyday tobacco use has dropped in most nations since 1990, the total number of smokers has increased 2. In 2015, 6.4 million deaths worldwide were attributable to smoking, representing a 4.7% increase in smoking-attributable deaths since 2005. This number is likely to reach 8 to 10 millions a year by 2030 1,2. The benefits of smoking cessation have been clearly proven in terms of morbidity and mortality for different diseases related to tobacco, especially for lung cancer 3,4. Although over 70% of smokers want to quit, less than 5% of quit attempts are successful annually 5. Currently, there are only 3 first-line approved medications in the USA and Europe for smoking-cessation: nicotine replacement therapy (NRT), sustained release bupropion, and varenicline, which are widely recommended in many national guidelines. Nevertheless, the therapeutic effectiveness of NRT is relatively modest, bupropion is not widely used because of its safety profile and varenicline's use is limited because of fear of potential cardio-vascular or neuropsychiatric adverse effects 6,7. Therefore, the discovery of new medications that could facilitate abstinence and reduce relapse to cigarette use represents a pressing necessity to reduce risks associated with tobacco smoking. We recently reported in rats that brain-penetrating statins-simvastatin and atorvastatin-can reduce risks of relapse to addiction 8. In fact, chronic treatment with low doses of statins daily during a 21-day period of abstinence , significantly reduced cocaine or nicotine seeking compared with placebo without altering seeking for food. Based on this information, we hypothesized that simvastatin could have beneficial effects on smoking cessation in
Published: 2018

147. Anterior pallidal deep brain stimulation for Tourette's syndrome: a randomised, double-blind, controlled trial

Author: Marie-Laure Welter, Jean-Luc Houeto, Stéphane Thobois, Benoit Bataille, Marc Guenot, Yulia Worbe, Andreas Hartmann, Virginie Czernecki, Eric Bardinet, Jerome Yelnik, Sophie Tezenas du Montcel, Yves Agid, Marie Vidailhet, Philippe Cornu, Audrey Tanguy, Solène Ansquer, Nematollah Jaafari, Emmanuel Poulet, Giulia Serra, Pierre Burbaud, Emmanuel Cuny, Bruno Aouizerate, Pierre Pollak, Stephan Chabardes, Mircea Polosan, Michel Borg, Denys Fontaine, Bruno Giordana, Sylvie Raoul, Tiphaine Rouaud, Anne Sauvaget, Isabelle Jalenques, Carine Karachi, Luc Mallet, M.L. Welter, E. Cuny, P. Derkinderen, D. Fontaine, J.L. Houeto, I. Jalenques, L. Mallet, P. Pollak, S. Thobois, A. Bissery, H. Oya, E. Bardinet, J. Yelnik, A. Buot, V. Czernecki, S. Tezenas du Montcel, A. Tanguy, M. Hajji, C. Karachi, A. Hartmann, Y. Agid, Y. Worbe, D. Dormont, M. Vidailhet, P. Cornu, B. Aouizerate, P. Burbaud, F. Durif, C. Fauchon, F. Rondepierre, P. Derost, M. Aya Kombo, M. Polosan, S. Chabardès, A. Krainik, P. Krack, B. Piallat, M. Guenot, E. Poulet, H. Klinger, G. Serra, E. Broussolle, T. Rouaud, A. Sauvaget, P. Damier, S Raoul, M. Borg, B. Giordana, M.-N. Magnie-Mauro, N. Jaafari, B. Bataille, S. Ansquer, I. Benatru, A. Fradet, E. Dugast, A. Ouerdani, E. Rabois, M. Quintin, S. Palfi, Krack, Paul, Pollak, Pierre, Service de Neuroradiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie, Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de neurologie [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de neurochirurgie fonctionnelle [Hôpital Pierre Wertheimer - HCL], CIC AP-HP (pitie-Salpetriere)/inserm, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service des Maladies du Système Nerveux [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Neuro-Imagerie de Recherche (CENIR), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Neurologie et thérapeutique expérimentale, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR70-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de neurologie [Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Ecole de Technologie Supérieure [Montréal] (ETS), Immunologie antivirale systémique et cérébrale, Université Paris-Sud - Paris 11 (UP11)-IFR93-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie et physiopathologie de la signalisation cellulaire (PPSC), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-CHU Bordeaux [Bordeaux]-Centre National de la Recherche Scientifique (CNRS), Hôpital Charles Perrens, Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Psychiatrie, CHU Grenoble, Centre Hospitalier Universitaire [Grenoble] (CHU), Laboratoire de Psychologie et NeuroCognition (LPNC ), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital Pasteur [Nice] (CHU), Service de neurologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre Mémoire de Ressources et de Recherche [CHU Clermont-Ferrand] (CMRR), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de neurologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Hôpital de La Milétrie, Service de Biostatistiques [Lyon], Hospices Civils de Lyon (HCL), Department of Neurosurgery, Carver College of Medicine [Iowa City], University of Iowa [Iowa City]-University of Iowa [Iowa City], Service de Neurologie [CHU Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, UM des troubles du mouvement, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre de recherche en neurosciences de Lyon (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Neurosciences précliniques, Clinique neurologique, Hôpital Laennec, inconnu, Inconnu, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service d'Explorations Fonctionnelles Neurologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Neurosurgery, Centre de Référence National 'Syndrome Gilles de la Tourette', Pôle des Maladies du Système Nerveux, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Pitié-Salpêtrière [APHP], Station Expérimentale des Procédés Pilotes en Environnement (STEPPE), Institut des Maladies Neurodégénératives [Bordeaux] (IMN), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Université de Bordeaux (UB), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), ANTE-INSERM U836, équipe 11, Fonctions cérébrales et neuromodulation, Clinique de psychiatrie, CHU Grenoble-CHU Grenoble, Réseau d'Etude des Gliomes, REG, Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux - Clermont Auvergne (NPsy-Sydo), CHU Clermont-Ferrand-Université Clermont Auvergne (UCA), Service de Neurochirurgie [CHU Pitié-Salpêtrière], Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Transduction du Signal et Plasticite Dans Le Systeme Nerveux, Gaz de France Suez (GDF Suez), CHU Pitié-Salpêtrière [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Center for NeuroImaging Research-Human MRI Neuroimaging core facility for clinical research [ICM Paris] (CENIR), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR70-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-CHU Bordeaux [Bordeaux]-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier Charles Perrens [Bordeaux], [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université de Rennes (UR), Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pôle des Maladies du Système Nerveux [CHU Pitié-Salpêtrière] (Pôle MSN), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS), Service de neurologie [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Pitié-Salpêtrière [AP-HP], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]-Centre National de la Recherche Scientifique (CNRS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Laboratoire de Psychologie et NeuroCognition (LPNC), Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Joseph Fourier - Grenoble 1 (UJF)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Centre Mémoire de Ressources et de Recherche [CHU de Clermont-Ferrand], Service de neurologie, and Hôpital Gabriel Montpied
Subjects: Adult, Male, medicine.medical_specialty, Movement disorders, Deep brain stimulation, Deep Brain Stimulation, [SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Stimulation, Globus Pallidus, Severity of Illness Index, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, law, Outcome Assessment, Health Care, Severity of illness, medicine, Clinical endpoint, Humans, Treatment Failure, Young adult, Adverse effect, ComputingMilieux_MISCELLANEOUS, [SDV.NEU.PC]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Psychology and behavior, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, musculoskeletal, neural, and ocular physiology, [SDV.NEU.SC]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Cognitive Sciences, Middle Aged, nervous system diseases, ddc:616.8, 030227 psychiatry, 3. Good health, Surgery, surgical procedures, operative, nervous system, Anesthesia, Female, Neurology (clinical), medicine.symptom, business, therapeutics, 030217 neurology & neurosurgery, Tourette Syndrome
Abstract: Summary Background Deep brain stimulation (DBS) has been proposed to treat patients with severe Tourette's syndrome, and open-label trials and two small double-blind trials have tested DBS of the posterior and the anterior internal globus pallidus (aGPi). We aimed to specifically assess the efficacy of aGPi DBS for severe Tourette's syndrome. Methods In this randomised, double-blind, controlled trial, we recruited patients aged 18–60 years with severe and medically refractory Tourette's syndrome from eight hospitals specialised in movement disorders in France. Enrolled patients received surgery to implant bilateral electrodes for aGPi DBS; 3 months later they were randomly assigned (1:1 ratio with a block size of eight; computer-generated pairwise randomisation according to order of enrolment) to receive either active or sham stimulation for the subsequent 3 months in a double-blind fashion. All patients then received open-label active stimulation for the subsequent 6 months. Patients and clinicians assessing outcomes were masked to treatment allocation; an unmasked clinician was responsible for stimulation parameter programming, with intensity set below the side-effect threshold. The primary endpoint was difference in Yale Global Tic Severity Scale (YGTSS) score between the beginning and end of the 3 month double-blind period, as assessed with a Mann-Whitney-Wilcoxon test in all randomly allocated patients who received active or sham stimulation during the double-blind period. We assessed safety in all patients who were enrolled and received surgery for aGPi DBS. This trial is registered with ClinicalTrials.gov, number NCT00478842. Findings Between Dec 6, 2007, and Dec 13, 2012, we enrolled 19 patients. We randomly assigned 17 (89%) patients, with 16 completing blinded assessments (seven [44%] in the active stimulation group and nine [56%] in the sham stimulation group). We noted no significant difference in YGTSS score change between the beginning and the end of the 3 month double-blind period between groups (active group median YGTSS score 68·5 [IQR 34·0 to 83·5] at the beginning and 62·5 [51·5 to 72·0] at the end, median change 1·1% [IQR −23·9 to 38·1]; sham group 73·0 [69·0 to 79·0] and 79·0 [59·0 to 81·5], median change 0·0% [–10·6 to 4·8]; p=0·39). 15 serious adverse events (three in patients who withdrew before stimulation and six each in the active and sham stimulation groups) occurred in 13 patients (three who withdrew before randomisation, four in the active group, and six in the sham group), with infections in DBS hardware in four patients (two who withdrew before randomisation, one in the sham stimulation group, and one in the active stimulation group). Other serious adverse events included one electrode misplacement (active stimulation group), one episode of depressive signs (active stimulation group), and three episodes of increased tic severity and anxiety (two in the sham stimulation group and one in the active stimulation group). Interpretation 3 months of aGPi DBS is insufficient to decrease tic severity for patients with Tourette's syndrome. Future research is needed to investigate the efficacy of aGPi DBS for patients over longer periods with optimal stimulation parameters and to identify potential predictors of the therapeutic response. Funding French Ministry of Health.
Published: 2017

148. Urinary lysophopholipids are increased in diabetic patients with nephropathy

Author: Jean-Michel Halimi, Pierre Gourdy, Ronan Roussel, Joost P. Schanstra, Samy Hadjadj, Jean-Loup Bascands, Aude Dupuy, Eva Feigerlova, Jean-Sébastien Saulnier-Blache, Bruno Guerci, Justine Bertrand-Michel, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Fédérale Toulouse Midi-Pyrénées, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle DUNE, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de néphrologie et immunologie clinique, Hôpital Bretonneau-Université de Tours-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Cellules Dendritiques, Immunomodulation et Greffes [Tours] (UFR de Médecine - EA4245), Université Francois Rabelais [Tours], Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Déterminants génétiques du diabète de type 2 et de ses complications vasculaires ((U 695)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7), Métabolisme et physiologie rénale (CRC - UMR_S 1138), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), DHU FIRE Centre de compétence des maladies pulmonaires rares, Diabète athérothrombose et thérapies Réunion Océan Indien (DéTROI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de La Réunion (UR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours, École pratique des hautes études (EPHE)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-École pratique des hautes études (EPHE)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de La Réunion (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de néphrologie et immunologie clinique [CHRU Tours], and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)
Subjects: Male, 0301 basic medicine, [SDV]Life Sciences [q-bio], Endocrinology, Diabetes and Metabolism, 030232 urology & nephrology, Pilot Projects, Diabetic nephropathy, Urine, Kidney, Severity of Illness Index, 0302 clinical medicine, Endocrinology, Fibrosis, Medicine, Diabetic Nephropathies, Renal Insufficiency, Lysophosphatidylcholine, Middle Aged, 6. Clean water, Up-Regulation, 3. Good health, medicine.anatomical_structure, Female, lipids (amino acids, peptides, and proteins), medicine.symptom, Lysophosphatidic acid, Glomerular Filtration Rate, medicine.medical_specialty, Urinary system, Nephropathy, 03 medical and health sciences, Diabetes mellitus, Internal medicine, Internal Medicine, Albuminuria, Humans, Aged, business.industry, Lysophosphatidylcholines, medicine.disease, Renal Elimination, 030104 developmental biology, Diabetes Mellitus, Type 2, Case-Control Studies, Lysophospholipids, business, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Kidney disease
Abstract: International audience; Diabetic nephropathy (DN) is a major cause of chronic kidney disease that frequently leads to end stage renal failure. Lysophosphatidic acid (LPA) and lysophosphatidylcholine (LPC) are lysophospholipid mediators shown to accumulate in kidney and to promote renal inflammation and tubulo-interstitial fibrosis in diabetic rodent models. Here we assessed whether LPA and LPC were associated to the development of nephropathy in diabetic human patients. Several molecular species of LPA and LPC were quantified by LC/MS-MS in urine and plasma from type 2 diabetic patients with (cases; n=41) or without (controls, n=41) nephropathy symptoms (micro/macro-albuminuria and eGFR
Published: 2017

149. CNGOF Guidelines: Time to Change!

Author: Thomas Schmitz, Arnaud Fauconnier, Xavier Fritel, Loïc Sentilhes, M.-V. Senat, Pôle d'Obstétrique Reproduction Gynécologie Centre Aliénor d'Aquitaine, Hôpital Pellegrin, Bordeaux, France., Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Research Center of Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, and Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Information retrieval, Text mining, Reproductive Medicine, business.industry, Computer science, [SDV]Life Sciences [q-bio], MEDLINE, CNGOF, Obstetrics and Gynecology, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2020

150. Pratiques de l’épisiotomie: enquête auprès des membres du Collège National des Gynécologues Obstétriciens Français

Author: A. Charveriat, Fabrice Pierre, Bertrand Gachon, Xavier Fritel, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, and CCSD, Accord Elsevier
Subjects: Gynecology, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, [SDV]Life Sciences [q-bio], Obstetrics and Gynecology, 3. Good health, [SDV] Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, Medicine, 030212 general & internal medicine, business
Abstract: Resume Objectif L’objectif principal etait de realiser une evaluation des pratiques a propos de l’episiotomie au sein des membres du CNGOF. Methodes En novembre 2018, a ete realise aupres des membres du CNGOF une enquete sur la base d’un questionnaire en ligne. Nous avons recueilli de maniere prospective: les caracteristiques des repondants, la frequence d’utilisation de l’episiotomie et les indications systematiques dans l’accouchement spontane et instrumental, les habitudes de realisation et de reparation de l’episiotomie, les modalites habituelles d’information de la femme, les elements consignes dans le dossier medical. Resultats Trois cent quatre-vingt-neuf membres du CNGOF ont repondu a l’enquete; 69% declaraient realiser une episiotomie dans moins de 10% des cas en cas d’accouchement spontane en presentation cephalique. L’indication d’episiotomie systematique la plus frequente pour l’accouchement spontane et instrumental etait l’antecedent de lesion obstetricale du sphincter anal (LOSA) (plus de 30% des participants). L’episiotomie systematique etait moins frequente en cas d’accouchement par ventouse que par forceps (OR = 0,18 [0,08–0,37]) ou spatules (OR = 0.28 [0,12–0,59]). La majorite (94%) des medecins declaraient realiser des episiotomies medio-laterales, 64% avec un angle de section inferieur ou egal a 45°, et 50% reparaient par une suture continue resorbable. La moitie (46%) declarait informer les femmes et recueillir leur consentement avant le geste. Conclusion Plusieurs pratiques, l’information des femmes, l’angle de section, et la technique de reparation de l’episiotomie, sont susceptibles d’etre modifiees par les nouvelles recommandations du CNGOF sur la protection perineale.
Published: 2019

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Journal

Database

Publisher

328 results on '"CIC - Poitiers"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources