91 results on '"Département de l'Information Médicale"'
Search Results
2. Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate
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Emmanuelle Trebouet, Matthieu Wargny, Karine Renaudin, Eric Mirallié, Lucy Chaillous, Catherine Ansquer, Françoise Kraeber-Bodéré, Christophe Leux, C. Caillard, Sahar Bannani, Service d'Endocrinologie [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique de Chirurgie Digestive et Endocrinienne [CHU Nantes], Département de l'Information Médicale [CHU Nantes], Nuclear Oncology (CRCINA-ÉQUIPE 13), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), 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), Service de Médecine Nucléaire [Nantes], Hôpital Laennec, Service d’Anatomie et Cytologie Pathologiques [CHU Nantes], Bernardo, Elizabeth, 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), and 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)
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Adult ,Male ,Technetium Tc 99m Sestamibi ,Multiglandular disease ,Sestamibi scan ,Parathyroidectomy ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Mild primary hyperparathyroidism ,Population ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,MIBI scintigraphy ,030230 surgery ,Scintigraphy ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Internal medicine ,medicine ,Humans ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,Tomography, Emission-Computed, Single-Photon ,Neck ultrasound ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Vascular surgery ,Hyperparathyroidism, Primary ,medicine.disease ,Normocalcemic form ,3. Good health ,Cardiac surgery ,Treatment Outcome ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Female ,Surgery ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,business ,Primary hyperparathyroidism ,Abdominal surgery - Abstract
International audience; BACKGROUND:Mild primary hyperparathyroidism (serum calcium ≤ 2.85 mmol/L) is the most representative form of pHPT nowadays. The aim of this study was to evaluate its subtypes and the multiglandular disease (MGD) rate as it may lower the sensitivity of preoperative parathyroid scintigraphy and the surgical cure rate.METHODS:We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 99mTc-MIBI SPECT/CT and surgery between January 2013 and December 2015. Cure was defined as normalization of serum calcium (or PTH in the normocalcemic form) at 6 months. MGD was defined by either two abnormal resected glands or persistent disease after resection of at least one abnormal gland.RESULTS:We included 121 patients. Median preoperative serum calcium was 2.68 mmol/L and median PTH was 83.4 pg/mL. A total of 141 glands were resected (95 adenomas, 33 hyperplasias). The subtypes were 57% classic, 32.2% normohormonal, and 10.7% normocalcemic. MGD occurred in 23.5% of patients divided as 13%, 30%, and 64% respectively (p = 0.0011). The surgical cure rate was 85.2%. The normocalcemic form had lower cure rate than the normohormonal (45% vs 84%, p = 0.018) and classic forms (45% vs 93%, p = 0.0006). MIBI scintigraphy identified at least one abnormal lesion, later confirmed by the pathologist in 90/98 patients, making the sensitivity per patient 91.8% (95% CI 84.1-96.2%).CONCLUSIONS:MGD is strongly associated with mild pHPT, especially the normocalcemic form where it accounts for 64% of cases. Bilateral neck exploration should be performed in this population to improve the cure rate, even if the scintigraphy shows a single focus.
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- 2019
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3. Effects of Interval Aerobic Training Program with Recovery bouts on cardiorespiratory and endurance fitness in seniors
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Elise Schmitt, Evelyne Lonsdorfer, Romain Remetter, Pierre Olivier Lang, Walid Bouaziz, Bernard Geny, Georges Kaltenbach, François Lefebvre, Pierre-Marie Leprêtre, Thomas Vogel, Dupuis, Christine, Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), Centre d’études des transformations des activités physiques et sportives (CETAPS), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut de Recherche Interdisciplinaire Homme et Société (IRIHS), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Pôle de Gériatrie [CHU Strasbourg], CHU Strasbourg, Département de l'Information Médicale [CHU Strasbourg], Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg ), Département des Explorations Fonctionnelles [CHU Strasbourg], Adaptations Physiologiques à l'Exercice et Réadaptation à l'effort - UR UPJV 3300 (APERE), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Unité de Réadaptation Cardiovasculaire [CH Corbie], Centre Hospitalier de Corbie (CH Corbie), Health and Wellbeing Academy [Cambridge, UK], Anglia Ruskin University (ARU), Montchoisi Clinic [Lausanne, Switzerland], This study was funded by the Department of Clinical Research and Innovation of the University Hospitals of Strasbourg., and CHU Amiens-Picardie-Université de Picardie Jules Verne (UPJV)
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Male ,medicine.medical_specialty ,Walk Test ,Physical Therapy, Sports Therapy and Rehabilitation ,endurance performance ,seniors ,03 medical and health sciences ,Oxygen Consumption ,sedentary ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Heart Rate ,Heart rate ,medicine ,Humans ,Aerobic exercise ,Orthopedics and Sports Medicine ,Prospective Studies ,030212 general & internal medicine ,Adverse effect ,Exercise ,interval training ,older adults ,Aged ,Sedentary lifestyle ,Aged, 80 and over ,cardiorespiratory fitness ,[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,business.industry ,[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,Cardiorespiratory fitness ,030229 sport sciences ,Interim analysis ,Oxygen uptake ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,aerobic capacity ,Physical Endurance ,Physical therapy ,Female ,Sedentary Behavior ,Ventilatory threshold ,business ,human activities - Abstract
International audience; Interval aerobic training programs (IATP) improve cardiorespiratory and endurance parameters. They are, however, unsuitable to seniors as frequently associated with occurrence of exhaustion and muscle pain. The purpose of this study was to measure the benefits of an IATP designed with recovery bouts (IATP-R) in terms of cardiorespiratory and endurance parameters and its acceptability among seniors (≥70 years). Sedentary healthy volunteers were randomly assigned either to IATP-R or sedentary lifestyle. All participants performed an incremental cycle exercise and 6-minute walk test (6-MWT) at baseline and 9.5 weeks later. The first ventilatory threshold (VT1 ); maximal tolerated power (MTP); peak of oxygen uptake (VO2peak ); maximal heart rate (HRmax ); and distance walked at 6-MWT were thus measured. IATP-R consisted of 19 sessions of 30-minute (6 × 4-min at VT1 + 1-minute at 40% of VT1 ) cycling exercise over 9.5 weeks. With an adherence rate of 94.7% without any significant adverse events, 9.5 weeks of IATP-R, compared to controls, enhanced endurance (VT1 : +18.3 vs -4.6%; HR at baseline VT1 : -5.9 vs +0.2%) and cardiorespiratory parameters (VO2peak : +14.1 vs -2.7%; HRmax : +1.6 vs -1.7%; MTP: +19.2 vs -2.3%). The walk distance at the 6-MWT was also significantly lengthened (+11.6 vs. -3.1%). While these findings resulted from an interim analysis planned when 30 volunteers were enrolled in both groups, IATP-R appeared as effective, safe, and applicable among sedentary healthy seniors. These characteristics are decisive for exercise training prescription and adherence.
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- 2018
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4. Severe leptospirosis in Morocco: comparative data from the Amazonian area
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Loïc Epelboin, Emilie Mosnier, Magalie Demar, Roxane Schaub, Félix Djossou, Mathieu Nacher, Stéphanie Houcke, Anne Jolivet, Erwann Fontaine, Paul Le Turnier, Unité des Maladies Infectieuses et Tropicales (UMIT), Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Université de Guyane (UG), Département de l'Information Médicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Medicine Department, Ecosystemes Amazoniens et Pathologie Tropicale (EPat), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Guyane (UG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Guyane (UG), Centre d'investigation clinique Antilles-Guyane (CIC - Antilles Guyane), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU de la Martinique [Fort de France]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Service de médecine interne et maladies tropicales, and CHU Bordeaux [Bordeaux]-Groupe hospitalier Saint-André
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medicine.medical_specialty ,business.industry ,[SDV]Life Sciences [q-bio] ,Amazonian ,Pain medicine ,030231 tropical medicine ,Critical Care and Intensive Care Medicine ,medicine.disease ,Leptospirosis ,Morocco ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Environmental protection ,Anesthesiology ,Emergency medicine ,medicine ,Humans ,030212 general & internal medicine ,business ,ComputingMilieux_MISCELLANEOUS ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience
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- 2017
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5. Progression of disease within 2 years (POD24) is a clinically relevant endpoint to identify high-risk follicular lymphoma patients in real life
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Amandine Le Bourgeois, Patrice Chevallier, Philippe Moreau, Christophe Leux, Benoit Tessoulin, Steven Le Gouill, Thierry Guillaume, Beatrice Mahe, Clara Sortais, Cyrille Touzeau, Thomas Gastinne, Anne Moreau, Anne Lok, Alice Garnier, Pierre Peterlin, Viviane Dubruille, Nicolas Blin, Céline Bossard, Bernardo, Elizabeth, Département d'Hématologie Clinique [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Regulation of Bcl2 and p53 Networks in Multiple Myeloma and Mantle Cell Lymphoma (CRCINA-ÉQUIPE 10), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), 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), Service d’Anatomopathologie [CHU Nantes], Immunobiology of Human αβ and γδ T Cells and Immunotherapeutic Applications (CRCINA-ÉQUIPE 1), Integrative Oncogenomics of Multiple Myeloma Pathogenesis and Progression (CRCINA-ÉQUIPE 11), Département de l'Information Médicale [CHU Nantes], 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), and 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)
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Male ,Oncology ,Time Factors ,Follicular lymphoma ,Cohort Studies ,0302 clinical medicine ,Recurrence ,Risk Factors ,Prednisone ,Antineoplastic Combined Chemotherapy Protocols ,Lymphoma, Follicular ,Aged, 80 and over ,Hematology ,General Medicine ,Middle Aged ,Prognosis ,3. Good health ,Treatment Outcome ,Vincristine ,030220 oncology & carcinogenesis ,Cohort ,Disease Progression ,Female ,Rituximab ,France ,medicine.drug ,Adult ,medicine.medical_specialty ,Cyclophosphamide ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,03 medical and health sciences ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Predictive Value of Tests ,Internal medicine ,Biomarkers, Tumor ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,medicine.disease ,Survival Analysis ,Lymphoma ,Clinical trial ,Doxorubicin ,Neoplasm Grading ,business ,030215 immunology - Abstract
International audience; Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma with heterogeneous outcomes. Progression or relapse of FL within 2 years (so-called POD24) after diagnosis is associated with a poor outcome for patients treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) in clinical trials. POD24 needs further validation before it can be used as a relevant endpoint to assess treatment efficacy. In the present retrospective monocentric study, we investigated the predictive value of POD24 in a cohort of grade 1, 2, or 3a FL patients treated in our institution (Nantes Medical University, France) and registered in our local database. We investigated the nature of treatment lines, patients' outcomes, and the prognostic value of POD24. Between 2007 and 2016, 317 patients were included. After first-line therapy, 60 patients relapsed within 2 years (POD24-pos cohort), and 254 patients did not relapse within 2 years (PO24-neg cohort). Thirty-three patients died, and 34 patients had an aggressive transformation. The median follow-up is 59.9 months (1.6-395.5). The median PFS is 59.9 months. Overall survival (OS) at 1 year, 3 years, and 5 years is 98.4% [97.0-99.8], 95.1% [92.6-97.6], and 92.5% [89.3-95.9], respectively. The 5-year OS was statistically lower for POD24-pos patients (82% [71.9-93.5]) than for POD24-neg patients (93.3% [88.98-97.8]) (p = 10-5). In multivariate analyses, transformation was predictive of OS, and PS (≥ 1) was predictive of POD24. POD24 is predictive of a worse OS and may be recommended as a relevant endpoint in clinical trials and in real life in particular for patients with advanced disease.
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- 2020
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6. 2019 ARIA Care pathways for allergen immunotherapy
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Bousquet, J. and Pfaar, O. and Togias, A. and Schünemann, H.J. and Ansotegui, I. and Papadopoulos, N.G. and Tsiligianni, I. and Agache, I. and Anto, J.M. and Bachert, C. and Bedbrook, A. and Bergmann, K.-C. and Bosnic-Anticevich, S. and Bosse, I. and Brozek, J. and Calderon, M.A. and Canonica, G.W. and Caraballo, L. and Cardona, V. and Casale, T. and Cecchi, L. and Chu, D. and Costa, E. and Cruz, A.A. and Czarlewski, W. and Durham, S.R. and Du Toit, G. and Dykewicz, M. and Ebisawa, M. and Fauquert, J.L. and Fernandez-Rivas, M. and Fokkens, W.J. and Fonseca, J. and Fontaine, J.-F. and Gerth van Wijk, R. and Haahtela, T. and Halken, S. and Hellings, P.W. and Ierodiakonou, D. and Iinuma, T. and Ivancevich, J.C. and Jacobsen, L. and Jutel, M. and Kaidashev, I. and Khaitov, M. and Kalayci, O. and Kleine Tebbe, J. and Klimek, L. and Kowalski, M.L. and Kuna, P. and Kvedariene, V. and La Grutta, S. and Larenas-Linemann, D. and Lau, S. and Laune, D. and Le, L. and Lodrup Carlsen, K. and Lourenço, O. and Malling, H.-J. and Marien, G. and Menditto, E. and Mercier, G. and Mullol, J. and Muraro, A. and O’Hehir, R. and Okamoto, Y. and Pajno, G.B. and Park, H.-S. and Panzner, P. and Passalacqua, G. and Pham-Thi, N. and Roberts, G. and Pawankar, R. and Rolland, C. and Rosario, N. and Ryan, D. and Samolinski, B. and Sanchez-Borges, M. and Scadding, G. and Shamji, M.H. and Sheikh, A. and Sturm, G.J. and Todo Bom, A. and Toppila-Salmi, S. and Valentin-Rostan, M. and Valiulis, A. and Valovirta, E. and Ventura, M.-T. and Wahn, U. and Walker, S. and Wallace, D. and Waserman, S. and Yorgancioglu, A. and Zuberbier, T. and the ARIA Working Group, MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France, INSERM U 1168, VIMA : Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France, Euforea, Brussels, Belgium, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany, Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany, Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States, Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada, Hospital Quirónsalud Bizkaia, Bilbao, Spain, Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, United Kingdom, Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital 'P&A Kyriakou', University of Athens, Athens, Greece, Department of Social Medicine, Faculty of Medicine, University of Crete and International Primary Care Respiratory Group, Crete, Greece, Faculty of Medicine, Transylvania University, Brasov, Romania, Centre for Research in Environmental Epidemiology (CREAL), ISGlobAL, Barcelona, Spain, IMIM (Hospital del Mar Research Institute), Barcelona, Spain, Universitat Pompeu Fabra (UPF), Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, ENT Department, Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GA2LEN, Humboldt-Uniersität zu Berlin, Berlin, Germany, Woolcock Institute of Medical Research, Woolcock Emphysema Centre and Local Health District, University of Sydney, Glebe, NSW, Australia, Allergist, La Rochelle, France, Imperial College London - National Heart and Lung Institute, Royal Brompton Hospital NHS, London, United Kingdom, Personalized Medicine Clinic Asthma & Allergy, Humanitas Research Hospital, Humanitas University, Milan, Italy, Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Cartagena, Colombia, Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia, Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain, Division of Allergy/Immunology, University of South Florida, Tampa, FL, United States, SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy, UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork), University of Porto, Porto, Portugal, ProAR – Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil, WHO GARD Planning Group, Salvador, Brazil, Medical Consulting Czarlewski, Levallois, France, Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom, Guy's and st Thomas' NHS Trust, Kings College London, London, United Kingdom, Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO, United States, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan, Unité de pneumo-allergologie de l'enfant, pôle pédiatrique, CHU de Clermont-Ferrand-Estaing, Clermont-Ferrand, France, Allergy Department, IdISSC, Hospital Clinico San Carlos, Madrid, Spain, Department of Otorhinolaryngology, Academic Medical Centres, Amsterdam, Netherlands, CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal, Medida, Lda, Porto, Portugal, Allergist, Reims, France, Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, Netherlands, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark, Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan, Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina, Allergy Learning and Consulting, Copenhagen, Denmark, Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland, Ukrainian Medical Stomatological Academy, Poltava, Ukraine, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology, National Research Center, Moscow, Russian Federation, Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey, Allergy & Asthma Center Westend, Berlin, Germany, Center for Rhinology and Allergology, Wiesbaden, Germany, Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Lodz, Poland, Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden, Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland, Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania, Faculty of Medicine, Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Vilnius University, Vilnius, Lithuania, Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy, Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico, Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany, KYomed INNOV, Montpellier, France, University of Medicine and Pharmacy, Hochiminh City, Viet Nam, Department of Paediatrics, Oslo University Hospital, Oslo, Norway, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Faculty of Health Sciences and CICS – UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal, Danish Allergy Centre, University of Copenhagen, Copenhagen, Denmark, CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy, Département de l’Information Médicale, Unité Médico-Economie, University Hospital, Montpellier, France, Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain, Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia, Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy, Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea, Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic, Allergy and Respiratory Diseases, Ospedale Policlino San Martino -University of Genoa, Genoa, Italy, Allergy Department, Pasteur Institute, Paris, France, David Hide Centre, St Mary's Hospital, Isle of Wight and University of Southampton, Southampton, United Kingdom, Department of Pediatrics, Nippon Medical School, Tokyo, Japan, Association Asthme et Allergie, Paris, France, Hospital de Clinicas, University of Parana, Parana, Brazil, Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom, Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland, Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela, The Royal National TNE Hospital, University College London, London, United Kingdom, Immunomodulation and Tolerance Group, Imperial College London, London, United Kingdom, Allergy and Clinical Immunology, Imperial College London, London, United Kingdom, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom, Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria, Outpatient Allergy Clinic Reumannplatz, Vienna, Austria, Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal, Allergist, Montevideo, Uruguay, Clinic of Children's Diseases, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania, Department of Public Health, Institute of Health Sciences, Vilnius, Lithuania, European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium, Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic, University of Turku, Turku, Finland, Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy, Pediatric Department, Charité, Berlin, Germany, Asthma UK, London, United Kingdom, Nova Southeastern University, Fort Lauderdale, FL, United States, Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada, and Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
- Abstract
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients. © 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
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- 2019
7. Hospital production cost of transcranial direct current stimulation (tDCS) in the treatment of depression
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Solène Schirr-Bonnais, Nicolas Mauduit, Olivier Sellal, Cécile Dert, François Etcheverrigaray, Anne Pichot, Anne Sauvaget, Samuel Bulteau, Christophe Leux, Agathe Tostivint, Johann Clouet, Valéry-Pierre Riche, Clémence Cabelguen, Département d'addictologie et de psychiatrie de liaison [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Motricité, interaction, performance EA 4334 (MIP), Le Mans Université (UM)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN), Pharmacie [CHD Vendée], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Département Partenariat et Innovation [CHU Nantes] (Cellule d'innovation), Centre hospitalier universitaire de Nantes (CHU Nantes)-Direction des Affaires Médicales et de la Recherche [CHU Nantes] (DAMR), Regenerative Medicine and Skeleton research lab (RMeS), Ecole Nationale Vétérinaire, Agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), UFR d’Odontologie [CHU Hôtel Dieu, Nantes], Université de Nantes (UN), Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, PHU 11 Pharmacie [CHU Nantes] (Pharmacie Centrale), Département de l'Information Médicale [CHU Nantes], MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, This work has been supported by a grant from the FrenchHealth Ministry for the DISCO study PRME-2017-0097., Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Le Mans Université (UM), Ecole Nationale Vétérinaire, Agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-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), Université de Nantes - UFR Odontologie, Jehan, Frederic, 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), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Regenerative Medicine and Skeleton (RMeS), École nationale vétérinaire, agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
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Cost ,medicine.medical_treatment ,Cost accounting ,Transcranial Direct Current Stimulation ,050105 experimental psychology ,TDCS ,03 medical and health sciences ,0302 clinical medicine ,Health Economics ,Multidisciplinary approach ,Physiology (medical) ,Medicine ,Humans ,0501 psychology and cognitive sciences ,Operations management ,Economics, Hospital ,Neurostimulation ,Health policy ,Depression (differential diagnoses) ,health care economics and organizations ,Psychiatry ,[SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system ,Health economics ,[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,Transcranial direct-current stimulation ,business.industry ,Depression ,Health Policy ,[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,05 social sciences ,Usability ,General Medicine ,Hospitals ,3. Good health ,Treatment Outcome ,Neurology ,[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system ,Neurology (clinical) ,France ,business ,030217 neurology & neurosurgery - Abstract
Summary Objectives Due to its ease of use, tolerance, and cost of acquisition, transcranial direct current stimulation (tDCS) could constitute a credible therapeutic option for non-resistant depression in primary care, when combined with drug management. This indication has yet to receive official recognition in France. The objective of this study is to evaluate the production cost of tDCS for the treatment of depression in hospitals, under realistic conditions. Methods The methodology adopted is based on cost accounting and was validated by a multidisciplinary working group. It includes equipment, staff, and structural costs to obtain the most realistic estimate possible. We first estimated the cost of producing a tDCS session, based on our annual activity objective, and then estimated the cost of a 15-session treatment program. This was followed up with a sensitivity analysis applying appropriate parameters. Results The hospital production cost of a tDCS depression treatment program for a single patient was estimated at €1555.60 euros: €99 in equipment costs, €1076.95 in staff costs, and €379.65 in structural costs. Conclusion This cost analysis should make it possible to draw up pricing proposals in compliance with regulations and health policy choices and to develop health-economic studies. This would ultimately lead to official recognition of tDCS treatment for depression in France and pave the way for studying various scenarios of coverage by the French national health insurance system.
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- 2018
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8. Dyspnea in patients receiving noninvasive ventilation for acute respiratory failure: prevalence, risk factors and prognostic impact – a prospective observational study
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Matthieu Resche-Rigon, Laurence Dangers, Alexandre Demoule, Ferhat Meziani, Thomas Similowski, Sébastien Perbet, Achille Kouatchet, Elie Azoulay, Claire Montlahuc, Samir Jaber, Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Pitié-Salpêtrière [APHP], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Urgences médicales, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), PRES Université Nantes Angers Le Mans (UNAM), Service d'anesthésie et de réanimation B, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), CHU Clermont-Ferrand, Département de l'information médicale et de la biostatistique [AP-HP Hôpital Saint-Louis], AP-HP Hôpital Saint-Louis, Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7), Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé (CRESS - U1153), Université Paris Diderot - Paris 7 (UPD7)-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 Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Université Paris-Sorbonne (UP4), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hopital Saint-Louis [AP-HP] (AP-HP), 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)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-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)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC), and Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)
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Pulmonary and Respiratory Medicine ,Mechanical ventilation ,medicine.medical_specialty ,Respiratory rate ,business.industry ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Odds ratio ,Intensive care unit ,3. Good health ,law.invention ,respiratory tract diseases ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Interquartile range ,law ,Emergency medicine ,Severity of illness ,medicine ,030212 general & internal medicine ,Prospective cohort study ,business ,ComputingMilieux_MISCELLANEOUS ,Cohort study - Abstract
Dyspnoea is a frequent and intense symptom in intubated patients, but little attention has been paid to dyspnoea during noninvasive mechanical ventilation in the intensive care unit (ICU).The objectives of this study were to quantify the prevalence, intensity and prognostic impact of dyspnoea in patients receiving noninvasive ventilation (NIV) for acute respiratory failure (ARF) based on secondary analysis of a prospective observational cohort study in patients who received ventilatory support for ARF in 54 ICUs in France and Belgium. Dyspnoea was measured by a modified Borg scale.Among the 426 patients included, the median (interquartile range) dyspnoea score was 4 (3-5) on admission and 3 (2-4) after the first NIV session (p=0.001). Dyspnoea intensity ≥4 after the first NIV session was associated with the Sequential Organ Failure Assessment Score (odds ratio (OR) 1.12, p=0.001), respiratory rate (OR 1.03, p=0.032), anxiety (OR 1.92, p=0.006), leaks (OR 2.5, p=0.002) and arterial carbon dioxide tension (OR 0.98, p=0.025). Dyspnoea intensity ≥4 was independently associated with NIV failure (OR 2.41, p=0.001) and mortality (OR 2.11, p=0.009), but not with higher post-ICU burden and altered quality of life.Dyspnoea is frequent and intense in patients receiving NIV for ARF and is associated with a higher risk of NIV failure and poorer outcome.
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- 2018
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9. Apports de l’analyse contextuelle des données non structurées des dossiers médicaux dans une étude rétrospective de parcours de soins en hémato-oncologie à Montpellier, France
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C. Duflos, G. Mercier, G. Cartron, T. Kanouni, Département de l'Information Médicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital La Colombière, Département Hématologie biologique [CHRU Montpellier], Pôle Biologie-Pathologie [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Unité de recherche médico-économique - CHU Montpellier
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03 medical and health sciences ,030505 public health ,0302 clinical medicine ,Coordination hémato-oncologie ,Epidemiology ,Public Health, Environmental and Occupational Health ,Parcours de soins ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,030212 general & internal medicine ,0305 other medical science ,Analyse contextuelle ,Données non structurées ,[SHS]Humanities and Social Sciences - Abstract
International audience; L’accompagnement des parcours de soins des patients d’hématolo-oncologie, au CHU de Montpellier, est réalisé par des infirmières de coordination. Une étude en cours vise à évaluer la charge de coordination en fonction du traitement et des caractéristiques cliniques et sociales du patient. Deux informations majeures sont présentes dans les transmissions des infirmières : l’isolement social et la survenue de prise d’antibiotiques en intercure. Ces transmissions ne sont pas structurées. Nous rapportons notre utilisation d’un logiciel permettant l’analyse contextuelle des transmissions, et la génération automatique de variables binaires à partir de ces transmissions non structurées.Méthodes : tous les patients d’hématologie ayant un dossier de coordination ont été inclus. L’analyse contextuelle et la génération de deux variables binaires a été réalisé au moyen de SAS Contextual Analysis® : « isolement », « antibiotique ». Un échantillon des dossiers a ensuite été relu par les auteurs, pour évaluer la validité de la variable « isolement ».Résultats : au total, 476 dossiers de patients, contenant 34 788 transmissions d’intercure, ont été analysés. La variable « antibiotique » a été construite en utilisant la classification ATC et la procédure de repérage des fautes de frappe du logiciel ; 672 prises d’antibiotiques ont été retrouvées. La variable « isolement » a été construite en définissant les concepts de famille proche et de vie en couple. Parmi les 476 patients, 250 avaient une information sur l’isolement, dont 37 patients identifiés comme isolés (test positif). La relecture de ces dossiers confirmait l’isolement chez 28 patients (76 %). Parmi les dossiers identifiés comme non isolés, l’absence d’isolement a été confirmée dans 98 des 100 dossiers tirés au sort.Discussion/conclusion : l'analyse contextuelle permet une analyse rapide et détaillée des données non structurées des transmissions infirmières. Le logiciel utilisé nécessite un apprentissage dont le premier plateau est rapidement atteint. Ce logiciel pourrait donc permettre de faciliter le travail des chercheurs. Cependant, l’extrapolabilité des règles de génération automatique de variables n’a pas été évaluée.
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- 2018
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10. Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study
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Morgane Michel, Jean-Marie Launay, Jacques Duranteau, Marc Leone, Alexandre Mebazaa, Bernard Cholley, Philippe Montravers, Jean-Yves Lefrant, Qin Lu, Matthieu Legrand, Charles Damoisel, Xavier Monnet, Matthieu Resche-Rigon, Bertrand Guidet, Karine Chevreul, Elie Azoulay, Isabelle Rennuit, Mervyn Singer, Nicolas Bréchot, Heikel Oueslati, Samir Jaber, Pierre-François Laterre, Diane Friedman, Romain Sonneville, Sebastien Pili-Floury, Nicolas Deye, Eric Vicaut, Etienne Gayat, Antoine Vieillard-Baron, Alain Cariou, Antoine Tesniere, Département d'Anesthésie Réanimation SMUR [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Espaces, Nature et Culture (ENeC), Université Paris-Sorbonne (UP4)-Centre National de la Recherche Scientifique (CNRS), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Unité de Soins Intensifs [Saint-Louis], Hôpital Raymond Poincaré [AP-HP], Service d'Anesthésie Réanimation, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Bichat - Claude Bernard, Département d'Anesthésie Réanimation [CHU Bichat-Claude-Bernard], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service d'anesthésie et soins intensifs [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'anesthésie et réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Université Catholique de Louvain = Catholic University of Louvain (UCL), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Département de la Recherche Clinique et du Développement [AP-HP Hôtel Dieu] (DRCD-URC Eco), Unité de Recherche Clinique en Economie de la Santé d'Ile-de-France, Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Psychiatrie et Neurologie personnalisées [AP-HP Hôpital Henri-Mondor] (DHU PePsy), Hôpital Henri Mondor, Service de RadioBiologie et d'Epidémiologie (IRSN/DRPH/SRBE), Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-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)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'Anesthésie et Soins Intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Université Paris Diderot - Paris 7 (UPD7), Unité de Recherche Clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Fernand-Widal, Département de l'information médicale et de la biostatistique [AP-HP Hôpital Saint-Louis], Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Ambroise Paré [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Radiobiologie et épidémiologie (DRPH/SRBE), UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), COMBE, Isabelle, and Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris]
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Male ,Time Factors ,Outcome Assessment ,health care facilities, manpower, and services ,030204 cardiovascular system & hematology ,Cardiovascular ,Critical Care and Intensive Care Medicine ,Medical and Health Sciences ,law.invention ,Cohort Studies ,0302 clinical medicine ,Belgium ,law ,Outcome Assessment, Health Care ,Odds Ratio ,Medicine ,Vasoconstrictor Agents ,Hospital Mortality ,Prospective Studies ,Survivors ,Prospective cohort study ,education.field_of_study ,Respiration ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Score ,Middle Aged ,Intensive care unit ,3. Good health ,Hospitalization ,Intensive Care Units ,Heart Disease ,Artificial ,Female ,Patient Safety ,France ,Cohort study ,medicine.medical_specialty ,Critical Illness ,Population ,Post-intensive care syndrome ,03 medical and health sciences ,Long-term survival ,Clinical Research ,Intensive care ,Humans ,education ,Aged ,business.industry ,Research ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Odds ratio ,Length of Stay ,medicine.disease ,Comorbidity ,Emergency & Critical Care Medicine ,Respiration, Artificial ,Health Care ,Good Health and Well Being ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Emergency medicine ,Discharge ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Biomarkers - Abstract
Background Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge. Methods FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep). Results Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73–4.65), p
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11. Clinical features and prognosis of paraquat poisoning in French Guiana
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Elenga, Narcisse, Merlin, Caroline, Le Guern, Rémi, Kom-Tchameni, Rémi, Ducrot, Yves-Marie, Pradier, Maxime, Ntab, Balthazar, Dinh-Van, Kim-Anh, Sobesky, Milko, Mathieu, Daniel, Dueymes, Jean-Marc, Egmann, Gérald, Kallel, Hathem, Mathieu-Nolf, Monique, Service de Pédiatrie [Cayenne, Guyanne Française], Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Institut de Microbiologie [CHRU Lille], Pôle de Biologie Pathologie Génétique [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Département des Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Tourcoing, Centre Hospitalier de l'Ouest Guyanais (CHOG), CHOG-Centre Hospitalier de l'Ouest Guyanais, Centre médico-chirurgical de Kourou [Guyane française], Département de l'information médicale, Centre Hospitalier de Cayenne, Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille, CH Cayenne, and Centres antipoison et de toxicovigilance (CAPTV Lille)
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[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
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12. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study
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Pierrat, Véronique, Marchand-Martin, Laetitia, Arnaud, Catherine, Kaminski, Monique, Resche-Rigon, Matthieu, Lebeaux, Cécile, Bodeau-Livinec, Florence, Morgan, Andrei S., Goffinet, François, Marret, Stéphane, Ancel, Pierre-Yves, Rozé, Jean-Christophe, Flamant, Cyril, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC), Centre Hospitalier Universitaire de Lille (CHU de Lille), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), 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), Département de l'information médicale et de la biostatistique [AP-HP Hôpital Saint-Louis], AP-HP Hôpital Saint-Louis, Département Méthodes quantitatives en santé publique (METIS), École des Hautes Études en Santé Publique [EHESP] (EHESP), DHU Risques Et Grossesse, Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service de pédiatrie néonatale et réanimation - neuropédiatrie [Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), 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), Institute for Research and Innovation in Biomedicine (IRIB), CIC - Mère Enfant Necker Cochin Paris Centre (CIC 1419), CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), This project has been funded with support from the following organisations: The French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry, the National Institute of Health and Medical Research (INSERM), the National Institute of Cancer, and the National Solidarity Fund for Autonomy (CNSA), The National Research Agency through the French EQUIPEX program of investments in the future (reference ANR-11-EQPX-0038), the PREMUP Foundation, Fondation de France (reference 00050329), and Fondation pour la Recherche Médicale (reference SPF20160936356)., ANR-11-EQPX-0038/11-EQPX-0038,RE-CO-NAI,Plateforme de REcherche sur les COhortes d'enfants suivis depuis la NAIssance(2011), 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), Hopital Saint-Louis [AP-HP] (AP-HP), 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)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de pédiatrie néonatale et réanimation - neuropédiatrie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), ANR-11-EQPX-0038,RE-CO-NAI,Plateforme de REcherche sur les COhortes d'enfants suivis depuis la NAIssance(2011), pierrat, veronique, Equipements d'excellence - Plateforme de REcherche sur les COhortes d'enfants suivis depuis la NAIssance - - RE-CO-NAI2011 - ANR-11-EQPX-0038 - EQPX - VALID, Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Universitaire de Lille ( CHU de Lille ), Épidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps, Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département Méthodes quantitatives en santé publique ( METIS ), École des Hautes Études en Santé Publique [EHESP] ( EHESP ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Assistance publique - Hôpitaux de Paris (AP-HP), CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Hôpital Charles Nicolle [Rouen], 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 ), Institute for Research and Innovation in Biomedicine ( IRIB ), CIC - Mère Enfant Necker Cochin Paris Centre ( CIC 1419 ), CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), ANR-11-EQPX-0038/11-EQPX-0038,RE-CO-NAI,Plateforme de REcherche sur les COhortes d'enfants suivis depuis la NAIssance ( 2011 ), CHU Lille, Université de Lille, Hôpital Jeanne de Flandre [Lille], Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité [CRESS (U1153 / UMR_A_1125 / UMR_S_1153)], Université Toulouse III - Paul Sabatier [UT3], and Hôpital Saint-Louis
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Male ,Pediatrics ,Developmental Disabilities ,[ SDV.MHEP.PED ] Life Sciences [q-bio]/Human health and pathology/Pediatrics ,Infant, Premature, Diseases ,Blindness ,Population based cohort ,Corrected Age ,0302 clinical medicine ,030202 anesthesiology ,Outcome Assessment, Health Care ,MESH: Blindness/epidemiology ,Blindness/etiology ,Cerebral Palsy/epidemiology ,Cerebral Palsy/etiology ,Child, Preschool ,Developmental Disabilities/epidemiology ,Developmental Disabilities/etiology ,Female ,Follow-Up Studies ,France/epidemiology ,Gestational Age ,Hearing Loss/epidemiology ,Hearing Loss/etiology ,Humans ,Infant, Extremely Premature ,Infant, Premature, Diseases/epidemiology ,Infant, Premature, Diseases/mortality ,Infant, Premature, Diseases/physiopathology ,Outcome Assessment (Health Care) ,Prospective Studies ,Survivors ,030212 general & internal medicine ,Prospective cohort study ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Gestational age ,Gross Motor Function Classification System ,[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie ,General Medicine ,3. Good health ,Gestation ,France ,Cohort study ,medicine.medical_specialty ,Pédiatrie ,Population ,Cerebral palsy ,03 medical and health sciences ,[SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics ,030225 pediatrics ,medicine ,education ,Hearing Loss ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,business.industry ,Cerebral Palsy ,Research ,medicine.disease ,Confidence interval ,MESH : Blindness/epidemiology ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business - Abstract
International audience; Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks' gestation in 2011, and to evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks' gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks' gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks' gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks' gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks' gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks' gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks' gestation, but no change was observed at 22-24 weeks' gestation. At 32-34 weeks' gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.
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- 2017
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13. Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: A randomised controlled trial in sedentary seniors
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Georges Kaltenbach, François Lefebvre, Pierre Olivier Lang, Walid Bouaziz, Pierre-Marie Leprêtre, Bernard Geny, Thomas Vogel, Elise Schmitt, Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), Centre d’études des transformations des activités physiques et sportives (CETAPS), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut de Recherche Interdisciplinaire Homme et Société (IRIHS), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Pôle de Gériatrie [CHU Strasbourg], CHU Strasbourg, Département de l'Information Médicale [CHU Strasbourg], Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg ), Adaptations Physiologiques à l'Exercice et Réadaptation à l'effort - UR UPJV 3300 (APERE), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Unité de Réadaptation Cardiovasculaire [CH Corbie], Centre Hospitalier de Corbie (CH Corbie), Centre Mémoire Ressources et Recherche [Strasbourg] (CMRR Strasbourg), Département des Explorations Fonctionnelles [CHU Strasbourg], Health and Wellbeing Academy [Cambridge, UK], Anglia Ruskin University (ARU), Geriatric and Rehabilitation Geriatric Division [CHU Lausanne] (UNIV Lausanne), Lausanne University Hospital [Switzerland]-Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), This study was supported by the Department of Clinical Research and Innovation of the University Hospitals of Strasbourg (France)., Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV)-Lausanne University Hospital, Dupuis, Christine, and CHU Amiens-Picardie-Université de Picardie Jules Verne (UPJV)
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Male ,medicine.medical_specialty ,Time Factors ,Paced Auditory Serial Addition Test ,Health Status ,Trail Making Test ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Randomized controlled trial ,Quality of life ,law ,Humans ,Medicine ,Aerobic exercise ,Prospective Studies ,030212 general & internal medicine ,Aged ,Sedentary lifestyle ,[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,medicine.diagnostic_test ,business.industry ,[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,General Medicine ,Physical Functional Performance ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Mental Health ,Quality of Life ,Physical therapy ,Anxiety ,Female ,Sedentary Behavior ,medicine.symptom ,business ,Ventilatory threshold ,human activities ,Physical Conditioning, Human - Abstract
BACKGROUND: Interval aerobic training programme with active recovery bouts (IATP-R) has shown to improve tolerance to IATP among seniors. However, data concerning its benefits for seniors' health are still limited. PURPOSE: The purpose of this study was to examine the effects of IATP-R on seniors' health status. METHODS: Sedentary volunteers (n = 60, aged ≥70 years) were randomly assigned to either IATP-R or maintained sedentary lifestyle for 9.5 weeks. IATP-R consisted of 30-minute cycling (6 × 4 minutes at first ventilatory threshold (VT1 ) intensity + 1 minute at 40% of VT1 ) twice a week. Cognitive and functional performances were assessed with the Trail Making Test (TMT-A; TMT-B); Paced Auditory Serial Addition Test (PASAT); Timed Up and Go (TUG) test; 6-Minute Walk Test (6-MWT); one-leg balance test; and the Short Physical Performance Battery (SPPB) tests, respectively. QoL and anxiety/depression status were measured by the Short Form-12 and the Goldberg's Scale, respectively. All participants were assessed at baseline and 9.5 weeks later. RESULTS: Compared to controls, IATP-R improved cognitive functions (TMT-A: +1.5% vs -21.5%; TMT-B: +0.9% vs -13.3%; PASAT: +1.4% vs -14.6%; semantic fluency: -1.1% vs +11.7%), functional performance (TUG: +5.4% vs -16.5%; 6-MWT: -3.2% vs +11.5%; SPPB: -3.2% vs +14.6%; One-leg balance: -16.3% vs +25.0%); QoL (physical health: -13.3% vs +23.1%; mental health: -7.1% vs +8.2%); and depressive symptoms (+26.3% vs -42.8%). Significant impacts were measured neither on letter modality of fluency tasks nor on anxiety score. CONCLUSION: These data showed that IATP-R is an effective training programme to improve functional and cognitive performances, mental health and well-being in sedentary seniors. Trial registration ClinicalTrials.gov NCT02263573. Registered October 1, 2014.
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- 2018
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14. Hospitalisation pour insuffisance cardiaque aiguë : le parcours intra-hospitalier prédit le risque de réhospitalisation pour insuffisance cardiaque aiguë à un an
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D. Logeart, C. Ségouin, Claire Duflos, Gregoire Mercier, P. Troude, Département de l'Information Médicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Unité de recherche médico-économique - CHU Montpellier
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Insuffisance cardiaque ,03 medical and health sciences ,[SHS.STAT]Humanities and Social Sciences/Methods and statistics ,030505 public health ,0302 clinical medicine ,Organisation ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Epidemiology ,Réhospitalisation ,Public Health, Environmental and Occupational Health ,Parcours hôpital ,030212 general & internal medicine ,0305 other medical science - Abstract
International audience; Chez les patients avec insuffisance cardiaque aiguë (ICA), les facteurs pronostiques de mortalité bien connus sont cliniques. La Haute Autorité de santé (HAS) met aussi l’accent sur les facteurs organisationnels modifiables, qui pourraient être d’autres facteurs pronostiques. Notre objectif est d’évaluer le lien entre les facteurs organisationnels lors d’une hospitalisation pour ICA et le risque de réhospitalisation.Méthodes : cette étude rétrospective sur dossiers et sur PMSI a inclus les patients âgés de plus de 65 ans, hospitalisés pour ICA à Lariboisière en 2013. Les variables de parcours étaient : unités fréquentées, durée de séjour, modes d’entrée et de sortie, réalisation de procédures diagnostiques, traitement de sortie. Des groupes homogènes de parcours ont été construits, et le lien avec le taux de réhospitalisations à un mois et à un an, pour ICA ou toutes causes, a été modélisé par un modèle binomial négatif avec offset, incluant le groupe et les variables cliniques classiques (ACFA, BPCO, diabète, HTA, insuffisance rénale, présentation clinique de l’ICA, sexe, tabac, FEVG, âge).Résultats : le parcours a pu être analysé chez 207 patients, parmi les 223 initialement inclus. Cinq groupes ont été retrouvés : trois groupes classiques des filières USIC, cardiologie, et médecine/gériatrie, un groupe avec un parcours dit chaotique, et un groupe de patients décédés. Le groupe est prédictif du nombre de réhospitalisations pour ICA à un an (p = 0,0015) : le groupe chaotique augmente le risque (p = 0,0054), le groupe cardiologie a une tendance à la réduction du risque (p = 0,0675). Le groupe n’est pas associé aux autres critères de jugement.Discussion/conclusion : le parcours intrahospitalier est lié au risque de réhospitalisation, indépendamment des variables cliniques. Ce résultat devrait être confirmé, puis suivi d’une recherche des mécanismes en cause dans la génération de ces parcours chaotiques et de leurs conséquences.
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- 2018
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15. Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study
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Pierre Corbeau, Jean-Philippe Lavigne, Nathalie Jourdan, Christophe Combescure, M. Rodier, A. Jeandrot, Albert Sotto, J.-L. Richard, S. Finge, Laboratoire de bactériologie, virologie et parasitologie, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service des maladies de la nutrition et de diabétologie, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Département de l'information médicale, Service des maladies métaboliques et endocriniennes, Service d'immunologie, Systèmes de sécrétion de type IV et virulence bactérienne, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Lavigne, Jean-Philippe
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medicine.medical_specialty ,Pathology ,biology ,business.industry ,Endocrinology, Diabetes and Metabolism ,C-reactive protein ,Virulence ,medicine.disease ,Gastroenterology ,Diabetic foot ,Article ,digestive system diseases ,Procalcitonin ,Diabetic foot ulcer ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Predictive value of tests ,Internal medicine ,Diabetes mellitus ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Internal Medicine ,Normal flora ,medicine ,biology.protein ,business - Abstract
International audience; AIMS/HYPOTHESIS: Infection of diabetic foot ulcers is common; at early stages it is difficult to differentiate between non-infected ulcers (or those colonised with normal flora) and ulcers infected with virulent bacteria that lead to deterioration. This pilot study aimed to assess the diagnostic accuracy of inflammatory markers as an aid to making this distinction. METHODS: We included 93 diabetic patients who had an episode of foot ulcer and had not received antibiotics during the 6 months preceding the study. Ulcers were classified as infected or uninfected, according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot classification. Diabetic patients without ulcers (n = 102) served as controls. C-reactive protein (CRP), orosomucoid, haptoglobin and procalcitonin were measured together with white blood cell and neutrophil counts. The diagnostic performance of each marker, in combination (using logistic regression) or alone, was assessed. RESULTS: As a single marker, CRP was the most informative for differentiating grade 1 from grade 2 ulcers (sensitivity 0.727, specificity 1.000, positive predictive value 1.000, negative predictive value 0.793) with an optimal cut-off value of 17 mg/l. In contrast, white blood cell and neutrophil counts were not predictive. The most relevant combination derived from the logistic regression was the association of CRP and procalcitonin (AUC 0.947), which resulted in a significantly more effective determination of ulcer grades, as shown by comparing receiver operating characteristic curves. CONCLUSIONS/INTERPRETATION: Measurement of only two inflammatory markers, CRP and procalcitonin, might be of value for distinguishing between infected and non-infected foot ulcers in subgroups of diabetic patients, to help ensure the appropriate allocation of antibiotic treatment. Nevertheless, external validation of the diagnostic value of procalcitonin and CRP in diabetic foot ulcers is needed before routine use can be recommended.
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- 2007
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16. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study
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A.-S. Brunel, B. Lamy, C. Cyteval, H. Perrochia, L. Téot, R. Masson, H. Bertet, A. Bourdon, D. Morquin, J. Reynes, V. Le Moing, Isabelle Alméras, Aurélie Du Thanh, Anthony Gélis, Claire Reynaud, Hélène Rouays, Chloé Trial, Sergio Fliueraru, Christian Herlin, Jean-Philippe Lavigne, Christophe Delfour, Marie-Pierre Baron, Pierre Viala, Thibaut Mura, Philippe Géraud, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hydrosciences Montpellier (HSM), Institut national des sciences de l'Univers (INSU - CNRS)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université de Montpellier (UM), Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Euromov (EuroMov), CHU Montpellier, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Département de l'Information Médicale, and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie
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0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Histology ,030106 microbiology ,Comorbidity ,medicine.disease_cause ,030207 dermatology & venereal diseases ,03 medical and health sciences ,pressure ulcers ,0302 clinical medicine ,Anti-Infective Agents ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Risk Factors ,Biopsy ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Pelvic Bones ,Pelvis ,Spinal Cord Injuries ,Aged ,Pressure Ulcer ,biology ,medicine.diagnostic_test ,Streptococcus ,business.industry ,Osteomyelitis ,microbiology ,General Medicine ,Middle Aged ,biology.organism_classification ,medicine.disease ,Magnetic Resonance Imaging ,Peptostreptococcus ,3. Good health ,Surgery ,medicine.anatomical_structure ,Infectious Diseases ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Staphylococcus aureus ,Female ,business ,Biomarkers - Abstract
International audience; There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.
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- 2015
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17. Effects of vitamin C, vitamin E, zinc gluconate, and selenomethionine supplementation on muscle function and oxidative stress biomarkers in patients with facioscapulohumeral dystrophy: A double-blind randomized controlled clinical trial
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Koen B.E. Böcker, Fabien Pillard, Audrey Jaussent, Gilles Carnac, Marie-Christine Picot, Emilie Passerieux, Jacques Mercier, Joël Pincemail, Fares Gouzi, Dalila Laoudj-Chenivesse, Gérald Hugon, Theo Verrips, Maurice Hayot, Jean-Olivier Defraigne, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Unité de biostatistiques et épidémiologie, Service d'exploration de la fonction respiratoire et de médecine du sport, CHU Toulouse [Toulouse], Département de l'Information Médicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, The Alan Turing Institute, Centre Hospitalier Universitaire de Liège (CHU-Liège), Utrecht University [Utrecht], and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
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Male ,Antioxidant ,medicine.medical_treatment ,Administration, Oral ,Pilot Projects ,Ascorbic Acid ,Walking ,medicine.disease_cause ,Biochemistry ,Antioxidants ,Physical performance ,0302 clinical medicine ,Vitamin E ,Facioscapulohumeral muscular dystrophy ,Selenomethionine ,Gait ,ComputingMilieux_MISCELLANEOUS ,0303 health sciences ,Chemistry ,Autosomal dominant trait ,Middle Aged ,Muscular Dystrophy, Facioscapulohumeral ,3. Good health ,Radical oxygen species ,Female ,Muscle Contraction ,Adult ,medicine.medical_specialty ,Gluconates ,Facioscapulohumeral muscular dystrophy (FSHD) ,03 medical and health sciences ,Atrophy ,Double-Blind Method ,Physiology (medical) ,Internal medicine ,medicine ,[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Humans ,Muscle, Skeletal ,030304 developmental biology ,Vitamin C ,medicine.disease ,Ascorbic acid ,Endocrinology ,Oxidative stress ,Dietary Supplements ,Physical Endurance ,[SDV.AEN]Life Sciences [q-bio]/Food and Nutrition ,030217 neurology & neurosurgery - Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant disease characterized by progressive weakness and atrophy of specific skeletal muscles. As growing evidence suggests that oxidative stress may contribute to FSHD pathology, antioxidants that might modulate or delay oxidative insults could help in maintaining FSHD muscle function. Our primary objective was to test whether oral administration of vitamin C, vitamin E, zinc gluconate, and selenomethionine could improve the physical performance of patients with FSHD. Adult patients with FSHD (n=53) were enrolled at Montpellier University Hospital (France) in a randomized, double-blind, placebo-controlled pilot clinical trial. Patients were randomly assigned to receive 500 mg vitamin C, 400mg vitamin E, 25mg zinc gluconate and 200 μg selenomethionine (n=26), or matching placebo (n=27) once a day for 17 weeks. Primary outcomes were changes in the two-minute walking test (2-MWT), maximal voluntary contraction, and endurance limit time of the dominant and nondominant quadriceps (MVCQD, MVCQND, TlimQD, and TlimQND, respectively) after 17 weeks of treatment. Secondary outcomes were changes in the antioxidant status and oxidative stress markers. Although 2-MWT, MVCQ, and TlimQ were all significantly improved in the supplemented group at the end of the treatment compared to baseline, only MVCQ and TlimQ variations were significantly different between groups (MVCQD: P=0.011; MVCQND: P=0.004; TlimQD: P=0.028; TlimQND: P=0.011). Similarly, the vitamin C (P
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- 2015
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18. Short- and long-term outcomes of HIV-infected patients admitted to the intensive care unit: impact of antiretroviral therapy and immunovirological status
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T. Mura, Alain Makinson, Olivier Jonquet, Jacques Reynes, David Morquin, Kada Klouche, Vincent Le Moing, Philippe Corne, Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Département de l'Information Médicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre d'Investigation Clinique, CHU Saint-Eloi-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinical Investigation Center 1001, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinical Investigation Center 1001, and BMC, Ed.
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Pediatrics ,medicine.medical_specialty ,[SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Population ,Critical Care and Intensive Care Medicine ,Prognostic factors ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Intensive care ,[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Medicine ,030212 general & internal medicine ,Mortality ,education ,education.field_of_study ,Intensive care units ,business.industry ,Human immunodeficiency virus ,Research ,Hazard ratio ,Retrospective cohort study ,Odds ratio ,Intensive care unit ,3. Good health ,Antiretroviral therapy ,Acquired immunodeficiency syndrome ,Critical care ,030228 respiratory system ,SAPS II ,business ,Viral load - Abstract
International audience; BackgroundThe purpose of this study was to assess the short- and long-term outcomes of HIV-infected patients admitted to intensive care units (ICU) according to immunovirological status at admission and highly active antiretroviral therapy (HAART) use in ICU.MethodsRetrospective study of 98 HIV-infected patients hospitalized between 1997 and 2008 in two medical ICU in Montpellier, France. The primary outcome was mortality in ICU. The secondary end point was probability of survival in the year following ICU admission.ResultsEighty-two (83.6%) admissions in ICU were related to HIV infection and 45% of patients had received HAART before admission. Sixty-two patients (63.3%) were discharged from ICU, and 34 (34.7%) were alive at 1 year. Plasma HIV RNA viral load (VL) and CD4+ cell count separately were not associated with outcome. Independent predictors of ICU mortality were the use of vasopressive agents (odds ratio (OR), 3.779; 95% confidence interval (CI), 1.11-12.861; p = 0.0334) and SAPS II score (OR, 1.04; 95% CI, 1.003-1.077; p = 0.0319), whereas introducing or continuing HAART in ICU was protective (OR, 0.278; 95% CI, 0.082-0.939; p = 0.0393). Factors independently associated with 1-year mortality were immunovirological status with high VL (>3 log10/ml) and low CD4 (ConclusionsIn a population of HIV-infected patients admitted to ICU, short- and long-term outcomes are related to acute illness severity and immunovirological status at admission. Complementary studies are necessary to identify HIV-infected patients who benefit from HAART use in ICU according to immunovirological status and the reasons of ICU admission.
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- 2012
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19. Students perceived stress in academic programs : Consequences for its management
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Doron, Julie, Neveu, Dorine, Visier, Laurent, Boiché, Julie, Trouillet, Raphaël, Dujols, Pierre, Ninot, Gregory, Dynamique des capacités humaines et des conduites de santé (EPSYLON), Université Montpellier 1 (UM1) - Université Paul-Valéry - Montpellier 3 (UM3) - Université Jean Monnet [Saint-Étienne] (UJM) - Université de Montpellier (UM), Pathogénèse et contrôle des infections chroniques (PCCI), Université de Montpellier (UM) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Université Montpellier 1 (UM1), Département de l'Information Médicale, and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) - Hôpital La Colombière
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Stress perçu ,Gestion du stress ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,[SCCO.PSYC] Cognitive science/Psychology ,[SHS.EDU] Humanities and Social Sciences/Education ,Filière universitaire ,Perceived stress ,Undergraduate curriculum ,Coping behaviour ,Etudiants ,Education - Abstract
International audience; Background: Academic stress contributes to the deterioration of the students' quality of life. Psychological determinants involved in the stress process, trait anxiety and coping, have been neglected when assessing the role of academic programs in stress. This study aimed at determining whether academic programs are associated with a high level of perceived stress above and beyond potential personal and environmental risk factors, as well as coping strategies.Methods: A cross-sectional survey was conducted in 2009 among third-year medical (total n = 170, participants 88%), dental (n = 63, 94%), psychology (n = 331, 61%) and sports sciences (n = 312, 55%) students in Montpellier (France). The stress level experienced during the last 2 months, trait anxiety and coping strategies were appraised. Substance use, psychological care, and stress triggers were also collected using a self-administered questionnaire.Results: Compared with medicine and after adjusting for gender and age, only the sports program was associated with a lower perceived stress risk: adjusted odds ratio: 0.54 [95% Confidence interval: 0.30; 0.99]. Substantial reductions in perceived stress risks were observed in science students after additional adjustments for non-academic stress triggers, substance use, psychological care (adjusted odds ratio: 0.20 [95% Confidence interval: 0.09; 0.41]), and also for trait anxiety and coping strategies (adjusted odds ratio: 0.23 [95% Confidence interval: 0.10; 0.54]). Compared with medicine and after these additional adjustments, psychology had a significantly lower perceived stress risk (0.34 [0.18; 0.64]; 0.40 [0.19; 0.86], respectively), dentistry had a similar risk (0.82 [0.35; 1.91]; 0.53 [0.20; 1.43], respectively).Conclusion: Sports and psychology programs had a lower perceived stress risk compared with medicine. Personal and environmental risk factors and coping strategies modified the association between academic program and perceived stress. Developing efficient coping strategies in students and improving academic environment could contribute to prevent the potential deleterious consequences of stress.; Position du problème: Le stress académique contribue à détériorer la qualité de vie des étudiants. La prédisposition à l’anxiété et les stratégies de coping, facteurs impliqués dans le stress, sont négligées dans l’étude du rôle du cursus universitaire sur le stress. Cette étude a analysé le rôle de la filière académique comme facteur de risque de stress perçu élevé après prise en compte des facteurs de risque personnels, environnementaux et des stratégies de coping.Méthodes: Enquête transversale menée chez des étudiants inscrits en troisième année à Montpellier en 2009–2010 : médecine, 170 (participants : 88 %) ; odontologie, 63 (94 %) ; psychologie, 331 (61 %) ; sports, 312 (55 %). Le niveau de stress perçu pendant les deux derniers mois, la prédisposition à l’anxiété et les stratégies de coping ont été évalués. Consommation de substances, suivi psychologique et sources de stress étaient aussi recueillis par auto-questionnaire.Résultats: Seule la filière sports avait un risque de stress perçu significativement moindre par rapport à la médecine après ajustement sur l’âge et le genre (Odds Ratioajusté : 0,54 [intervalle de confiance à 95 % : 0,30 ; 0,99]). Ce risque était réduit après ajustements complémentaires sur les facteurs environnementaux non académiques, les consommations de substances, un suivi psychologique (0,20 [0,09 ; 0,41]) ainsi que sur l’anxiété et les stratégies de coping (0,23 [0,10 ; 0,54]). Comparée à la médecine, la filière psychologie avait un risque moindre de stress perçu après ces mêmes ajustements (0,34 [0,18 ; 0,64] ; 0,40 [0,19 ; 0,86], respectivement), et la filière odontologie avait un risque semblable (0,82 [0,35 ; 1,91] ; 0,53 [0,20 ; 1,43], respectivement).Conclusion: Les filières sports et psychologie auraient un risque moindre de stress perçu par rapport à la filière médecine. L’association entre filière et stress perçu est influencée par les facteurs de risque personnels, environnementaux et les stratégies de coping. Développer des stratégies de coping efficaces et améliorer le cadre académique contribueraient à prévenir les conséquences délétères du stress.
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- 2012
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20. Mineralocorticoid Modulation of Cardiac Ryanodine Receptor Activity Is Associated With Downregulation of FK506-Binding Proteins
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Romain Perrier, Héctor H. Valdivia, Yannis Sainte-Marie, Ana María Gómez, Ćline Latouche, Frederic Jaisser, Spyros Zissimopoulos, Sylvain Richard, Xinsheng Zhu, Marie Christine Picot, Jean-Pierre Benitah, F. Anthony Lai, Emeline Perrier, Angélica Rueda, Roxane Schaub, Laetitia Pereira, Physiopathologie cardiovasculaire, Université Montpellier 1 (UM1)-IFR3, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), Gènes et pression artérielle (INSERM U772), Collège de France (CdF (institution))-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Wales Heart Research Institute, School of Medicine [Cardiff], Cardiff University-Institute of Medical Genetics [Cardiff]-Cardiff University-Institute of Medical Genetics [Cardiff], Department of Physiology, University of Wisconsin Medical School, Département de l'Information Médicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, A05071FS/APV05030FSA, strep eurepe CT 2005 N°018802, CONTICA, Gomez, Ana Maria, Université Montpellier 1 ( UM1 ) -IFR3-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Gènes et pression artérielle ( Inserm U772 ), Collège de France ( CdF ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Cardiff University School of Medicine, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, and ANR : A05071FS/APV05030FSA,A05071FS/APV05030FSA
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Male ,Patch-Clamp Techniques ,MESH : Arrhythmias, Cardiac ,MESH: Myocytes, Cardiac ,030204 cardiovascular system & hematology ,MESH: Down-Regulation ,MESH : Receptors, Mineralocorticoid ,MESH: Ryanodine Receptor Calcium Release Channel ,MESH : Down-Regulation ,Mice ,chemistry.chemical_compound ,MESH : Calcium Signaling ,0302 clinical medicine ,Mineralocorticoid receptor ,MESH: Receptors, Mineralocorticoid ,Myocytes, Cardiac ,MESH: Animals ,MESH : Patch-Clamp Techniques ,Aldosterone ,Cells, Cultured ,MESH : Ryanodine Receptor Calcium Release Channel ,Calcium signaling ,0303 health sciences ,MESH : Rats ,Ryanodine receptor ,TOR Serine-Threonine Kinases ,[ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,MESH : Mice, Transgenic ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Sarcoplasmic Reticulum ,MESH: Arrhythmias, Cardiac ,cardiovascular system ,MESH: Sarcoplasmic Reticulum ,MESH : Sarcoplasmic Reticulum ,Cardiology and Cardiovascular Medicine ,MESH: Cells, Cultured ,RM ,medicine.medical_specialty ,MESH: Rats ,medicine.drug_class ,MESH: Mice, Transgenic ,MESH : Male ,MESH : Myocytes, Cardiac ,Down-Regulation ,Mice, Transgenic ,MESH : Protein Kinases ,MESH : Rats, Wistar ,MESH : Tacrolimus Binding Proteins ,MESH: Calcium Signaling ,Tacrolimus Binding Proteins ,03 medical and health sciences ,Downregulation and upregulation ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Mineralocorticoids ,Physiology (medical) ,Internal medicine ,MESH : Cells, Cultured ,MESH : Mice ,MESH: Patch-Clamp Techniques ,medicine ,Animals ,Humans ,Calcium Signaling ,Patch clamp ,Rats, Wistar ,MESH: Protein Kinases ,MESH: Mice ,030304 developmental biology ,MESH: Tacrolimus Binding Proteins ,Heart Failure ,MESH: Humans ,MESH : Aldosterone ,business.industry ,MESH : Humans ,MESH: Aldosterone ,Arrhythmias, Cardiac ,Ryanodine Receptor Calcium Release Channel ,MESH: Rats, Wistar ,medicine.disease ,R1 ,MESH : Mineralocorticoids ,MESH: Male ,Rats ,Receptors, Mineralocorticoid ,Endocrinology ,chemistry ,MESH: Mineralocorticoids ,Mineralocorticoid ,Heart failure ,MESH: Heart Failure ,MESH : Animals ,MESH : Heart Failure ,business ,Protein Kinases - Abstract
Background— The mineralocorticoid pathway is involved in cardiac arrhythmias associated with heart failure through mechanisms that are incompletely understood. Defective regulation of the cardiac ryanodine receptor (RyR) is an important cause of the initiation of arrhythmias. Here, we examined whether the aldosterone pathway might modulate RyR function. Methods and Results— Using the whole-cell patch clamp method, we observed an increase in the occurrence of delayed afterdepolarizations during action potential recordings in isolated adult rat ventricular myocytes exposed for 48 hours to aldosterone 100 nmol/L, in freshly isolated myocytes from transgenic mice with human mineralocorticoid receptor expression in the heart, and in wild-type littermates treated with aldosterone. Sarcoplasmic reticulum Ca 2+ load and RyR expression were not altered; however, RyR activity, visualized in situ by confocal microscopy, was increased in all cells, as evidenced by an increased occurrence and redistribution to long-lasting and broader populations of spontaneous Ca 2+ sparks. These changes were associated with downregulation of FK506-binding proteins (FKBP12 and 12.6), regulatory proteins of the RyR macromolecular complex. Conclusions— We suggest that in addition to modulation of Ca 2+ influx, overstimulation of the cardiac mineralocorticoid pathway in the heart might be a major upstream factor for aberrant Ca 2+ release during diastole, which contributes to cardiac arrhythmia in heart failure.
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- 2009
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21. In-vitro and in-vivo evidence of dose-dependent decrease of uropathogenic Escherichia coli virulence after consumption of commercial Vaccinium macrocarpon (cranberry) capsules
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Gisèle Bourg, Jean-Philippe Lavigne, Henri Botto, Albert Sotto, Christophe Combescure, Lavigne, Jean-Philippe, Systèmes de sécrétion de type IV et virulence bactérienne, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de l'information médicale, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'urologie, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Foch [Suresnes]
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Microbiology (medical) ,Adult ,Capsules ,Urine ,Biology ,medicine.disease_cause ,Placebo ,beta-Lactams ,Bacterial Adhesion ,beta-Lactam Resistance ,Article ,Microbiology ,Cell Line ,food ,Double-Blind Method ,In vivo ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,medicine ,Escherichia coli ,Vaccinium macrocarpon ,Animals ,Humans ,Caenorhabditis elegans ,food.beverage ,Escherichia coli Infections ,Cross-Over Studies ,Dose-Response Relationship, Drug ,CRANBERRY JUICE ,cranberry ,Epithelial Cells ,General Medicine ,therapy, urinary tract infection ,Crossover study ,Dose–response relationship ,Infectious Diseases ,Treatment Outcome ,Adherence ,Urinary Tract Infections ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Female - Abstract
International audience; This study evaluated the antibacterial efficacy of the consumption of cranberry capsules vs. placebo in the urine of healthy volunteers. A first double-blind, randomised, crossover trial involved eight volunteers who had followed three regimens, with or without cranberry, with a wash-out period of at least 6 days between each regimen. Twelve hours after consumption of cranberry or placebo hard capsules, the first urine of the morning was collected. Different Escherichia coli strains were cultured in the urine samples. Urinary antibacterial adhesion activity was measured in vitro using the human T24 epithelial cell-line, and in vivo using the Caenorhabditis elegans killing model. With the in-vitro model, 108 mg of cranberry induced a significant reduction in bacterial adherence to T24 cells as compared with placebo (p
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- 2008
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22. Clinical and molecular epidemiology of multidrug-resistant Citrobacter spp. infections in a French university hospital
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Albert Sotto, Aba Mahamat, N. Bouziges, J.-P. Lavigne, C. Defez, Laboratoire de bactériologie, virologie et parasitologie, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Systèmes de sécrétion de type IV et virulence bactérienne, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de l'Information Médicale, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and Lavigne, Jean-Philippe
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Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,Cephalosporin ,Drug resistance ,Microbiology ,Hospitals, University ,MESH: Epidemiology, Molecular ,Medical microbiology ,MESH: Aged, 80 and over ,Citrobacter ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Drug Resistance, Multiple, Bacterial ,medicine ,Humans ,MESH: Enterobacteriaceae Infections ,Aged ,MESH: Aged ,MESH: Hospitals, University ,Aged, 80 and over ,Cross Infection ,Molecular Epidemiology ,MESH: Humans ,MESH: Middle Aged ,biology ,Molecular epidemiology ,Enterobacteriaceae Infections ,MESH: Cross Infection ,MESH: Adult ,General Medicine ,MESH: Drug Resistance, Multiple, Bacterial ,Citrobacter koseri ,Middle Aged ,biology.organism_classification ,MESH: Male ,MESH: France ,Infectious Diseases ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Vancomycin ,MESH: Citrobacter ,France ,medicine.drug - Abstract
Citrobacter spp. are aerobic, gram-negative bacilli that are frequently found in water, soil, food, and the intestines of animals and humans [1]. Even though their level of virulence is low and they rarely cause infections in humans, these pathogens have been associated with a wide spectrum of infections involving the central nervous system and the gastrointestinal, urinary, or respiratory tracts [1]. The fact that Citrobacter spp. are rather uncommon in clinical specimens explains why few studies of them appear in the medical literature [2, 3]. However, these organisms may be responsible for serious infections, especially in immunocompromised hosts. To evaluate the epidemiology of Citrobacter spp. in our 1,700-bed university hospital in southern France, we conducted a prospective study from 1 October 2003 to 30 April 2004. Hospitalized patients were screened for the presence of Citrobacter spp. and nonrepetitive clinical strains isolated consecutively from infection sites were included in the study. Antibiotic susceptibility testing was performed using the Vitek 2 GNS-F7 card (bioMerieux, Marcy l’Etoile, France) and an agar disk-diffusion assay on Mueller-Hinton agar. Strains were classified as susceptible, intermediately resistant or resistant to the other antibiotics tested according to the recommendations of the Antibiotic Susceptibility Testing Committee of the French Society for Microbiology [4]. The strains that were found to be resistant to extended-spectrum cephalosporins were additionally screened for extended-spectrum β-lactamase (ESBL) production using the double-disk synergy test. Isoelectric focusing was performed using polyacrylamide gels as described previously [5]. Macrorestriction analysis of chromosomal DNAwas performed using pulsed-field gel electrophoresis according to previously published procedures and analyzed with Gel compar computer software (Applied Math, Belgium) as described previously [5]. The qnrA, qnrB and qnrS genes were screened using PCR as described previously [5]. During the study period, information concerning patient age, sex and immune status (MacCabe score [6]), hospital ward, source of infection, mortality, comorbid diseases, antecedent of hospitalization (notably prior stay in an intensive care unit), prior antibiotic therapy, date of bacterial isolation, length of hospitalization, and the source of infection were collected to determine the risk factors for infections caused by extended-spectrum, cephalosporinresistant Citrobacter spp. Duplicate isolates from the same patient were excluded. Of the 1,531 Enterobacteriaceae we isolated, 45 strains were Citrobacter spp., i.e., 2.94% isolated from 45 patients. The characteristics of these 45 patients are presented in Table 1. The infections were of nosocomial origin in 62% of cases. Citrobacter koseri was the species isolated most frequently (57.7%), but this finding differs from previous Eur J Clin Microbiol Infect Dis (2007) 26:439–441 DOI 10.1007/s10096-007-0315-3
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- 2007
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23. Miniaturized oligonucleotide arrays: a new tool for discriminating colonization from infection due to Staphylococcus aureus in diabetic foot ulcers
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Sotto, Albert, Richard, Jean-Louis, Jourdan, Nathalie, Combescure, Christophe, Bouziges, Nicole, Lavigne, Jean-Philippe, Lavigne, Jean-Philippe, Systèmes de sécrétion de type IV et virulence bactérienne, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies de la nutrition et de diabétologie, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service des maladies métaboliques et endocriniennes, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Département de l'information médicale, and Laboratoire de bactériologie
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[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,digestive system diseases - Abstract
OBJECTIVE: We sought to evaluate the use of oligonucleotide arrays to discriminate colonization from infection due to Staphylococcus aureus in diabetic foot ulcers. RESEARCH DESIGN AND METHODS: We included diabetic patients hospitalized in a diabetic foot department for an episode of foot ulcer. Only patients who had no antibiotic treatment during the previous 6 months were included. At admission, ulcers were classified on clinical examination, according to the Infectious Diseases Society of America system. Seventy-two patients with a culture positive only for S. aureus as the sole pathogen were included. In individuals with a grade 1 ulcer, a second wound bacterial specimen was obtained 1 month later. Using oligonucleotide arrays, S. aureus resistance and virulence genes were compared between grade 1 and grades 2-4 ulcers. RESULTS: S. aureus was initially isolated from 22 grade 1 and 50 grade 2-4 ulcers: 35 were methicillin resistant and 37 methicillin sensitive. In 20 grade 1 ulcers (92%), no virulence genes were identified, whereas these genes were present in all but 1 grade 2-4 ulcers. During follow-up, the two grade 1 ulcers that were infected with strains carrying virulence genes rapidly deteriorated; the array technology showed unchanged genotype profiles. On the contrary, two grade 1 ulcers healed: the genotype profiles were different from those at inclusion but without appearance of virulence genes. CONCLUSIONS: The DNA array appears as a promising technique and is easy to perform. Our observational study suggests that it might help distinguish colonized grade 1 from infected grade 2 wounds, predict ulcer outcome, and contribute to a more adequate use of antibiotics.
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- 2007
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24. Cost of lung cancer: a methodological review
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Alain Vergnenegre, Bruno Housset, Laurent Molinier, Alain Grand, Jean-Pierre Daurès, Christophe Combescure, Cristos Chouaïd, Didier Fabre, Département de l'information médicale, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de Pneumologie et de Pathologie Professionnelle, CHI Créteil, Service de Pathologie respiratoire et allergologie [CHU Limoges], CHU Limoges, L Molinier, C Combescure, C Chouaïd, JP Daurès, B Housset, Fabre D, Grand A, and A SCHILLER
- Subjects
medicine.medical_specialty ,Lung Neoplasms ,Total cost ,MESH: Health Care Costs ,Disease ,macromolecular substances ,Health administration ,03 medical and health sciences ,Indirect costs ,0302 clinical medicine ,Resource (project management) ,Cost of Illness ,Carcinoma, Non-Small-Cell Lung ,Credibility ,parasitic diseases ,Humans ,Medicine ,Carcinoma, Small Cell ,health care economics and organizations ,Pharmacology ,Actuarial science ,Health economics ,MESH: Humans ,business.industry ,030503 health policy & services ,Health Policy ,fungi ,Public Health, Environmental and Occupational Health ,MESH: Carcinoma, Small Cell ,Health Care Costs ,MESH: Cost of Illness ,3. Good health ,Surgery ,MESH: Lung Neoplasms ,030220 oncology & carcinogenesis ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,0305 other medical science ,business ,Strengths and weaknesses ,MESH: Carcinoma, Non-Small-Cell Lung - Abstract
International audience; Cost of illness (COI) studies estimate the overall economic burden of a specific disease, rather than simply treatment-related costs. While having been criticised for not allowing resource prioritisation, COI studies can provide useful guidance, so long as they adhere to accepted methodology. The aim of this review is to analyse the methods used to evaluate the cost of lung cancer. Because of the increasing incidence and high direct and indirect costs of lung cancer, it is an important disease in terms of economic implications, and therefore provides a relevant example with which to review COI study methodologies. First, the key points of the methodology relating to COI studies were identified. COI studies relating to lung cancer were then reviewed, focussing on an analysis of the different methods used and an identification of the strengths and weaknesses of each approach. The COI studies that were analysed confirmed that lung cancer is a costly illness, and that hospitalisation and treatments account for a large part of direct costs, while indirect costs represent a large part of the total costs. The review also showed that COI studies adopted significantly different approaches to estimate the costs of lung cancer, reflecting a lack of consensus on the methodology of COI studies in this area. Hence, to increase the credibility of COI studies, closer agreement among researchers on methodological principles would be desirable.
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- 2006
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25. Reference values for vastus lateralis fiber size and type in healthy subjects over 40 years old. A systematic review and meta-analysis
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Jacques Mercier, Maurice Hayot, Pascal Pomiès, C. Prefaut, Nicolas Molinari, Jonathan Maury, Fares Gouzi, 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), CHU de Montpellier, Département de l'Information Médicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital La Colombière, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
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2. Zero hunger ,0303 health sciences ,medicine.medical_specialty ,Physiology ,business.industry ,Healthy subjects ,Fiber size ,030204 cardiovascular system & hematology ,medicine.disease ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Atrophy ,Chronic disease ,Physiology (medical) ,Reference values ,Internal medicine ,medicine ,Physical therapy ,[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,10. No inequality ,business ,ComputingMilieux_MISCELLANEOUS ,030304 developmental biology ,Skeletal muscle atrophy - Abstract
Skeletal muscle atrophy is a major systemic impairment in chronic diseases. Yet its determinants have been hard to identify because a clear research definition has not been agreed upon. The reduction in muscle fiber cross-sectional area (CSA) is a widely acknowledged marker of muscle atrophy, but no reference values for the muscle fiber CSA at the age of the onset of chronic disease have ever been published. Thus, we aimed to systematically review the studies providing data on fiber CSA and fiber type proportion in the vastus lateralis of the quadriceps of healthy subjects (age >40 yr) and then to pool and analyze the data from the selected studies to determine reference values for fiber CSA. We followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and identified 19 studies, including 423 subjects that matched the inclusion criteria. On the basis of fiber type and gender, the mean fiber CSA and the lower limits of normal (LLNs) were (%type I*60) + 1,743 μm2 and (%type I*60) − 718 μm2, respectively, for men; and (%type I*70) + 139 μm2 and (%type I*70) − 1,485 μm2, respectively, for women. There was no significant heterogeneity among subgroups of fiber type and gender. The pooled type I fiber proportion was 50.3% (LLN = 32.9%). In multivariate analysis, fiber CSA was significantly correlated with V̇o2 peak ( r = 190.92; P = 0.03), and type I fiber proportion was correlated with age ( r = −0.024; P = 0.005), body mass index ( r = 0.096; P = 0.005), and V̇o2 peak ( r = −0.053; P = 0.005). Our metaanalysis of a homogeneous set of studies is the first to provide valuable LLNs for fiber CSA according to fiber type and gender. This analysis will be improved by prospective assessment in well-characterized healthy subjects.
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26. [Evaluation of the economic impact and the patient pathway in the treatment of chronic total occlusion].
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Delporte L, Brianceau MC, Rihani EK, Masse M, Lauerière C, Odou P, Delhaye C, and Décaudin B
- Abstract
Objectives: Chronic total occlusion (CTO) of coronary arteries is defined as complete absence of antegrade coronary flow without iodine passage, since more than 3 months. Coronary revascularization is a highly resource-intensive angioplasty procedure involving numerous medical devices (MDs). Its consumption and associated costs are not covered by either the medical act classification (CCAM) or the hospitalization fees and additional MD funding. The primary aim of this study is to analyze the financial sustainability of this activity for a public healthcare institution and to assess the budgetary impact of CTO treatment on the most expensive items of expenditure. The secondary aim is to describe the patient's intra-hospital pathway., Methods: CTO revascularization stays are categorized under the code 05K06 "Vascular Stents without Myocardial Infarction". Major cost items were identified using national coded expenditure data and compared with those from our cost study. Every CTO intervention from January to November 2021 were retrospectively retrieved. Establishment purchase prices in 2021 were used to determine MD costs. Clinical data were extracted from electronic patient records. Operative data (procedure duration, professionals involved, and MD used) were extracted. Human Resources (HR) costs were integrated into the calculations. A Sankey diagram was created. Data are expressed as mean±standard deviation., Results: In our study, 41 patients underwent 45 interventions. The median was 65 years. Seventy-eight percent of interventions were successful with a median duration of 113minutes. Two hundred and two different MD references were used, with 27% reimbursed additionally and 73% funded within the homogeneous group of stays (HGS). The total cost of MD described in the coded expenditure data is 2142€, of which 721€ is funded within the HGS. In our cohort, it represented averages of 2736€±1393€ and 1710€±926€, respectively. Regarding HR, the total cost described in the coded expenditure data was 442€ compared to 410€±169€ in our cohort. Finally, patient pathway analysis showed an average length of stay (LOS) of 1.8 days. Two pathways were identified depending on admission context: weekday hospitalization or cardiac intensive care., Conclusions: CTO revascularization is a planned intervention with a short LOS and a highly standardized patient pathway. Our study highlights a proliferation of MD references used during CTO revascularization due to innovative industrial developments. The cost differential with coded expenditure data confirms the need for a revision of the procedure and its categorization within an HGS, which is currently non-specific., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)
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- 2024
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27. Clinical outcomes of COVID-19 in patients with sickle cell disease in French Guiana.
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Elenga N, Ntab B, Mafema Missindu J, Thomas Boizan N, and Abassi A
- Abstract
Objectives: French Guiana also suffered concrete epidemiological consequences of the SARS-CoV2 epidemic. These regions are home to a large number of sickle cell patients who are at risk of developing severe forms of COVID-19. This study aimed to describe the characteristics and prognosis of patients with sickle disease infected with SARS-CoV2 during the first and second epidemic waves of 2020 in French Guiana., Design: We conducted a multicenter, retrospective cohort study that included sickle cell patients followed up in French Guiana., Results: Among the 79 patients infected with SARS-CoV2, there were 26 children <18 years. Forty-two patients were hospitalized and 37 were outpatients. Respiratory illness (38 %), vaso-occlusive crises (18 %), and acute chest syndrome (8 %) were the main causes of hospitalization. There were two cases of pulmonary embolism and one case of deep limb thrombosis. Seven patients were transferred to the ICU. Of these, three received mechanical ventilation, and two died. The deceased patients had the SS phenotype (a 16-year-old boy and a 32-year-old man), both of whom exhibited severe pneumonitis complicated by COVID-19., Conclusion: Despite the two deaths, the overall outcome was favorable., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors.)
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- 2024
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28. Changes in Lean Tissue Mass, Fat Mass, Biological Parameters and Resting Energy Expenditure over 24 Months Following Sleeve Gastrectomy.
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Maïmoun L, Aouinti S, Puech M, Lefebvre P, Deloze M, de Santa Barbara P, Renard E, Christol JP, Myzia J, Picot MC, Mariano-Goulart D, and Nocca D
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- Humans, Female, Male, Longitudinal Studies, Energy Metabolism, Gastrectomy, Obesity surgery, Body Composition
- Abstract
Sleeve gastrectomy (SG) induces weight loss but its effects on body composition (BC) are less well known. The aims of this longitudinal study were to analyse the BC changes from the acute phase up to weight stabilization following SG. Variations in the biological parameters related to glucose, lipids, inflammation, and resting energy expenditure (REE) were concomitantly analysed. Fat mass (FM), lean tissue mass (LTM), and visceral adipose tissue (VAT) were determined by dual-energy X-ray absorptiometry in 83 obese patients (75.9% women) before SG and 1, 12 and 24 months later. After 1 month, LTM and FM losses were comparable, whereas at 12 months the loss of FM exceeded that of LTM. Over this period, VAT also decreased significantly, biological parameters became normalized, and REE was reduced. For most of the BC, biological and metabolic parameters, no substantial variation was demonstrated beyond 12 months. In summary, SG induced a modification in BC changes during the first 12 months following SG. Although the significant LTM loss was not associated with an increase in sarcopenia prevalence, the preservation of LTM might have limited the reduction in REE, which is a longer-term weight-regain criterion.
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- 2023
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29. Total alkaline phosphatase levels by gestational age in a large sample of pregnant women.
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Titaux C, Ternynck C, Pauchet M, Stichelbout M, Bizet G, Maboudou P, Onraed B, Clément G, Lenne X, Potier G, Subtil D, and Chudzinski A
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- Female, Humans, Pregnancy, Pregnancy Trimester, Second, Retrospective Studies, Alkaline Phosphatase blood, Gestational Age
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Introduction: Total alkaline phosphatase (tALP) levels rise physiologically in maternal serum during pregnancy, and excessively so in certain conditions. However, current reference values are dated, nonlinear, and based on small samples. Factors related to variation in tALP remain unexplained. Thus, our goals in this study were to establish a physiological development curve for tALP within low-risk pregnancies and to evaluate the factors influencing tALP values., Methods: This was a single-center, retrospective, observational study. All patients who delivered a live singleton infant at our center from January 1, 2011 to May 31, 2019, and had a tALP assay during pregnancy, were included regardless of the gestational age at which the assay was conducted., Results: A total of 2415 pregnancies were included. Median tALP decreased during the first trimester, it increased slightly during the second trimester, and then increased sharply during the third trimester. Factors associated with a significant increase in tALP were chronic histiocytic intervillositis, cholestasis, multiple pregnancies, liver disease, preeclampsia, smoking, and low weight for gestational age. Conversely, gestational diabetes was associated with a discrete decrease in tALP., Discussion: Our large sample allowed establishment of tALP reference curves based on gestational age. To interpret these results more thoroughly, factors that influence tALP rates should be further scrutinized., Competing Interests: Declarations of competing interest None., (Copyright © 2022. Published by Elsevier Ltd.)
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- 2023
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30. Opioid misuse in community pharmacy patients with chronic non-cancer pain.
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Philip C, Roy S, Eiden C, Soler M, Georgin F, Müller A, Picot MC, Donnadieu-Rigole H, and Peyriere H
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- Adult, Analgesics, Opioid adverse effects, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Morphine, Chronic Pain drug therapy, Opioid-Related Disorders drug therapy, Opioid-Related Disorders epidemiology, Pharmacies
- Abstract
Aims: Community pharmacists could contribute to identify people misusing prescription opioids, which may be associated with hospitalizations, substance use disorders and death. This study investigated prescription opioid misuse in community pharmacy patients and the factors potentially associated with high Prescription Opioid Misuse Index (POMI) scores., Methods: In this cross-sectional study, pharmacy students asked patients with opioid prescriptions to fill in a questionnaire (including the POMI) in community pharmacies in a French region, in April 2019. Eligible patients were adults with chronic non-cancer pain who consented to participate., Results: In total, 414 patients (62.4% women; mean age: 58.00 years ± 16.00) were included. The prescribed opioids were mainly weak opioids (73.2%; paracetamol/tramadol: 35%). Strong opioids (32.6%) included oxycodone (11.95%), fentanyl (9%) and morphine (9%). The median morphine milligram equivalent (MME) was 40 mg/day (IQR
25-75 : 20-80). The POMI score (0 to 6) was ≥4 in 16% of patients who were younger (P < .01), more urban (P = .03), with higher pain visual analogue scale (VAS) score (P < .01) and MME (P < .01), and treated more frequently with strong opioids (P = .04). In multivariate analysis, age (ORfor 10y : 0.68 (95% CI: 0.56-0.82, P < .0001)), VAS (OR2units : 1.78 (95% CI: 1.26-2.40, P = .0008)), and MME (>100 mg, OR: 2.65 (95% CI: 1.14-4.41, P = .0194)) were significantly associated with POMI scores ≥4., Conclusions: The high proportion of patients with high POMI scores underlines the interest of prescription opioid misuse screening in community pharmacies, in order to help these patients and refer them to pain specialists, if needed., (© 2021 British Pharmacological Society.)- Published
- 2022
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31. Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial.
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Vacher C, Romo L, Dereure M, Soler M, Picot MC, and Purper-Ouakil D
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- Adolescent, Child, Emotions, Humans, Parenting, Parents, Quality of Life, Randomized Controlled Trials as Topic, Treatment Outcome, Attention Deficit Disorder with Hyperactivity diagnosis, Attention Deficit Disorder with Hyperactivity therapy, Cognitive Behavioral Therapy
- Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED., Methods: Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder)., Discussion: Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population., Trial Registration: Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017., (© 2022. The Author(s).)
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- 2022
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32. Characterization of benzodiazepine misuse and comorbidities in patients with alcohol use disorder.
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Lopez E, Jeanne G, Lefort LH, Autissier C, Picot MC, Peyrière H, and Donnadieu-Rigole H
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- Adult, Benzodiazepines adverse effects, Child, Preschool, Comorbidity, Humans, Prospective Studies, Alcoholism diagnosis, Alcoholism epidemiology, Substance Withdrawal Syndrome, Substance-Related Disorders diagnosis, Substance-Related Disorders epidemiology
- Abstract
Background: Due to the frequent presence of anxious symptoms and sleep disorders, benzodiazepines (BZD) are often prescribed to patients with alcohol use disorder (AUD)., Objectives: To assess BZD misuse and psychiatric comorbidities in patients with AUD., Methods: This prospective, monocentric study included all adult patients with AUD hospitalized in a French addiction unit for alcohol withdrawal from November 2017 to May 2018., Results: Among the 153 patients included, 75 (49%) were using BZD at the time of their hospitalization. Duration of alcohol addiction was longer in BZD users: (33 ± 27 years vs. 29 ± 11 years; P = 0.001). BZD misuse was noted in 27 patients consuming benzodiazepines (36% of BZD users and 18% of all included patients), mainly increase in the dose (on average, 3 ± 4 times the prescribed dose). The most frequently misused benzodiazepines were diazepam (43.2%), alprazolam (18.9%), and lormetazepam (13.5%). The frequency of patients with lifetime use of cocaine or heroin was higher among BZD misusers than among non-misusers (84.6% vs. 42.2%; <0.01 and 53.9% vs. 27.1%; P = 0.04). The frequency of patients consuming cocaine in the last month was higher in BZD misusers than in others: 16% versus 6%, P = 0.002. In multivariate analysis, age (OR=1.65 for 5 years, 95% CI = 1.19-2.27; P = 0.023), psychiatric comorbidities (at least one comorbidity: OR=6.03, 95% CI = 1.40-25.83; P = 0.015) and lifetime cocaine consumption (OR=4.37, 95% CI = 1.21-15.86; P = 0.025) were independently associated with BZD misuse., Conclusion: BZD prescription for long periods might result in tolerance and dose increase. Educational therapy, prescribers' awareness, and development of therapeutic alternatives are essential to limit BZD misuse., (© 2021 Société Française de Pharmacologie et de Thérapeutique.)
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- 2021
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33. Cerebral palsy in twins and higher multiple births: a Europe-Australia population-based study.
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Sellier E, Goldsmith S, McIntyre S, Perra O, Rackauskaite G, Badawi N, Fares A, and Smithers-Sheedy H
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- Australia epidemiology, Birth Weight, Child, Preschool, Cross-Sectional Studies, Europe epidemiology, Female, Humans, Male, Pregnancy, Premature Birth epidemiology, Prevalence, Registries, Risk, Cerebral Palsy epidemiology, Gestational Age, Multiple Birth Offspring
- Abstract
Aim: To describe the birth prevalence, temporal trends, and clinical outcomes of twins, triplets, or quadruplets with cerebral palsy (CP)., Method: This was a cross-sectional study using data for twins, triplets, and quadruplets with prenatally or perinatally acquired CP and pooled from the Surveillance of Cerebral Palsy in Europe network (born 1992-2009) and Australian Cerebral Palsy Register (born 1993-2009). Children were at least 4 years old at time of registration. Children born in regions with population ascertainment and available denominator data were included in prevalence calculations (n=1033 twins, 81 triplets, and 11 quadruplets). Clinical data from children registered in all participating registers were described, including 2163 twins (56% male), 187 triplets (59% male), and 20 quadruplets (45% male)., Results: The birth prevalence of CP was higher with increasing plurality (twins 6.5 per 1000 live births [95% confidence interval {CI} 6.1-6.9], triplets 17.1 [95% CI 13.6-21.2], quadruplets 50.7 [95% CI 25.6-88.9]); however, prevalence by gestational age was similar across all pluralities. Between 1992-1994 and 2007-2009, prevalence of CP among twins declined (p=0.001) but prevalence of CP among triplets did not change significantly over time (p=0.55). The distributions of Gross Motor Function Classification System, epilepsy, and impairments of intellect, vision, and hearing were similar regardless of plurality., Interpretation: The data combined from two CP register networks indicated that triplets and quadruplets had increased risk of CP compared to twins. The higher prevalence of CP in triplets and quadruplets is due to their higher risk of preterm birth. Prevalence of CP among twins significantly declined in Europe and Australia. Clinical outcomes were similar for all multiple births., (© 2021 Mac Keith Press.)
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- 2021
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34. Maternal HLA Ib Polymorphisms in Pregnancy Allo-Immunization.
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Persson G, Picard C, Marin G, Isgaard C, Stæhr CS, Molinari N, Chiaroni J, Lebech M, Hviid TVF, and Di Cristofaro J
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- Adolescent, Adult, Alleles, Female, Gene Dosage, Gene Frequency, Genetic Association Studies, Genotype, Humans, Immunization, Immunoglobulin G immunology, Phenotype, Pregnancy, Young Adult, HLA-DQ Antigens genetics, HLA-DQ Antigens immunology, Isoantibodies immunology, Polymorphism, Genetic
- Abstract
During pregnancy the formation of alloreactive anti-human leukocyte antigen (HLA) antibodies are a major cause of acute rejection in organ transplantation and of adverse effects in blood transfusion. The purpose of the study was to identify maternal HLA class Ib genetic factors associated with anti-HLA allo-immunization in pregnancy and the degree of tolerance estimated by IgG4 expression. In total, 86 primiparous women with singleton pregnancies were included in the study. Maternal blood samples and umbilical cord samples were collected at delivery. Clinical data were obtained. Maternal blood serum was screened for HLA class I and II antibodies, identification of Donor Specific Antibody (DSA), activation of complement measured by C1q and IgG4 concentrations. Mothers were genotyped for HLA class Ib ( HLA-E, -F and -G ). Anti-HLA class I and II antibodies were identified in 24% of the women. The maternal HLA-E*01:06 allele was significantly associated with a higher fraction of anti-HLA I immunization (20.0% vs. 4.8%, p = 0.048). The maternal HLA-G 3'-untranslated region UTR4-HLA-G*01:01:01:05 haplotype and the HLA-F*01:03:01 allele were significantly associated with a low anti-HLA I C1q activation (16.7% vs . 57.1%, p = 0.028; 16.7% vs. 50.0%, p = 0.046; respectively). Both HLA‑G and HLA - F*01:03:01 showed significantly higher levels of IgG4 compared with the other haplotypes. The results support an association of certain HLA class Ib alleles with allo-immunization during pregnancy. Further studies are needed to elucidate the roles of HLA-E*01:06, HLA-F*01:03 and HLA‑G UTR4 in reducing the risk for allo-immunization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Persson, Picard, Marin, Isgaard, Stæhr, Molinari, Chiaroni, Lebech, Hviid and Di Cristofaro.)
- Published
- 2021
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35. Adult T-cell leukemia/lymphoma incidence rate in French Guiana: a prospective cohort of women infected with HTLV-1.
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Ramassamy JL, Tortevoye P, Ntab B, Seve B, Carles G, Gaquière D, Madec Y, Fontanet A, and Gessain A
- Subjects
- Adolescent, Adult, Female, French Guiana epidemiology, Humans, Incidence, Japan, Pregnancy, Prospective Studies, Human T-lymphotropic virus 1, Leukemia-Lymphoma, Adult T-Cell diagnosis, Leukemia-Lymphoma, Adult T-Cell epidemiology
- Abstract
Adult T-cell leukemia/lymphoma (ATL) is an aggressive malignancy caused by the human T-cell leukemia virus type 1 (HTLV-1). The incidence of ATL among HTLV-1 carriers remains largely unknown in endemic countries other than Japan as very few prospective studies have been performed. We assessed the ATL incidence rate among HTLV-1 infected women in a prospective cohort in French Guiana. This is the first prospective study to assess the ATL incidence rate in an area of South America where HTLV-1 prevalence is high. Patients were enrolled between 1991 and 2005, and follow-up continued until April 2018. In the general hospital in Saint-Laurent-du-Maroni, 307 pregnant women were diagnosed with HTLV-1 infection, and 268 of them were observed for a median of 16.7 years. During follow-up, 9 ATL incident cases occurred resulting in an ATL incidence rate of 2.03 per 1000 HTLV-1 carrier-years (95% confidence interval, 0.93-3.85 per 1000 HTLV-1 carrier-years). The median age at diagnosis was 47.4 years, and median survival from diagnosis was low at 3.5 months. The ATL incidence rate was elevated for a study population consisting mostly of young people, which could either be a general feature in South America or could be specific to the Noir Marron population that constituted most of the cohort., (© 2020 by The American Society of Hematology.)
- Published
- 2020
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36. Assessment of primary lymphedema and post-thrombotic lower limb edema patient's pathway.
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Bozon G, Mestre Godin S, Chorron G, Nou Howaldt M, Laroche JP, LeCollen L, Calais C, Quéré I, and Galanaud JP
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- Adult, Aged, Chronic Disease, Combined Modality Therapy, Female, France epidemiology, Health Care Surveys, Humans, Lower Extremity, Lymphedema diagnosis, Lymphedema epidemiology, Lymphedema physiopathology, Male, Middle Aged, Postthrombotic Syndrome diagnosis, Postthrombotic Syndrome epidemiology, Postthrombotic Syndrome physiopathology, Prognosis, Risk Factors, Critical Pathways, Lymphedema therapy, Patient Care Team, Postthrombotic Syndrome therapy
- Abstract
Objectives: To assess: (1) lower limb primary lymphedema or post-thrombotic syndrome patient's pathway in terms of health care professional use and (2) if aetiology of edema has an impact on this pathway., Methods: Ancillary survey of the transversal prospective CHROEDEM pilot study. Forty patients with either lower limb primary lymphedema or post-thrombotic syndrome were invited to participate., Results: Seventy-five percent of primary lymphedema patients and 50% of post-thrombotic patients benefited from a multidisciplinary management (P=0.10) including the general practitioner, the vascular medicine physician and either a physiotherapist (particularly in case of primary lymphedema), a registered nurse (particularly in case of post-thrombotic syndrome). Main ambulatory health care professionals' correspondent of hospital-based vascular medicine physicians were general practitioners (80%) in post-thrombotic patients, and general practitioners (60%) and physiotherapists (45%) in primary lymphedema patients. Pharmacists were also involved in patient education., Conclusion: Management of primary lymphedema and post-thrombotic related chronic edema is usually multidisciplinary. General practitioners and vascular medicine physicians are the cornerstones of this management, that also involves the physiotherapist in case of primary lymphedema and in a lesser extent the registered nurse and the pharmacist. This suggests that these five healthcare professional should play a key role in case of development of standardized patient pathways for primary lymphedema and post-thrombotic syndrome., (Copyright © 2020. Published by Elsevier Masson SAS.)
- Published
- 2020
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37. Growth charts in Kabuki syndrome 1.
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Ruault V, Corsini C, Duflos C, Akouete S, Georgescu V, Abaji M, Alembick Y, Alix E, Amiel J, Amouroux C, Barat-Houari M, Baumann C, Bonnard A, Boursier G, Boute O, Burglen L, Busa T, Cordier MP, Cormier-Daire V, Delrue MA, Doray B, Faivre L, Fradin M, Gilbert-Dussardier B, Giuliano F, Goldenberg A, Gorokhova S, Héron D, Isidor B, Jacquemont ML, Jacquette A, Jeandel C, Lacombe D, Le Merrer M, Sang KHLQ, Lyonnet S, Manouvrier S, Michot C, Moncla A, Moutton S, Odent S, Pelet A, Philip N, Pinson L, Reversat J, Roume J, Sanchez E, Sanlaville D, Sarda P, Schaefer E, Till M, Touitou I, Toutain A, Willems M, Gatinois V, and Geneviève D
- Subjects
- Abnormalities, Multiple diagnosis, Abnormalities, Multiple physiopathology, Adolescent, Body Height, Body Mass Index, Body Weight, Child, Child, Preschool, Face physiopathology, Female, Growth Charts, Hematologic Diseases diagnosis, Histone Demethylases genetics, Humans, Male, Mutation genetics, Vestibular Diseases diagnosis, Abnormalities, Multiple genetics, DNA-Binding Proteins genetics, Face abnormalities, Hematologic Diseases genetics, Hematologic Diseases physiopathology, Neoplasm Proteins genetics, Vestibular Diseases genetics, Vestibular Diseases physiopathology
- Abstract
Kabuki syndrome (KS, KS1: OMIM 147920 and KS2: OMIM 300867) is caused by pathogenic variations in KMT2D or KDM6A. KS is characterized by multiple congenital anomalies and neurodevelopmental disorders. Growth restriction is frequently reported. Here we aimed to create specific growth charts for individuals with KS1, identify parameters used for size prognosis and investigate the impact of growth hormone therapy on adult height. Growth parameters and parental size were obtained for 95 KS1 individuals (41 females). Growth charts for height, weight, body mass index (BMI) and occipitofrontal circumference were generated in standard deviation values for the first time in KS1. Statural growth of KS1 individuals was compared to parental target size. According to the charts, height, weight, BMI, and occipitofrontal circumference were lower for KS1 individuals than the normative French population. For males and females, the mean growth of KS1 individuals was -2 and -1.8 SD of their parental target size, respectively. Growth hormone therapy did not increase size beyond the predicted size. This study, from the largest cohort available, proposes growth charts for widespread use in the management of KS1, especially for size prognosis and screening of other diseases responsible for growth impairment beyond a calculated specific target size., (© 2019 Wiley Periodicals, Inc.)
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- 2020
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38. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence.
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Bousquet J, Schünemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, Klimek L, Pfaar O, Wallace D, Ansotegui I, Agache I, Bedbrook A, Bergmann KC, Bewick M, Bonniaud P, Bosnic-Anticevich S, Bossé I, Bouchard J, Boulet LP, Brozek J, Brusselle G, Calderon MA, Canonica WG, Caraballo L, Cardona V, Casale T, Cecchi L, Chu DK, Costa EM, Cruz AA, Czarlewski W, D'Amato G, Devillier P, Dykewicz M, Ebisawa M, Fauquert JL, Fokkens WJ, Fonseca JA, Fontaine JF, Gemicioglu B, van Wijk RG, Haahtela T, Halken S, Ierodiakonou D, Iinuma T, Ivancevich JC, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kleine Tebbe J, Kowalski ML, Kuna P, Kvedariene V, La Grutta S, Larenas-Linnemann D, Lau S, Laune D, Le L, Lieberman P, Lodrup Carlsen KC, Lourenço O, Marien G, Carreiro-Martins P, Melén E, Menditto E, Neffen H, Mercier G, Mosgues R, Mullol J, Muraro A, Namazova L, Novellino E, O'Hehir R, Okamoto Y, Ohta K, Park HS, Panzner P, Passalacqua G, Pham-Thi N, Price D, Roberts G, Roche N, Rolland C, Rosario N, Ryan D, Samolinski B, Sanchez-Borges M, Scadding GK, Shamji MH, Sheikh A, Bom AT, Toppila-Salmi S, Tsiligianni I, Valentin-Rostan M, Valiulis A, Valovirta E, Ventura MT, Walker S, Waserman S, Yorgancioglu A, and Zuberbier T
- Subjects
- Humans, Practice Guidelines as Topic, Algorithms, Asthma diagnosis, Asthma immunology, Asthma therapy, Evidence-Based Practice, Rhinitis, Allergic diagnosis, Rhinitis, Allergic immunology, Rhinitis, Allergic therapy
- Abstract
The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on many factors. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines have considerably improved the treatment of allergic rhinitis. However, there is an increasing trend toward use of real-world evidence to inform clinical practice, especially because randomized controlled trials are often limited with regard to the applicability of results. The Contre les Maladies Chroniques pour un Vieillissement Actif (MACVIA) algorithm has proposed an allergic rhinitis treatment by a consensus group. This simple algorithm can be used to step up or step down allergic rhinitis treatment. Next-generation guidelines for the pharmacologic treatment of allergic rhinitis were developed by using existing GRADE-based guidelines for the disease, real-world evidence provided by mobile technology, and additive studies (allergen chamber studies) to refine the MACVIA algorithm., (Copyright © 2019 American Academy of Allergy, Asthma & Immunology. All rights reserved.)
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- 2020
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39. 2019 ARIA Care pathways for allergen immunotherapy.
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Bousquet J, Pfaar O, Togias A, Schünemann HJ, Ansotegui I, Papadopoulos NG, Tsiligianni I, Agache I, Anto JM, Bachert C, Bedbrook A, Bergmann KC, Bosnic-Anticevich S, Bosse I, Brozek J, Calderon MA, Canonica GW, Caraballo L, Cardona V, Casale T, Cecchi L, Chu D, Costa E, Cruz AA, Czarlewski W, Durham SR, Du Toit G, Dykewicz M, Ebisawa M, Fauquert JL, Fernandez-Rivas M, Fokkens WJ, Fonseca J, Fontaine JF, Gerth van Wijk R, Haahtela T, Halken S, Hellings PW, Ierodiakonou D, Iinuma T, Ivancevich JC, Jacobsen L, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kleine Tebbe J, Klimek L, Kowalski ML, Kuna P, Kvedariene V, La Grutta S, Larenas-Linemann D, Lau S, Laune D, Le L, Lodrup Carlsen K, Lourenço O, Malling HJ, Marien G, Menditto E, Mercier G, Mullol J, Muraro A, O'Hehir R, Okamoto Y, Pajno GB, Park HS, Panzner P, Passalacqua G, Pham-Thi N, Roberts G, Pawankar R, Rolland C, Rosario N, Ryan D, Samolinski B, Sanchez-Borges M, Scadding G, Shamji MH, Sheikh A, Sturm GJ, Todo Bom A, Toppila-Salmi S, Valentin-Rostan M, Valiulis A, Valovirta E, Ventura MT, Wahn U, Walker S, Wallace D, Waserman S, Yorgancioglu A, and Zuberbier T
- Subjects
- Allergens administration & dosage, Allergens immunology, Animals, Asthma epidemiology, Asthma immunology, Attitude of Health Personnel, Biomarkers, Clinical Decision-Making, Comorbidity, Cost of Illness, Cost-Benefit Analysis, Disease Management, Disease Susceptibility, Humans, Practice Guidelines as Topic, Precision Medicine methods, Rhinitis, Allergic epidemiology, Rhinitis, Allergic immunology, Treatment Outcome, Asthma therapy, Critical Pathways, Desensitization, Immunologic adverse effects, Desensitization, Immunologic methods, Rhinitis, Allergic therapy
- Abstract
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients., (© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)
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- 2019
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40. The effect of excessive fat tissue on the measure of bone mineral density by dual X-ray absorptiometry: the impact of substantial weight loss following sleeve gastrectomy.
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Maïmoun L, Mariano-Goulart D, Jaussent A, Lefebvre P, Picot MC, Mahadea K, Boudousq V, Fouillade C, Nocca D, and Ben Bouallègue F
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- Adipose Tissue physiopathology, Adolescent, Adult, Aged, Bone and Bones physiopathology, Female, Humans, Male, Middle Aged, Obesity physiopathology, Predictive Value of Tests, Reproducibility of Results, Time Factors, Treatment Outcome, Young Adult, Absorptiometry, Photon, Adipose Tissue diagnostic imaging, Adiposity, Bone Density, Bone and Bones diagnostic imaging, Gastrectomy, Obesity diagnostic imaging, Obesity surgery, Weight Loss
- Abstract
Purpose: Dual-energy X-ray absorptiometry (DXA) is used in clinical routine to determine areal bone mineral density (aBMD). However, it is not clear whether excessive fat mass or substantial weight loss modify the aBMD measurements. The aim of this study was to evaluate the effect of soft tissue composition on aBMD measured by DXA using a clinical model (i.e. sleeve gastrectomy: SG) that induces substantial body weight loss., Methods: Areal bone mineral density and body composition (fat mass: FM and lean tissue mass: LTM) were determined by DXA in 41 obese patients (33 women, 80.5%) just before SG and 1 month later., Results: One month after SG, mean weight loss was -9.8 ± 2.6 kg, with a significant decrease in LTM and FM (kg) ranging from -7.3% to -9.5%. The relative variation in aBMD was increased at the lumbar spine (2.45 ± 3.44%) and decreased at the hip (-1.47 ± 2.28%), whereas no variation was observed for the whole body and radius. The variation in aBMD at the lumbar spine was inversely correlated with variations in weight, whole-body FM and trunk FM, but not LTM., Conclusion: This study shows evidence of a potential effect of body composition, particularly FM, on aBMD. However, given the modest change in aBMD, which was close to the precision error of aBMD measurements, it appears that significant weight loss does not have a clinically significant impact on the evaluation of aBMD using DXA., (© 2019 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)
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- 2019
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41. [Identification of abuse/dependence cases by the French addictovigilance network (FAN): A pilot study of the addictovigilance center and the psychotherapeutic center of Nancy (France)].
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Barberot P, Gibaja V, Benkhedda C, Dobre D, Tournebize J, and Kahn JP
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- Adolescent, Adult, Aged, Female, France, Humans, Male, Middle Aged, Pilot Projects, Retrospective Studies, Young Adult, Adverse Drug Reaction Reporting Systems, Pharmacovigilance, Substance-Related Disorders epidemiology
- Abstract
Objectives: France is the only European country with a dedicated addictovigilance network (French addictovigilance network [FAN]). However, the reporting of cases of abuse/dependence is insufficient. In an attempt to overcome this under-reporting, data from the medical information systems program (PMSI) is regularly used to identify cases. Since addictions are frequently associated with psychiatric comorbidities, a pilot study was conducted for the first time in a psychiatric hospital. It aims, through a PMSI request, to identify the sociodemographic characteristics and psychiatric diagnoses of patients consuming psychoactive substances (PAS) and the PAS types consumed., Methods: This is a retrospective observational study conducted over a nine-month period at the psychotherapeutic center of Nancy (CPN). The codes used for the PMSI request are those of the international classification of diseases, tenth revision (ICD-10), codes F10 to F19 that characterize mental and behavioral disorders associated with the use of PAS. Cases presenting the four criteria necessary for an addictovigilance notification: (1) identified notifier, (2) identified patient, (3) known consumed product (s) and (4) presence of an effect related to the abuse/dependence of PAS; were retained and analyzed., Results: On an initial number of 252 cases, 82 cases of abuse/dependence were retained. The selected sample is predominantly male (67%). Cannabis (29%) and heroin (15%) are the most common illicit PAS. Regarding drugs, the consumption of benzodiazepines, a predominantly female phenomenon, is observed in 34% of subjects. Sixty-four per cent of the subjects were diagnosed "disorders related to the use of PAS", 14% as neurotic disorders, 9% as schizophrenia and 5% as of the mood disorders., Conclusion: This study identified a significant number of potentially reportable cases to the French Addictovigilance Network and demonstrated the interest of investigating cases of abuse/dependence in a psychiatric hospital., (Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2019
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42. [Roles of the general practitioner and the vascular medicine physician for patient education concerning venous thromboembolism: The patient's perspective].
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Le Collen L, Douillard A, Pontal D, Quéré I, and Galanaud JP
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- France, Health Care Surveys, Health Communication, Health Knowledge, Attitudes, Practice, Humans, Randomized Controlled Trials as Topic, Referral and Consultation, Venous Thromboembolism diagnosis, Venous Thromboembolism physiopathology, Anticoagulants therapeutic use, General Practitioners, Patient Education as Topic methods, Patient Satisfaction, Physician's Role, Specialization, Venous Thromboembolism drug therapy
- Abstract
Introduction: Venous thromboembolism (pulmonary embolism and deep-vein thrombosis) is a frequent, serious but also chronic disease. Studies reported that both general practitioners (GPs) and vascular medicine physicians (VMPs) report participating in patient education concerning venous thromboembolic disease., Objective: To assess the role of GPs and VMPs in venous thromboembolic disease patient education, examining the patient's perspective., Method: Phone survey of the French patients recruited in the CACTUS trial assessing anticoagulant treatment in case of first distal deep-vein thrombosis., Results: Among the 103 participating patients, 92% (n=95) reported being satisfied by information provided by the GP and VMP. Information was considered as necessary in 96% of cases (n=99). Eighty-five percent of patients (n=88) felt they did not need complementary information. The VMP would have spent more time on education as compared with the GP (an entire consultation in 93.2% vs. 38.8% of cases respectively) the information provided by the VMP being also clearer and more complete. More than 75% of patients reported that no physician warned them about risks of anticoagulants, long-term complications of venous thromboembolic disease or its prevention., Conclusion: In CACTUS, patients reported being satisfied by information provided by their managing physicians and information provided by the VMP was clearer and more complete. Important education messages may not have been delivered suggesting the need for a standardization of venous thromboembolic disease patient's education., (Copyright © 2019. Published by Elsevier Masson SAS.)
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- 2019
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43. The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing.
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Bousquet J, Illario M, Farrell J, Batey N, Carriazo AM, Malva J, Hajjam J, Colgan E, Guldemond N, Perälä-Heape M, Onorato GL, Bedbrook A, Leonardini L, Stroetman V, Birov S, Abreu C, Abrunhosa A, Agrimi A, Alalääkkölä T, Allegretti N, Alonso-Trujillo F, Álvarez-Benito M, Angioli S, Apóstolo J, Armitage G, Arnavielhe S, Baena-ParejoI M, Bamidis PD, Balenović A, Barbolini M, Baroni I, Blain H, Bernard PL, Bersani M, Berti E, Bogatyrchuk L, Bourret R, Brehm J, Brussino L, Buhr D, Bultje D, Cabeza E, Cano A, De Capitani C, Carantoña E, Cardoso A, Coll Clavero JI, Combe B, Conforti D, Coppola L, Corti F, Coscioni E, Costa E, Crooks G, Cunha A, Daien C, Dantas, Darpón Sierra J, Davoli M, Dedeu Baraldes A, De Luca V, De Nardi L, Di Ciano M, Dozet A, Ekinci B, Erve S, Espinoza Almendro JM, Fait A, Fensli R, Fernandez Nocelo S, Gálvez-Daza P, Gámez-Payá J, García Sáez M, Garcia Sanchez I, Gemicioğlu B, Goetzke W, Goossens E, Geurdens M, Gütter Z, Hansen H, Hartman S, Hegendörfer G, Heikka H, Henderson D, Héran D, Hirvonen S, Iaccarino G, Jansson N, Kallasvaara H, Kalyoncu F, Kirchmayer U, Kokko JA, Korpelainen J, Kostka T, Kuna P, Lajarín Ortega T, Lama CM, Laune D, Lauri D, Ledroit V, Levato G, Lewis L, Liotta G, Lundgren L, Lupiañez-Villanueva F, Mc Garry P, Maggio M, Manuel de Keenoy E, Martinez C, Martínez-Domene M, Martínez-Lozano Aranaga B, Massimilliano M, Maurizio A, Mayora O, Melle C, Mendez-Zorilla A, Mengon H, Mercier G, Mercier J, Meyer I, Millet Pi-Figueras A, Mitsias P, Molloy DW, Monti R, Moro ML, Muranko H, Nalin M, Nobili A, Noguès M, O'Caoimh R, Pais S, Papini D, Parkkila P, Pattichis C, Pavlickova A, Peiponen A, Pereira S, Pépin JL, Piera Jiménez J, Portheine P, Potel L, Pozzi AC, Quiñonez P, Ramirez Lauritsen X, Ramos MJ, Rännäli-Kontturi A, Risino A, Robalo-Cordeiro C, Rolla G, Roller R, Romano M, Romano V, Ruiz-Fernández J, Saccavini C, Sachinopoulou A, Sánchez Rubio MJ, Santos L, Scalvini S, Scopetani E, Smedberg D, Solana-Lara R, Sołtysik B, Sorlini M, Stericker S, Stramba Badiale M, Taillieu I, Tervahauta M, Teixeira A, Tikanmäki H, Todo-Bom A, Tooley A, Tuulonen A, Tziraki C, Ussai S, Van der Veen S, Venchiarutti A, Verdoy-Berastegi D, Verissimo M, Visconti L, Vollenbroek-Hutten M, Weinzerl K, Wozniak L, Yorgancıoğlu A, Zavagli V, and Zurkuhlen AJ
- Abstract
Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.
- Published
- 2019
44. Increased Methamphetamine Use among Persons Who Inject Drugs in Hai Phong, Vietnam, and the Association with Injection and Sexual Risk Behaviors.
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Feelemyer J, Duong Thi H, Khuê Pham M, Hoang Thi G, Thi Tuyet Thanh N, Thi Hai Oanh K, Arasteh K, Moles JP, Vu Hai V, Vallo R, Quillet C, Rapoud D, Michel L, Hammett T, Laureillard D, Nagot N, and Des Jarlais D
- Subjects
- Adult, Anti-HIV Agents administration & dosage, Female, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections transmission, Humans, Male, Medication Adherence, Middle Aged, Risk-Taking, Sexual Behavior statistics & numerical data, Sexual Partners, Vietnam epidemiology, Viral Load, Amphetamine-Related Disorders epidemiology, Heroin Dependence epidemiology, Methamphetamine administration & dosage, Substance Abuse, Intravenous epidemiology
- Abstract
Methamphetamine use has increased significantly in Southeast Asia in the last 5-10 years, but there is little research on risk behaviors associated with the increase in this region. We evaluate injection and sexual risk behaviors associated with current methamphetamine use among heterosexual persons who inject drugs (PWID) in Hai Phong, Vietnam. We recruited 1336 PWID and assessed associations between methamphetamine use, injection and sexual risk behaviors, stratified by HIV serostatus. There were several statistically significant associations between methamphetamine use and sexual risk behaviors among HIV-positive PWID, but we did not find any associations between methamphetamine use and injection risk behaviors. Methamphetamine may increase the likelihood of PWID transmitting HIV to non-injecting primary sexual partners, as it can reduce ART adherence and can lead to weakening of the immune system and increased HIV viral loads. All participants were injecting heroin, and methamphetamine use may interfere with opiate use treatment. Public health efforts should focus on the large increase in methamphetamine use and the associated sexual risk behaviors. Emphasis on sexual risk behavior, particularly among those who are HIV-positive, in conjunction with continued monitoring of ART adherence and HIV viral loads, is critical.
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- 2018
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45. Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia.
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Ory J, Mourgues C, Raybaud E, Chabanne R, Jourdy JC, Belard F, Guérin R, Cosserant B, Faure JS, Calvet L, Pereira B, Guelon D, Traore O, and Gerbaud L
- Subjects
- Costs and Cost Analysis, Cross Infection economics, Humans, Infection Control economics, Oral Hygiene economics, Pneumonia, Ventilator-Associated economics, Treatment Outcome, Cross Infection prevention & control, Infection Control methods, Intensive Care Units, Oral Hygiene methods, Pneumonia, Ventilator-Associated prevention & control
- Abstract
Objectives: Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP., Materials and Methods: In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…)., Results: A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program., Conclusion and Clinical Relevance: Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable., Trial Registration: NCT02400294.
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- 2018
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46. [Anemia, a new severity factor in young infants with acute viral bronchiolitis?]
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Tourniaire G, Milési C, Baleine J, Crozier J, Lapeyre C, Combes C, Nagot N, and Cambonie G
- Subjects
- Bronchiolitis, Viral therapy, Continuous Positive Airway Pressure, Female, Hemoglobins analysis, Hospitalization, Humans, Infant, Infant, Newborn, Logistic Models, Male, Retrospective Studies, Anemia complications, Bronchiolitis, Viral complications, Severity of Illness Index
- Abstract
Introduction: The role of anemia is raised as a risk of low respiratory infection of the child, but there are no data on anemia as a severity factor in acute viral bronchiolitis (AVB) in infants., Methods: All infants less than 16 weeks old admitted to Montpellier University Hospital from 2015/10/01 to 2016/04/01 for AVB were included in a retrospective observational study. The primary objective was to determine whether the hemoglobin (Hb) concentration on admission was an independent factor of clinical severity, judged by the modified Wood's clinical asthma score (m-WCAS). The secondary objective was to assess the impact of Hb level on the characteristics of hospitalization, including the type and duration of respiratory support., Results: The m-WCAS was used at least once during hospitalization in 180 out of 220 patients (82%), making it possible to distinguish patients with mild AVB (maximum m-WCAS<2, n=81) from patients with severe AVB (maximum m-WCAS>2, n=99). A logistic regression model indicated that the Hb concentration, for every 1g/dL decrement, was an independent factor of AVB severity (OR 1.16 [1.03-1.29], P=0.026). A level under 10g/dL on admission was associated with a higher use of continuous positive airway pressure (P<0.001), as well as a longer duration of respiratory support (P=0.01)., Conclusion: This study suggested that anemia may influence the clinical expression of AVB in young infants., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
- Published
- 2018
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47. Clinical features and prognosis of paraquat poisoning in French Guiana: A review of 62 cases.
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Elenga N, Merlin C, Le Guern R, Kom-Tchameni R, Ducrot YM, Pradier M, Ntab B, Dinh-Van KA, Sobesky M, Mathieu D, Dueymes JM, Egmann G, Kallel H, and Mathieu-Nolf M
- Subjects
- Adolescent, Adult, Aged, Charcoal administration & dosage, Child, Child, Preschool, Dose-Response Relationship, Drug, Drug Overdose mortality, Female, French Guiana, Humans, Incidence, Infant, Length of Stay statistics & numerical data, Male, Middle Aged, Prognosis, Retrospective Studies, Suicide, Attempted statistics & numerical data, Survival Rate, Young Adult, Drug Overdose diagnosis, Drug Overdose therapy, Paraquat poisoning
- Abstract
Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates. Because of its high toxicity, the European Union withdrew it from its market in 2007. The aim of this study is to analyze all cases of paraquat poisoning hospitalized in French Guiana in order to assess their incidence and main characteristics.Medical records of all paraquat intoxicated patients hospitalized from 2008 until 2015 were reviewed in this retrospective study.Demographics, clinical presentation, and laboratory data were evaluated.A total of 62 cases were reviewed. The incidence of paraquat poisoning was 3.8/100,000 inhabitants/year. There were 44 adults and 18 children younger than 16 years of age. The median ages were 31 years [18.08-75.25] in adults and 13.4 years [0.75-15.08] in children, respectively. The median duration of hospitalization was longer in children [15.5 days (1-24)] than in adults [2 days (1-30)], P < .01. The majority of cases was due to self-poisoning (84%).Children had ingested a lower quantity of paraquat [48.8 mg/kg (10-571.1)] than adults [595.8 mg/kg (6-3636.4), P = .03]. There were more deaths among adults (65%) than in children (22%), P = .004. The severity and outcome was determined primarily by the amount of paraquat ingested.In conclusion, French Guiana has the largest cohort of paraquat poisonings in the European Union. The major factor affecting the prognosis of patients was the ingested amount of paraquat. The administration of activated charcoal or Pemba, in situ, within the first hour after ingestion of paraquat is essential.
- Published
- 2018
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48. Prevalence of Antipsychotic-Treated Patients in a Cohort of Adult Addicted Patients.
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Peyrière H, Diot C, Nogue E, Verschave M, Laure M, Picot MC, Petit P, Donnadieu-Rigole H, and Leglise Y
- Subjects
- Adult, Ambulatory Care Facilities, Cohort Studies, Comorbidity, Cross-Sectional Studies, Diagnosis, Dual (Psychiatry), Female, Humans, Male, Mental Disorders epidemiology, Middle Aged, Prevalence, Substance-Related Disorders drug therapy, Substance-Related Disorders epidemiology, Antipsychotic Agents therapeutic use, Mental Disorders drug therapy, Opiate Substitution Treatment statistics & numerical data, Substance-Related Disorders therapy
- Abstract
Purpose: The objective of this cross-sectional study was to describe and estimate the prevalence of antipsychotics (AP) in a cohort of addicted patients, and to compare the profiles of addictive patients receiving AP or not., Methods: We included all adult patients seen at the addiction care center of Montpellier University Hospital, between January 1, 2015, and March 31, 2015. Demographic, clinical, and therapeutic data were collected from the patients' medical records., Results: During the study period, 415 patients were included, with a mean age of 38 ± 10 years. They were mostly men (73.3%), French (54.9%), and unemployed (61.8%). Among the study population, 93 patients (patients treated with AP [trAP], 22.4%) were treated by 111 different AP, mainly cyamemazine (29.0% of treated patients), aripiprazole (20.4%), olanzapine (17.2%), and quetiapine (16.1%), mostly in monotherapy (80.6%) and by oral route (93.2% of AP). Psychiatric history was more frequent in trAP than in those without AP (untrAP) (55.9% vs 35.4% respectively; P < 0.001). Professional activity tended to be less frequent in patients with AP (25.3% vs 38.9%, P = 0.08).When compared with untrAP, trAP consumed more amphetamine (10.8% vs 4.4%; P = 0.02) and tended to consume less opiates (7.5% vs 14.9%; P = 0.06); the consumptions of cannabis (43.0% vs 35.7%; P = 0.20) and cocaine (22.6% vs 16.8%; P = 0.20) were not statistically different.Opiate maintenance therapy was reported in 63.7% of trAP and 68.4% of untrAP (P = 0.41): it consisted of methadone (trAP, 60.3% vs untrAP, 56.5%) and buprenorphine (trAP, 39.7% vs untrAP, 43.5%)., Conclusions: The concomitant management of psychiatric and substance use disorders in the same center may explain the high prevalence of trAP in this study. Cannabis and psychostimulants may have been used in these patients as self-medication for mental disease-related symptoms or adverse effects of APs.
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- 2017
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49. [Perinatal health and medical administrative data: What uses, which stakeholders, what the issues for birth data? - Special REDSIAM].
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Serfaty A, Baron S, Crenn-Hebert C, Barry Y, and Tala S
- Subjects
- Delivery, Obstetric statistics & numerical data, Female, France epidemiology, Humans, Infant, Newborn, Maternal-Child Health Services organization & administration, Maternal-Child Health Services standards, Perinatal Care standards, Pregnancy, Databases, Factual statistics & numerical data, Maternal-Child Health Services statistics & numerical data, National Health Programs statistics & numerical data, Parturition, Patient Discharge statistics & numerical data, Perinatal Care statistics & numerical data
- Abstract
Background: The uses of medical administrative data (MAD/BDMA) emerged in perinatal health following the work on regionalization of very pre-term birth. They have become more numerous since the late 2000s. The objective of this article is to take stock of the existing work carried out within the REDSIAM-perinatality group, on MAD/BDMA and their uses for the period of "birth"., Methods: The studied MADs are the Hospital Discharge Data (PMSI) and the French national health database (SNIIRAM). The material includes knowledge shared by the members of the REDSIAM-perinatality group, scientific references and gray literature., Results: Our exploratory study shows that the uses of MAD in perinatal health are diversified at the local, regional and national levels. The works and publications, increasing, take the form of public access of processed data. Collective thinking makes it possible to move from a localized use to an institution, a network or several, to a national use and an inscription in public authorities' responses. In 2015/2016, two institutional sites provide access to data on maternal and child health: Data.Drees and ATIH ScanSanté. MAD/BDMA uses are multiple: epidemiological use (count of births by gestational age, weight in particular; perinatal indicators), quality of care, planning (maternity activities, regionalization of care). There is an increasing interest among stakeholders, producers and/or operators of MAD/BDMA (decision-makers, professionals or researchers)., Conclusion: The BDMA, including the PMSI and the SNIIRAM, are used and relevant in Perinatal health with the rise of health networks, the territorialisation of health, in an increased demand for quality of care. Their use will increase the reliability of the data collected and an inscription in the validation studies, more and more numerous in the field of BDMA. The algorithms need to be more finely compiled, validated and enhanced., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
50. Molecular, clinical and neuropsychological study in 31 patients with Kabuki syndrome and KMT2D mutations.
- Author
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Lehman N, Mazery AC, Visier A, Baumann C, Lachesnais D, Capri Y, Toutain A, Odent S, Mikaty M, Goizet C, Taupiac E, Jacquemont ML, Sanchez E, Schaefer E, Gatinois V, Faivre L, Minot D, Kayirangwa H, Sang KLQ, Boddaert N, Bayard S, Lacombe D, Moutton S, Touitou I, Rio M, Amiel J, Lyonnet S, Sanlaville D, Picot MC, and Geneviève D
- Subjects
- Adolescent, Alleles, Child, DNA Mutational Analysis, Female, Gene Order, Genetic Loci, Humans, Intelligence, Male, Neuropsychological Tests, Abnormalities, Multiple diagnosis, Abnormalities, Multiple genetics, DNA-Binding Proteins genetics, Face abnormalities, Genetic Association Studies, Hematologic Diseases diagnosis, Hematologic Diseases genetics, Mutation, Neoplasm Proteins genetics, Phenotype, Vestibular Diseases diagnosis, Vestibular Diseases genetics
- Abstract
Kabuki syndrome (KS-OMIM 147920) is a rare developmental disease characterized by the association of multiple congenital anomalies and intellectual disability. This study aimed to investigate intellectual performance in children with KS and link the performance to several clinical features and molecular data. We recruited 31 children with KMT2D mutations who were 6 to 16 years old. They all completed the Weschler Intelligence Scale for Children, fourth edition. We calculated all indexes: the Full Scale Intellectual Quotient (FSIQ), Verbal Comprehension Index (VCI), Perceptive Reasoning Index (PRI), Processing Speed Index (PSI), and Working Memory Index (WMI). In addition, molecular data and several clinical symptoms were studied. FSIQ and VCI scores were 10 points lower for patients with a truncating mutation than other types of mutations. In addition, scores for FSIQ, VCI and PRI were lower for children with visual impairment than normal vision. We also identified a discrepancy in indexes characterized by high WMI and VCI and low PRI and PSI. We emphasize the importance of early identification and intensive care of visual disorders in patients with KS and recommend individual assessment of intellectual profile., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2017
- Full Text
- View/download PDF
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