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Summary Background Little information is available on the long-term incidence of bleeding events after ST-segment elevation myocardial infarction (STEMI) with the current antithrombotic strategy. Aims To evaluate the effect of bleedings for up to 12 months on clinical events and therapeutic compliance in unselected STEMI patients treated with prasugrel or clopidogrel. Methods Patients were treated with clopidogrel or prasugrel according to guidelines. The primary endpoint was first occurrence of a bleeding event from hospital discharge to 12 months, assessed by the Bleeding Academic Research Consortium (BARC) classification using a dedicated questionnaire. Topography of bleedings, causes of premature cessation and ischaemic events were compared between clopidogrel- and prasugrel-treated patients. Results A total of 390 patients were enrolled (211 in the prasugrel group, 179 in the clopidogrel group). Elderly, female and low-body weight patients were more likely to receive clopidogrel. At 12 months, the incidence of major bleedings (BARC 3) was lower with prasugrel (1% vs 6%; P = 0.02), mainly due to fewer transfusions. Elderly age was a risk factor for severe bleeding. Premature treatment cessation was related to ischaemic complications (P = 0.03), and occurred more frequently with prasugrel (P = 0.001). One-year mortality was very low (1.9 per 100 person-years, 95% confidence interval 0.9–4.0), and was higher in the clopidogrel group (P = 0.03). Conclusions In this unselected STEMI population, the rate of major bleedings with prasugrel at 12 months was low, but nuisance bleedings were frequent and led to more premature cessations than with clopidogrel. Prevention of bleeding complications, even minor, is necessary to prevent disruption of antithrombotic medication.

The assessment of a health technology is frequently accompanied by uncertainty about its impact, at short or long terms, on the health of the population. The Health Authorities may request additional « post-registration » data that will allow a relevant reassessment of these technologies. The responsibility to collect this information lies with the industry and the HAS evaluates the methodology. This guideline provides practical benchmarks on methodological aspects of these studies. It describes the different types of studies to consider depending on the objectives, including the use of databases and cohorts and European studies. It emphasizes the importance of establishing a scientific committee, clearly defining the objectives of the study, justifying the methodological choices, documenting the representativeness or completeness of centers, investigators and patients, limiting the number of lost of follow-up patients and missing data, describing the statistical analysis methods, the bias and their possible impact on results. The publication of the results of these studies is strongly encouraged.

Background and purposeThis work aimed at prospectively record all primary central nervous system tumor (PCNST) cases in France, for which histological diagnosis was available. The objectives were to (i) create a national database and network to perform epidemiological studies, (ii) implement clinical and basic research protocols, and (iii) harmonize the health care of patients affected by PCNST.MethodsThe methodology is based on a multidisciplinary national network already established by the French Brain Tumor DataBase (FBTDB) (Recensement national histologique des tumeurs primitives du système nerveux central [RnhTPSNC]), and the active participation of the Scientific Societies involved in neuro-oncology in France.ResultsFrom 2004 to 2009, 43,929 cases of newly diagnosed and histologically confirmed PCNST have been recorded. Histological diagnoses included gliomas (42,4%), all other neuroepithelial tumors (4,4%), tumors of the meninges (32,3%), nerve sheath tumors (9,2%), lymphomas (3,4%) and others (8,3%). Cryopreservation was reported for 9603 PCNST specimens. Tumor resections were performed in 78% cases, while biopsies accounted for 22%. Median age at diagnosis, sex, percentage of resections and number of cryopreserved tumors were detailed for each histology, according to the WHO classification.Discussion/conclusionMany current applications and perspectives for the FBTDB are illustrated in the discussion. To our knowledge, this work is the first database in Europe, dedicated to PCNST, including clinical, surgical and histological data (with also cryopreservation of the specimens), and which may have major epidemiological, clinical and research implications.RésuméObjectifCe travail a pour objectif de recenser de manière prospective l’ensemble des cas de tumeurs primitives du système nerveux central (TPSNC), ayant un diagnostic histologique, en France. Les buts sont de créer une base de données et un réseau national pour favoriser la mise en place d’études épidémiologiques, biologiques et cliniques, et d’harmoniser la prise en charge des patients atteints de TPSNC.MéthodeLa méthodologie est basée sur l’existence d’un réseau national multidisciplinaire déjà établi par le Recensement national histologique des tumeurs primitives du système nerveux central (RnhTPSNC) (French Brain Tumor DataBase [FBTDB]), et la participation active des sociétés savantes impliquées en neuro-oncologie.RésultatsDe 2004 à 2009, 43 929 cas incidents de TPSNC ayant une confirmation histologique ont été recensés : gliomes (42,4 %), ensemble des autres tumeurs neuroépithéliales (4,4 %), tumeurs des méninges (32,3 %), tumeurs des nerfs intracrâniens et/ou intrarachidiens (9,2 %), lymphomes (3,4 %), et autres (8,3 %). La cryopréservation a été notée pour 9603 cas de TPSNC. Une intervention d’exérèse a été réalisée dans 78 % des cas, et une biopsie dans 22 %. L’âge médian au diagnostic, le sexe, le pourcentage de tumeurs réséquées, et le nombre de cas cryopréservés sont détaillés pour chaque histologie.Discussion/conclusionLes principales applications actuelles et futures du RnhTPSNC sont présentées dans la discussion. À notre connaissance, ce travail constitue la première base de données en Europe, dédiée aux TPSNC, qui recense des données cliniques, chirurgicales et histologiques (incluant la cryopréservation), et ses applications et perspectives sont très nombreuses.

Summary Importance Professional use of pesticides is a risk factor for non-Hodgkin lymphoma. The main biological mechanisms of both pesticides and chemotherapy are genotoxicity and reactive oxygen species generation. Cellular adaptation among patients exposed to low doses of genotoxic and oxidative compounds may hinder chemotherapy efficiency in lymphoma patients. Objective We aim to determine the influence of occupational exposure to pesticides on response to immuno-chemotherapy and survival of patients treated for Diffuse Large B Cell Lymphoma (DLBCL). Design The ProLyPhy study is a retrospective cohort of patients treated between 2010 and mid-2015, for DLBCL, with a least 2-year follow-up. Setting The study took place in six hospitals of central southern France (Languedoc-Roussillon district): two university hospitals, three general hospitals, and one private hospital. Participants We pre-included 404 patients with newly-diagnosed DLBCL treated with anthracycline-based immuno-chemotherapy (R-CHOP like). Occupational history was reconstructed for 244 patients. Occupational data were analysed with the Pestipop French job-exposure matrix to determine probability of occupational exposure to pesticides, and with the Pestimat French crop exposure matrix for farming activities to characterise the probability of using specific compounds. Main outcome and measure We have compared complete response (CR), 2-year event-free survival (EFS) and overall survival (OS) of exposed and non-exposed patients, after adjustment on confounding factors. Results Average age was 61.3 years (range 19–90), 62.7% of patients were male, 67 had occupational exposure to pesticides, of which 38 from farming activities. Occupational exposure did not impact clinical and biological characteristics at diagnostic. We observed that exposed patients had significantly lower CR rate: 77.6% versus 88.7% (P = 0.027), OR = 0.31 (0.55–0.09, P = 0.007); this difference was higher among farmers: 68.6% CR versus 87.2%, P = 0.005, OR = 0.22 (0.56–0.09, P = 0.001). Two-year EFS was 70% in the occupationally-exposed group versus 82%, HR = 2.1 (95% CI: 1.2–3.6, P = 0.008). Among farmers, the difference was more pronounced: 2-year EFS was 56% versus 83%, HR = 3.1 (95% CI: 1.7–5.6, P Conclusion and relevance This retrospective study suggests that agricultural occupational exposure to pesticides is an independent risk factor for treatment failure, EFS and OS in DLBCL. Trial registration The study was registered in ClinicalTrials.gov ( NCT02898870 ).

Resume Introduction L’etude francaise Express avait pour objectif de comparer deux strategies de recrutement alveolaire chez des patients ayant un syndrome de detresse respiratoire aigue (SDRA) ventiles a 6 ml/kg de poids ideal theorique (PIT). Le but de notre etude etait d’apprecier au sein d’une unite de reanimation l’impact de la participation a l’etude Express sur les parametres de ventilation mecanique appliquee chez des patients eligibles mais non inclus. Patients et methode Entre le 16 octobre 2002 et le 14 janvier 2005, tous les patients eligibles mais non inclus ont ete etudies. Les parametres ventilatoires de quatre groupes equivalents de patients ( n = 14 ou 15), determines en fonction de la periode d’etude, ont ete compares. Les volumes courants (VT) maximal et minimal, les frequences respiratoires (FR) maximale et minimale regles par le medecin, durant toute la periode de ventilation mecanique, ont ete colliges retrospectivement. Resultats Cinquante-neuf dossiers de patients ont ete analyses. Entre la premiere et la derniere periode de l’etude, le VT maximal moyen a diminue de 9,0 ± 1,3 a 7,4 ± 1,0 ml/kg de PIT ( p = 0,03), la proportion de patients ventiles avec un VT maximal superieur a 8 ml/kg de PIT a diminue de 93 a 20 % ( p p = 0,03) et la proportion de patients ventiles avec une FR minimale inferieure a 20 c/min a diminue de 100 a 73 % ( p r = −0,43, p r = −0,28 , p r = 0,33, p Conclusion La participation a l’etude Express a impacte sur les reglages des parametres ventilatoires par les medecins. Le VT maximal a diminue et la FR minimale a augmente chez les patients en SDRA eligibles mais non inclus.

Introduction A l’heure ou le partage responsable des donnees d’essai clinique est en plein essor et ou l’exigence de qualite des etudes cliniques ne cesse de croitre, la question de l’efficacite du processus de « data management » (DTM) est au cœur de nos problematiques organisationnelle et technique. L’enjeu est de pouvoir garantir la qualite des donnees tout en assurant une mise a disposition rapide. Ainsi, la conjugaison de ces deux aspects se traduit par le besoin d’optimisation du « workflow » du DTM. Methodes La methode se decline en trois etapes : etablir un etat des lieux detaille du « workflow » actuel, permettant de definir la structure du DTM, elaborer un « workflow » optimise et enfin, eprouver ce nouveau processus au travers d’un outil informatique specialement developpe pour l’automatisation du DTM que nous avons denomme BLANKA. Resultats (i) Etat des lieux – le « workflow » actuel du DTM est structure en trois tâches principales et successives : la conception de l’eCRF, le controle de qualite et le gel de la base de donnees. Chacune d’entre elles donne lieu a une phase de conceptualisation et a une phase de production. Cette organisation en cascade implique un « input » specifique pour chacune des tâches et rend les modifications complexes, augmente le risque d’erreur et diminue par consequent la qualite des livrables. En consequence, face au volume et a la complexite des tâches a realiser, le « data manager » doit imperativement optimiser son temps. (ii) Proposition d’optimisation – le « workflow » optimise propose deux changements majeurs. Le premier est conceptuel et vise a restructurer le DTM par phase et non par tâche ; le deuxieme est technique et prend forme dans l’automatisation de la phase de production. Ainsi, la premiere phase de conceptualisation est regroupee en amont du projet et considere toutes les tâches. Le « data manager » (DM) a d’emblee une vision globale de l’ensemble du projet et des livrables a produire. Operationnellement, le cahier des charges, l’e-crf, les controles de coherences et la mise en forme des donnees sont produits lors la meme phase, et en amont du projet. Techniquement, il est necessaire d’automatiser la phase de production pour reduire les difficultes de programmation et les risques d’erreur liees aux actions repetitives et manuelles, pour ameliorer et standardiser la qualite des livrables, et enfin, optimiser le temps. (iii) Mise en place-BLANKA – BLANKA est un complement Excel (add-in) programme en VBA permettant, a partir d’un dictionnaire de donnees (DD) specifique au logiciel, de generer un e-crf sur RedCap, le « Data Management Plan » (DMP), les programmes SAS de controles de coherence, de mise en forme des donnees et de gel des donnees. Le DD est ainsi la synthese et la centralisation de toute la phase de conceptualisation. Il est l’unique « input » de tous les livrables. Conclusion Le « workflow » optimise a permis une reduction considerable du temps dedie a la production des livrables. Ce temps est ainsi alloue au temps de suivi et de gestion du DTM de l’etude. D’autre part, le risque lie aux erreurs de programmation manuelle est minimise, et les livrables standardises. Ce « workflow » offre au DM la possibilite de s’investir plus a la conceptualisation du DTM, de son etude et de sa gestion plutot qu’a la production tout en ayant une vision globale du projet, ce qui augmente significativement le niveau de qualite du DTM.

The Sapporo criteria-related definition commonly used for diagnosis of the antiphospholipid syndrome (APS) associates the occurrence of thrombotic and/or obstetrical events with persistently positive antiphospholipid antibodies (aPL-Ab), including lupus anticoagulant (LAC), anticardiolipin IgG (aCL-G) or IgM, and/or anti-b2-glycoprotein I IgG or IgM antibodies. Criteria used to define the purely obstetrical clinical subtype of the APS syndrome include the aPLs listed above plus a fetal loss later than 10-weeks gestation, 3 or more unexplained consecutive embryonic losses before the 10th week gestation, or eclampsia or features of placental insufficiency requiring the preterm birth before 34 weeks of a morphologically normal child. Some investigators have questioned the serological criteria associated with this form of APS and have suggested that the aCL-G, anticardiolipin IgM, and anti-b2-glycoprotein I IgM measurements should be excluded. To determine the effects of the various aPL-Ab subtypes on pregnancy outcome, the investigators prospectively monitored women who had had an unexplained embryonic loss during their first pregnancy and were undergoing their untreated second pregnancy. They selected women who did not have APS; any hormonal abnormalities; or inflammatory, infectious, or malignant diseases; and who had normal parental karyotypes; the pregnancy outcomes of 142 women who tested positive for at least 1 of the 5 classical aPL-Abs were compared with those of 142 control women who were confirmed to be aPL-Abs negative. Compared with the women without aPL-Abs, the aPL-Ab-positive women experienced more clinical complications during their second pregnancy, including pregnancy loss (of which the majority were embryonic losses), preeclampsia, placental abruption, and intrauterine fetal growth restriction. The presence of LAC alone (type IIa aPL-Ab positivity) was associated with the highest risk of recurrent embryonic loss and intrauterine growth restriction. Positive tests for combinations of aPL-Ab (type I aPL-Ab positivity) were associated with the highest risk of late complications, placental abruption, and preeclampsia. A finding of anti-b2-glycoprotein I IgM positivity had no apparent diagnostic clinical relevance. These findings demonstrate that among women with a first unexplained pregnancy loss before the 10th week of gestation, those who are aPL-Abs positive have a higher risk of complications in their next pregnancy, including embryonic loss, preeclampsia, placental abruption, and intrauterine growth restriction, than women who are aPL-Abs negative. These findings suggest that the aPL-Ab LAC, aCL-G or IgM, and anti-b2-glycoprotein I IgG are helpful in identifying patients at increased risk of an adverse outcome, whereas anti-b2-glycoprotein I IgM has questionable diagnostic value.

Background and purpose Glioblastoma, the most common malignant primary brain tumor in adults, is usually rapidly fatal. The current care standards for newly diagnosed glioblastoma consist, when feasible, in surgical resection, radiotherapy, and chemotherapy, as described in the Stupp protocol. Despite optimal treatment, nearly all malignant gliomas recur. If the tumor is symptomatic for mass effect, repeated surgery may be proposed. Methods We retrospectively analyzed the survival of patients with histologically confirmed primary glioblastoma (WHO grade 4) who were operated in two centers between January 2004 and December 2007. All patients who underwent a second resection for recurrent glioblastoma were included. Results During this period, 320 patients were operated in the two centers, with 240 surgical resections and 80 surgical biopsies. In the surgical resection group, 8.3% (20 patients) underwent a second surgical resection for glioblastoma. The mean age was 52 years. At the end of the study, seven patients were alive. The median survival was 24 months and progression-free survival was 7.5 months. Conclusions The effect of resection of recurrent glioblastoma on survival has not been extensively studied. No randomized trials have been conducted. Our data were globally identical to other retrospective studies. Selected patients with recurrent glioblastoma may be candidates for repeated surgery when the situation appears favorable based on assessment of the individual patient's factors. Factors such medical history, neurological status, location of the tumor, and progression-free survival have been proven in retrospective studies to give better results.

We estimated the direct additional medical costs of nosocomial infections (NI) using a cohort study in acute and longer-term care at Nîmes University Hospital in France. Patients hospitalised between May 2001 and January 2003 with NI were considered as exposed; all others were eligible as non-exposed. Thirty patients were randomly chosen for each site of infection: respiratory tract, bloodstream, surgical site, urinary tract and other sites for a total of 150 exposed patients. Each exposed patient was matched with a non-exposed patient according to gender, age, severity of the underlying disease, diagnosis according to hospital discharge records, ward type and length of hospitalisation before inclusion. Additional direct medical costs for the exposed patients compared to the non-exposed and the difference between actual costs and the diagnosis-related group rate were measured. Costs resulting from laboratory tests, radiology, surgery and exploratory examinations, and antimicrobial agents were estimated to be Euro2421 for a respiratory tract infection, Euro1814 for a surgical site infection, Euro953 for a bloodstream infection and Euro574 for a urinary tract infection. Total additional costs of NI (direct medical costs and costs of extra length of stay) in acute care were estimated to be up to Euro3.2 million per year (95% confidence interval: 2,275,063-4,132,157). In conclusion, both prevention of avoidable NI and better estimation of the actual costs of NI should be priorities for all healthcare facilities.

Resume Objectif. – Evaluation des relations entre medecins traitants et reanimateurs. Type d'etude. – Questionnaire telephonique aupres des reanimateurs de huit departements du sud de la France entre le 14 juin et 28 septembre 2004. Methodes. – Deux cent quarante-cinq sur 264 reanimateurs ont repondu a un questionnaire telephonique concernant leurs relations avec les medecins traitant des patients admis dans leur unite. Resultats. – Le mode d'amission par le service d'accueil des urgences etait le plus frequent (55 %), 20 % des patients admis etant estimes l'avoir ete avec une lettre d'un medecin generaliste. Dans cette lettre, la pertinence des informations etait evaluee a 6,5/10 pour les antecedents, 7/10 pour les traitements suivis, 6/10 pour l'histoire de la pathologie causale et 2/10 pour le mode de vie du patient. La lettre etait jugee insuffisante par 50 % des reanimateurs, un complement d'information aupres du medecin traitant etant necessaire dans 30 % des admissions. Pendant le sejour en reanimation, 33 % des medecins traitants s'informaient de l'etat du patient. De son cote, le reanimateur n'informait quasiment jamais le medecin traitant des patients avec un sejour superieur a dix jours. A la sortie de reanimation, 80 % des reanimateurs informaient le medecin traitant par un compte rendu dactylographie exhaustif. La collaboration entre reanimateur et medecin traitant etait evaluee a 5,5/10. Apres analyse multivariee, les facteurs d'insatisfaction des reanimateurs (collaboration

Escherichia coli urinary tract isolates were collected in 1997–2003 from NîmesUniversity Hospital in order to investigate long-term trends in antibiotic resistance and to explore the relationship between antibiotic use and the emergence of resistance. Time-series analysis (ARIMA models) and dynamic regression models were used to investigate relationships between antibiotic use and resistance to ofloxacin and ciprofloxacin. Significant increases were seen in the frequency of ofloxacin (8.9 to 16.7%) and ciprofloxacin resistance (6.2 to 10.1%) (p < 0.001). Using multivariate dynamic regression analysis, it was found that an increased use of one defined daily dose (DDD)/1000 patient-days for ofloxacin, ciprofloxacin and norfloxacin induced average increases of 0.81%, 0.65%and 0.53%in E. coli ofloxacin resistance (p < 0.01), with average delays of 4, 4 and 6 months, respectively. An increase of 1 DDD/1000 patient-days of ciprofloxacin, ofloxacin and norfloxacin use induced increases of 0.73%, 0.82% and 0.63% in E. coli ciprofloxacin resistance (p < 0.01), with average delays of 4, 4 and 5 months, respectively. The use of nalidixic acid was not associated significantly with an increase in resistance to fluoroquinolones by multivariate analysis.

Background The prognostic value of cardiac troponin T (cTn-T) in a mixture of patients with both acute and chronic congestive heart failure (CHF), simultaneously assessed and compared with neurohormonal factors, has not yet been thoroughly evaluated. Thus, we focused on the prognostic value of cTn-T in comparison with atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and plasma norepinephrine (PNE) in this population. Methods Prognostic correlates of elevation of cTn-T, ANP, BNP, PNE were analyzed in 63 acute and chronic CHF patients followed up to record worsening CHF and cardiac death. Results cTn-T (≥0.03 μg/L) was found in 17.4% (11 of 63) of patients. cTn-T correlated with ANP, BNP, PNE. Acute CHF patients were more positive for cTn-T and BNP. In our cohort, neither cTn-T (≥0.03 μg/L) nor PNE were associated with increased mortality and worsening HF in CHF patients. After adjustment, BNP was the only independent predictor of cardiac events (RR, 3.23; p=0.01). Conclusions BNP emerged as the only independent predictor of cardiac events in a mixture of patients with both acute and chronic CHF, suggesting that it is the analyte that best reflects long-term prognosis in a diverse population enrolled to mirror the “real world” situation.

A case-control study was conducted in a university hospital to determine the risk factors for nosocomial infection with multidrug-resistant Pseudomonas aeruginosa (MDR-PA) among all hospitalized patients and among those with a nosocomial infection due to P. aeruginosa. Eighty patients infected with MDR-PA, 75 infected with a non-MDR phenotype and 240 random controls were included in the 12-month study. Among all hospitalized patients, age, severity index, having a bedridden condition, transfer from other units, nasogastric feeding, urinary catheterization and exposure to beta-lactams (OR=2.5) or fluoroquinolones (OR=4.1) in the seven days before infection were linked to nosocomial infection due to MDR-PA. Among patients infected by P. aeruginosa, exposure to fluoroquinolones (OR=4.7) or surgery (OR=0.5) were linked to the isolation of MDR-PA. This study showed that, in addition to urinary catheterization, nasogastric feeding is an important risk factor in MDR-PA infection. Indeed, an imbalance in gut flora, modifications to the mucous membranes due to the use of nasogastric feeding and the selection pressures exerted by antibiotics were implicated in the occurrence of this infection.

Background: Cardiac troponins I (cTnI) and T (cTnT) have been shown to be highly sensitive and specific markers of myocardial cell injury. We investigated the diagnostic value of cTnI and cTnT for the diagnosis of myocardial damage in a rat model of doxorubicin (DOX)-induced cardiomyopathy, and we examined the relationship between serial cTnI and cTnT with the development of cardiac disorders monitored by echocardiography and histological examinations in this model. Methods: Thirty-five Wistar rats were given 1.5 mg/kg DOX, i.v., weekly for up to 8 weeks for a total cumulative dose of 12 mg/kg BW. Ten rats received saline as a control group. cTnI was measured with Access® (ng/ml) and a research immunoassay (pg/ml), and compared with cTnT, CK-MB mass and CK. By using transthoracic echocardiography, anterior and posterior wall thickness, LV diameters and LV fractional shortening (FS) were measured in all rats before DOX or saline, and at weeks 6 and 9 after treatment in all surviving rats. Histology was performed in DOX-rats at 6 and 9 weeks after the last DOX dose and in all controls. Results: Eighteen of the DOX rats died prematurely of general toxicity during the 9-week period. End-diastolic (ED) and end-systolic (ES) LV diameters/BW significantly increased, whereas LV FS was decreased after 9 weeks in the DOX group (p

Resume Objectifs : Repertorier les horaires de decision dˈinsertion dˈun catheter arteriel pulmonaire (CAP) dans une unite de reanimation. Type dˈetude : Descriptive et prospective. Patients : Patients dˈune unite de reanimation chirurgicale de centre hospitalo-universitaire. Methodes : Les heures de decision dˈinsertion non programmee dˈun CAP ont ete repertoriees par tranches horaires dˈune heure. A chaque CAP, les complications immediates (ponction arterielle, pneumothorax, troubles du rythme ventriculaire, difficulte et/ou echec de catheterisme de lˈartere pulmonaire) ont ete notees. Resultats : Cent quarante-neuf patients (99 hommes, âge = 63 ± 15 ans, index de masse corporelle = 25 ± 6 kg·m–2, score Apache II median = 16) ont ete inclus dans lˈetude. Cent soixante-cinq decisions dˈinsertion de CAP ont ete prises (16 patients ont necessite deux CAP inseres a des sites differents). Neuf ponctions arterielles, deux pneumothorax, 32 catheterismes difficiles, 42 troubles du rythme ventriculaire et huit echecs de catheterisme de lˈartere pulmonaire ont ete repertories. Lˈinsertion de CAP a ete decidee 34 fois entre neuf et dix heures lors de la reunion medicale quotidienne. Pendant la nuit, cette frequence etait inferieure a 3 par heure entre une et neuf heures. Conclusions : Les decisions dˈinsertion de CAP sont variables en fonction de lˈhoraire de la journee avec une baisse de frequence pendant la nuit entre trois et neuf heures.

Purposes The aim of this study was to evaluate one-year incidence of bleeding events and their impact on compliance in patients admitted for ST Elevation Myocardial Infarction (STEMI) and treated by prasugrel or clopidogrel in « real-world ». Methods Patients admitted for a STEMI were treated by either clopidogrel or prasugrel according to the physician with respect of guidelines. The primary endpoint was the first occurrence of bleeding events within 12 months assessed by the Bleeding Academic Research Consortium (BARC) classification using a dedicated questionnaire focused on bleeding events. Topography bleedings, causes of premature cessation and ischemic events were also compared. Results 390 patients were enrolled, 211 in prasugrel group and 179 in clopidogrel group. Patients in the prasugrel group were younger, with higher body weight and were more frequently men. At 12 months, a bleeding complication occurred in 40% of patients regardless of its severity or treatment prescribed. Major bleedings (BARC 3) were significantly lower with prasugrel than clopidogrel (1% versus 6%, p=0.001). Minimal bleedings (BARC 1) were more frequent in clopidogrel group than prasugrel group (respectively 27% and 18%; p=0.05). However BARC 2 bleedings occurred more often in prasugrel group (14% versus 6%, p=0.01) (figure). Subcutaneous and gastrointestinal haemorraghes were the most frequent. Over one-year, the rate of cessation was 18% in the prasugrel group and only 10% in the clopidogrel group (p=0.04). Respectively for prasugrel and clopidogrel, rates of recommend discontinuation were 10% and 4% (p=0.02) and of disruption were 8% and 5% (p=0.3). Despite more frequent discontinuation, mortality remains very low in the prasugrel group (0.5% versus 7%, p=0.0003). Conclusion In real-world, in a low bleeding risk population, the rate of major bleedings with prasugrel at 12 months was low but nuisance bleedings were frequent with significant impact on premature cessation Download : Download full-size image Abstract 0098 – Figure: 12 months bleedings classification

Objectives: The study was undertaken to evaluate the release kinetics of cardiac troponin I (c-cTn-I) in ischemic myocardial injury. Design and Methods: The reference range for cTn-I was established by determination of cTn-I in sera and plasma obtained from 622 healthy volunteers (Group 1). cTn-I was compared to: (a) Creatine kinase (CK) MB mass and myoglobin in 12 patients with severe skeletal muscle damage (Group 2); (b) CK-MB activity in 48 patients with myocardial infarction (MI) receiving intravenous thrombolysis (Group 3) (in this group, an additional 43 patients with MI were analyzed separately to characterize cTn-I patterns in thrombolyzed and nonthrombolyzed populations); and in 44 patients with unstable angina (Group 4). Results: In Groups 1 and 2, no positive results (⩾0.1 μg/L) were obtained. In Group 3, the time-courses of cTn-I were mostly monophasic in form. A pathologic increase occurred earlier in cTn-I than in CK-MB activity ( p = 0.0002); the period with increased cTn-I was longer ( p = 0.001), the overall sensitivity of cTn-I (93.9%) was higher than that of CK-MB activity ( p = 0.00001). cTn-I was more sensitive at admission ( p = 0.0004). In additional patients, the cTn-I peak occurred and cTn-I disappeared significantly later in nonthrombolyzed than in the thrombolyzed group. In Group 4, positive tests results were detected in 45% of patients for cTn-I, 16% for CK-MB activity, and 32% for CK-MB mass. Conclusions: The cTn-I assay appears to be ideally suited for the detection of ischemic myocardial injury in complex clinical situations because of its high specificity; cTn-I indicates myocardial tissue damage in patients with unstable angina and is superior to CK-MB activity and mass in this respect.

Introduction Les proteasomes plasmatiques (p-proteasomes) ou proteasomes circulants sont consideres comme des nouveaux marqueurs seriques tumoraux. Objectif Determiner les valeurs diagnostiques et pronostiques des p-proteasomes dans une population de patients atteints de melanome classee selon la classification AJCC. Methodologie Les taux de p-proteasomes etaient quantifies chez 90 patients et 40 temoins entre mars 2003 et mars 2008 avec un test ELISA. La composition des p-proteasomes etait determinee par analyse proteomique chez des patients atteints de melanome metastatique (n = 3). Resultats Les concentrations moyennes de p-proteasomes etaient correlees aux stades cliniques. Elles etaient significativement plus elevees chez les patients stade IV et stade III avec atteinte ganglionnaire (9 187 ± 1 294 et 5 091 ± 454 ng/mL, respectivement) comparativement aux temoins (2 535 ± 187 ng/mL, p 4 300 ng/mL) etaient significativement correles a un risque accru de progression (HR = 7,34, IC 95 % 3,54 a 15,21).

BackgroundResidual platelet reactivity (RPR) has been shown to be related to adverse cardiovascular events. However, assessment of residual platelet reactivity was often evaluated in heterogeneous populations including both patients with stable disease and acute coronary syndrome.ObjectivesWe aim to delineate determinants of RPR in a cohort of stable cardiovascular patients.MethodsWe included 750 stable cardiovascular patients treated for at least one month with aspirin (n=213), clopidogrel (n=107) or both (n=425). We evaluated RPR using collagen platelet aggregation (CPA), collagen being a stimulus not directly involved in the specific pathways of aspirin and clopidogrel.ResultsMean age was 65±12 years, 76% were male; the mean duration of the CV disease was 1.6 years. CPA ranged from 6% to 96% in our population. CPA was of 41+/-16, 61+/-14 and 28+/-15% in aspirin, clopidogrel and dual treatment groups, respectively (P