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1. Risk and Protective Factors of Lifetime Cocaine-Associated Chest Pain

Author

Virgile Clergue-Duval, Louise Nicolas-Sacy, Emily Karsinti, El-Hadi Zerdazi, Jean-Louis Laplanche, Georges Brousse, Andries T. Marees, Eske M. Derks, Patrick Henry, Frank Bellivier, Florence Vorspan, Vanessa Bloch, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Clinique, Psychanalyse, Développement (CliPsyD), Université Paris Nanterre (UPN), Centre Hospitalier Emile Roux [AP-HP], Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), Service d'Addictologie et Pathologie Duelles [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, VU University Medical Center [Amsterdam], Tournayre, Christophe, and Economics

Subjects
medicine.medical_specialty, Acute coronary syndrome, chest pain, Multivariate analysis, medicine.medical_treatment, RC435-571, cocaine, Single-nucleotide polymorphism, 030204 cardiovascular system & hematology, Chest pain, Logistic regression, acute coronary syndrome, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, single nucleotide polymorphism, Internal medicine, medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, ALDH2, Psychiatry, Harm reduction, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, opioid maintenance treatment, GUCY1A3, Brief Research Report, medicine.disease, Confidence interval, Stimulant, Psychiatry and Mental health, rs2238151, medicine.symptom, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Introduction: Cocaine users often present with repetitive events of cocaine-associated chest pain (CACP), clinically resembling acute coronary syndromes. The aim of the study is to describe the specific risk factors for CACP.Method: Cocaine users (n = 316) were recruited for a multicenter cross-sectional study. Lifetime CACP history, sociodemographic factors, and lifetime use of cocaine and other substances were assessed. Thirty single nucleotide polymorphisms (SNPs) of NOS3, ROCK2, EDN1, GUCY1A3, and ALDH2 genes, suggested by the literature on coronary spasms, were selected. The associations with CACP history were tested using the chi-square test, Student's t-test and logistic regression.Results: Among the 316 subjects [78.5% men, mean age 37.5 years, (standard-deviation ±8.7)], 190 (60.1%) were daily cocaine users and 103 (32.6%) reported a lifetime CACP history. Among those with a lifetime CACP history, the median was 10 events per individual. In multivariate analysis, lifetime CACP history was associated with daily cocaine use [odds-ratio (OR) 3.24; 95% confidence intervals (1.29–9.33)], rapid route of cocaine use [OR 2.33 (1.20–4.64) vs. intranasal use], and lifetime amphetamine use [daily amphetamine use: OR 2.80 (1.25–6.32) and non-daily amphetamine use: OR 2.14 (1.15–4.04) vs. never used]. Patients with lifetime opioid maintenance treatment (OMT) reported significantly less lifetime CACP history [OR 0.35 (0.16–0.76)]. None of the selected SNPs was associated with CACP history after multiple testing corrections.Conclusions: Clinical variables describing the intensity of stimulant use were positively associated with lifetime CACP history, while OMT was negatively associated with it. Specific harm reduction strategies can target these risk factors.

Published
2021
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2. Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

Author

Pierre Kalfon, Mohamed Boucekine, Philippe Estagnasie, Marie-Agnès Geantot, Audrey Berric, Georges Simon, Bernard Floccard, Thomas Signouret, Mélanie Fromentin, Martine Nyunga, Juliette Audibert, Adel Ben Salah, Bénédicte Mauchien, Achille Sossou, Marion Venot, René Robert, Arnaud Follin, Anne Renault, Maïté Garrouste-Orgeas, Olivier Collange, Quentin Levrat, Isabelle Villard, Didier Thevenin, Julien Pottecher, René-Gilles Patrigeon, Nathalie Revel, Coralie Vigne, Elie Azoulay, Olivier Mimoz, Pascal Auquier, Karine Baumstarck, IPREA Study Group, Hôpital Louis Pasteur [Chartres], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Hôpital Ambroise Paré [AP-HP], Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, CH de Troyes, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Européen de Marseille (HEM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Victor Provo, Centre Hospitalier Emile Roux [AP-HP], Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), 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), CHRU Brest - Département d'Anesthésie Réanimation (CHU - BREST - DAR), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre hospitalier Saint-Joseph [Paris], CHU Strasbourg, service de réanimation, groupe hospitalier de la Rochelle-Ré-Aunis, Hôpital Beaujon [AP-HP], Centre Hospitalier de Lens, Hôpital de Hautepierre [Strasbourg], Centre Hospitalier d'Auxerre, Hôpital Pasteur [Nice] (CHU), Hôpital Nord [CHU - APHM], Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), IPREA Study Group: Karine Vie, Gwenaëlle Lannuzel, Hélène Bout, Jean-Philippe Parthiot, Isabelle Chazal, Philippe Charve, Caroline Prum, Jean-Pierre Quenot, Nora Perrot, Francis Augier, Niloufar Behechti, Claudine Cocusse, Céline Foulon, Laurence Goncalves, Abdesselem Hanchi, Etienne Legros, Ana Isabel Mercier, Nicolas Meunier-Beillard, Nathalie Nuzillat, Alicia Richard, Claire Boulle, Benjamin Kowalski, Elisa Klusek, Tarek Sharshar, Andrea Polito, Caroline Duvallet, Sonia Krim, Nicolas Girard, Cécile Jourdain, Stéphane Techer, Corinne Chauvel, Corinne Bruchet, Johanna Temime, Stéphanie Beaussart, Fabienne Jarosz, Jullien Crozon-Clauzel, Serge Olousouzian, Sylvie Pereira, Loïc Argentin, Valérie Cerro, Déborah Levy, Sébastien Andre, Christophe Guervilly, Laurent Papazian, Myriam Moussa, Stéphanie Renoult, Delphine Biet, Steve Novak, Jean-Christophe Orban, Aminata Diop, Carole Ichai, Antoine Tesniere, Jean-Pascal Goupil, Frédérique Laville, Nadège Rutter, Sandie Brochon, Kelly Tiercelet, Julien Amour, Nora Ait-Hamou, Marjorie Leger, Virginie Souppart, Emilie Griffault, Marie-Line Debarre, Céline Deletage, Anne-Laure Guerin, Carole Guignon, Sabrina Seguin, Christophe Hart, Kathy Dernivoix, Caroline Wuiot, Karine Sanches, Stéphane Hecketsweiler, Catherine Sylvestre-Marconville, Vincent Gardan, Stéphanie Deparis-Dusautois, Yana Chaban, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), and Centre hospitalier d'Auxerre (CHA)

Subjects
Male, Multivariate analysis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, Risk Factors, law, Surveys and Questionnaires, Cluster Analysis, Generalized estimating equation, Patient-reported outcome, Pain Measurement, Aged, 80 and over, Univariate analysis, Chest drain, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Intensive care unit, 3. Good health, Intensive Care Units, Adult intensive care unit, Female, France, Central venous catheter, Discomfort, medicine.medical_specialty, Critical Illness, Pain, Statistics, Nonparametric, 03 medical and health sciences, medicine, Humans, Pain Management, Aged, business.industry, Research, IPREA, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Length of Stay, Critical care, 030228 respiratory system, Life support, Multivariate Analysis, Emergency medicine, Quality of Life, Self Report, business, Intra-hospital transport
Abstract

BackgroundThe short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay.MethodsThe study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the “Inconforts des Patients de REAnimation” (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed.ResultsPatients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0–5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores.ConclusionPatients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients’ perceptions of their ICU stay regarding recalled pain.Trial Registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015

Published
2020
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3. T-piece versus pressure-support ventilation for spontaneous breathing trials before extubation in patients at high risk of reintubation: protocol for a multicentre, randomised controlled trial (TIP-EX)

Author

Jean-Paul Mira, Jeremy Bourenne, Agathe Delbove, René Robert, Gaetan Beduneau, Jean-Pierre Frat, Jérôme Devaquet, Arnaud Gacouin, Laurence Dangers, Nicolas Terzi, Stéphanie Ragot, Guylaine Labro, Antoine Romen, Gael Pradel, Christophe Leroy, Jean Reignier, Laurent Argaud, Rémi Coudroy, Quentin Levrat, Stephan Ehrmann, Jean-Pierre Quenot, Emmanuel Vivier, Guillaume Lacave, Christophe Guitton, Marie-Ange Azais, Alexandre Lautrette, Mai-Anh Nay, Anahita Rouzé, Damien Contou, Martin Dres, Gwenaël Prat, Jean Dellamonica, Arnaud W. Thille, Nicholas Sedillot, Béatrice Lacombe, Université de Lille, CNRS, Centre hospitalier universitaire de Poitiers [CHU Poitiers], CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Tours [CHRU Tours], Centre Hospitalier Victor Dupouy, Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], Centre hospitalier de Pau, Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier de Versailles André Mignot [CHV], CHU Dijon, CIC - CHU Henri Mondor, Centre Hospitalier Universitaire [Grenoble] [CHU], CHRU Brest - Service de Réanimation Médicale [CHU - BREST - Réa Med], Centre Hospitalier Emile Muller [Mulhouse] [CH E.Muller Mulhouse], Centre hospitalier universitaire de Nantes [CHU Nantes], Service d'anesthésie et réanimation chirurgicale [Nantes], Service de réanimation médicale [CHU Rouen], Centre Hospitalier Universitaire de Nice [CHU Nice], Centre Hospitalier Régional d'Orléans [CHRO], Centre Hospitalier Régional Universitaire [Lille] [CHRU Lille], Centre hospitalier Bretagne Atlantique (Morbihan) [CHBA], Hôpital Cochin [AP-HP], Hôpital de la Timone [CHU - APHM] [TIMONE], Centre Jean Perrin [Clermont-Ferrand] [UNICANCER/CJP], Hôpital Edouard Herriot [CHU - HCL], Hôpital Foch [Suresnes], Centre hospitalier Saint Joseph - Saint Luc [Lyon], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon [CHD Vendée], Centre Hospitalier Emile Roux [AP-HP], INSERM CIC 0802 [INSERM - CHU de Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire Félix-Guyon [Saint-Denis, La Réunion, France], Centre Hospitalier de Versailles André Mignot (CHV), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Groupe Hospitalier Bretagne Sud (GHBS), Centre Hospitalier Henri Mondor d'Aurillac, Unité de soins intensifs médicaux [CHU Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Hôpital Charles Nicolle [Rouen], Unité de Recherche Clinique de la Côte d’Azur [Nice] (URRIS UR2CA), Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Régional d'Orléans (CHRO), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre Hospitalier Fleyriat [Bourg en Bresse], Unité de Soins Intensifs [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Hospices Civils de Lyon (HCL), Centre Hospitalier de La Rochelle (CHR), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), 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), REVA research network, CarMeN, laboratoire, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche Clinique de la Côte d’Azur (URRIS UR2CA), Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_treatment, [SDV]Life Sciences [q-bio], Pressure support ventilation, law.invention, Spontaneous breathing trial, Positive-Pressure Respiration, 03 medical and health sciences, Work of breathing, 0302 clinical medicine, Randomized controlled trial, law, Informed consent, medicine, respiratory medicine (see thoracic medicine), Humans, 030212 general & internal medicine, adult intensive & critical care, respiratory physiology, Mechanical ventilation, business.industry, Intensive Care, General Medicine, Intensive care unit, Respiration, Artificial, 3. Good health, [SDV] Life Sciences [q-bio], 030228 respiratory system, Anesthesia, Breathing, Airway Extubation, Medicine, France, business, Ventilator Weaning
Abstract

IntroductionIn intensive care unit (ICU), the decision of extubation is a critical time because mortality is particularly high in case of reintubation. To reduce that risk, guidelines recommend to systematically perform a spontaneous breathing trial (SBT) before extubation in order to mimic the postextubation physiological conditions. SBT is usually performed with a T-piece disconnecting the patient from the ventilator or with low levels of pressure-support ventilation (PSV). However, work of breathing is lower during PSV than during T-piece. Consequently, while PSV trial may hasten extubation, it may also increase the risk of reintubation. We hypothesise that, compared with T-piece, SBT performed using PSV may hasten extubation without increasing the risk of reintubation.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing T-piece vs PSV for SBTs in patients at high risk of reintubation in ICUs. Nine hundred patients will be randomised with a 1:1 ratio in two groups according to the type of SBT. The primary outcome is the number of ventilator-free days at day 28, defined as the number of days alive and without invasive mechanical ventilation between the initial SBT (day 1) and day 28. Secondary outcomes include the number of days between the initial SBT and the first extubation attempt, weaning difficulty, the number of patients extubated after the initial SBT and not reintubated within the following 72 hours, the number of patients extubated within the 7 days following the initial SBT, the number of patients reintubated within the 7 days following extubation, in-ICU length of stay and mortality in ICU, at day 28 and at day 90.Ethics and disseminationThe study has been approved by the central ethics committee ‘Ile de France V’ (2019-A02151-56) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT04227639.

Published
2020
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4. Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study

Author

Sylvie Bastuji-Garin, Cynthia Engels, Etienne Audureau, Marie Laurent, Eveline Liuu, Elena Paillaud, Jean-Philippe David, Nadia Oubaya, Florence Canoui-Poitrine, Lola Corsin, IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Henri Mondor, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris-Est Créteil Val-de-Marne - Institut de formation en ergothérapie (UPEC IFE), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre hospitalier universitaire de Poitiers (CHU Poitiers), 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), and Tapia, Claudia

Subjects
medicine.medical_specialty, Activities of daily living, Geriatric rehabilitation, medicine.medical_treatment, Comorbidity, lcsh:Geriatrics, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Elderly, Interquartile range, Internal medicine, Activities of Daily Living, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Geriatric Assessment, Acquired hospital infection functional decline, Aged, Geriatrics, Aged, 80 and over, Rehabilitation, [SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, business.industry, Incidence (epidemiology), [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, medicine.disease, Hospitals, Europe, lcsh:RC952-954.6, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, Research Article
Abstract

Background In some European countries, including France, older patients with functional decline in acute units are transferred to geriatric rehabilitation units. Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. Previous prognostic models of functional decline are based on only baseline parameters. However, some events can occur during rehabilitation and modify the association between baseline parameters and rehabilitation performance such as heart failure episode, falls or hospital-acquired infection (HAI). The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. Methods We used a prospective cohort of consecutive patients aged ≥75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. Results Among the 252 eligible patients, 160 (median age 84 years [interquartile range (IQR) 80–88] had available ADL scores at baseline (median score 7 [IQR 4–10]) and at discharge (median 9 [6–12]). Median CIRS-G score was 11 [8–13], 23 (14%) had a pulmonary HAI; 28 (17.5%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P = 0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P = 0.02, or psychiatric disease, P = 0.02) and albumin level p = 0.03). Significant associations were found between functional decline and CIRS-G-R (OR 3.07 [95%CI 1.27–7.41], p = 0.01), between functional decline and pulmonary HAI (OR 3.12 [1.17–8.32],p = 0.02), and between CIRS-G-R and pulmonary HAI (OR 12.9[4.4–37.7], p = 0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 2.26 [0.83–6.16], p = 0.11) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. Conclusion Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

Published
2020
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5. A decrease in brown adipose tissue activity is associated with weight gain during chemotherapy in early breast cancer patients

Author

Emilie Gadéa, Angeline Ginzac, Ioana Molnar, Marion Chanchou, Xavier Durando, B. Barres, Charles Merlin, Bruno Coudert, Emilie Thivat, Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Centre d'Investigation Clinique [CHU Clermont-Ferrand] (CIC 1405), Institut National de la Santé et de la Recherche Médicale (INSERM)-Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), CHU Clermont-Ferrand-CHU Clermont-Ferrand, Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Département de Médecine nucléaire, Centre Jean PERRIN, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'oncologie médicale [Centre Georges-François Leclerc], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER, and GINZAC, Angeline

Subjects
0301 basic medicine, Cancer Research, medicine.medical_treatment, Docetaxel, Brown adipose tissue, Weight Gain, Gastroenterology, 0302 clinical medicine, Breast cancer, Adipose Tissue, Brown, Surgical oncology, Positron Emission Tomography Computed Tomography, Early breast cancer, [SDV.MHEP.EM] Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Lost Weight, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Middle Aged, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Neoadjuvant Therapy, 3. Good health, medicine.anatomical_structure, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Female, medicine.symptom, Research Article, Adult, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, Antineoplastic Agents, Breast Neoplasms, lcsh:RC254-282, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Fluorodeoxyglucose F18, Internal medicine, Genetics, medicine, Humans, Aged, Chemotherapy, business.industry, Energy metabolism, Trastuzumab, medicine.disease, 030104 developmental biology, business, Weight gain, Thermogenesis
Abstract

Background A decrease in thermogenesis is suspected to be implicated in the energy expenditure reduction during breast cancer treatment. This study aimed to investigate the impact of chemotherapy on the metabolic activity of brown adipose tissue (BAT) and the link with weight variation. Methods This was an ancillary analysis of a multicentre trial involving 109 HER2+ breast cancer patients treated with neoadjuvant chemotherapy. A centralised review of 18F-FDG uptake intensity (SUVmax) in specific BAT regions (cervical and supraclavicular) was conducted on two PET-CT scans for each patient (before and after the first course of chemotherapy). Results Overall, after one course of chemotherapy a significant decrease of 4.4% in 18F-FDG-uptake intensity was observed. It was not correlated to initial BMI, age or season. During chemotherapy, 10.1% (n = 11) of the patients lost weight (− 7.7 kg ± 3.8 kg; ie, − 9.4% ± 3.7%) and 29.4% (n = 32) gained weight (+ 5.1 kg ± 1.7 kg; ie, + 8.5% ± 2.6%). Among these subgroups, only the patients who had gained weight underwent a significant decrease (13.42%) in 18F-FDG uptake intensity (p = 0.042). Conclusion This study is the first to highlight in a large cohort of patients the negative impact of chemotherapy on brown adipose tissue activity. Weight gain during chemotherapy could thus potentially be explained in part by a decrease in brown adipose tissue activity.

Published
2020
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6. Circulating 20S proteasome for assessing protein energy wasting syndrome in hemodialysis patients

Author

Marine Freist, Elodie Gentes, Carole Philipponnet, Mohamed Hadj Abdelkader, Bruno Pereira, Aurélien Piraud, Cyril Garrouste, Anne-Elisabeth Heng, Julien Aniort, Unité de Nutrition Humaine (UNH), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néphrologie - Hémodialyses [CHU Clermont-Ferrand], Pôle RHEUNNIRS [CHU Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Dept Clin Nutr, Unité de Biostatistiques [CHU Clermont-Ferrand], Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Unité de Biostatistiques, Direction de la Recherche Clinique (DRCI)

Subjects
Male, 0301 basic medicine, dialyse, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030232 urology & nephrology, Muscle Proteins, Biochemistry, protéasome, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Gastroenterology, 0302 clinical medicine, Medicine and Health Sciences, 2. Zero hunger, Multidisciplinary, Protein energy wasting, Muscle Analysis, Middle Aged, C-Reactive Proteins, Muscle atrophy, atrophie musculaire, 3. Good health, Hospitalization, Bioassays and Physiological Analysis, Nephrology, Creatinine, Medicine, Female, patient, Hemodialysis, medicine.symptom, Research Article, Proteasome Endopeptidase Complex, medicine.medical_specialty, Science, Nutritional Status, Circulating Proteasome, Research and Analysis Methods, Protein-Energy Malnutrition, 03 medical and health sciences, Signs and Symptoms, Renal Dialysis, Internal medicine, Medical Dialysis, medicine, Humans, Mortality, Survival rate, Nutrition, Aged, Wasting Syndrome, business.industry, Biology and Life Sciences, Proteins, Protein Complexes, Proteasomes, medicine.disease, perte d'énergie, Patient Outcome Assessment, 030104 developmental biology, Proteasome, Clinical Medicine, Atrophy, Complication, business, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Kidney disease
Abstract

International audience; Protein energy wasting (PEW) including muscle atrophy is a common complication in chronic hemodialysis patients. The ubiquitin proteasome system (UPS) is the main proteolytic system causing muscle atrophy in chronic kidney disease and proteasome 20S is the catalytic component of the UPS. Circulating proteasome 20S (c20S proteasome) is present in the blood and its level is related to disease severity and prognosis in several disorders. We hypothesized that c20S proteasome could be related with muscle mass, other PEW criteria and their evolution in hemodialysis patients. Stable hemodialysis patients treated at our center for more than 3 months were followed over 2 years. C20S proteasome assay was performed at baseline. Biological and clinical data were collected, muscle mass was assessed by multi-frequency bio-impedancemetry, and nutritional scores were calculated at baseline, 1 year and 2 years. Hospitalizations and mortality data were collected over the 2 years. Forty-nine patients were included. At baseline, the c20S proteasome level was 0.40 [0.26-0.55] mu g/ml. Low muscle mass as defined by a lean tissue index (LTI) < 10th in accordance with the International Society of Renal Nutrition and Metabolism guidelines was observed in 36% and PEW in 62%. Increased c20S proteasome levels were related with LTI at baseline (R = 0.43, p = 0.004) and with its 2 year-variation (R = -0.56, p = 0.003). Two-year survival rate was not different between higher and lower c20S proteasome values (78.9 vs 78.4%, p = 0.98 log-rank test). C20S proteasome is not a good marker for assessing nutritional status in hemodialysis patients and predicting patient outcomes.

Published
2020
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7. Treatment-Induced Cardiotoxicity in Breast Cancer: A Review of the Interest of Practicing a Physical Activity

Author

Ioana Molnar, Xavier Durando, Martine Duclos, Emilie Gadéa, Romain Trésorier, Judith Passildas, Catherine Abrial, Angeline Ginzac, Emilie Thivat, Imagerie Moléculaire et Stratégies Théranostiques - Clermont Auvergne (IMoST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA), Centre Jean Perrin, CRLCC Jean Perrin, Centre Hospitalier Emile Roux, Unité de Nutrition Humaine - Clermont Auvergne (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne (UCA), Service de Médecine du Sport et des Explorations Fonctionnelles, CHU Clermont-Ferrand, Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Service Médecine du Sport et Explorations Fonctionnelles [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], and CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand]

Subjects
Cancer Research, medicine.medical_specialty, Anthracycline, Side effect, Population, Antineoplastic Agents, Breast Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Trastuzumab, medicine, Humans, Anthracyclines, 030212 general & internal medicine, Intensive care medicine, education, HER2-positive breast cancer, Exercise, Cardiotoxicity, education.field_of_study, business.industry, Physical activity, Cancer, General Medicine, medicine.disease, 3. Good health, Discontinuation, Oncology, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Patient Compliance, Female, business, medicine.drug
Abstract

International audience; Physical activity is known to prevent the occurrence of cancer and decrease the risk of breast cancer. At diagnosis of breast cancer, fewer than half of the patients reach the international recommendation for physical activity. However, breast cancer patients, and particularly HER2+ breast cancer patients, are exposed to treatment-induced cardiotoxicity because of a side effect of 2 molecules used in standard therapy to treat these tumors, i.e., anthracycline and trastuzumab. Cardiotoxicity can sometimes lead to discontinuation of the treatment and even to the development of cardiovascular diseases. Exercise is known to protect the cardiovascular system in the healthy population. Consequently, being physically active during treatment appears to be a way to prevent the negative impact of cancer treatment on the heart in this population. In particular, aerobic exercising could have a protective effect against treatment-induced cardiotoxicity. A supervised physical activity program seems to be the best way for breast cancer patients to be active during treatment. However, there is very little information, and in particular a lack of guidelines, on exercising available to patients. The interventional trials that have been conducted on this topic are very heterogeneous and no standard recommendations have been made available for cancer patients thus far. An effective physical activity program needs to take each patient’s barriers and motivations into account in order to encourage the practice of physical activity throughout treatment. To ensure the success of the program, it is essential to facilitate adherence and especially maintain motivation. Further studies are needed to determine what practice guidelines oncologists should give their patients.

Published
2019
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8. Weight Evolution During Endocrine Therapy for Breast Cancer in Postmenopausal Patients: Effect of Initial Fat Mass Percentage and Previous Adjuvant Treatments

Author

Xavier Durando, Angeline Ginzac, Béatrice Morio, Judith Passildas, Catherine Abrial, Martine Duclos, Marie-Ange Mouret-Reynier, Yves Boirie, Isabelle Van Praagh, Emilie Gadéa, Emilie Thivat, Pascale Dubray-Longeras, Fabrice Kwiatkowski, Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Service Médecine du Sport et Explorations Fonctionnelles [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagerie Moléculaire et Stratégies Théranostiques - Clermont Auvergne (IMoST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA), Centre Jean Perrin, CRLCC Jean Perrin, Unité de Nutrition Humaine - Clermont Auvergne (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne (UCA), Service de médecine du sport et des explorations fonctionnelles, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre Hospitalier Emile Roux, and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)

Subjects
Postmenopausal breast cancer, Cancer Research, medicine.medical_specialty, Antineoplastic Agents, Hormonal, medicine.medical_treatment, Body water, Population, adjuvant treatment, Breast Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Weight loss, Internal medicine, medicine, [SDV.MHEP.AHA]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Longitudinal Studies, 030212 general & internal medicine, education, Aged, education.field_of_study, Chemotherapy, body composition, business.industry, endocrine therapy, Body Weight, Weight change, fat mass, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, Middle Aged, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, medicine.disease, 3. Good health, Postmenopause, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Lean body mass, Female, medicine.symptom, business, Bioelectrical impedance analysis, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

Background Weight changes during adjuvant treatment for early-stage breast cancer has been associated with a poor prognosis. The long-term evolution of body composition during adjuvant treatment for breast cancer, in particular, endocrine therapy, is not well known, and new data on this topic are required. The present study assessed the evolution of weight and body composition among 33 postmenopausal breast cancer patients receiving endocrine therapy after standard adjuvant chemotherapy that included taxanes. Patients and Methods Dual-energy x-ray absorptiometry was used to measure the fat and lean body mass. Body water was assessed using multifrequency bioelectrical impedance analysis. The Hospital Anxiety and Depression questionnaire and the short version of the International Physical Activity Questionnaire were also administered. Results During endocrine therapy, 5 of the 33 patients (15.2%) lost weight and 12 (36.4%) gained weight. The overall average gain was 2.0 ± 5.5 kg (P = .04). During this period, the fat mass, lean body mass, and body water increased. The factors linked to fat mass gain included an excess fat mass (≥ 36%) before treatment and weight loss during chemotherapy. In the overall period of adjuvant cancer treatment, 30% of the population gained > 5% of their initial weight. The average gain was the same as that during the endocrine therapy period (2.0 ± 5.4 kg; P = .031) and was characterized by an increase in total lean body mass, mainly localized in the trunk region. Conclusion Endocrine therapy appears as a pivotal period in weight and body composition management. Overfat and obese patients and those who lose weight during chemotherapy were more subject to weight and fat mass gain during endocrine therapy.

Published
2018
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9. Plasma amyloid levels within the Alzheimer's process and correlations with central biomarkers

Author

Nathalie Sastre, Cécile Adam, Didier Hannequin, Sophie Chauvelier, Marie–Ange Cariot, Hermine Lenoir, Laure Caillard, Djamila Krabchi, Léna Joffredo, Jean-Marc Tréluyer, Olivier Hanon, Françoise Lala, Frédéric Bloch, Bruno Vellas, Stéphanie Bombois, Laurence Hugonot–Diener, Philippe-Henri Robert, Céline Guillemaud, Xavier Delbeuck, Julien Dumurgier, Jean-François Mangin, Nathalie Charasz, Jean-Luc Novella, Vincent Camus, Pierre Anthony, Sylvain Lehmann, Anne-Sophie Rigaud, Audrey Gabelle, Clémence Boully, Lisette Volpe–Gillot, Jacques Touchon, Jacques Boddaert, Vincent Deramecourt, Giovanni Castelnovo, Yasmina Boudali, Marie Chupin, S. Schraen-Maschke, Olivier Guerin, Joël Belmin, Isabelle Saulnier, Valérie Chauviré, Nathalie Schwald, Salim Gherabli, Philippe Robert, Sarah Benisty, Candice Picard, Marie Laurent, Foucaud du Boisgueheneuc, Florien Labourée, Gabiel Abitbol, Sophie Haffen, Patrick Gelé, Hélène Briault, Jean Luc Novella, François Sellal, Claire Gervais, Marie–Agnès Picat, Anne Chawakilian, Marie–Thérèse Rabus, Pierre Jean Ousset, Galdric Orvoen, Thierry Dantoine, Pierre Vandel, Jaques Hugon, Rezki Daheb, Jean-Sébastien Vidal, David Wallon, Diane Dupuy, Karl Mondon, Lisette Volpe-Gillot, Adeline Rollin Sillaire, Christine Delmaire, Frédéric Blanc, Emmanuelle Duron, Anna Kearney–Schwartz, Evelyne Galbrun, Florence Latour, Christine Perret–Guillaume, Florence Moulin, C. Bayle, Sylvie Pariel, Jean-Philippe David, Mohamed Abdellaoui, Stéphanie Libercier, Valérie Gissot, Bernadette Allinquant, Jean-Yves Gaubert, Elena Paillaud, Jean–Marc Michel, Caroline Hommet, Gilles Berrut, Luc Buée, Eliana Alonso, Agnès Devendeville, Anne–Cécile Troussiere, Marie–Anne Mackowiak, Yann Spivac, Jacques Hugon, Pascaline Cassagnaud, Olivier Martinaud, Marion Paulin, Claire Paquet, Matthieu Plichart, Guillaume Sacco, Olivier Godefroy, Sophie Pichierri, Athanase Benetos, M.-L. Seux, Marc Paccalin, Edouard Chaussade, Centre de Mémoire de Ressources et de Recherche [Paris Broca], AP-HP - Hôpital Broca [Paris], Maladie d'Alzheimer : marqueurs génétiques et vasculaires, neuropsychologies (EA 4468), Université Paris Descartes - Paris 5 (UPD5)-Groupe hospitalier Broca, Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Lille Neurosciences & Cognition - U 1172 (LilNCog (ex-JPARC)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Mémoire de Ressources et de Recherche [Hôpitaux Civils de Colmar, Strasbourg], Hôpitaux Civils de Colmar, CATI Multicenter Neuroimaging Platform (CATI), Université Paris-Saclay, Centres Mémoire de Ressources et de Recherche Montpellier (CMRR), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Centre Mémoire de Ressources et de Recherche Paris Nord Ile-de-France (CMRR), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Mémoire de Ressources et de Recherche [CHU de Toulouse, Hôpital Purpan], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Centre Hospitalier Emile Roux [AP-HP], Centres Mémoire de Ressources et de Recherche [CHRU Nancy] (CMRR de Lorraine), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Mémoire de Ressources et de Recherche [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service de médecine interne [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Mémoire de Ressources et Recherche - CMRR [Haute-Normandie], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital Léopold-Bellan, Centre Mémoire de Ressources et de Recherche [CHRU de Poitiers La Miletrie], CHRU de Poitiers La Miletrie [Poitiers], Centre Mémoire de Ressources et de Recherche [Nice] (CMRR Nice), Université Côte d'Azur (UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Centre Mémoire de Ressources et de Recherche [CHU Amiens], CHU Amiens-Picardie, Centre de Mémoire de Ressources et de Recherches [Limoges] (CMRR Limoges), CHU Limoges-CH Esquirol [Limoges] (CH Esquirol), Centre Mémoire de Ressources et de Recherche [CHRU de Tours Hôpital Bretonneau], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau [Tours], Imagerie et cerveau (iBrain - Inserm U1253 - UNIV Tours ), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Médecine Gériatrique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Mémoire de Ressources et de Recherche [CHRU de Besançon] (CMRR), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques [CHRU de Besançon], Laboratoire de Neurosciences Intégratives et Cliniques - UFC (EA 481) (NEURO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre de Mémoire de Ressource et Recherche [Champagne-Ardenne-Reims] (CMRR Reims - Champagne-Ardenne), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims (CHU Reims)-Centre Hospitalier Universitaire de Reims (CHU Reims)-Fédération nationale des Centres de Mémoire de Ressources et de Recherche (FCMRR), Vieillissement, Fragilité (VIEFRA - EA 3797), Université de Reims Champagne-Ardenne (URCA), French Ministry of Health (Programme Hospitalier de Recherche Clinique [PHRC 2009/01-04 and PHRC-13-0404]), Fondation Plan Alzheimer, Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)-Hôpital Bretonneau [Tours], Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gériatrie à orientation cardiologique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Lille Neurosciences & Cognition - U 1172 (LilNCog), Centre Mémoire [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Nice Sophia Antipolis (1965 - 2019) (UNS), Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), Laboratoire de Neurosciences Intégratives et Cliniques - UFC (UR 481) (NEURO), DE CARVALHO, Philippe, Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Psychiatrie et Neurosciences (U894), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Male, 0301 basic medicine, Apolipoprotein E, Epidemiology, [SDV]Life Sciences [q-bio], 0302 clinical medicine, Cerebrospinal fluid, Prospective Studies, Prospective cohort study, Aged, 80 and over, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, [SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Health Policy, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Middle Aged, Alzheimer's disease, Mental Status and Dementia Tests, Magnetic Resonance Imaging, [SDV] Life Sciences [q-bio], Psychiatry and Mental health, Biomarker (medicine), Female, Cohort study, medicine.medical_specialty, Amyloid, 03 medical and health sciences, Cellular and Molecular Neuroscience, Amyloid β peptides, Developmental Neuroscience, Alzheimer Disease, Internal medicine, mental disorders, medicine, Humans, Dementia, Cognitive Dysfunction, Plasma biomarkers, CSF biomarkers, Aged, Amyloid beta-Peptides, business.industry, Mild cognitive impairment, Plasma levels, medicine.disease, 030104 developmental biology, Endocrinology, Csf biomarkers, Neurology (clinical), Geriatrics and Gerontology, business, Biomarkers, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; INTRODUCTION:Diagnostic relevance of plasma amyloid β (Aβ) for Alzheimer's disease (AD) process yields conflicting results. The objective of the study was to assess plasma levels of Aβ42 and Aβ40 in amnestic mild cognitive impairment (MCI), nonamnestic MCI, and AD patients and to investigate relationships between peripheral and central biomarkers.METHODS:One thousand forty participants (417 amnestic MCI, 122 nonamnestic MCI, and 501 AD) from the Biomarker of AmyLoïd pepTide and AlZheimer's diseAse Risk multicenter prospective study with cognition, plasma, cerebrospinal fluid (CSF), and magnetic resonance imaging assessments were included.RESULTS:Plasma Aβ1-42 and Aβ1-40 were lower in AD (36.9 [11.7] and 263 [80] pg/mL) than in amnestic MCI (38.2 [11.9] and 269 [68] pg/mL) than in nonamnestic MCI (39.7 [10.5] and 272 [52] pg/mL), respectively (P = .01 for overall difference between groups for Aβ1-42 and P = .04 for Aβ1-40). Globally, plasma Aβ1-42 correlated with age, Mini-Mental State Examination, and APOE ε4 allele. Plasma Aβ1-42 correlated with all CSF biomarkers in MCI but only with CSF Aβ42 in AD.DISCUSSION:Plasma Aβ was associated with cognitive status and CSF biomarkers, suggesting the interest of plasma amyloid biomarkers for diagnosis purpose.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Published
2018
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10. CKD complications in kidney-transplanted patients going back to dialysis: impact on patients outcomes

Author

Cyril Garrouste, Mohamed Hadj Abdelkader, Aurelien Mulliez, Myriam Isnard, Julien Aniort, Youssef Ali, Anne Elisabeth Heng, Didier Aguilera, Saleh Kaysi, Marc Bouiller, Unité de Nutrition Humaine (UNH), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Jacques Lacarin, American University of Beirut Faculty of Medicine and Medical Center (AUB), Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), Service de Néphrologie - Hémodialyses [CHU Clermont-Ferrand], Pôle RHEUNNIRS [CHU Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], and CHU Clermont-Ferrand-CHU Clermont-Ferrand

Subjects
Nephrology, Adult, Male, medicine.medical_specialty, Complications, Time Factors, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Renal Dialysis, Risk Factors, Chronic kidney disease, Internal medicine, medicine, Humans, Treatment Failure, Renal Insufficiency, Chronic, Intensive care medicine, Survival rate, Dialysis, Kidney transplantation, Aged, Retrospective Studies, Kidney, business.industry, Middle Aged, medicine.disease, Kidney Transplantation, Log-rank test, Hospitalization, medicine.anatomical_structure, Arterial blood, Female, Graft failure, France, business, Biomarkers, Kidney disease
Abstract

International audience; Aims The management of chronic kidney disease (CKD) complications is not always adequate in patients with a failed kidney transplant. We aimed to evaluate the frequency of CKD complications and assess whether they may lead to worse outcomes in this patient population.Method We analyzed 49 kidney transplant recipients with a failed transplant (T+) and matched non-transplanted patients (T-) starting dialysis between 2000 and 2010 in five dialysis centers in France. CKD complications at dialysis initiation, hospitalizations and death were recorded and compared between the two groups.Results At dialysis initiation, T+ patients were more likely to have bicarbonate < 22 mmol/l (77.6 vs. 22.0%, p < 0.01), phosphate > 1.5 mmol/l (77.6 vs. 59.2%, p = 0.03), arterial blood pressure > 130/80 mmHg (75.5 vs. 93.9%, p = 0.01), body mass index < 23 (59.2 vs. 32.7%, p = 0.01) and albumin < 38 g/l (69.4 vs. 36.7%) than T-patients. T+ patients were hospitalized more frequently in the year following dialysis initiation (40.8 +/- 7.0 vs. 16.3 +/- 5.3%, log rank p = 0.01) and 5-year survival rate was lower than in T-patients (82.1 +/- 6.2 vs. 64.0 +/- 7.4%, log rank p = 0.02). However risk of hospitalization and mortality was lesser after adjustments for CKD complications.Conclusion Despite regular follow-up by nephrologists, CKD complications before initiation of dialysis are more frequent in T+ patients than in T-patients. A better management of CKD complications in T+ patients could improve outcomes after dialysis initiation.

Published
2017
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11. Diagnostic Delay Is Associated with a Greater Risk of Early Surgery in a French Cohort of Crohn’s Disease Patients

Author

Vered Abitbol, Bruno Lesgourgues, Laurent Peyrin-Biroulet, Stanislas Chaussade, Stéphane Nahon, Thierry Paupard, Pierre Lahmek, Service d’hépato-gastro-entérologie [CH Le Raincy-Montfermeil], Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Dunkerque, Service de Gastro-entérologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Hépato-gastro-entérologie [CHRU Nancy], and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)

Subjects
Male, Delayed Diagnosis, Time Factors, Physiology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Constriction, Pathologic, Kaplan-Meier Estimate, Cohort Studies, 0302 clinical medicine, Crohn Disease, Prospective Studies, Young adult, Prospective cohort study, Colectomy, Digestive System Surgical Procedures, Crohn's disease, Enterostomy, Gastroenterology, 3. Good health, Diagnostic delay, Jejunum, Quartile, 030220 oncology & carcinogenesis, Cohort, Female, 030211 gastroenterology & hepatology, France, Immunosuppressive Agents, Cohort study, medicine.drug, Adult, Risk, medicine.medical_specialty, Young Adult, 03 medical and health sciences, Internal medicine, medicine, Humans, Tumor Necrosis Factor-alpha, business.industry, Adalimumab, medicine.disease, Infliximab, Surgery, Methotrexate, business, Intestinal Obstruction
Abstract

International audience; To investigate whether a diagnostic delay is associated with a poor outcome in Crohn's disease (CD).Medical and socioeconomic characteristics as well as medications and need for surgery of consecutive CD adults patients followed in three referral centers were prospectively recorded using an electronic database (Focus_MICIA (R)). A long diagnostic delay was defined by the upper quartile. We compared patients with long diagnostic delay to those with earlier diagnosis regarding the time to: (1) first intestinal surgery, (2) first use of immunosuppressants (IMSs), and (3) first use of anti-tumor necrosis factor (anti-TNF) therapy using the Kaplan-Meier test and the log-rank test.A total of 497 patients with CD (53.6 % women) were analyzed. Median diagnostic delay was 5 months (IQR 25-75 %: 2-13 months). Median follow-up was 9 years (IQR 4-16.2), and 148 (29.8 %) patients had major surgery. There were no significant differences between patients with late and early diagnosis regarding age at diagnosis, disease phenotype, need for IMS therapy, and need for anti-TNF therapy. Time to first major surgery was shorter in patients with late diagnosis (p = 0.05).In this large multicenter prospective cohort of French CD patients, a long diagnostic delay (> 13 months) increased the risk of early surgery. No associated factors could be identified in this study.

Published
2016
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12. Impact of acoustic airflow nebulization on intrasinus drug deposition of a human plastinated nasal cast: New insights into the mechanisms involved

Author

Valérie Forest, Marc Durand, Gérald Aubert, Laurent Navarro, Jérémie Pourchez, Philippe Rusch, Sandrine Le Guellec, Michèle Cottier, Oto-Rhino-Laryngologie, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire Interdisciplinaire des Nanoparticules Aérosolisées (LINA-ENSME), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Institut Fédératif de Recherche en Sciences et Ingénierie de la Santé (IFRESIS-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-IFR143, Centre Ingénierie et Santé (CIS-ENSMSE), Laboratoire Antibiologie, CHU Saint-Etienne, Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), DTF-Aerodrug, DTF, Département Biomécanique et Biomatériaux (DB2M-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-CIS, Laboratoire Interdisciplinaire d'Etude des Nanoparticules Aérosolisées (LINA-ENSMSE), Service d'Histologie Embryologie, CHRU Saint-Etienne, Centre Hospitalier Emile Roux, Faculté de Médecine de Tours, Université Jean Monnet, Toucas, Andrée-Aimée, and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Models, Anatomic, Drug deposition, Nasal cavity, Pathology, medicine.medical_specialty, Materials science, Maxillary sinus, [SPI.GPROC] Engineering Sciences [physics]/Chemical and Process Engineering, Airflow, Pharmaceutical Science, 02 engineering and technology, Acoustic airflow, Plastination, 03 medical and health sciences, 0302 clinical medicine, Acoustic rhinometry, Paranasal Sinuses, otorhinolaryngologic diseases, medicine, Humans, [SPI.GPROC]Engineering Sciences [physics]/Chemical and Process Engineering, 030223 otorhinolaryngology, Aerosols, Air Movements, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Aerosol therapy, medicine.diagnostic_test, Healthy subjects, Acoustics, respiratory system, 021001 nanoscience & nanotechnology, Paranasal sinuses, medicine.anatomical_structure, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Gentamicins, Nasal Cavity, Rhinomanometry, 0210 nano-technology, Biomedical engineering
Abstract

Purpose The impact of 100 Hz (Hertz) acoustic frequency airflow on sinus drug deposition of aerosols was investigated using a human plastinated nasal cast. The influence of drug concentration and endonasal anatomical features on the sinus deposition enhanced by the 100 Hz acoustic airflow was also examined. Methods Plastinated models were anatomically, geometrically and aerodynamically validated (endoscopy, CT scans, acoustic rhinometry and rhinomanometry). Using the gentamicin as a marker, 286 experiments of aerosol deposition were performed. Changes of airborne particles metrology produced under different nebulization conditions (100 Hz acoustic airflow and gentamicin concentration) were also examined. Results Aerodynamic and geometric investigations highlighted a global behaviour of plastinated models in perfect accordance with a nasal decongested healthy subject. The results of intrasinus drug deposition clearly demonstrated that the aerosols can penetrate into the maxillary sinuses. The 100 Hz acoustic airflow led to increase the deposition of drug into the maxillary sinuses by a factor 2–3 depending on the nebulization conditions. A differential intrasinus deposition of active substance depending on maxillary ostium anatomical features and drug concentration was emphasized. Conclusion The existence of a specific transport mechanism of penetration of nebulized particles delivered with acoustic airflow was proposed.

Published
2011
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13. Plastinated nasal model: a new concept of anatomically realistic cast

Author

Michèle Cottier, Philippe Rusch, Bruno Louis, Jérémie Pourchez, André Coste, Jean François Pouget, Marc Durand, Jean Michel Prades, Daniel Isabey, Oto-Rhino-Laryngologie, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Fédératif de Recherche en Sciences et Ingénierie de la Santé (IFRESIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-IFR143, Laboratoire Interdisciplinaire des Nanoparticules Aérosolisées (LINA-ENSME), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), INSERM U955, équipe 13, 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Biomécanique cellulaire et respiratoire (BCR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Radio-Diagnostic et Imagerie Médicale (RDIM), Clinique Mutualiste Saint-Etienne, CHU Saint-Etienne, Service d'Histologie Embryologie, CHRU Saint-Etienne, (1) Centre Hospitalier Emile Roux Le Puy, (2) Université Jean Monnet, (3) Université Paris 12, (4) Clinique Mutualiste Saint Etienne, (5) CHU Saint Etienne, and Toucas, Andrée-Aimée

Subjects
Male, Models, Anatomic, Biomimetic materials, Vacuum, Maxillary sinus, [SPI.GPROC] Engineering Sciences [physics]/Chemical and Process Engineering, Polymers, nasal airway cast, MESH: Rhinomanometry, MESH: Models, Anatomic, 03 medical and health sciences, 0302 clinical medicine, Plastination, Acoustic rhinometry, Aerosol deposition, maxillary sinuses, Biomimetic Materials, otorhinolaryngologic diseases, medicine, Humans, [SPI.GPROC]Engineering Sciences [physics]/Chemical and Process Engineering, 030223 otorhinolaryngology, Nose, [SDV.IB] Life Sciences [q-bio]/Bioengineering, MESH: Humans, plastination, medicine.diagnostic_test, business.industry, MESH: Biomimetic Materials, Healthy subjects, General Medicine, Anatomy, respiratory system, anatomic model, MESH: Male, Rhinomanometry, MESH: Polymers, medicine.anatomical_structure, Otorhinolaryngology, 030220 oncology & carcinogenesis, MESH: Vacuum, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, business, MESH: Female
Abstract

International audience; BACKGROUND: For many years, researchers have been interested in investigating airflow and aerosol deposition in the nasal cavities. The nasal airways appear to be a complex geometrical system. Thus, in vitro experimental studies are frequently conducted with a more or less biomimetic nasal replica. AIM: This study is devoted to the development of an anatomically realistic nose model with bilateral nasal cavities, i.e. nasal anatomy, airway geometry and aerodynamic properties as close as possible to in vivo behaviour. METHODS: A specific plastination technique of cephalic extremities was developed by the Anatomy Laboratory at the Saint-Etienne University in the last 10 years. The plastinated models obtained were anatomically, geometrically and aerodynamically validated using several techniques (endoscopy, CT scans, acoustic rhinometry and rhinomanometry). RESULTS: Our plastination model exhibited a high level of anatomic quality, including a very good mucosa preservation. Aerodynamical and geometrical investigations highlighted a global behaviour of plastinated models perfectly in accordance with a nasal decongested healthy subject. CONCLUSIONS: The present plastination model provides a realistic cast of nasal airways, and may be a useful tool for nasal flow, drug delivery and aerosol deposition studies.

Published
2011
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14. Diagnostic delay in a French cohort of Crohn's disease patients

Author

Stanislas Chaussade, Pierre Lahmek, Bruno Lesgourgues, Cécile Poupardin, Vered Abitbol, Laurent Peyrin-Biroulet, Stéphane Nahon, Service d’hépato-gastro-entérologie [CH Le Raincy-Montfermeil], Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'hépato-gastro-entérologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Hépato-gastro-entérologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de gastroentérologie, Hôpital Cochin [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Multivariate analysis, Delayed Diagnosis, Time Factors, Referral, Adolescent, [SDV]Life Sciences [q-bio], Disease, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Crohn Disease, Risk Factors, Medicine, Humans, Prospective Studies, Young adult, Prospective cohort study, business.industry, Incidence (epidemiology), Incidence, Gastroenterology, General Medicine, 3. Good health, Diagnostic delay, Socioeconomic deprivation, Crohn's disease, Quartile, Socioeconomic Factors, 030220 oncology & carcinogenesis, Cohort, Disease Progression, 030211 gastroenterology & hepatology, Female, France, business, Follow-Up Studies
Abstract

Diagnostic delay is frequent in Crohn's disease (CD) and may partly depend on socioeconomic status. The aim of this study was to determine the diagnostic delay and to identify associated risk factors, including socioeconomic deprivation in a French cohort of CD patients. Methods Medical and socioeconomic characteristics of all consecutive CD patients followed in 2 referral centers between September 2002 and July 2012 were prospectively recorded using an electronic database. Diagnostic delay was defined as the time period (months) from the first symptom onset to CD diagnosis. A long diagnostic delay was defined by the upper quartile of this time period. Univariate and multivariate analyses were performed to identify the baseline characteristics of patients associated with a long diagnostic delay. Results Three hundred and sixty-four patients with CD (mean age = 29.2 ± 12.6 years, 40.8% men) were analyzed. Median diagnostic delay was 5 months, and a long diagnostic delay was more than 12 months. Fifty-six patients (15.3%) had perianal lesions, and 28 patients (8.6%) had complicated disease at diagnosis. None of the following factors were associated with a long diagnostic delay: age, gender, CD location and behavior, marital and educational, language understanding, geographic origin and socioeconomic deprivation score measured by the EPICES score. Conclusion In this French referral center-based cohort of CD patients, the median diagnostic delay was 5 months. None of the baseline characteristics of the CD, including socioeconomic deprivation, influenced diagnostic delay in this cohort.

Published
2014
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15. Particle Deposition in a Child Respiratory Tract Model: In Vivo Regional Deposition of Fine and Ultrafine Aerosols in Baboons

Author

Iolanda Albuquerque-Silva, Laurent Vecellio, Marc Durand, John Avet, Déborah Le Pennec, Michèle de Monte, Jérôme Montharu, Patrice Diot, Michèle Cottier, Francis Dubois, Jérémie Pourchez, Institut Fédératif de Recherche en Sciences et Ingénierie de la Santé (IFRESIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-IFR143, Centre Ingénierie et Santé (CIS-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Laboratoire Interdisciplinaire d'Etude des Nanoparticules Aérosolisées (LINA-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-CIS, Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), DTF-Aerodrug, DTF, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Lyon, Faculté de Médecine, Université Jean Monnet [Saint-Étienne] (UJM), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université François Rabelais, CHRU et DTF-Aerodrug (Tours), Centre Hospitalier Emile Roux (Le Puy en Velay), Université De Lyon (Lyon), CHU, Université Jean Monnet (Saint Etienne), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Chatagnon, Amélie, and Université Jean Monnet - Saint-Étienne (UJM)

Subjects
Pathology, Respiratory System, 0302 clinical medicine, Medicine and Health Sciences, scintigraphy, Comparative Anatomy, Respiratory system, 0303 health sciences, child, Multidisciplinary, Inhalation, Chemistry, Radiology and Imaging, Radiation Exposure, Deposition (aerosol physics), medicine.anatomical_structure, Models, Animal, Medicine, Anatomy, Research Article, Biotechnology, medicine.medical_specialty, [SPI.GPROC] Engineering Sciences [physics]/Chemical and Process Engineering, Radiation Biophysics, Science, Biophysics, Biomedical Engineering, Bioengineering, Research and Analysis Methods, 03 medical and health sciences, In vivo, medicine, Animals, Humans, [SPI.GPROC]Engineering Sciences [physics]/Chemical and Process Engineering, Particle Size, airborne particles, 030304 developmental biology, Aerosols, baboon, Radiochemistry, Biology and Life Sciences, Bioethics, respiratory tract, Aerosol, 030228 respiratory system, Animal Studies, Medical Devices and Equipment, Particle size, deposition pattern, Clinical Medicine, Papio, Particle deposition, Respiratory tract
Abstract

International audience; To relate exposure to adverse health effects, it is necessary to know where particles in the submicron range deposit in the respiratory tract. The possibly higher vulnerability of children requires specific inhalation studies. However, radio-aerosol deposition experiments involving children are rare because of ethical restrictions related to radiation exposure. Thus, an in vivo study was conducted using three baboons as a child respiratory tract model to assess regional deposition patterns (thoracic region vs. extrathoracic region) of radioactive polydisperse aerosols ([d16-d84], equal to [0.15 μm-0.5 μm], [0.25 μm-1 μm], or [1 μm-9 μm]). Results clearly demonstrated that aerosol deposition within the thoracic region and the extrathoraic region varied substantially according to particle size. High deposition in the extrathoracic region was observed for the [1 μm-9 μm] aerosol (72% ± 17%). The [0.15 μm-0.5 μm] aerosol was associated almost exclusively with thoracic region deposition (84% ± 4%). Airborne particles in the range of [0.25 μm-1 μm] showed an intermediate deposition pattern, with 49% ± 8% in the extrathoracic region and 51% ± 8% in the thoracic region. Finally, comparison of baboon and human inhalation experiments for the [1 μm-9 μm] aerosol showed similar regional deposition, leading to the conclusion that regional deposition is species-independent for this airborne particle sizes.

Published
2014
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16. Citrulline enhances myofibrillar constituents expression of skeletal muscle and induces a switch in muscle energy metabolism in malnourished aged rats

Author

Béatrice Morio, Philippe Chafey, Servane Le Plénier, Christophe Moinard, Voahangy Randrianarison-Huetz, C. Faure, Christian Aussel, Philippe Noirez, Luc Cynober, Prévention et traitement de la perte protéique musculaire en situation de résistance à l'anabolisme (PRETRRAM - EA 4466), Université Paris Descartes - Paris 5 (UPD5), Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université, Plateforme protéomique 3P5 [Institut Cochin] (3P5), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), UFR STAPS, service interhospitalier de Biochimie, Hôpital de l'Hotel Dieu, A- P H-P, service biologie, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Stress Cellulaire : Physiopathologie, Stratégies Nutritionnelles et Thérapeutiques Innovantes (EA 4466), Université Paris Descartes - Paris 5 (UPD5)-Faculté des Sciences Pharmaceutiques et Biologiques, APPERT Institute, Fondation Le Lous, Clermont Université-Université d'Auvergne - Clermont-Ferrand I (UdA)-Institut National de la Recherche Agronomique (INRA), Centre Hospitalier Emile Roux, Prévention et traitement de la perte protéique musculaire en situation de résistance à l'anabolisme ( PRETRRAM - EA 4466 ), Université Paris Descartes - Paris 5 ( UPD5 ), Unité de Nutrition Humaine ( UNH ), Institut National de la Recherche Agronomique ( INRA ) -Université d'Auvergne - Clermont-Ferrand I ( UdA ) -Clermont Université, Plateforme protéomique 3P5 [Institut Cochin] ( 3P5 ), Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Stress Cellulaire : Physiopathologie, Stratégies Nutritionnelles et Thérapeutiques Innovantes ( EA 4466 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Faculté des Sciences Pharmaceutiques et Biologiques, Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Proteomics, Glycogenolysis, Arginine, Proteome, 030309 nutrition & dietetics, [ SDV.AEN ] Life Sciences [q-bio]/Food and Nutrition, Muscle Proteins, arginine, Biochemistry, Rats, Sprague-Dawley, Random Allocation, chemistry.chemical_compound, Citrulline, Glycolysis, Myofibrillar proteins, myosin heavy-chain, 2. Zero hunger, 0303 health sciences, dysfunction, Energetic metabolism, protein-synthesis, Animal proteomics, Mitochondrial respiratory chain, medicine.anatomical_structure, Muscle, leucine, medicine.medical_specialty, proteolysis, Biology, 03 medical and health sciences, atrophy, Internal medicine, medicine, Animals, Muscle, Skeletal, Molecular Biology, 030304 developmental biology, Skeletal muscle, Metabolism, gel-electrophoresis, Diet, Rats, Citric acid cycle, Endocrinology, chemistry, identification, Energy Metabolism, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, massive intestinal resection
Abstract

We are grateful to Florence Blandel for carbonylated protein analysis. We would like to thank Morgane Le-Gall, Guilhem Clary, and Cedric Broussard for their help in the DIGE experiments and MS analysis. We also thank Professor E. Fontaine for helpful discussion.; Citrulline (Cit) actions on muscle metabolism remain unclear. Those latter were investigated using a proteomic approach on Tibialis muscles from male Sprague-Dawley rats. At 23 months of age, rats were either fed ad libitum (AL group) or subjected to dietary restriction for 12 weeks. At the end of the restriction period, one group of rats was euthanized (R group) and two groups were refed for one week with a standard diet supplemented with nonessential amino acids group or Cit (CIT group). Results of the proteomic approach were validated using targeted Western blot analysis and assessment of gene expression of the related genes. Maximal activities of the key enzymes involved in mitochondrial functioning were also determined. Cit supplementation results in a significant increase in the protein expression of the main myofibrillar constituents and of a few enzymes involved in glycogenolysis and glycolysis (CIT vs. AL and R, p < 0.05). Conversely, the expression of oxidative enzymes from Krebs cycle and mitochondrial respiratory chain was significantly decreased (CIT vs. AL, p < 0.05). However, maximal activities of key enzymes of mitochondrial metabolism were not significantly affected, except for complex 1 which presented an increased activity (CIT vs. AL and R, p < 0.05). In conclusion, Cit supplementation increases expression of the main myofibrillar proteins and seems to induce a switch in muscle energy metabolism, from aerobia toward anaerobia.

Published
2013
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17. Determinants of benzodiazepine use in a representative population of HIV infected individuals: the role of HIV status disclosure (ANRS-EN12-VESPA study)

Author

Perrine Roux, Lionel Fugon, Laurent Michel, France Lert, Yolande Obadia, Bruno Spire, Maria Patrizia Carrieri, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Troubles du comportement alimentaire de l'adolescent (UMR_S 669), Université Paris-Sud - Paris 11 (UP11)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de traitement des addictions, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-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)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-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)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-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)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Peer, Hal, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale ( SESSTIM - U912 INSERM - AMU - IRD ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Troubles du comportement alimentaire de l'adolescent ( UMR_S 669 ), Université Paris-Sud - Paris 11 ( UP11 ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Emile Roux, Epidémiologie, sciences sociales, santé publique ( IFR 69 ), and Université Panthéon-Sorbonne ( UP1 ) -Université Paris-Sud - Paris 11 ( UP11 ) -École des hautes études en sciences sociales ( EHESS ) -Assistance publique - Hôpitaux de Paris (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 ) -Université Panthéon-Sorbonne ( UP1 ) -Université Paris-Sud - Paris 11 ( UP11 ) -École des hautes études en sciences sociales ( EHESS ) -Assistance publique - Hôpitaux de Paris (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 ) -Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Adult, Male, medicine.medical_specialty, Health (social science), Social Psychology, medicine.drug_class, Social Stigma, Population, HIV Infections, Truth Disclosure, Logistic regression, Anxiolytic, Benzodiazepines, 03 medical and health sciences, Social support, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Risk Factors, Humans, Medicine, 030212 general & internal medicine, education, Psychiatry, Qualitative Research, Benzodiazepine, education.field_of_study, business.industry, Public Health, Environmental and Occupational Health, Social Support, virus diseases, Life Sciences, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Middle Aged, medicine.disease, Anxiety Disorders, 030227 psychiatry, 3. Good health, Cross-Sectional Studies, Logistic Models, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Anxiety, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Hiv status, medicine.symptom, business, Stress, Psychological, Clinical psychology
Abstract

International audience; Objective: HIV infection may result in stressful situations such as disclosure to others and could be a mediator between seropositivity status and psychiatric illness, depression or anxiety. Several results have shown that anxiolytic use (mainly benzodiazepines) is highly prevalent in HIV-infected individuals, but few studies have highlighted to what extent this use could be associated with HIV disclosure. Design: A national cross-sectional survey representative of people living with HIV and AIDS in France enrolled 2932 individuals in 102 French HIV hospital departments. Methods: Face-to-face interviews and self-administered questions collected information about patients' experience with HIV and HIV care, including use of psychotropic drugs, social support, stigma and disclosure of HIV status. We identified factors associated with regular BDZ use (i.e. more than once a week) using a weighted logistic regression model. Results: Regular BDZ use and anxiety symptoms were reported by 16% and 29% of the patients respectively. After multiple adjustment for known correlates of BDZ use and anxiety symptoms, individuals who had disclosed their HIV status to relatives or friends were found to be more likely (OR[95%CI]= 1.78 [1.02-3.09]) to regularly use BDZ. Conclusions: These results show both to what extent disclosure to others continues to be a stressful step in the course of HIV infection and that disclosure is something which could be identified by BDZ use. They also highlight the need for appropriate case management and psychiatric care to help patients manage the consequences of disclosure.

Published
2011
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18. Validation d’une batterie brève d’évaluation des praxies gestuelles pour consultation Mémoire. Évaluation chez 419 témoins, 127 patients atteints de troubles cognitifs légers et 320 patients atteints d’une démence

Author

E Galbrun, C Moroni, groupe de réflexion sur les praxies du Cmrr Ile-de-France Sud, F Mahieux-Laurent, C Fabre, A Dubrulle, Université de Lille, Hôpital Dupuytren [CHU Limoges], Centre Hospitalier Emile Roux [AP-HP], Service de Rééducation Neurologique [Saint-Didier-au-Mont-D'Or], Psychologie : Interactions, Temps, Emotions, Cognition (PSITEC) - ULR 4072 [PSITEC], CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), SSR Val Rosay [Saint-Didier-au-Mont-D'Or], and Psychologie : Interactions, Temps, Emotions, Cognition (PSITEC) - ULR 4072 (PSITEC)

Subjects
Gynecology, medicine.medical_specialty, Validation study, business.industry, Medical screening, 05 social sciences, 050105 experimental psychology, 03 medical and health sciences, [SCCO]Cognitive science, 0302 clinical medicine, Neurology, Reference values, Medicine, 0501 psychology and cognitive sciences, Dementia diagnosis, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Resume Introduction L’objectif de ce travail etait de construire une batterie breve d’evaluation des praxies gestuelles, pour utilisation en consultation Memoire et d’en etablir des normes. Patients et methodes La batterie comprend trois dimensions differentes : execution sur commande verbale de gestes symboliques (cinq gestes), de mimes d’action (cinq gestes) et imitation de gestes abstraits (huit gestes). Des normes ont ete etablies a partir de 419 sujets normaux. La comparaison des performances de ces normaux avec les resultats obtenus chez 320 patients atteints de demence a permis d’evaluer leurs sensibilite et specificite. Un groupe de 127 patients atteints de troubles cognitifs legers a egalement ete etudie. Resultats Des valeurs seuils ont ete proposees pour chaque dimension, basees sur les valeurs du cinquieme percentile observe dans trois classes d’âge et trois groupes de niveau culturel. La specificite des normes etablies etait elevee pour les trois dimensions. La sensibilite, en revanche, etait faible, la plus importante etant observee pour l’imitation de gestes abstraits, suivie des mimes d’action et des gestes symboliques. Dans les trois dimensions, le groupe de patients atteints d’un trouble cognitif leger presentait une frequence de scores inferieurs aux normes, intermediaire entre les sujets normaux et les patients dements. Conclusion L’instrument propose correspond bien aux buts initiaux de brievete et de haute specificite. Il peut etre utilement employe en consultation Memoire pour determiner la presence du critere « apraxie » du diagnostic de demence et donc y contribuer, a cote des autres elements de l’examen clinique et neuropsychologique.

Published
2009
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19. Clonal dissemination of a CTX-M-15 beta-lactamase-producing Escherichia coli strain in the Paris area, Tunis, and Bangui

Author

M. Lavollay, Béatrice Burghoffer, A. Akpabie, T. Frank, Valérie Gautier, S. Ben Redjeb, K. Mamlouk, Raymond Bercion, Guillaume Arlet, Université Pierre et Marie Curie - Paris 6 (UPMC), Laboratoire de Microbiologie, Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Institut Pasteur de Bangui, Réseau International des Instituts Pasteur (RIIP), Unité d'Hygiène, Centre Hospitalier Emile Roux [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), This work was supported by grants from Faculté de Médecine Pierre et Marie Curie, Université Paris VI, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
clone (Java method), Paris, Tunisia, [SDV]Life Sciences [q-bio], MESH: beta-Lactamases, Microbial Sensitivity Tests, Biology, medicine.disease_cause, Polymerase Chain Reaction, beta-Lactam Resistance, beta-Lactamases, Microbiology, law.invention, 03 medical and health sciences, Plasmid, Mechanisms of Resistance, law, Escherichia coli, medicine, Humans, Pharmacology (medical), Typing, Escherichia coli Infections, Polymerase chain reaction, 030304 developmental biology, MESH: Escherichia coli Infections, Pharmacology, 0303 health sciences, MESH: Microbial Sensitivity Tests, MESH: Humans, 030306 microbiology, MESH: Escherichia coli, Electroporation, MESH: Paris, Outbreak, MESH: Conjugation, Genetic, MESH: Polymerase Chain Reaction, 6. Clean water, MESH: beta-Lactam Resistance, Electrophoresis, Gel, Pulsed-Field, 3. Good health, Central African Republic, Multiple drug resistance, Infectious Diseases, MESH: Electrophoresis, Gel, Pulsed-Field, MESH: Central African Republic, Conjugation, Genetic, MESH: Tunisia
Abstract

One hundred twenty CTX-M-15-producing Escherichia coli strains isolated in 10 different hospitals from Paris (France), in the Hospital Charles Nicolle in Tunis (Tunisia), and in the Pasteur Institute in Bangui, Central African Republic (CAR), between 2000 and 2004 were studied. Eighty isolates, recovered from the three countries, were clonally related by repetitive extragenic palindromic PCR and pulsed-field gel electrophoresis. Various resistance profiles were identified among these clonal strains. After conjugation or electroporation of plasmids from E. coli strains representative of each profile and each geographic region, we observed seven resistance profiles in the recipient strains. Incompatibility typing showed that all the plasmids transferred from the clonal strains studied, except one, belonged to the incompatibility group FII. They all shared a multidrug resistance region (MDR) resembling the MDR region located in pC15-1a, a plasmid associated with an outbreak of a CTX-M-15-producing E. coli strain in Canada. They also shared the common backbone of an apparent mosaic plasmid, including several features present in pC15-1a and in pRSB107, a plasmid isolated from a sewage treatment plant. This study suggests that although the plasmid-borne bla CTX-M-15 gene could be transferred horizontally, its dissemination between France, Tunisia, and CAR was due primarily to its residence in an E. coli clone with a strong propensity for dissemination.

Published
2006
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