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201. Access to treatment among persons with hemophilia: A spatial analysis assessment in the Rhone-Alpes region, France

Author: Julie Freyssenge, Valérie Chamouard, Vincent Leroy, Florent Renard, Claude Negrier, Karim Tazarourte, Département de Gastroentérologie et hépatologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Environnement Ville Société (EVS), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-École nationale supérieure d'architecture de Lyon (ENSAL)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École Nationale des Travaux Publics de l'État (ENTPE)-Université Jean Monnet [Saint-Étienne] (UJM)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université Lumière - Lyon 2 (UL2)-École normale supérieure - Lyon (ENS Lyon), Urgences Médicales, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Hôpital Edouard Herriot-Pavillon E, Ctr. Reg. Traitement Hemophille, Service pharmaceutique, Hospices Civils de Lyon (HCL)-Groupement Hospitalier Est, Environnement, Ville, Société (EVS), École normale supérieure de Lyon (ENS de Lyon)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Male, medicine.medical_specialty, Pharmacology (nursing), Context (language use), Pharmacy, Emergency treatment, Hemophilia A, 030226 pharmacology & pharmacy, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Hospital pharmacy, ComputingMilieux_MISCELLANEOUS, Factor IX, Pharmacology, Clotting factor, Spatial Analysis, Bleeding episodes, business.industry, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Blood Coagulation Factors, 3. Good health, Emergency medicine, Geographic Information Systems, Female, France, Pharmacy Service, Hospital, business, Prophylactic treatment, medicine.drug
Abstract: Objectives In France, only hospital pharmacies can dispense clotting factor concentrates to persons with hemophilia, which limits the access to care for the treatment and the prevention of bleeding episodes. Moreover, the cost of clotting factor concentrates may restrain the maintenance of sufficient stocks in hospital pharmacies. The aim of this study was to investigate the accessibility of clotting factor concentrates to persons with hemophilia in the context of long-term prophylaxis and emergency treatment in the Rhone-Alpes region of France. Methods A geographic information system was used for evaluating accessibility of clotting factor concentrates. Persons with hemophilia and hospital pharmacies were geolocalized with the use of postal data, and the evaluation of accessibility was based on the road network. Results Approximately 72% of the study area was accessible in less than 30 minutes to a hospital pharmacy. Eighty-five percent of persons with hemophilia had access to clotting factor concentrates for prophylactic treatment in less than 20 minutes. Most of them were patients with severe or moderate hemophilia. Regarding emergency doses, factor VIII was accessible in less than 30 minutes in 45.6% of the study area, and factor IX in 30.5%. Conclusion This study highlights that spatial access to clotting factor concentrates by persons with hemophilia in the Rhone-Alpes region is good for prophylactic treatment but is more uneven for emergency doses.
Published: 2019

202. [Expert consensus statement on blood pressure measurement from the French Society of Hypertension, an affiliate of the French Society of Cardiology]

Author: Denolle, Thierry, Asmar, Roland, Boivin, Jean-Marc, Girerd, Xavier, Le Jeune, Sylvain, Vaisse, Bernard, Antakly-Hanon, Yara, Artifoni, Mathieu, Atallah, André, Bachelet, Christophe, Barber-Chamoux, Nicolas, Bejan-Angoulvant, Theodora, Blacher, Jacques, Boulestreau, Romain, Chantrel, François, Dimitrov, Yves, Doll, Gérard, Dugelay, Giselle, Duly-Bouhanick, Béatrice, Gosse, Philippe, Guerrot, Dominique, Jarraya, Faiçal, Lamirault, Guillaume, Lequeux, Benoît, Lopez-Sublet, Marilucy, Mercier, Alain, Millet, Laurène, Mounier-Vehier, Claire, Mourad, Jean-Jacques, Nasr, Edgar, Ormezzano, Olivier, Perez, Laurence, Persu, Alexandre, Ribstein, Jean, Silhol, François, Sosner, Philippe, Steyer, Elisabeth, Temmar, Mohamed, Van De Borne, Philippe, Vidal-Petiot, Emmanuelle, Service de cardiologie et maladies vasculaires [CHU de Rennes], CHU Pontchaillou [Rennes], Département de médecine générale [Univ. Lorraine], Université de Lorraine (UL), Service d'endocrinologie-métabolisme [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Hôpital de la Timone [CHU - APHM] (TIMONE), Service de médecine interne [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de cardiologie, Centre Hospitalier de la Basse Terre, CIC 501, Centre d’Investigation Clinique (CIC), Service de Pharmacologie Clinique, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Equipe 3: EREN- Equipe de Recherche en Epidémiologie Nutritionnelle (CRESS - U1153), Université Paris 13 (UP13)-Institut National de la Recherche Agronomique (INRA)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC), Université de Bordeaux (UB), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Hôpital Saint-André, Service de Néphrologie [Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service de cardiologie [CHU de Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Institut français de l'Education (IFÉ), École normale supérieure - Lyon (ENS Lyon), Hôpital cardiologique, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital avicenne, Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Avicenne, Clinique Cardiologie et Hypertension Artérielle, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Laboratoire 'Mobilité, Vieillissement, Exercice' (MOVE) (MOVE), Université de Poitiers, Cabinet médical, Centre d'Investigations Préventives et Cliniques (CIPC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-hôpital Jean-Verdier, Department of Cardiology, Erasme University Hospital, Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], Société française d’hypertension artérielle (SFHTA), Service d’Endocrinologie, Métabolisme et Prévention des Risques Cardio-Vasculaires [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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Clermont-Ferrand, Université de Tours (UT), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Centre hospitalier de Haguenau, CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Sfax - University of Sfax, Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Avicenne [AP-HP], Cliniques Universitaires Saint-Luc [Bruxelles], Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université de Tours, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Hôpital Européen Georges Pompidou [APHP] (HEGP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Consensus, Time Factors, Hypertension, Humans, Blood Pressure Determination, France, Blood Pressure Monitoring, Ambulatory, Societies, Medical, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.
Published: 2019

203. [Expert consensus statement on blood pressure measurement from the French Society of Hypertension, an affiliate of the French Society of Cardiology]

Author: Thierry Denolle, Roland Asmar, Jean-Marc Boivin, Xavier Girerd, Sylvain Le Jeune, Bernard Vaisse, Yara Antakly-Hanon, Mathieu Artifoni, André Atallah, Christophe Bachelet, Nicolas Barber-Chamoux, Theodora Bejan-Angoulvant, Jacques Blacher, Romain Boulestreau, François Chantrel, Yves Dimitrov, Gérard Doll, Giselle Dugelay, Béatrice Duly-Bouhanick, Philippe Gosse, Dominique Guerrot, Faiçal Jarraya, Guillaume Lamirault, Benoit Lequeux, Marilucy Lopez-Sublet, Alain Mercier, Laurène Millet, Claire Mounier-Véhier, Jean-Jacques Mourad, Edgar Nasr, Olivier Ormezzano, Laurence Perez, Alexandre Persu, Jean Ribstein, François Silhol, Philippe Sosner, Elisabeth Steyer, Mohamed Temmar, Philippe Van De Borne, Emmanuelle Vidal-Petiot, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Société française d’hypertension artérielle (SFHTA), Département de médecine générale [Univ. Lorraine], Université de Lorraine (UL), Service d'Endocrinologie, Métabolisme et Prévention des Maladies Cardio-vasculaires [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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Timone [CHU - APHM] (TIMONE), Service de médecine interne [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Clermont-Ferrand, Université de Tours (UT), Equipe 3: EREN- Equipe de Recherche en Epidémiologie Nutritionnelle (CRESS - U1153), Université Paris 13 (UP13)-Institut National de la Recherche Agronomique (INRA)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bordeaux (UB), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre hospitalier de Haguenau, Hôpital Saint-André, Service de Néphrologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Sfax - University of Sfax, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service de cardiologie [CHU de Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital cardiologique, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Avicenne [AP-HP], Clinique Cardiologie et Hypertension Artérielle, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Cliniques Universitaires Saint-Luc [Bruxelles], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Laboratoire 'Mobilité, Vieillissement, Exercice' (MOVE) (MOVE), Université de Poitiers, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], and Guerrot, Dominique
Subjects: medicine.medical_specialty, Evening, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, General Medicine, 030204 cardiovascular system & hematology, Sitting, 3. Good health, 03 medical and health sciences, Orthostatic vital signs, Masked Hypertension, 0302 clinical medicine, Blood pressure, Drug control, Ambulatory, Physical therapy, Medicine, Observational study, 030212 general & internal medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.
Published: 2019

204. CT-texture analysis of subsolid nodules for differentiating invasive from in-situ and minimally invasive lung adenocarcinoma subtypes

Author: Gilbert Ferretti, Adrien Jankowski, Maud Medici, Alexandre Moreau-Gaudry, François Laurent, Sylvie Lantuejoul, Mathieu Lederlin, Julien G. Cohen, E. Reymond, Anne-Claire Toffart, Centre Hospitalier Universitaire [Grenoble] (CHU), Centre d'Investigation Clinique - Innovation Technologique - INSERM - CHU de Grenoble (CIC-IT Grenoble (CIT803)), CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Département d'anatomie et cythologie pathologique, CHU Grenoble-Hôpital Michallon, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, In situ, Multivariate analysis, [SDV]Life Sciences [q-bio], Adenocarcinoma of Lung, Adenocarcinoma in Situ, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Neoplasm Invasiveness, Radiology, Nuclear Medicine and imaging, Aged, Retrospective Studies, Lung, Radiological and Ultrasound Technology, business.industry, Mean age, General Medicine, Middle Aged, medicine.disease, Lung neoplasm, Thoracic surgery, medicine.anatomical_structure, Texture analysis, 030220 oncology & carcinogenesis, Adenocarcinoma, Female, sense organs, Tomography, X-Ray Computed, Nuclear medicine, business, Multidetector computed tomography (MDCT)
Abstract: International audience; The purpose of this study was to evaluate the usefulness of computed tomography-texture analysis (CTTA) in differentiating between in-situ and minimally-invasive from invasive adenocarcinomas in subsolid lung nodules (SSLNs).MATERIAL AND METHODS:Two radiologists retrospectively reviewed 49 SSLNs in 44 patients. There were 27 men and 17 women with a mean age of 63±7 (SD) years (range: 47-78years). For each SSLN, type (pure ground-glass or part-solid) was assessed by consensus and CTTA was conducted independently by each observer using a filtration-histogram technique. Different filters were used before histogram quantification: no filtration, fine, medium and coarse, followed by histogram quantification using mean intensity, standard deviation (SD), entropy, mean positive pixels (MPP), skewness and kurtosis.RESULTS:We analyzed 13 pure ground-glass and 36 part-solid nodules corresponding to 16 adenocarcinomas in-situ (AIS), 5 minimally invasive adenocarcinomas (MIA) and 28 invasive adenocarcinomas (IVA). At uni- and multivariate analysis CTTA allowed discriminating between IVAs and AIS/MIA (P
Published: 2018

205. Endovascular cooling versus standard femoral catheters and intravascular complications: A propensity-matched cohort study

Author: Xavier Valette, Damien du Cheyron, Jean-Jacques Parienti, Nicolas Terzi, Amélie Seguin, Bertrand Sauneuf, Olivier Andremont, Flore-Anne Lecoq, Cédric Daubin, Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Institut National de la Santé et de la Recherche Médicale (INSERM), Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2 ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, Unité de Biostatistique et de Recherche Clinique (UBRC), Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), and Centre Hospitalier Public du Cotentin (CHPC)
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Emergency Nursing, Targeted temperature management, law.invention, 03 medical and health sciences, 0302 clinical medicine, Matched cohort, Hypothermia, Induced, Risk Factors, law, medicine, Central Venous Catheters, Humans, Therapeutic hypothermia, Catheter-related-thrombosis, Prospective Studies, Propensity Score, Aged, Retrospective Studies, Cooling catheter, business.industry, Thrombosis, 030208 emergency & critical care medicine, Middle Aged, Cardiac arrest, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Intensive care unit, Heart Arrest, 3. Good health, Surgery, Femoral Artery, Catheter, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Catheter-Related Infections, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Cohort, Emergency Medicine, Female, Cardiology and Cardiovascular Medicine, business, Central venous catheter, Cohort study
Abstract: Background Targeted temperature management (TTM) contributes to improved neurological outcome in adults who have been successfully resuscitated after cardiac arrest with shockable rhythm. Endovascular cooling catheters are widely used to induce and maintain targeted temperature in the ICU. The aim of the study was to compare the risk of complications with cooling catheters and standard central venous catheters. Materials and methods In this prospective single-centre cohort study, we included all patients admitted to an intensive care unit for successfully resuscitated cardiac arrest that required endovascular TTM (Coolgard®, Zoll™ Medical corporation, MA, USA), between August 2012 and November 2014, inclusive. We matched the endovascular cooling catheter cohort with a retrospective historical cohort of 512 central femoral venous catheters from the 3SITES trial to compare thrombotic and infectious complications. Results Overall, 108 patients were included in the cooling cohort, of which 89 had ultrasound doppler. The duration of catheterization was 4.9 days in the control group versus 4.2 days in the TTM group (p = 0.08). After propensity-score matching, there were significantly more thrombotic complications in the cooling (n = 75) than in the control (n = 75) group (12 of 75 (16%) versus 0 of 75 (0%), respectively, p = 0.005), and 4 patients presented major complications. There were 8 colonized catheters in each group (11%) (p > 0.99), and none of the patients had a catheter-related bloodstream infection. Conclusions In our propensity-score matched study, endovascular cooling catheters were associated with an increased risk of venous catheter-related thrombosis compared to standard central venous catheters.
Published: 2018

206. Open prostatectomy versus 180-W XPS GreenLight laser vaporization: Long-term functional outcome for prostatic adenomas > 80 g

Author: J-A. Long, N. Peilleron, C. Thuillier, J.-L. Descotes, Nicolas Terrier, C. Lanchon, Bernard Boillot, Q. Franquet, S. Grisard, D. Poncet, D. Carnicelli, E. Bey, Jean-Jacques Rambeaud, V. Arnoux, G. Fiard, J. Lefrancq, Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Grenoble, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service d'urologie, CHU Grenoble-Hôpital Michallon, Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Percy Military Teaching Hospital, and Clinique d'urologie
Subjects: Male, medicine.medical_specialty, Time Factors, Multivariate analysis, Hyperplasie benign de prostate, PVP, [SDV]Life Sciences [q-bio], Urology, medicine.medical_treatment, Enucleation, Prostatic Hyperplasia, Open prostatectomy, 030232 urology & nephrology, Photovaporisation prostatique, Urinary catheterization, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Prostate, Humans, Medicine, Aged, Retrospective Studies, GreenLight laser vaporization, Outcome, Prostatectomy, business.industry, Urinary retention, GreenLight, Recovery of Function, Adenomectomie voie haute, 3. Good health, medicine.anatomical_structure, Greenlight laser, 030220 oncology & carcinogenesis, Laser Therapy, Benign prostatic obstruction, medicine.symptom, business, Open Prostatectomy
Abstract: INTRODUCTION GreenLight photoselective vaporisation of the prostate (PVP) offers an endoscopic alternative to open prostatectomy (OP) for treatment of large adenomas. This study compares long-term functional outcome of both techniques in patients with Benign prostatic obstruction (BPO)>80g. MATERIAL AND METHOD Data from patients who underwent surgical treatment for BPO>80g from January 2010 to February 2015 at our institution were retrospectively collected and compared according to surgical technique. Patient's demographics, surgeon's experience, operative data and long-term functional results were analyzed, using IPSS and International continence society (ICS) male questionnaire associated with Quality of life scores (IPSS-QL and ICS-QL). Predictors of long-term outcome were also assessed. RESULTS In total, 111 consecutive patients, 57 PVP and 54 OP, were included in the study with a mean follow-up of 24 and 33 month respectively. Patient's age, Charlson score, preoperative IPSS and urinary retention rates were similar. Mean prostatic volume was superior in the OP group (142 versus 103g, P
Published: 2018

207. [Guide to university hospital careers in dermatology. The GRENT (Graines Engrais Tuteurs - Seed Fertilizer Plant stick) Program]

Author: Christine Bodemer, Olivier Chosidow, Marie Beylot-Barry, Selim Aractingi, Caroline Gaudy-Marqueste, Mahtab Samimi, Angèle Soria, Michel Richard, Carle Paul, Bernard Cribier, Brigitte Dréno, J.-P. Lacour, Assistance Publique - Hôpitaux de Marseille (APHM), Institut National de la Santé et de la Recherche Médicale (INSERM), Infectiologie et Santé Publique (UMR ISP), Institut National de la Recherche Agronomique (INRA)-Université de Tours (UT), Service de dermatologie, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université Pierre et Marie Curie - Paris 6 (UPMC), Centre d'Immunologie et de Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire Henri Mondor, Université Paris Est Créteil, Hôpitaux Universitaires de Strasbourg, Service de Dermatologie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, CHU Toulouse [Toulouse], CHU Grenoble-Hôpital Michallon, Physiopathologie du cancer du foie, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Institut National de la Recherche Agronomique (INRA)-Université de Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), and Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: 030203 arthritis & rheumatology, business.industry, Fertilizer plant, Dermatology, University hospital, 3. Good health, Toxicology, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Medicine, business, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology
Abstract: National audience
Published: 2018

208. Indications and limits of stereoelectroencephalography (SEEG)

Author: Alexandra Montavont, Louise Tyvaert, Delphine Taussig, Lorella Minotti, Julia Scholly, Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Epileptology, CHU Grenoble-Hôpital Michallon, CHU Strasbourg, Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL), Service de neurologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), and Université de Rennes (UR)
Subjects: 0301 basic medicine, medicine.medical_specialty, Electroencephalography, Temporal, Stereoelectroencephalography, 03 medical and health sciences, Epilepsy, Imaging, Three-Dimensional, 0302 clinical medicine, Eloquent cortex, Physiology (medical), medicine, Seizure control, Humans, Drawbacks, Epilepsy surgery, Extra-temporal, Brain Mapping, medicine.diagnostic_test, business.industry, Brain, General Medicine, Deep electrodes, medicine.disease, Epileptogenic zone, Electrodes, Implanted, 3. Good health, 030104 developmental biology, Neurology, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Stereoelectroencephalography (SEEG), Neurology (clinical), Radiology, Indications, business, Subdural electrodes, 030217 neurology & neurosurgery
Abstract: International audience; Epilepsy surgery is now an accepted treatment to achieve seizure control in carefully selected patients, both children and adults, suffering from drug-resistant focal epilepsy. Although surgical strategies can often be defined on the basis of non-invasive diagnostic procedures, and despite the recent advances in this field, an increasing number of more complex cases requires invasive EEG (iEEG) to provide precise information on the localization of the epileptogenic zone (EZ), its relationships with eloquent cortex (EC), and the feasibility of a tailored surgical resection. Stereoelectroencephalography (SEEG) is one of the iEEG techniques currently used in the presurgical work-up, and it is well-distinguished from other invasive techniques, such as subdural grids and strips. SEEG depth electrodes enable exploration of deeply located structures and lesions, and of buried cortex, which are not easily assessable by subdural or other iEEG methods. Simultaneous recording of SEEG signals from deep and superficial brain structures allows, when the position of each electrode is precisely determined, delineation of a three-dimensional, spatial and temporal organization of epileptic activities. In the following chapter we discuss some specific indications (temporal or extra-temporal, lesional or non-lesional epilepsies) as well as the limits of the SEEG technique, with respect to some epileptological issues during presurgical evaluation.
Published: 2018

209. Evaluation of a Computed Assisted Medical Intervention (CAMI) systems in scientific autopsy

Author: F. Paysant, Alexandre Moreau-Gaudry, V. Scolan, Sandrine Voros, F. Grenier, J. Boutonnat, I. Bricault, Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Département de pharmacochimie moléculaire (DPM ), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Centre d'Investigation Clinique - Innovation Technologique - INSERM - CHU de Grenoble (CIC-IT Grenoble (CIT803)), and CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA)
Subjects: medicine.medical_specialty, [SDV.BIO]Life Sciences [q-bio]/Biotechnology, business.industry, General surgery, 010401 analytical chemistry, Autopsy, 01 natural sciences, 0104 chemical sciences, Pathology and Forensic Medicine, 03 medical and health sciences, 0302 clinical medicine, Intervention (counseling), [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, medicine, Radiology, Nuclear Medicine and imaging, 030216 legal & forensic medicine, Radiology, business, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2017

210. Direct-acting antiviral agent–based regimen for HCV recurrence after combined liver-kidney transplantation: Results from the ANRS CO23 CUPILT study

Author: Jérôme Dumortier, A. Rohel, Jean-Charles Duclos-Vallée, Christophe Duvoux, Vincent Di Martino, Christine Silvain, Sébastien Dharancy, Danielle Botta-Fridlund, Sylvie Radenne, Maryline Debette-Gratien, Nassim Kamar, Audrey Coilly, Vincent Leroy, Georges-Philippe Pageaux, Armand Abergel, Louis d’Alteroche, Emilie Rossignol, Claire Francoz, Pauline Houssel-Debry, P. Perré, Filomena Conti, Claire Fougerou-Leurent, François Habersetzer, Camille Besch, Christophe Moreno, H. Montialoux, Valérie Canva, Albert Tran, Didier Samuel, Victor de Lédinghen, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Paul Brousse, Physiopathologie et traitement des maladies du foie, Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Service d'Hépatologie, Hôpital Henri Mondor, AP-HP, Créteil, France., Hôpital Henri Mondor, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département de Gastroentérologie et hépatologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'hépato-gastro-entérologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Département d'hépatologie, Service d'hépatologie, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital de la Croix-Rousse [CHU - HCL], Physiopathologie du cancer du foie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital de la Milétrie, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Chirurgie Digestive, Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Interactions Virus-Hôte et Maladies Hépatiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Virologie, Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Pharmacologie des Immunosuppresseurs et de la Transplantation (PIST), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, ANRS France Recherche Nord & sud Sida-hiv hépatites, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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), Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Paul Brousse-Université Paris-Sud - Paris 11 (UP11), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Université de Limoges (UNILIM)-CHU Limoges, Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Toulouse (UT)-Université de Toulouse (UT)- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent
Subjects: Graft Rejection, Male, Sofosbuvir, [SDV]Life Sciences [q-bio], medicine.medical_treatment, kidney transplantation/nephrology, Hepacivirus, 030230 surgery, Liver transplantation, medicine.disease_cause, 0302 clinical medicine, Recurrence, Risk Factors, Immunology and Allergy, liver disease: infectious, Pharmacology (medical), Prospective Studies, Prospective cohort study, education.field_of_study, Graft Survival, Middle Aged, Prognosis, Hepatitis C, 3. Good health, [SDV] Life Sciences [q-bio], kidney failure/injury, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, medicine.drug, Adult, medicine.medical_specialty, infectious disease, Hepatitis C virus, Population, clinical research/practice, Antiviral Agents, 03 medical and health sciences, Internal medicine, medicine, Humans, Adverse effect, education, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Transplantation, business.industry, Kidney Transplantation, Liver Transplantation, Regimen, Immunology, infection and infectious agents - viral: hepatitis C, business, liver transplantation/hepatology, Follow-Up Studies
Abstract: International audience; Hepatitis C virus (HCV) infection is associated with reduced patient survival following combined liver-kidney transplantation (LKT). The aim of this study was to assess the efficacy and safety of second-generation direct-acting antivirals (DAAs) in this difficult-to-treat population. The ANRS CO23 "Compassionate use of Protease Inhibitors in Viral C Liver Transplantation" (CUPILT) study is a prospective cohort including transplant recipients with recurrent HCV infection treated with DAAs. The present work focused on recipients with recurrent infection following LKT. The study population included 23 patients. All patients received at least one NS5B inhibitor (sofosbuvir) in their antiviral regimen an average of 90 months after LKT. Ninety-six percent of recipients achieved a sustained virological response (SVR) at week 12 (SVR12). In terms of tolerance, 39% of recipients presented with at least one serious adverse event. None of the patients experienced acute rejection during therapy and there were no deaths during follow-up. The glomerular filtration rate (GFR) decreased significantly from baseline to the end of therapy. However, this study did not show that the decline in GFR persisted over time or that it was directly related to DAAs. The DAA-based regimen is well tolerated with excellent results in terms of efficacy. It will become the gold standard for the treatment of recurrent HCV following LKT.
Published: 2017

211. Immunohistochemical evaluation of two antibodies against PD-L1 and prognostic significance of PD-L1 expression in epithelioid peritoneal malignant mesothelioma: A RENAPE study

Author: S. Velasco, M. Chassang, Laurence Gladieff, Jean-Marc Guilloit, Frédéric Dumont, Thomas Courvoisier, Magali Svrcek, E. Mery, Jack Porcheron, Pablo Ortega-Deballon, V. Barrau, M. Serrano, Pierre Meeus, H. Senellart, Cécile Brigand, R. Kianmanesh, I. Bricault, M. Capovilla, O. Pellet, I. Bonnefoy, B. Lelong, A. Poulet, A. Chevallier, Delphine Vaudoyer, Frédéric Guyon, Julien Dubreuil, G. Ferron, S. Valmary-Degano, D. Geffroy, Franck Zinzindohoué, François-Noël Gilly, Laure Fournier, G. Lang Averous, Jean-Jacques Tuech, Catherine Arvieux, Karine Abboud, P. Rousselot, Y. Touchefeu, Guillaume Passot, R. Tetreau, Christine Hoeffel, Peggy Dartigues, Julio Abba, A. Dohan, Frédéric Bibeau, P. Peyrat, Naoual Bakrin, O. Sgabura, J.M. Bereder, Bruno Heyd, J. Lacroix, Frédéric Marchal, Johan Gagnière, Clarisse Eveno, J. Hommell-Fontaine, P. Rat, P. Jourdan-Enfer, C. Labbé-Devilliers, C. de Chaisemartin, Prudence Colpart, L. M'Hamdi, S. Carrere, Denis Pezet, D. Bouzard, R. Lo Dico, Marc Pocard, Gérard Lorimier, A. Leroux-Broussier, Cédric Nadeau, V. Verriele-Beurrier, François Quenet, Caroline Malhaire, S. Isaac, Nicolas Pirro, C. Hordonneau, Olivier Glehen, Clarisse Dromain, R. Kaci, L. Ghouti, E. Mathiotte, Vincent Servois, Mohammad Alyami, Pascale Mariani, H. Ben Rejeb, A. Guibal, S. Msika, Laurent Villeneuve, Romuald Wernert, F. Monnien, Diane Goéré, Emilie Thibaudeau, M. H. Laverrière, G. Balague, F. Poizat, M. Faruch-Bilfeld, Andrea Skanjeti, I. Berton-Rigaud, Yoann Lherm, Université Bourgogne Franche-Comté [COMUE] (UBFC), Pathology Department, CHU Besançon, Besançon, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Hospices Civils de Lyon, Departement de Neurologie (HCL), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de Hautepierre [Strasbourg], Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre Paul Papin(Angers), Institut Bergonié [Bordeaux], UNICANCER, Department of Oncologic Surgery, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Departement of pathology, CHU Pontchaillou [Rennes], Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Département de chirurgie digestive, CHU Strasbourg, CRLC Val d'Aurelle-Paul Lamarque, CRLCC Val d'Aurelle - Paul Lamarque, Département de chirurgie digestive [Institut Paoli Calmettes], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Department of Radiology, Université Paris-Sud - Paris 11 (UP11), Laboratoire de Mécanique des Systèmes et des Procédés (LMSP), Université d'Orléans (UO)-Centre National de la Recherche Scientifique (CNRS), Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Surgical Oncology Institut Claudius Regaud, 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Department of Surgical Oncology, Dept. of Nucl. Med., Jean Minjoz Univ. Hosp., Besancon, Centre Hospitalier Universitaire de Reims (CHU Reims), CRLCC René Gauducheau, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Center Paul Papin, Laboratoire de physique de la matière (LPM), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Institut Curie [Paris], Université de Lyon, Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Department of oncologic surgery, Department of nuclear Imaging, CHU Clermont-Ferrand, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Service d'hépato-gastro-entérologie, CHU Saint-Etienne, Equipe Avenir. University of Burgundy, Univers, Transport, Interfaces, Nanostructures, Atmosphère et environnement, Molécules (UMR 6213) (UTINAM), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Institut national des sciences de l'Univers (INSU - CNRS), Service de Pathologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université, Service d'Oncologie Médicale Thoracique et Digestive [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Médecine nucléaire, biophysique, isotopes [CHRU Besançon], Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), and Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)
Subjects: Male, Mesothelioma, PD-L1, Pathology, medicine.medical_specialty, Survival, Antibodies, Neoplasm, [SDV]Life Sciences [q-bio], B7-H1 Antigen, Epithelioid subtype, 03 medical and health sciences, 0302 clinical medicine, Immune system, Biomarkers, Tumor, medicine, Humans, Lymphocytes, 030212 general & internal medicine, Peritoneal Neoplasms, Retrospective Studies, Immunity, Cellular, biology, business.industry, General Medicine, Middle Aged, Prognosis, medicine.disease, Immunohistochemistry, Peritoneal Malignant Mesothelioma, 3. Good health, Survival Rate, Oncology, 030220 oncology & carcinogenesis, biology.protein, Peritoneal mesothelioma, Biomarker (medicine), Female, Surgery, Hyperthermic intraperitoneal chemotherapy, France, Antibody, business, Follow-Up Studies
Abstract: Background Epithelioid peritoneal malignant mesothelioma (EPMM) is the most common subtype of this aggressive tumor. We compared two antibodies against PD-L1, a recent theranostic biomarker, and evaluated the prognostic value of PD-L1 expression by mesothelial and immune cells in EPMM. Methods Immunohistochemistry was performed on 45 EPMM. Clinical and pathological data were extracted from the RENAPE database. Using E1L3N and SP142 clones, inter-observer agreement, PD-L1 expression by mesothelial and immune cells and inter-antibody agreement were evaluated. The prognostic relevance of PD-L1 expression was evaluated in 39 EPMM by univariate and multivariate analysis of overall survival (OS) and progression-free survival (PFS). Results Inter-observer agreement on E1L3N immunostaining was moderate for mesothelial and immune cells, and fair for mesothelial and poor for immune cells using SP142. Using E1L3N, 31.1% of mesothelial and 15.6% of immune cells expressed PD-L1, and 22.2% of mesothelial and 26.7% of immune cells using SP142. Inter-antibody agreement was moderate. In most positive cases, 1–5% of tumor cells were positive. Using E1L3N, PD-L1 expression by lymphocytes was associated with better OS and PFS by both univariate and multivariate analysis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy predicted better prognosis than other treatments. Solid subtype was an independent prognostic factor for worse OS. Conclusion E1L3N appeared easier to use than SP142 to evaluate PD-L1 expression. A minority of EPMM expressed PD-L1, and only a few cells were positive. PD-L1 expression by immune cells evaluated with E1L3N was an independent prognostic factor in EPMM.
Published: 2017

212. 2008–2018: Ten years of gradual changes in the sedation guidelines for critically ill patients

Author: Xavier Drouot, Jean-François Payen, Gerald Chanques, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de physiologie, explorations fonctionnelles [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 hospitalier universitaire de Poitiers (CHU Poitiers), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, and Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Subjects: medicine.medical_specialty, Critical Care, Critical Illness, [SDV]Life Sciences [q-bio], Sedation, Conscious Sedation, Guidelines as Topic, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, Pain Management, Intensive care medicine, Psychomotor Agitation, ComputingMilieux_MISCELLANEOUS, Intensive care unit acquired weakness, business.industry, Critically ill, Delirium, 030208 emergency & critical care medicine, General Medicine, 3. Good health, Anesthesiology and Pain Medicine, medicine.symptom, business
Abstract: International audience
Published: 2018

213. Reuse of medical face masks in domestic and community settings without sacrificing safety: Ecological and economical lessons from the Covid-19 pandemic

Author: Alcaraz, Jean-Pierre, Le Coq, Laurence, Pourchez, Jérémie, Thomas, Dominique, Chazelet, Sandrine, Boudry, Isabelle, Barbado, Maud, Silvent, Sophie, Dessale, Claire, Antoine, Fabienne, Guimier-Pingault, Catherine, Cortella, Laurent, Rouif, Sophie, Bardin-Monnier, Nathalie, Charvet, Augustin, Dufaud, Olivier, Leclerc, Lara, Montigaud, Yoann, Laurent, Coralie, Verhoeven, Paul, Joubert, Aurélie, Bouhanguel, Ala, Andres, Yves, Gaffé, Joël, Martin, Donald, Huet, Christophe, Boisset, Sandrine, Maurin, Max, Rumeau, Pascal, Charlot, Frédéric, Richaud, Emmanuel, Moreau-Gaudry, Alexandre, Bonneterre, Vincent, Cinquin, Philippe, Landelle, Caroline, Université Grenoble Alpes (UGA), Valorisation Energie-matière des Résidus et Traitement des Emissions (GEPEA-VERTE), Laboratoire de génie des procédés - environnement - agroalimentaire (GEPEA), École nationale vétérinaire, agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Nantes université - UFR des Sciences et des Techniques (Nantes univ - UFR ST), Nantes Université - pôle Sciences et technologie, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Sciences et technologie, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - Institut Universitaire de Technologie Saint-Nazaire (Nantes Univ - IUT Saint-Nazaire), Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-École nationale vétérinaire, agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Département Systèmes Energétiques et Environnement (IMT Atlantique - DSEE), IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT), Université de Lorraine (UL), Institut national de recherche et de sécurité (Vandoeuvre lès Nancy) (INRS ( Vandoeuvre lès Nancy)), Centre d'Investigation Clinique [Grenoble] (CIC Grenoble), CHU Grenoble-Hôpital Michallon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Universitaire [Grenoble] (CHU), ARC-Nucleart CEA Grenoble (NUCLEART), Laboratoire d'Innovation pour les Technologies des Energies Nouvelles et les nanomatériaux (LITEN), Institut National de L'Energie Solaire (INES), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Institut National de L'Energie Solaire (INES), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Ionisos SAS, Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service des Agents Infectieux et Hygiène [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Traitement Eau Air Métrologie (GEPEA-TEAM), Institut Français Textile-Habillement, IFTH, Consortium des Moyens Technologiques Communs (CMTC), Institut National Polytechnique de Grenoble (INPG), Laboratoire Procédés et Ingénierie en Mécanique et Matériaux (PIMM), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Centre National de la Recherche Scientifique (CNRS)-Arts et Métiers Sciences et Technologies, HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Systèmes Nanobiotechnologiques et Biomimétiques (TIMC-SyNaBi ), Translational Innovation in Medicine and Complexity / Recherche Translationnelle et Innovation en Médecine et Complexité - UMR 5525 (TIMC ), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP ), Université Grenoble Alpes (UGA)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP ), Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Ecole Polytechnique de l'Université de Nantes (EPUN), Université de Nantes (UN)-Université de Nantes (UN)-Institut Universitaire de Technologie - Nantes (IUT Nantes), Université de Nantes (UN)-Institut Universitaire de Technologie Saint-Nazaire (IUT Saint-Nazaire), Université de Nantes (UN)-Institut Universitaire de Technologie - La Roche-sur-Yon (IUT La Roche-sur-Yon), Université de Nantes (UN)-Ecole Nationale Vétérinaire, Agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Université Bretagne Loire (UBL)-Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Ecole Nationale Vétérinaire, Agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Université Bretagne Loire (UBL), IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Centre Ingénierie et Santé (CIS-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Réactions et Génie des Procédés (LRGP), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL), Centre d'Investigation Clinique - Innovation Technologique - INSERM - CHU de Grenoble (CIC-IT Grenoble (CIT803)), Université Grenoble Alpes (UGA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Grenoble, Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle pharmacie, CHU de Grenoble, CHU Grenoble, Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de L'Energie Solaire (INES), Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), CHU de St Etienne, Translational microbial Evolution and Engineering (TIMC-TrEE), Institut Français du Textile et de l'Habillement - IFTH, Ecole Nationale Supérieure d'Arts et Métiers (Arts et Métiers ParisTech) (ENSAM), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-GMCAO), Environnement et Prévention en Santé des Populations (TIMC-EPSP ), Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-ThEMAS ), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)
Subjects: [PHYS]Physics [physics], Environmental Engineering, [SDV.BIO]Life Sciences [q-bio]/Biotechnology, Mask, SARS-CoV-2, Health, Toxicology and Mutagenesis, Public Health, Environmental and Occupational Health, Masks, COVID-19, General Medicine, General Chemistry, Reuse, Sciences de l'ingénieur, Pollution, Article, Environmental Chemistry, Humans, Polypropylene, Waste management, Pandemics, Personal Protective Equipment, ComputingMilieux_MISCELLANEOUS, Filtration
Abstract: The need for personal protective equipment increased exponentially in response to the Covid-19 pandemic. To cope with the mask shortage during springtime 2020, a French consortium was created to find ways to reuse medical and respiratory masks in healthcare departments. The consortium addressed the complex context of the balance between cleaning medical masks in a way that maintains their safety and functionality for reuse, with the environmental advantage to manage medical disposable waste despite the current mask designation as single-use by the regulatory frameworks. We report a Workflow that provides a quantitative basis to determine the safety and efficacy of a medical mask that is decontaminated for reuse. The type IIR polypropylene medical masks can be washed up to 10 times, washed 5 times and autoclaved 5 times, or washed then sterilized with radiations or ethylene oxide, without any degradation of their filtration or breathability properties. There is loss of the anti-projection properties. The Workflow rendered the medical masks to comply to the AFNOR S76-001 standard as "type 1 non-sanitory usage masks". This qualification gives a legal status to the Workflow-treated masks and allows recommendation for the reuse of washed medical masks by the general population, with the significant public health advantage of providing better protection than cloth-tissue masks. Additionally, such a legal status provides a basis to perform a clinical trial to test the masks in real conditions, with full compliance with EN 14683 norm, for collective reuse. The rational reuse of medical mask and their end-of-life management is critical, particularly in pandemic periods when decisive turns can be taken. The reuse of masks in the general population, in industries, or in hospitals (but not for surgery) has significant advantages for the management of waste without degrading the safety of individuals wearing reused masks.
Published: 2021

214. Sorafenib vs surgical resection for hepatocellular carcinoma with macrovascular invasion: A propensity score analysis

Author: Julien Calderaro, Ariane Mallat, Didier Samuel, Françoise Roudot-Thoraval, I. Bricault, Thomas Decaens, Christophe Duvoux, René Adam, Giuliana Amaddeo, Christian Letoublon, Alain Luciani, Alexis Laurent, Nathalie Ganne-Carrié, Charlotte Costentin, Eric Vibert, Jean-Charles Nault, Daniel Cherqui, Bernard Paule, CHU Henri Mondor, Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), Université Paris 13 (UP13), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génomique Fonctionnelle des Tumeurs Solides (U1162), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hématologie -Immunologie -Cibles thérapeutiques, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de chirurgie digestive et de l'urgence, CHU Grenoble-Hôpital Michallon, Service de Neuroradiologie, Hôpital Henri Mondor, UMR INSERM U955, École nationale vétérinaire d'Alfort (ENVA), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Paul Brousse, Inserm U776 rythmes biologiques et Cancer, Rythmes Biologiques et Cancers, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Unité de Chronothérapie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service d'hépato-gastro-entérologie [APHP Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Pôle Recherche Clinique-Santé Publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Service d'hépatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Université Paris Descartes - Paris 5 (UPD5), Service d'hépato-gastroentérologie, Service de santé publique [Mondor], Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université Grenoble Alpes (UGA), Hôpital Jean Verdier [Bondy], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Paul-Brousse (Villejuif, Val-de-Marne), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse, Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri-Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Université Paris Descartes - Paris 5 (UPD5), and École nationale vétérinaire - Alfort (ENVA)
Subjects: Male, Niacinamide, Sorafenib, Surgical resection, medicine.medical_specialty, Carcinoma, Hepatocellular, Multivariate analysis, Bilirubin, [SDV]Life Sciences [q-bio], propensity analysis, Antineoplastic Agents, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Quality of life, Internal medicine, medicine, Humans, Propensity Score, Aged, Retrospective Studies, Hepatology, business.industry, Phenylurea Compounds, Mortality rate, Liver Neoplasms, surgical resection, hepatocellular carcinoma, Middle Aged, medicine.disease, 3. Good health, Surgery, Liver, chemistry, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Propensity score matching, macrovascular invasion, Female, 030211 gastroenterology & hepatology, France, business, medicine.drug
Abstract: Background and aim Sorafenib is the standard of care for patients with hepatocellular carcinoma (HCC) and macrovascular invasion (MVI), with limited survival. Retrospective surgical studies have reported prolonged survival in this situation. This study aimed to compare the overall survival of patients with HCC and MVI treated with surgical resection or sorafenib. Methods 143 patients with HCC and MVI but no extra-hepatic spread, treated with surgical resection (SR-patients; n=75) or sorafenib (SOR-patients; n=68) in four French centres between 1990 and 2013 were reviewed retrospectively. A propensity score analysis was performed to reduce bias. Results SR-patients were significantly younger and had a lower tumour burden than SOR-patients. Median overall survival (OS) rates were 10.1 months [95% CI: 4.1-16.1] in SR-patients and 12.9 months [95% CI: 7.9-17.9] in SOR-patients (p=0.959). The 90-day mortality rate was 16% (n=12) in SR-patients and 7.5% (n=5) in SOR-patients (p=0.196). SR-patients had a median disease-free survival of 4.60 months [95% CI: 3.3-5.9]. Under the propensity analysis, median OS was 12.0 months [95% CI: 5.5-18.5] in SR-patients versus 9.7 months [95% CI: 6.1-13.3] in SOR-patients (p = 0.682). Under multivariate analysis, extensive MVI (HR=1.956, p=0.024) and bilirubin >17 μmol/l (HR=1.738, p=0.011) were the two factors significantly associated with mortality. Conclusion Under a propensity score analysis, the overall survival of patients with HCC and MVI undergoing surgical resection was similar to that achieved with sorafenib. We were not able to identify a patient subgroup experiencing a surgery-related improvement in survival, and quality of life was not evaluable. This article is protected by copyright. All rights reserved.
Published: 2017

215. Prostatectomie radicale laparoscopique robot-assistée : quelles sont les preuves à l’heure d’une demande de nomenclature spécifique ?

Author: X. Rébillard, G. Poinas, G. Fiard, J.-L. Descotes, M. Leprêtre, C. Delaitre-Bonnin, J.-A. Long, Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique Beau Soleil [Montpellier], Service d'urologie, CHU Grenoble-Hôpital Michallon, Ecosystèmes Insulaires Océaniens (UMR 241) (EIO), Université de la Polynésie Française (UPF)-Institut Louis Malardé [Papeete] (ILM), Institut de Recherche pour le Développement (IRD)-Institut de Recherche pour le Développement (IRD)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER), Mapi Group, Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM), and Association Française d'Urologie
Subjects: Gynecology, medicine.medical_specialty, Prostate cancer, business.industry, Prostatectomie radicale, [SDV]Life Sciences [q-bio], Urology, 030232 urology & nephrology, Robotics, Functional outcomes, Radical prostatectomy, Résultats oncologiques, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Oncological outcomes, Medicine, Robotique, Cancer de prostate, business, Résultats fonctionnels
Abstract: Resume Introduction Malgre une diminution du nombre de prostatectomies totales en France, la proportion de prostatectomies assistees par robot augmente. L’objectif de ce travail est de faire une mise au point comparant les resultats de la prostatectomie robot-assistee avec ceux des voies d’abord ouverte et cœlioscopique. Materiel et methodes Une revue systematique de la litterature sur PubMed a ete effectuee. Les etudes prospectives ainsi que les meta-analyses comparant prostatectomie totale robot-assistee (PTAR), laparoscopique (PTL) et par chirurgie ouverte (PTCO) ont ete retenues. Resultats La fonction erectile etait significativement meilleure apres PTAR qu’apres PTL. Comparativement a la PTCO, la sexualite etait d’apres des meta-analyses, significativement meilleure a 12 mois et le risque absolu de dysfonction erectile significativement diminue. La continence apres PTAR etait significativement meilleure, et des 3 mois, qu’apres PTL. Comparativement a la PTCO, le taux de patients continents etait discordant, tantot significativement meilleurs pour la PTAR, tantot sans difference. Le taux de marges positives etait similaire entre les techniques de PTAR, PTL et PTCO. Le suivi a long terme montrait des resultats equivalents sous reserve d’un recul insuffisant. En termes de complications peri-operatoires, aucune difference significative n’a ete observee entre la PTAR comparativement a la de PTL ou PTCO. Conclusion La PTAR offre les memes garanties oncologiques que les voies ouvertes et laparoscopique. La continence et la sexualite sont meilleures qu’en laparoscopie et par voie ouverte. Il n’existe toutefois pas d’etude randomisee a long terme comparant PTAR et PTCO. Ces donnees sont importantes a connaitre pour justifier d’un codage specifique CCAM.
Published: 2017

216. Prise en charge des pseudo-anévrismes rénaux intraparenchymateux post-traumatiques : à propos d’une série de 325 patients traumatisés rénaux

Author: C. Thuillier, Gaelle Fiard, B. Boillot, Jean-Alexandre Long, V. Arnoux, J.-L. Descotes, R. Guyot, N. Terrier, J.-J. Rambeaud, CHU Clermont-Ferrand, Service d'urologie, CHU Grenoble-Hôpital Michallon, CHU Annecy, Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), and Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Subjects: Gynecology, medicine.medical_specialty, Traumatisme rénal fermé, business.industry, [SDV]Life Sciences [q-bio], Urology, 030232 urology & nephrology, Blunt renal trauma, Pseudoaneurysm, Pseudoanévrisme, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Medicine, business
Abstract: Resume Introduction L’objectif a ete de decrire la prise en charge des pseudo-anevrismes (PA) post-traumatiques, intraparenchymateux, dans notre centre ; de la comparer aux donnees de la litterature afin de proposer un algorithme de prise en charge. Materiel et methodes Les dossiers de 325 traumatises renaux inclus dans une base de donnees prospective entre janvier 2004 et mai 2016 ont ete revus. Une revue des cas publies de PA a ete realisee sur Pubmed a l’aide des termes « blunt renal trauma » et « pseudoaneurysm » (excluant les cas de fistules arterioveineuses, de traumatismes ouverts et de PA extraparenchymateux) a permis l’analyse de 29 cas supplementaires. La prise en charge des traumatises renaux dans notre centre est decrite. Resultats Parmi les 325 patients traumatises renaux, 160 (49,3 %) etaient des traumatismes de grade IV et V. Un traitement conservateur a ete realise dans 93,2 % des cas. Huit cas de PA ont ete recenses, soit une incidence de 2,5 %. Quatre ont ete embolises d’emblee. Parmi les 4 cas surveilles, on a note 2 cas de thrombose spontanee, 1 cas d’absence de regression motivant une embolisation et 1 cas de recidive hemorragique occulte. Les PA surveilles ayant evolue favorablement avaient tous une taille inferieure a 1 cm. La fonction relative scintigraphique moyenne a 6 mois des reins ayant presente un PA embolise etait de 71,6 %. La revue de la litterature a permis de rapporter 29 cas publies, embolises pour 26 d’entre eux, avec un taux de succes de 84,6 %. Deux patients ont ete surveilles, mais l’un a finalement ete embolise devant la persistance de la lesion. Conclusion La formation d’un PA post-traumatique est une complication rare (2,5 %) des traumatismes fermes du rein. L’embolisation en presence de symptomes ou a fortiori d’une instabilite hemodynamique permet une bonne preservation renale. Les PA detectes de maniere fortuite (imagerie de suivi) et de taille inferieure a 1 cm semblent pouvoir etre surveilles. Niveau de preuve 5.
Published: 2017

217. Anti–N-Methyl-<scp>d</scp>-Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care

Author: de Montmollin, Etienne, Demeret, Sophie, Brule, Noëlle, Conrad, Marie, Dailler, Frédéric, Lerolle, Nicolas, Navellou, Jean-Christophe, Schwebel, Carole, Alves, Mikael, Cour, Martin, Engrand, Nicolas, Tonnelier, Jean-Marie, Maury, Eric, Ruckly, Stephane, Picard, Géraldine, Rogemond, Véronique, Magalhaes, Éric, Sharshar, Tarek, Timsit, Jean-François, Honnorat, Jérome, Sonneville, Romain, Study Group, ENCEPHALITICA, Louart, Benjamin, Centre Hospitalier de Saint-Denis [Ile-de-France], Service de neurologie 1 [CHU Pitié-Salpétrière], 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 universitaire de Nantes (CHU Nantes), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, CHI Poissy-Saint-Germain, Hôpital Edouard Herriot [CHU - HCL], Fondation Ophtalmologique Adolphe de Rotschild, CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Decision Sciences in Infectious Disease Prevention, Control and Care (Team DeSCID), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Référence Maladie Rare 'Syndromes neurologiques Paranéoplasiques', Hospices Civils de Lyon (HCL)-Hopital Neurologique, Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service médical des soins intensifs [CHU Raymond Poincaré], Hôpital Raymond Poincaré [AP-HP], Institut NeuroMyoGène (INMG), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Male, encephalitis, medicine.medical_treatment, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 0302 clinical medicine, Modified Rankin Scale, law, Secondary Prevention, 030212 general & internal medicine, Anti-N-Methyl-D-Aspartate Receptor Encephalitis, Incidence (epidemiology), Brain, Plasmapheresis, Prognosis, Intensive care unit, 3. Good health, Intensive Care Units, Treatment Outcome, anti–N-methyl-d-aspartate receptor, Administration, Intravenous, Female, Steroids, Rituximab, France, Immunotherapy, Encephalitis, medicine.drug, Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Cyclophosphamide, Immunoglobulins, Neuroimaging, Receptors, N-Methyl-D-Aspartate, Young Adult, 03 medical and health sciences, Age Distribution, Intensive care, Internal medicine, medicine, Humans, Sex Distribution, Intensive care medicine, Retrospective Studies, Analysis of Variance, business.industry, medicine.disease, critical care, incidence, business, 030217 neurology & neurosurgery
Abstract: International audience; RATIONALE:Encephalitis caused by anti-N-methyl-d-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There are limited data on intensive care unit (ICU) management of these patients.OBJECTIVES:To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis.METHODS:This was an observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis at the French National Reference Centre, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin Scale score of 0-2.MEASUREMENTS AND MAIN RESULTS:Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n = 61/74; 82%), intravenous immunoglobulins (n = 71/74; 96%), and plasmapheresis (n = 17/74; 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab, or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 d after ICU admission) immunotherapy (odds ratio, 16.16; 95% confidence interval, 3.32-78.64; for combined first-line immunotherapy with steroids and intravenous immunoglobulins vs. late immunotherapy), and a low white blood cell count on the first cerebrospinal examination (odds ratio, 9.83 for 50 cells/mm3; 95% confidence interval, 1.07-90.65). Presence of nonneurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome.CONCLUSIONS:The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.
Published: 2017

218. Indocyanine green fluorescence angiography for free flap monitoring: A pilot study

Author: Jean-Luc Cracowski, Cynthia Hamou, Marine Hitier, Georges Bettega, Christian Righini, Université Joseph Fourier - Grenoble 1 (UJF), Hôpital Michallon, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Service de chirurgie plastique et maxillofaciale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Mobilités : Vieillissement, Pathologie, Santé (COMETE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU), Centre hospitalier universitaire de Grenoble (CHU de Grenoble), CHU Grenoble, INSERM U823, équipe 5 (cibles diagnostiques ou thérapeutiques et vectorisation de drogues dans le cancer du poumon), Service d'ORL et de chirurgie cervicale, CHU Grenoble-CHU Grenoble-Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), and Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-Université Joseph Fourier - Grenoble 1 (UJF)
Subjects: Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], [SHS.PSY]Humanities and Social Sciences/Psychology, Pilot Projects, Physical examination, Free flap, 030230 surgery, Free Tissue Flaps, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Fluorescence angiography, medicine, Humans, Fluorescein Angiography, Adverse effect, ComputingMilieux_MISCELLANEOUS, Aged, medicine.diagnostic_test, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, Postoperative complication, Middle Aged, Plastic Surgery Procedures, medicine.disease, Indocyanine green, eye diseases, 3. Good health, Surgery, Venous thrombosis, Treatment Outcome, Free flaps, Otorhinolaryngology, chemistry, 030220 oncology & carcinogenesis, Angiography, Female, Radiology, Mandibular Reconstruction, Oral Surgery, business, Perfusion
Abstract: Summary Objective We evaluated the feasibility and the tolerance of repeated fluorescent indocyanine green angiography in free flap monitoring, and determined the intraoperative predictive values of flap vitality. Background The free flap failure rate has been significantly reduced, but free flap loss still occurs and remains a costly disaster. Repeated clinical examinations are commonly used for flap monitoring, but they can be unreliable because of their subjectivity. Laser-induced fluorescence of indocyanine green is a new method for assessing tissue perfusion. Methods 20 patients undergoing microsurgical reconstruction were monitored by indocyanine green fluorescence angiography, intraoperatively, and during 4 days after surgery, with 18 injections. Monitoring was made by clinical examination, and then compared to angiographic findings. Results The vascular complication rate was 15% (3/20) with 2 cases of venous thrombosis and one case of partial necrosis of the flap skin paddle. Both cases of venous thrombosis were salvaged by secondary surgery. There was no total flap loss. ICG angiography allowed detecting each intra and postoperative complication, earlier than clinical examination. The mean per-operative intensity of fluorescence was significantly lower in flaps with vascular complications (23.8 GL/ms; p = 0.008). The postoperative slope (p = 0.02) and amplitude (p = 0.03) of the fluorescent signal were both significantly lower than for uncomplicated flaps, before surgical revision. These 2 parameters came back to normal values after secondary surgery. There was no adverse effect of ICG despite the repeated injections. Conclusion ICG angiography is a feasible and safe technique for the detection of free flap vascular complications.
Published: 2016

219. Drug-induced aseptic meningitis: A possible T-cell–mediated hypersensitivity

Author: F. Hacard, Audrey Nosbaum, Thierry Vial, Pauline Pralong, Marc Vocanson, Frédéric Bérard, Aurore Gouraud, Jean-François Nicolas, Julie Castagna, Aurore Rozières, Christine Chuniaud-Louche, Département d'allergie et d'immunologie clinique [CHU Lyon Sud], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Immunologie de l'allergie cutanée et vaccination – Immunology of skin allergy and vaccination, Centre International de Recherche en Infectiologie - UMR (CIRI), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Centre antipoison et de toxicovigilance (Lyon) (CAPTV Lyon), Hospices Civils de Lyon (HCL), Département Pluridisciplinaire de Médecine, Dermatologie, CHU Grenoble-Hôpital Michallon, Hôpital Chambéry, Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: business.industry, T cell, Drug-induced aseptic meningitis, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Immunology, medicine, Lymphocyte activation, [SDV.IMM]Life Sciences [q-bio]/Immunology, Immunology and Allergy, Enzyme linked immunospot assay, business, Meningitis, ComputingMilieux_MISCELLANEOUS, 030215 immunology
Abstract: International audience
Published: 2018

220. Prostatic Fragment Requiring Endoscopic Management After Prostatic Artery Embolization for Indwelling Bladder Catheter

Author: Jean Alexandre Long, Aurélie Delouche, Christian Sengel, Benedicte Guillaume, D. Poncet, Gilbert Ferretti, Julien Ghelfi, Stéphane Charara, Gaelle Fiard, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Clinique Universitaire de Radiologie et Imagerie Médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Grenoble, and Pôle d'imagerie
Subjects: Male, medicine.medical_specialty, business.industry, [SDV]Life Sciences [q-bio], Prostatic Hyperplasia, Arteries, Endoscopic management, Prostatic artery embolization, 030218 nuclear medicine & medical imaging, Surgery, Urinary Bladder Neck Obstruction, 03 medical and health sciences, Catheters, Indwelling, 0302 clinical medicine, Text mining, 030220 oncology & carcinogenesis, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business, Indwelling bladder catheter, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2018

221. Folfirinox versus gemcitabine/nab-paclitaxel as first-line therapy in patients with metastatic pancreatic cancer: a comparative propensity score study

Author: Julien Taieb, Isabelle Trouilloud, Jean-Marc Phelip, David Tougeron, Christophe Locher, Simon Pernot, Vincent Hautefeuille, Anne Thirot Bidault, Pascal Artru, Bertrand Le Roy, Astrid Pozet, Angélique Saint, Nelson Lourenco, Anne-Laure Pointet, Dominique Béchade, Jérôme Desramé, Nicolas Williet, Denis Pezet, Service de gastroentérologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Département de gastro-entérologie et d'oncologie digestive [HEGP - APHP], Université Paris Descartes - Paris 5 (UPD5)-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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), 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), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Département d'oncologie digestive, Institut Bergonié [Bordeaux], UNICANCER-UNICANCER, Service d'Oncologie Médicale [CHU Saint -Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Biomarqueurs et essais cliniques en Cancérologie et Onco-Hématologie (BECCOH), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay, CHU Amiens-Picardie, CHU Pontchaillou [Rennes], Center Jean Mermoz, Clinique Saint Jean, Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Département de Gastroentérologie et hépatologie, and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon
Subjects: 0301 basic medicine, Oncology, medicine.medical_specialty, FOLFIRINOX, survival, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, First line therapy, Internal medicine, Metastatic pancreatic cancer, medicine, pancreatic adenocarcinoma, In patient, lcsh:RC799-869, ComputingMilieux_MISCELLANEOUS, Nab-paclitaxel, business.industry, gemcitabine/nab-paclitaxel, Gastroenterology, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Gemcitabine, 3. Good health, metastatic, 030104 developmental biology, 030220 oncology & carcinogenesis, Propensity score matching, Folfirinox, lcsh:Diseases of the digestive system. Gastroenterology, business, medicine.drug
Abstract: Background: Folfirinox (FFX) and gemcitabine/nab-paclitaxel (GN) are both standard first-line treatments in patients with metastatic pancreatic cancer (mPC). However, data comparing these two chemotherapeutic regimens and their sequential use remain scarce. Methods: Data from two independent cohorts enrolling patients treated with FFX ( n = 107) or GN ( n = 109) were retrospectively pooled. Primary endpoint was overall survival (OS). Progression-free survival (PFS) was the secondary endpoint. A propensity score based on age, gender, performance status (PS), and presence of liver metastases was used to make groups comparable. Results: In the whole study population, OS was significantly higher in FFX (14 months; 95% CI: 10–21) than in GN groups (9 months; 95% CI: 8–12) before ( p = 0.008) and after ( p = 0.021) adjusting for age, number of metastatic sites, liver metastases, peritoneal carcinomatosis and CA19.9 level at baseline. PFS tends to be higher in FFX (6 months) than GN groups (5 months; p = 0.053). After matching ( n = 49/group), patients were comparable for all baseline characteristics including PS. In the matched population, there was a trend toward greater OS in patients treated with FFX (HR = 0.67; p = 0.097). However, survival in each group was not solely a result of the first-line regimen. The proportion of patients who were fit for GN after FFX failure (FFX–GN sequence) was higher (46.9%) than the reverse sequence (20.4%; p = 0.01), which suggests a higher feasibility for the FFX–GN sequence. Corresponding median OS were 19 months versus 9.5 months, respectively ( p = 0.094). Conclusion: This study shows greater OS with FFX than with GN in patients with mPC. GN after FFX failure appears more feasible than the reverse sequence.
Published: 2019

222. My Little Smart Personal Assistant: A Co-Designed Solution to Ensure an Optimized Ageing-Well at Home in Rural European Settings

Author: Kern, J. B., Strola, S., Quintas, j., JACQUET, J.P., Benhamou, P.Y., Centre Hospitalier Universitaire [Grenoble] (CHU), EURIPA France, Neuilly sur Seine, Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre d'Investigation Clinique [Grenoble] (CIC Grenoble ), CHU Grenoble-Hôpital Michallon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Laboratory of Automatic and Systems, Instituto Pedro Nunes, Coimbra, Portugal, Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Subjects: [SDV]Life Sciences [q-bio]
Abstract: International audience; My Little Smart Personal Assistant is a co-designed remote connected device with an interactive vocal assistant that provides a panel of social/medical services for the rural European elderly population. The aim is to create a new patient-centered solution to improve quality of life, self-autonomy, and integration within local community. This should improve aging-well at home in rural settings.
Published: 2019

223. Suboptimal performance of cardiovascular magnetic resonance imaging for the assessment of myocardial viability at the early phase of an acute coronary syndrome: Usefulness of SPECT myocardial perfusion imaging

Author: Laurent Riou, Gérald Vanzetto, Adrien Jankowski, Marjorie Canu, Catherine Ghezzi, Daniel Fagret, Gilles Barone-Rochette, Loïc Djaileb, Alex Calizzano, Alexis Broisat, Département de médecine Nucléaire [CHU Grenoble-Alpes], Centre Hospitalier Universitaire [Grenoble] (CHU), Radiopharmaceutiques biocliniques (LRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Département de cardiologie [CHU de Grenoble], French alliance clinical trial [Paris] (F-CRIN), French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Perret, Pascale, and Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes)
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, [SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 03 medical and health sciences, Myocardial perfusion imaging, 0302 clinical medicine, Text mining, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Acute Coronary Syndrome, Coronary Artery Bypass, ComputingMilieux_MISCELLANEOUS, Tissue Survival, Tomography, Emission-Computed, Single-Photon, medicine.diagnostic_test, business.industry, Myocardial Perfusion Imaging, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, 3. Good health, Cardiology, Cardiology and Cardiovascular Medicine, Early phase, business
Abstract: International audience; no abstract
Published: 2019

224. Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study

Author: Maxime Maignan, Raphaël Briot, Audrey Lehmann, Jean-Louis Quesada, Marc Blancher, Guillaume Debaty, Stephanie Fey, Roselyne Collomb-Muret, Audrey Wuyts, Jean-Jacques Banihachemi, François-Xavier Ageron, Barthelemy Bertrand, Claire Bollart, Damien Viglino, Cyrielle Clapé, François Albasini, 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 [2016-2019] (UGA [2016-2019]), CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre d'Investigation Clinique [Grenoble] (CIC Grenoble ), CHU Grenoble-Hôpital Michallon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Hopital Saint-Jean-de-Maurienne, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Métropole Savoie [Chambéry], Hospital Albertville-Moutiers, Université Grenoble Alpes - UFR Pharmacie (UGA UFRP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Physiologie cardio-Respiratoire Expérimentale Théorique et Appliquée (TIMC-IMAG-PRETA), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and Briot, Raphael
Subjects: Male, Critical Care and Emergency Medicine, Time Factors, Sufentanil, 030204 cardiovascular system & hematology, Severity of Illness Index, 0302 clinical medicine, Clinical endpoint, Medicine and Health Sciences, Medicine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Acute Pain/diagnosis, Acute Pain/drug therapy, Acute Pain/etiology, Administration, Intranasal, Administration, Intravenous, Adult, Aerosols, Analgesics, Opioid/administration & dosage, Analgesics, Opioid/adverse effects, Double-Blind Method, Emergency Service, Hospital, Female, France, Humans, Middle Aged, Morphine/administration & dosage, Morphine/adverse effects, Pain Management/adverse effects, Pain Management/methods, Sufentanil/administration & dosage, Sufentanil/adverse effects, Treatment Outcome, Wounds and Injuries/complications, Wounds and Injuries/diagnosis, Analgesics, Data Processing, Morphine, Pharmaceutics, Drugs, General Medicine, Acute Pain, 3. Good health, Analgesics, Opioid, Research Design, Anesthesia, Information Technology, medicine.drug, Research Article, Computer and Information Sciences, [SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT], [SDV.SP.MED] Life Sciences [q-bio]/Pharmaceutical sciences/Medication, Clinical Research Design, Placebo, Research and Analysis Methods, 03 medical and health sciences, Drug Therapy, Adverse Reactions, [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication, Pain Management, Adverse effect, Pharmacology, Intention-to-treat analysis, business.industry, [SDV.OT] Life Sciences [q-bio]/Other [q-bio.OT], Emergency department, Opioids, Wounds and Injuries, Adverse Events, Analgesia, business
Abstract: Background Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first-pass metabolism. We aimed to determine whether IN sufentanil (INS) for patients presenting to an emergency department with acute severe traumatic pain results in a reduction in pain intensity non-inferior to IVM. Methods and findings In a prospective, randomized, multicenter non-inferiority trial conducted in the emergency departments of 6 hospitals across France, patients were randomized 1:1 to INS titration (0.3 μg/kg and additional doses of 0.15 μg/kg at 10 minutes and 20 minutes if numerical pain rating scale [NRS] > 3) and intravenous placebo, or to IVM (0.1 mg/kg and additional doses of 0.05 mg/kg at 10 minutes and 20 minutes if NRS > 3) and IN placebo. Patients, clinical staff, and research staff were blinded to the treatment allocation. The primary endpoint was the total decrease on NRS at 30 minutes after first administration. The prespecified non-inferiority margin was −1.3 on the NRS. The primary outcome was analyzed per protocol. Adverse events were prospectively recorded during 4 hours. Among the 194 patients enrolled in the emergency department cohort between November 4, 2013, and April 10, 2016, 157 were randomized, and the protocol was correctly administered in 136 (69 IVM group, 67 INS group, per protocol population, 76% men, median age 40 [IQR 29 to 54] years). The mean difference between NRS at first administration and NRS at 30 minutes was −4.1 (97.5% CI −4.6 to −3.6) in the IVM group and −5.2 (97.5% CI −5.7 to −4.6) in the INS group. Non-inferiority was demonstrated (p < 0.001 with 1-sided mean-equivalence t test), as the lower 97.5% confidence interval of 0.29 (97.5% CI 0.29 to 1.93) was above the prespecified margin of −1.3. INS was superior to IVM (intention to treat analysis: p = 0.034), but without a clinically significant difference in mean NRS between groups. Six severe adverse events were observed in the INS group and 2 in the IVM group (number needed to harm: 17), including an apparent imbalance for hypoxemia (3 in the INS group versus 1 in the IVM group) and for bradypnea (2 in the INS group versus 0 in the IVM group). The main limitation of the study was that the choice of concomitant analgesics, when they were used, was left to the discretion of the physician in charge, and co-analgesia was more often used in the IVM group. Moreover, the size of the study did not allow us to conclude with certainty about the safety of INS in emergency settings. Conclusions We confirm the non-inferiority of INS compared to IVM for pain reduction at 30 minutes after administration in patients with severe traumatic pain presenting to an emergency department. The IN route, with no need to obtain a venous route, may allow early and effective analgesia in emergency settings and in difficult situations. Confirmation of the safety profile of INS will require further larger studies. Trial registration ClinicalTrials.gov NCT02095366. EudraCT 2013-001665-16., In the emergency departments of six French hospitals, Marc Blancher and team compared intranasal sufentanil versus intravenous morphine for acute severe trauma pain in a randomized, double-blind, non-inferiority trial., Author summary Why was this study done? To relieve acute pain in an emergency room, the priorities are analgesia as early as possible, using an agent with rapid onset of action and powerful enough to achieve a level of pain as low as possible. Intravenous morphine is the most commonly used strong analgesic, but the need to obtain intravenous access is a clear limitation to its rapid use. The intranasal route using sufentanil spray could provide rapid easy administration with fast peak action time. What did the researchers do and find? We compared the effectiveness of intranasal sufentanil to that of intravenous morphine for patients presenting at an emergency room with acute severe traumatic pain. Patients were randomly assigned to receive intranasal sufentanil and intravenous placebo, or intravenous morphine and intranasal placebo. The 2 treatments gave similar levels of relief from pain according to self-assessments of pain by the patients. What do these findings mean? In the emergency room, intranasal sufentanil is feasible and not inferior to intravenous morphine in reducing severe pain due to traumatic injury at 30 minutes. Adverse events were frequent, as expected for opioids, but rarely serious. Larger studies are needed to confirm safety. The use of intranasal sufentanil might provide an easy and time-saving solution in the management of acute pain.
Published: 2019

225. Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients Receiving Mechanical Ventilation

Author: Garrouste-Orgeas, Maïté, Flahault, Cécile, Vinatier, Isabelle, Rigaud, Jean-Philippe, Thieulot-Rolin, Nathalie, Mercier, Emmanuelle, Rouget, Antoine, Grand, Hubert, Lesieur, Olivier, Tamion, Fabienne, Hamidfar, Rebecca, Renault, Anne, Parmentier-Decrucq, Erika, Monseau, Yannick, Argaud, Laurent, Bretonnière, Cédric, Lautrette, Alexandre, Badie, Julio, Boulet, Eric, Floccard, Bernard, Forceville, Xavier, Kipnis, Eric, Soufir, Lilia, Valade, Sandrine, Bige, Naïke, Gaffinel, Alain, Hamzaoui, Olfa, Simon, Georges, Thirion, Marina, Bouadma, Lila, Large, Audrey, Mira, Jean-Paul, Amdjar-Badidi, Nora, Jourdain, Mercé, Jost, Paul-Henri, Maxime, Virginie, Santoli, François, Ruckly, Stephane, Vioulac, Christel, Leborgne, Marie Annick, Bellalou, Lucie, Fasse, Léonor, Misset, Benoît, Bailly, Sébastien, Timsit, Jean-François, Medical-Surgical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Laboratoire de Psychopathologie et Processus de Santé (LPPS - EA 4057), Université Paris Descartes - Paris 5 (UPD5), Centre de recherche en éducation de Nantes (CREN), Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN)-Le Mans Université (UM), De la Préhistoire à l'Actuel : Culture, Environnement et Anthropologie (PACEA), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Réanimation médicale, CHU Bretonneau, Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5)-Réseau Inserm de Recherche en éthique médicale, Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Unité de Réanimation médicale, CHU Grenoble, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Service de Réanimation Médicale Polyvalente, Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Service de réanimation polyvalente, CH Belfort-Montbéliard, Service de réanimation chirurgicale, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Réanimation, CH Meaux, Biologie et physiologie des états septiques, IFR114-Université de Lille, Droit et Santé, Service d'anesthesiologie, Hôpital Saint Joseph, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Hôpital Victor Dupouy, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Hôpital Salengro, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Ambroise Paré [AP-HP], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Grenoble Alpes - UFR Pharmacie (UGA UFRP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, BRICHEUX, Genevieve, Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, 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), CHU Clermont-Ferrand-Hôpital Gabriel Montpied, Laboratoire Microorganismes : Génome et Environnement - Clermont Auvergne (LMGE), Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], General Intensive Care Medicine, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Raymond Poincaré [Garches], Université Grenoble Alpes (UGA), CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, [SDV.MP.PRO] Life Sciences [q-bio]/Microbiology and Parasitology/Protistology, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, [SDV.MP.PRO]Life Sciences [q-bio]/Microbiology and Parasitology/Protistology, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2019

226. Impact of the acute local inhibition of soluble epoxide hydrolase on diabetic skin microcirculatory dysfunction

Author: Laurent Imbert, Mohamed Skiba, Christophe Morisseau, Marie Cornic, Bruce D. Hammock, Sylvain Kotzki, Yann Savina, Matthieu Roustit, Frédéric Bounoure, Pierre-Alain Thiebaut, Jean-Luc Cracowski, Jean-Michel Picquenot, Jeremy Bellien, Pierre-Alex Serreau, Thomas Duflot, Vincent Richard, Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2 ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de pharmacologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Différenciation et communication neuronale et neuroendocrine (DC2N), Université Grenoble Alpes - UFR Pharmacie (UGA UFRP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel), University of California [Davis] (UC Davis), University of California, Laboratoire Hypoxie et Physiopathologies cardiovasculaires et respiratoires [Grenoble] (HP2), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique [Grenoble] (CIC Grenoble ), CHU Grenoble-Hôpital Michallon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Laboratoire de Pharmacocinétique, toxicologie et pharmacogénétique [CHU Rouen], Normandie Université (NU)-Normandie Université (NU), Département de Pathologie [CHU Rouen], Department of Entomology and Cancer Center [Davis, CA, USA], The study was co-supported by grants from the Fondation de France (2011-20459), the French National Research Agency (ANR-16-CE17-0012) and the National Institute of Health (NIEHS/R01ES002710)., ANR-16-CE17-0012,SAPHIR,Impact de la modulation des activités enzymatiques de l'époxyde hydrolase soluble sur l'hypertension pulmonaire et la dysfonction ventriculaire droite lors de l'insuffisance cardiaque expérimentale et humaine(2016), Brakenhielm, Ebba, Impact de la modulation des activités enzymatiques de l'époxyde hydrolase soluble sur l'hypertension pulmonaire et la dysfonction ventriculaire droite lors de l'insuffisance cardiaque expérimentale et humaine - - SAPHIR2016 - ANR-16-CE17-0012 - AAPG2016 - VALID, and University of California (UC)
Subjects: Male, skin microvascular dysfunction, [SDV.BIO]Life Sciences [q-bio]/Biotechnology, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Endocrinology, Diabetes and Metabolism, Medical Physiology, Sus scrofa, Vasodilation, Pharmacology, soluble epoxide hydrolase, Inbred C57BL, Benzoates, Mice, 0302 clinical medicine, Urea, Enzyme Inhibitors, Skin, Epoxide Hydrolases, 0303 health sciences, integumentary system, Diabetes, Pharmacology and Pharmaceutical Sciences, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, topical form, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, 030220 oncology & carcinogenesis, Administration, [SDV.IMM]Life Sciences [q-bio]/Immunology, Cardiology and Cardiovascular Medicine, Type 2, Blood Flow Velocity, Signal Transduction, Epoxide hydrolase 2, [SDV.IMM] Life Sciences [q-bio]/Immunology, Clinical Sciences, Administration, Cutaneous, Article, 03 medical and health sciences, Endocrinology & Metabolism, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Diabetes mellitus, Internal Medicine, medicine, Diabetes Mellitus, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Animals, 030304 developmental biology, business.industry, Animal, Microcirculation, medicine.disease, [SDV.BIO] Life Sciences [q-bio]/Biotechnology, Mice, Inbred C57BL, Disease Models, Animal, Cutaneous, Diabetes Mellitus, Type 2, Regional Blood Flow, Disease Models, business, Gels, Diabetic Angiopathies
Abstract: International audience; The impact of the local inhibition of soluble epoxide hydrolase, which metabolizes vasodilator and anti-inflammatory epoxyeicosanoids, on diabetic skin microvascular dysfunction was assessed. In diabetic db/db mice, basal skin blood flow assessed using laser Doppler imaging was similar to that of control mice, but thermal hyperemia was markedly reduced. At 2 h after the topical administration of an aqueous gel containing the soluble epoxide hydrolase inhibitor trans-4-[4-(3-adamantan-1-yl-ureido)-cyclohexyloxy]-benzoic acid (t-AUCB: 400 mg/L), the peak concentration of t-AUCB was detected in the skin of diabetic mice, which quickly decreased thereafter. In parallel, 2 h after application of t-AUCB treatment, thermal hyperemia was increased compared to the control gel. Quantification of t-AUCB in plasma of treated animals showed no or low systemic diffusion. Furthermore, haematoxylin and eosin histological staining of skin biopsies showed that skin integrity was preserved in t-AUCB-treated mice. Finally, for pig ear skin, a surrogate for human skin, using Franz diffusion cells, we observed a continuous diffusion of t-AUCB from 2 h after application to beyond 24 h. A single topical administration of a soluble epoxide hydrolase inhibitor improves microcirculatory function in the skin of db/db mice and might represent a new therapeutic approach for preventing the development of skin complications in diabetic patients.
Published: 2019

227. Investigating the toxic effects induced by iron oxide nanoparticles on neuroblastoma cell line: an integrative study combining cytotoxic, genotoxic and proteomic tools

Author: Mohsen Sakly, David Béal, Sylvie Berthier, Michel Seve, Dalel Askri, Walid Rachidi, Benoit Chovelon, Salem Amara, Sylvia G. Lehmann, Valérie Cunin, Josiane Arnaud, Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Chimie Interface Biologie pour l’Environnement, la Santé et la Toxicologie (CIBEST ), SYstèmes Moléculaires et nanoMatériaux pour l’Energie et la Santé (SYMMES), Institut de Chimie du CNRS (INC)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Laboratoire d'Enzymologie (DBPC), CHU Grenoble-GREPI EA 2938, Département de pharmacochimie moléculaire (DPM ), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Département de biologie intégrée, CHU Grenoble-Hôpital Michallon, Laboratoire de Physiologie Intégrée, Faculté des Sciences de Bizerte [Université de Carthage], Université de Carthage - University of Carthage-Université de Carthage - University of Carthage, Physiologie Intégrée, Centre Hospitalier Universitaire [Grenoble] (CHU), PROteomics and METabolomics Platform [Grenoble] (PROMETHEE), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), and Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)
Subjects: Proteomics, [SDV.BIO]Life Sciences [q-bio]/Biotechnology, Proteome, Cell Survival, Cell, Biomedical Engineering, Apoptosis, [SDV.CAN]Life Sciences [q-bio]/Cancer, 02 engineering and technology, [SDV.BC.BC]Life Sciences [q-bio]/Cellular Biology/Subcellular Processes [q-bio.SC], 010501 environmental sciences, Toxicology, Ferric Compounds, 01 natural sciences, Iron oxide nanoparticles neuroblastoma toxicity proteomics, chemistry.chemical_compound, Cell Line, Tumor, [SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], [SDV.BC.IC]Life Sciences [q-bio]/Cellular Biology/Cell Behavior [q-bio.CB], medicine, Animals, Humans, Cytotoxic T cell, Particle Size, 0105 earth and related environmental sciences, Membrane Potential, Mitochondrial, Chemistry, Cell Cycle, Cell Membrane, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, Cell cycle, 021001 nanoscience & nanotechnology, 3. Good health, Cell biology, Comet assay, medicine.anatomical_structure, Toxicity, Cancer cell, Nanoparticles, Comet Assay, Reactive Oxygen Species, 0210 nano-technology, Iron oxide nanoparticles, [SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology, DNA Damage
Abstract: International audience; Nanomaterials have gained much attention for their use and benefit in several fields. Iron Oxide Nanoparticles (IONPs) have been used in Biomedicine as contrast agents for imaging cancer cells. However, several studies reported the potential toxicity of those nanoparticles in different models, especially in cells. Therefore, in our present study, we investigated the effects of IONPs on the SH-SY5Y neuroblastoma cell line. We carried out cytotoxic and genotoxic studies to evaluate the phenotypic effects, and proteomic investigation to evaluate the molecular effects and the mechanisms by which this kind of NPs could induce toxicity. Our results showed that the use of three different sizes of IONPs (14, 22 and 30 nm) induced cell detachment, cell morphological changes, size, and concentration-dependent IONP internalization and cell mortality. IONPs induced slight genotoxic damage assayed by modified comet assay without affecting cell cycle, mitochondrial function, membrane integrity, intracellular calcium level, and without inducing ROS generation. All the studies were performed to compare also the effects of IONPs to the ferric iron by incubating cells with equivalent concentration of FeCl3. In all tests, the NPs exhibited more toxicity than the ferric iron. The proteomic analysis followed by gene ontology and pathway analysis evidenced the effects of IONPs on cytoskeleton, cell apoptosis, and cancer development. Our findings provided more information about IONP effects on human cells and especially on cancer cell line.
Published: 2019

228. The features of circulating and tumor-infiltrating γδ T cells in melanoma patients display critical perturbations with prognostic impact on clinical outcome

Author: Joel Plumas, Stéphane Mouret, Florence de Fraipont, Laurence Chaperot, Julie Charles, Pauline Girard, Marie-Thérèse Leccia, Camille Cluzel, Caroline Aspord, Emmanuelle Degeorges, Olivier Manches, Laboratoire de Psychologie : Cognition, Comportement, Communication (LP3C - EA1285), Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Université de Rennes 2 (UR2), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut Brestois des Sciences de l'Homme et de la Société (IBSHS), Université de Brest (UBO), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire recherche et développement, EFS, Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Département Pluridisciplinaire de Médecine, Dermatologie, CHU Grenoble-Hôpital Michallon, Laboratoire Oligoéléments et Résistance au Stress Oxydant induit par les Xénobiotiques (Laboratoire ORSOX), Université Joseph Fourier - Grenoble 1 (UJF)-UMR-E3 UJF/CEA-LRC-CEA(LAN) 8M, and Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Université de Rennes 2 (UR2)-Institut Brestois des Sciences de l'Homme et de la Société (IBSHS)
Subjects: 0301 basic medicine, lcsh:Immunologic diseases. Allergy, Immunology, Tumor cells, Human leukocyte antigen, lcsh:RC254-282, predictive factor, 03 medical and health sciences, 0302 clinical medicine, medicine, melanoma, Immunology and Allergy, tumor microenvironment, immune checkpoint, ComputingMilieux_MISCELLANEOUS, Original Research, Tumor microenvironment, business.industry, Tumor immunosurveillance, Melanoma, γδ t cells, immune escape, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Immune checkpoint, 3. Good health, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Cancer research, [SDV.IMM]Life Sciences [q-bio]/Immunology, Cytokine secretion, business, lcsh:RC581-607, γδt cells
Abstract: γδT cells hold a pivotal role in tumor immunosurveillance through their prompt activation and cytokine secretion, their ability to kill tumor cells in an Human Leukocyte Antigen (HLA)-unrestricted manner, and their combination of features of both innate and adaptive immunity. These unique properties and functional plasticity render them very attractive both as targets and vectors for cancer immunotherapy. Yet, these potent and fascinating antitumor effectors have not been extensively explored in melanoma. We provided here a detailed investigation of the phenotypic and functional properties of circulating and tumor-infiltrating γδT cells in melanoma patients, and their impact on clinical evolution. High proportions of circulating- and tumor-infiltrating γδT and δ2+ subset were associated with better clinical outcome. We reported however that circulating and tumor-infiltrating γδT cells from melanoma patients displayed an altered expression of NCR, KIR, and immune checkpoints, and identified NKp44, PD1, 41BB/41BBL, TIM3, and LAG3 as crucial checkpoints allowing immune escape and tumor progression. Notably, melanoma drastically impaired the ability of γδT cells to exhibit activation molecules, secrete cytokines, and display cytotoxicity toward melanoma in response to stimulation with phosphoantigens. It drove them toward regulatory and Th17 profiles associated with poor clinical outcomes. Our study highlights that melanoma hijacked γδT cells to escape from immune control, and revealed that circulating and tumor-infiltrating γδT cell features are promising potential biomarkers of clinical evolution. Such understanding of the physiopathology of γδT cells may help designing new therapeutic approaches exploiting the antitumor potential of γδT cells while counteracting their skewing by tumors to improve patient outcomes.
Published: 2019

229. Cryogenic Subthreshold Swing Saturation in FD-SOI MOSFETs Described With Band Broadening

Author: Benoit Bertrand, Mikael Casse, L. Le Guevel, Marc Sanquer, Philippe Galy, Franck Arnaud, S. Barraud, H. Bohuslavskyi, V. Barral, A. G. M. Jansen, M. Vinet, S. De Franceschi, Gael Pillonnet, Xavier Jehl, Gerard Billiot, Louis Hutin, Commissariat à l'énergie atomique et aux énergies alternatives - Laboratoire d'Electronique et de Technologie de l'Information (CEA-LETI), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Laboratoire de Transport Electronique Quantique et Supraconductivité (LaTEQS), PHotonique, ELectronique et Ingénierie QuantiqueS (PHELIQS), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Clinique Cardiologie et Hypertension Artérielle, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Département d'Architectures, Conception et Logiciels Embarqués-LETI (DACLE-LETI), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and STMicroelectronics [Crolles] (ST-CROLLES)
Subjects: 010302 applied physics, Physics, Valence (chemistry), Condensed matter physics, Condensed Matter - Mesoscale and Nanoscale Physics, Silicon on insulator, FOS: Physical sciences, Gate voltage, 01 natural sciences, Electronic, Optical and Magnetic Materials, Gate oxide, Subthreshold swing, 0103 physical sciences, Mesoscale and Nanoscale Physics (cond-mat.mes-hall), Density of states, Electrical and Electronic Engineering, [PHYS.COND]Physics [physics]/Condensed Matter [cond-mat], Saturation (magnetic), Order of magnitude, ComputingMilieux_MISCELLANEOUS
Abstract: In the standard MOSFET description of the drain current $ {I}_{{D}}$ as a function of applied gate voltage $ {V}_{{ {GS}}}$ , the subthreshold swing ${{SS(T)}}\equiv {{dV}}_{{{GS}}}/ {d}\log {I}_{ {D}}$ has a fundamental lower limit as a function of temperature ${T}$ given by ${ {SS(T)}}=\ln 10\,\, {k}_{ {B}} {T}/ {e}$ . However, recent low-temperature studies of different advanced CMOS technologies have reported SS (4 K or lower) values that are at least an order of magnitude larger. Here, we present and analyze the saturation of SS(T) in 28 nm fully-depleted silicon-on-insulator (FD-SOI) devices for both n- and p-type MOSFETs of different gate oxide thicknesses and gate lengths down to 4 K. Until now, the increase of interface-trap density close to the band edge as temperature decreases has been put forward to understand the saturation. Here, an original explanation of the phenomenon is presented by considering a disorder-induced tail in the density of states at the conduction (valence) band edge for the calculation of the MOS channel transport by applying the Fermi–Dirac statistics. This results in a subthreshold $ {I}_{ {D}}\sim {e}^{{{ {eV}}}_{{{GS}}}/ {k}_{ {B}} {T}_{0}}$ for $ {T}_{0}=35$ K with saturation value ${ {SS}}( {T} . The proposed model adequately describes the experimental data of SS(T) from 300 down to 4 K using $ {k}_{ {B}} {T}_{0} \simeq 3$ meV for the width of the exponential tail and can also accurately describe ${ {SS}}( {I}_{ {D}})$ within the whole subthreshold region. Our analysis allows a direct determination of the technology-dependent band-tail extension forming a crucial element in future compact modeling and the design of cryogenic circuits.
Published: 2019

230. The French COMETE-Cancer network for adrenal cancer: 10 years of activity as part of a national plan for clinical care of rare cancers

Author: Delphine Vezzosi, Eric Baudin, Bernard Goichot, Olivier Chabre, Marie-Christine Vanthyghem, Rossella Libe, Herve Lefebvre, Antoine Tabarin, Jérôme Bertherat, B. Verges, Patricia Niccoli, Sandrine Laboureau, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Endocrinologie (BORDEAUX - Endocrino), CHU Bordeaux [Bordeaux], Service d'endocrinologie, CHU Grenoble-Hôpital Michallon, Service de Médecine Interne, Endocrinologie et Nutrition [CHU Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS)-CHU Strasbourg, Service d'Endocrinologie (TOULOUSE - Endocrino), CHU Toulouse [Toulouse], Différenciation et communication neuronale et neuroendocrine (DC2N), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'Endocrinologie, Diabète et Maladies Métaboliques [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Service d'Endocrinologie, Diabétologie et Maladies Métaboliques (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), and Institut Gustave Roussy (IGR)
Subjects: medicine.medical_specialty, business.industry, Family medicine, [SDV.BC.IC]Life Sciences [q-bio]/Cellular Biology/Cell Behavior [q-bio.CB], [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Medicine, Plan (archaeology), Cancer, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Clinical care, business, medicine.disease, 3. Good health
Abstract: International audience; P826The French COMETE-Cancer network for adrenal cancer: 10 years of activity as part of a national plan for clinical care of rare cancersIntroductionThe French National Institute of Cancer (INCa) launched supported by the Ministry of Health in 2008 a program for the recognition of national networks for the management of rare cancers. Among the 23 selected networks COMETECancer was recognized by INCa in 2009 for Adrenocortical carcinoma (ACC) and malignant pheochromocytoma/paraganglioma (MPP). At that time 60–120 new ACC/year and 30 new MPP/year were expected at the national level.AimTo describe the general activities of COMETE-cancer after 10-years of activity.Materials and methodsINCa list 7 tasks for the national rare cancer networks: 1) Expertise: double reading of tumor samples, Referral National Multisciplinary Staff (RNMS); 2) Care practice: national best practice guidelines release; 3) Referral: patient access to highly specialized/innovative treatments (clinical trial); 4) Observation: exhaustive recording of national cases in registries; 5) Clinical and translationalresearch; 6) Healthcare professional training; 7) Role of patient associations. TheFrench COMETE-K network is coordinated by two-sites Centers (Cochin andGustave Roussy). Ten Regional Experts Centers have been recognized for anational geographical coverage.ResultsA double reading is done in about 200 cases of ACC/MPP tumor samples/year. A RNMS is organized twice a month (web based system): about 170 ACC and MPP patients/year are discussed. The coverage rate of ‘new’ patients reviewed in RNMS/‘estimated’ total number cases was 68%. The consistency between treatment proposed in RNMS and treatment administered was of 84%. Since2010, 958 ACC and 384 MPP have been entered in the ENSAT database. Two National best practice guidelines for ACC/MPP were released. About 70 ACC/MPP have been referred to the COMETE-Cancer centers for highly specialized and innovative treatment (phase II-III trial, radiofrequency/cryotherapy, liver chimioembolisation). COMETE-Cancer participated in two international trials (ADIUVO in ACC and FIRSTMAPP in MPP) and more than 20 translational studies. Every year more than 500 healthcare professional (student, endocrinologists, surgeons, pathologist, oncologists) are trained. Moreover, it strongly collaborates with the patients ‘Association Surre´nale’ by writing specific documents on the clinical ACC/MPP management.ConclusionsCOMETE-cancer has led to a homogenous national organization for clinical care of ACC and MPP. The RNMS proved to be very efficient for that. Links with the ENSAT, ENDO-ERN and EURACAN networks will allow further progress at the European level.DOI: 10.1530/endoabs.63.P826
Published: 2019

231. Nebulized hypertonic saline 3% for 1 versus 3 days in hospitalized bronchiolitis: a blinded non-inferiority randomized controlled trial

Author: Mathilde Bonnet, Anne Ego, Catherine Barbier, Roseline Mazet, Amandine Rubio, Sophie Thoret, Isabelle Pin, Gaëlle Beal, Department of Pediatrics [Chambéry], Centre Hospitalier Métropole Savoie [Chambéry], Department of Pediatrics [Grenoble], CHU Grenoble, Centre d'Investigation Clinique [Grenoble] (CIC Grenoble ), CHU Grenoble-Hôpital Michallon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Department of Pharmacy [Grenoble], Public Health Department [Grenoble], CHU Grenoble-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), This study was supported by grant from Fondation Agir pour les Maladies Chroniques (AMPC) and from Grenoble-Alpes University Hospital., and Bodescot, Myriam
Subjects: Male, Randomization, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Drug Administration Schedule, law.invention, 03 medical and health sciences, 0302 clinical medicine, Non inferiority, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, Hypertonic saline, Randomized controlled trial, Double-Blind Method, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030225 pediatrics, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Children, Saline Solution, Hypertonic, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, business.industry, Nutritional Support, Nebulizers and Vaporizers, Remission Induction, lcsh:RJ1-570, Infant, lcsh:Pediatrics, medicine.disease, 3. Good health, Clinical trial, Oxygen, Treatment Outcome, Sample size determination, Bronchiolitis, Acute Bronchiolitis, Anesthesia, Pediatrics, Perinatology and Child Health, Acute Disease, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Female, Saline Solution, business, Child, Hospitalized, Research Article
Abstract: Background The use and optimal duration of treatment with nebulized hypertonic saline (HS) in infants hospitalized for acute bronchiolitis is unclear. The objective was to compare the efficacy of 1 versus 3 days of nebulized 3% HS at 72 h of treatment. We conducted a blinded non-inferiority randomized controlled trial including infants aged less than 12 months old, hospitalized for a moderate bronchiolitis. Methods Nebulisations of 3% HS for 1 day were followed by either the continuation of 3% HS (HS3d group) or switched to 0.9% normal isotonic saline (HS1d group) for 2 days Randomization was performed according to a predefined list with a 1:1 ratio, obtained with a random generator number with blocks.. Main outcome was mean Wang clinical severity score (CSS) after 72 h of treatment. Results One hundred sixteen infants (HS1d n = 59 and HS3d n = 57), were included over two epidemic seasons from 2014 to 2016, but recruitement did not reach the planned sample size. The difference for the Wang CSS score in the HS3d vs HS1d group was 0.71 [IC 90% 0.1; 1.3], above the precluded value of 0.4 set in the protocol defining the non-inferiority of shorter treatment duration. Clinical remission was more rapidly obtained in the HS3d than in HS1d (2.3 ± 1.6 vs 2.9 ± 1.4 days, p = 0.04), with a non-significant tendency for less need of nutritional support and supplemental oxygen in HS3d group. Clinical worsening and treatment intolerance were similar in the 2 groups. Conclusions Despite being underpowered, results seem not to be in favour of reducing the duration of nebulised HS treatment from 3 to 1 day in acute moderate bronchiolitis. Trial registration Clinical trials NCT 02538458, October 2014.
Published: 2019

232. Positive Impact of Genetic Test on the Management and Outcome of Patients With Paraganglioma and/or Pheochromocytoma

Author: Lucile Offredo, Delphine Zenaty, Eric Baudin, Antoine Tabarin, Peggy Pierre, Alexandre Buffet, Anne-Paule Gimenez-Roqueplo, Philippe Herman, Igor Tauveron, Frédéric Chabolle, Judith Favier, Olivier Chabre, Laurence Amar, Christiane Ajzenberg, Rossella Libé, Yves Reznik, Brigitte Delemer, Bernard Goichot, Delphine Vezzosi, Laurene Ben Aim, Julien Hadoux, Delphine Drui, Vincent Darrouzet, Sandrine Laboureau, Sophie Leboulleux, Isabelle Raingeard, Jean-Louis Sadoul, Daniele Bernardeschi, Annabelle Esvant, Bertrand Cariou, Hervé Lefebvre, Jérôme Bertherat, Rachel Desailloud, Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Médecine nucléaire, Département d'imagerie médicale [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Toulouse [Toulouse], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Henri Mondor, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Foch [Suresnes], Centre Hospitalier Universitaire [Grenoble] (CHU), CHU de Bordeaux Pellegrin [Bordeaux], Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Amiens-Picardie, Les Hôpitaux Universitaires de Strasbourg (HUS), CHU Pontchaillou [Rennes], Hôpital Lariboisière-Fernand-Widal [APHP], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Différenciation et communication neuronale et neuroendocrine (DC2N), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Lapeyronie [Montpellier] (CHU), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Archet 2 [Nice] (CHU), Université Paris-Saclay, CHU Bordeaux [Bordeaux], CHU Clermont-Ferrand, AP-HP Hôpital universitaire Robert-Debré [Paris], Université de Paris - UFR Pharmacie [Santé] (UP UFR Pharmacie), Université de Paris (UP), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Université Paris Descartes - Paris 5 (UPD5)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service d'Endocrinologie [Nantes], Service d'Endocrinologie (TOULOUSE - Endocrino), CHU Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre d'Information sur la Surdité et l'Implant Cochléaire [Paris] (CISIC), CHU Pitié-Salpêtrière [APHP], unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'oto-rhino-laryngologie, Hôpital Beaujon-Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service d'endocrinologie, CHU Grenoble-Hôpital Michallon, Service d'Endocrinologie - Diabète - Nutrition [Reims], Université de Reims Champagne-Ardenne (URCA)-Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Service d'Endocrinologie (AMIENS - Endocrino), Service de Médecine Interne, Endocrinologie et Nutrition [CHU Strasbourg], CHU Strasbourg-Les Hôpitaux Universitaires de Strasbourg (HUS), Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, Institut Scientifique de Santé Publique [Belgique] - Scientific Institute of Public Health [Belgium] (WIV-ISP), Réseau International des Instituts Pasteur (RIIP), Département d'Endocrinologie, Diabète et Maladies Métaboliques [CHU Rouen], Normandie Université (NU)-Normandie Université (NU), Service d'Endocrinologie (TOURS - Endocrino), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service Endocrinologie - Diabétologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service d'Endocrinologie (NICE - Endocrino), Centre Hospitalier Universitaire de Nice (CHU Nice), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Service d'Endocrinologie (BORDEAUX - Endocrino), Génétique, Reproduction et Développement - Clermont Auvergne (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), Service de pédiatrie générale, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Institut Gustave Roussy (IGR), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), 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 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), Réhabilitation Chirurgicale mini-Invasive et Robotisée de l'Audition, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Médecine Interne - Diabète et Maladies métaboliques [Hôpital Hautepierre-Strasbourg]], Hôpital de Hautepierre [Strasbourg], Laboratoire de Neurobiologie des Réseaux Sensorimoteurs (LNRS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5), Service d'Endocrinologie (MONTPELLIER - Endocrino), Collège de France (CDF), Collège de France (CdF), Développement et évolution (DE), Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Les Hôpitaux Universitaires de Strasbourg (HUS)-CHU Strasbourg, Hôpital Lariboisière, Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génétique, Reproduction et Développement (GReD), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Service Endocrinologie, maladies métaboliques et nutrition [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Unité de recherche de l'institut du thorax (ITX-lab), Hôpital Beaujon [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Oncology, Male, SDHB, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Adrenal Gland Neoplasms, Aftercare, Kaplan-Meier Estimate, Biochemistry, Neoplasms, Multiple Primary, 0302 clinical medicine, Endocrinology, Paraganglioma, [SDV.BC.IC]Life Sciences [q-bio]/Cellular Biology/Cell Behavior [q-bio.CB], Child, ComputingMilieux_MISCELLANEOUS, medicine.diagnostic_test, Middle Aged, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Prognosis, 3. Good health, Succinate Dehydrogenase, Survival Rate, Von Hippel-Lindau Tumor Suppressor Protein, 030220 oncology & carcinogenesis, Female, Adult, medicine.medical_specialty, Adolescent, 030209 endocrinology & metabolism, Context (language use), Pheochromocytoma, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, 03 medical and health sciences, Young Adult, Germline mutation, Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Genetic Testing, Germ-Line Mutation, Genetic testing, Aged, Retrospective Studies, business.industry, Biochemistry (medical), Retrospective cohort study, Genetic Status, medicine.disease, Lost to Follow-Up, SDHD, business, Follow-Up Studies
Abstract: International audience; OC5.1Positive impact of genetic test on the management and outcome of patients with paraganglioma and/or pheochromocytomaContextParagangliomas and pheochromocytomas (PPGL) are rare neuroendocrine tumors, characterized by a strong genetic component. Indeed, up to 40% of patients carry a germline mutation in a PPGL susceptibility gene. In accordance with the international recommendations, genotyping of PPGL susceptibility genes is therefore proposed to all patients with PPGL, but it has actually never beenshown whether the identification of a germline mutation in one PPGL susceptibility gene changes the outcome of mutation-carriers.ObjectiveOur objective was to evaluate how a positive genetic test impacts the management and outcome of propositus patients with PPGL carrying a germline mutation in one of the four major PPGL susceptibility genes (SDHB, SDHD, SDHC and VHL).DesignWe performed a multicentric retrospective study on 221 propositus carrying a SDHB, SDHD, SDHC or VHL germline mutation and followed in 24 French clinical centers of the Group of Endocrine Tumors and/or the COMETE network. Patients were divided into two groups: Genetic patients, who were informed of their genetic status within the year following the first PPGL diagnosis, and Historic patients who only benefited from the genetic test several years after initial PPGL diagnosis.ResultsCompared to Historic patients, Genetic patients had a better follow-up, with a higher number of examinations and a reduced number of patients lost to follow-up (9.6% versus 72%). During follow-up, smaller (18.7 mm versus 27.6, PZ0.0128) new PPGL and metastases as well as lower metastatic spread were observed in Genetic patients. Importantly, these differences were reversed in the Historic cohort after genetic testing. Genetic patients who developed metachronous metastases had a better 5-year survival than Historic ones (PZ0.0127).ConclusionAltogether our study clearly shows the positive impact of the identification of an SDHx or VHL mutation in the management, clinical outcome and survival of patients with PPGL. It reveals, for the first time, the clinical benefits of the practice of oncogenetics for patients with a rare cancer and strongly strengthens the recommendations of the Endocrine Society to consider PPGL genetic testingin all patients affected by PPGL.DOI: 10.1530/endoabs.63.OC5.1
Published: 2019

233. Human mesenchymal stem cells improve rat islet functionality under cytokine stress with combined upregulation of heme oxygenase-1 and ferritin

Author: Sandrine Lablanche, Cécile Cottet-Rousselle, Justine Cristante, Sandra Pesenti, Eric Fontaine, Frédéric Lamarche, Emily Tubbs, Anne-Sophie Gauchez, Anaïck Moisan, Jean-Marc Moulis, Pierre-Yves Benhamou, Camille Laporte, Catherine Garrel, Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes (UGA), Plateforme de radioactivité [Grenoble], Université Grenoble Alpes (UGA)-Institut de Biologie et de Pathologie - IBP [CHU Grenoble]-Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Département de biologie intégrée, CHU Grenoble-Hôpital Michallon, Université Grenoble Alpes - UFR Pharmacie (UGA UFRP), Centre Hospitalier Universitaire [Grenoble] (CHU), Foundation 'Agir Pour les Maladies Chroniques,' Grenoble, France, H2020 UE 646272, Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Biologie et de Pathologie - IBP [CHU Grenoble]-Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: 0301 basic medicine, medicine.medical_treatment, Medicine (miscellaneous), 0302 clinical medicine, Diabetes mellitus type 1, cytokine, lcsh:QD415-436, [SDV.BDD]Life Sciences [q-bio]/Development Biology, lcsh:R5-920, geography.geographical_feature_category, Heme oxygenase 1, biology, Chemistry, Biologie du développement, Islet, Development Biology, Up-Regulation, 3. Good health, Cell biology, Cytokine, 030220 oncology & carcinogenesis, Cytokines, Molecular Medicine, medicine.symptom, Stem cell, lcsh:Medicine (General), endocrine system, diabète de type 1, Inflammation, Biochemistry, Genetics and Molecular Biology (miscellaneous), lcsh:Biochemistry, Islets of Langerhans, 03 medical and health sciences, Stress, Physiological, cellule souche, medicine, Animals, Humans, ilot de langerhans, geography, Research, Mesenchymal stem cell, Mesenchymal Stem Cells, diabetes mellitus type 1, islets of Langerhans transplantation, mesenchymal stem cells, co-culture, cytokines, heme oxygenase 1, Cell Biology, Coculture Techniques, Rats, stem cell, Heme oxygenase, Ferritin, Transplantation, 030104 developmental biology, Ferritins, Heme Oxygenase (Decyclizing), biology.protein, Islets of Langerhans transplantation, Co-culture
Abstract: Background Islets of Langerhans transplantation is a promising therapy for type 1 diabetes mellitus, but this technique is compromised by transplantation stresses including inflammation. In other tissues, co-transplantation with mesenchymal stem cells has been shown to reduce damage by improving anti-inflammatory and anti-oxidant defences. Therefore, we probed the protection afforded by bone marrow mesenchymal stem cells to islets under pro-inflammatory cytokine stress. Methods In order to evaluate the cytoprotective potential of mesenchymal stem cells on rat islets, co-cultures were exposed to the interleukin-1, tumour necrosis factor α and interferon γ cocktail for 24 h. Islet viability and functionality tests were performed. Reactive oxygen species and malondialdehyde were measured. Expression of stress-inducible genes acting as anti-oxidants and detoxifiers, such as superoxide dismutases 1 and 2, NAD(P)H quinone oxidoreductase 1, heme oxygenase-1 and ferritin H, was compared to non-stressed cells, and the corresponding proteins were measured. Data were analysed by a two-way ANOVA followed by a Holm-Sidak post hoc analysis. Results Exposure of rat islets to cytokines induces a reduction in islet viability and functionality concomitant with an oxidative status shift with an increase of cytosolic ROS production. Mesenchymal stem cells did not significantly increase rat islet viability under exposure to cytokines but protected islets from the loss of insulin secretion. A drastic reduction of the antioxidant factors heme oxygenase-1 and ferritin H protein levels was observed in islets exposed to the cytokine cocktail with a prevention of this effect by the presence of mesenchymal stem cells. Conclusions Our data evidenced that MSCs are able to preserve islet insulin secretion through a modulation of the oxidative imbalance mediated by heme and iron via heme oxygenase-1 and ferritin in a context of cytokine exposure. Electronic supplementary material The online version of this article (10.1186/s13287-019-1190-4) contains supplementary material, which is available to authorized users.
Published: 2019

234. Resection of small bowel adenocarcinoma metastases: Results of the ARCAD-NADEGE cohort study

Author: Cedric Lecaille, Mohamad Chehimi, Romain Coriat, Marc Pocard, Thomas Aparicio, Sylvain Manfredi, David Tougeron, Eric Terrebonne, Isabelle Baumgaertner, Aziz Zaanan, Jean-Louis Legoux, Jean-Baptiste Bachet, Olivier Bouché, Anne-Laure Villing, Pauline Afchain, Jean-Marc Gornet, Robert Benamouzig, Johan Gagnière, Corinne Sarda, Jean-Luc Faucheron, Pierre Rompteaux, J. Forestier, Nathalie Bonichon-Lamichhane, Thierry Lecomte, Service de Gastro-entérologie [Avicenne], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Sorbonne Paris Nord, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA), Service de Chirurgie Digestive et Hépatobiliaire [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service d'Hépato-Gastro-Entérologie [Hôpital Saint-Louis, AP-HP], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Gastro-entérologie et hépatologie [Hôpital Cochin], [AP-HP], Hôpital Cochin [AP-HP], Service de gastro-entérologie [Henri Mondor AP-HP, Créteil], Hôpital Henri Mondor-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'hépato-gastro-entérologie [Hôpital Trousseau : CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Oncologie Médicale [CHU Saint -Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Clinique Tivoli Ducos [Bordeaux], CHU Robert Debré [Reims], Centre Hospitalier Universitaire [Grenoble] (CHU), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Polyclinique Bordeaux Nord Aquitaine, Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Hôpital Saint-Quentin, Hôpital d'Auxerre, Partenaires INRAE, Hopital de castres, Service Hépato-gastro-entérologie et oncologie digestive [CHR Orléans], Centre Hospitalier Régional d'Orléans (CHRO), A.R.C.A.D. (Aide et Recherche en CAncerologie Digestive) fundation [NA2009], Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Service Chirurgie Disgestive, Centre Hospitalier Universitaire Estaing, Hôpital Saint-Louis, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), 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), AP HP, Departement Oncologie, Centre Hospitalier Universitaire Henri Mondor, Groupe innovation et ciblage cellulaire (GICC), EA 7501 [2018-...] (GICC EA 7501), Université de Tours, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Cooperator Multidisciplinary Oncology Group (GERCOR), Service de Gastroentérologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Université de Reims Champagne-Ardenne (URCA), Unité de Chirurgie Colorectale, CHU Grenoble-Hôpital Michallon, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Centre de Recherche en Cancérologie de Lyon (CRCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Pontchaillou, Service d'Hépato-Gastroentérologie [Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Département d'hépatologie et de gastroentérologie [CHU Bordeaux], Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], Université de Picardie Jules Verne (UPJV), Regional Hospital of Orleans, Centre de Recherche en Nutrition Humaine, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-CHU Trousseau [APHP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne), CHU Trousseau [APHP], Service d'Oncologie Médicale [CHU Saint-Antoine], and CHU Saint-Antoine [AP-HP]
Subjects: Male, Lymphovascular invasion, [SDV]Life Sciences [q-bio], Gastroenterology, Metastasis, 0302 clinical medicine, Duodenal Neoplasms, Positron Emission Tomography Computed Tomography, Clinical endpoint, Prospective Studies, Neoplasm Metastasis, Digestive System Surgical Procedures, Aged, 80 and over, Univariate analysis, Small bowel adenocarcinoma, General Medicine, Middle Aged, Prognosis, Magnetic Resonance Imaging, Primary tumor, 3. Good health, Survival Rate, medicine.anatomical_structure, Oncology, Metastases resection, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, France, Cohort study, medicine.drug, Adult, Ampulla of Vater, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Adenocarcinoma, Disease-Free Survival, 03 medical and health sciences, Internal medicine, medicine, Humans, Aged, Neoplasm Staging, Lung, business.industry, medicine.disease, Oxaliplatin, Adjuvant chemotherapy, Hepatic metastases, Surgery, business, Follow-Up Studies
Abstract: Introduction Data are lacking with regard to curative resection of metastasis from small bowel adenocarcinoma (SBA). This study evaluated outcomes and prognostic factors in patients with curatively resected metastatic SBA. Methods A series of 34 patients undergoing resection of metastatic SBA from January 2009 to November 2014 at French centers were included into this cohort study. The primary endpoint was overall survival (OS). Secondary endpoints were recurrence-free survival (RFS) and prognostic factors. Univariate analyses were performed to determine prognostic risk factors. Results The sites of SBA metastases were peritoneal (29.4%), liver (26.5%), lymph nodes (11.8%), lung (2.9%), multiple (14.7%), and other (14.7%). Thirty (88.2%) patients received adjuvant or perioperative chemotherapy, mainly was oxaliplatin-based (76.5%). The median OS was 28.6 months and RFS was 18.7 months. Fourteen (41.2%) patients survived for more than 36 months. In univariate analysis, poor differentiation (P = 0.006), invaded margins (P = 0.003), and lymphatic invasion in the primary tumor (P = 0.039) were associated with decreased OS. Conclusion Overall survival of patients after resection of metastatic SBA remains poor, but long-term survivors are observed. Resection of metastatic SBA should be consider if patients are expected to be operated on with curative intent and have moderately or well-differentiated tumors.
Published: 2019

235. Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l’adulte : résultats à 5 ans

Author: Jean-Jacques Rambeaud, Bernard Boillot, C. Thuillier, J.-L. Descotes, Jean-Alexandre Long, D. Poncet, G. Fiard, C. Lanchon, Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Service d'urologie, CHU Grenoble-Hôpital Michallon, Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and CHU Grenoble
Subjects: Gynecology, Ré-interventions, medicine.medical_specialty, Complications, Principe de Mitrofanoff, business.industry, Urology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Mitofranoff procedure, Reinterventions, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Continence, medicine, Cystostomie continente, business, Continent cystostomy
Abstract: Resume Objectif Evaluer a long terme dans une population adulte, la continence, les reprises chirurgicales et la satisfaction des patients porteurs d’une derivation urinaire cutanee continente fonctionnelle de type Mitrofanoff. Materiel et methodes Etude retrospective de revue des dossiers menee de 1997 a 2015. Les donnees pre-, per- et postoperatoire ont ete colligees. Tous les patients ont ete contactes au terme de l’etude, un questionnaire leur a ete soumis. Resultats Soixante-sept patients ont ete operes d’une cystostomie continente de type Mitrofanoff. Quarante-cinq patients repondaient aux criteres d’inclusions suivants : âge du patient superieur a 18 ans, pas d’antecedent de derivation urinaire cutanee anterieure, suivi superieur a 6 mois. La cohorte etait composee majoritairement par des patients porteurs de vessies neurologiques (84 %) representes par des blesses medullaires (54 %) et des patients spina-bifida (15 %). L’âge median etait de 35 ans [22–49]. Le suivi median etait de 64 mois [39–90]. Le montage chirurgical utilisait un conduit appendiculaire chez 30 patients (67 %) et un conduit ileal remodele chez 15 patients (33 %). Au terme du suivi 88 % des patients ont une continence urinaire stomiale totale, 89 % ont une continence uretrale. Vingt-neuf patients ont necessite une (41 %) ou plusieurs re-interventions. Les indications des 58 reprises chirurgicales etaient les suivantes : stenose de l’orifice stomial (31 %), fuites urinaires uretrales (29 %), fuites urinaires stomiales (15 %), lithiases (9 %). Ces complications etaient majoritairement traitees par abord local (31 %) ou abord endoscopique (35 %). Aucune difference statistiquement significative en matiere de complications chirurgicales immediates ou tardives (p = 0,93) n’a ete mise en evidence entre les deux types montages ; trans-appendiculaire et conduit ileal remodele. Quatre-vingt-quatorze pour cent des patients decrivaient un confort urinaire satisfaisant. L’orifice stomial etait juge esthetique par 71 %, sa realisation a permis une amelioration de la qualite de vie pour 89 % d’entre eux. Conclusion La derivation urinaire cutanee selon Mitrofanoff reste une alternative chirurgicale fiable sur le long terme, mais necessitant des interventions iteratives pour maintenir un conduit fonctionnel continent et catheterisable. En depit du nombre de re-interventions les patients restent satisfaits de ce mode mictionnel. Niveau de preuve 4.
Published: 2019

236. Giant Meckel’s Diverticulum

Author: Jean-Luc Faucheron, Adrian Mancini, Fabian Reche, Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Unité de Chirurgie Colorectale, and CHU Grenoble-Hôpital Michallon
Subjects: Meckel's diverticulum, Small bowel resection, medicine.medical_specialty, medicine.diagnostic_test, business.industry, General surgery, [SDV]Life Sciences [q-bio], Gastroenterology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Meckel Diverticulum, 030220 oncology & carcinogenesis, medicine, 030211 gastroenterology & hepatology, Surgery, Laparoscopy, Meckel diverticulum, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2019

237. A proliferation‐inducing ligand–mediated anti‐inflammatory response of astrocytes in multiple sclerosis

Author: Mahdia Benkhoucha, Mashal Claude Ahmed, Dominique Baeten, Romain Marignier, Jose Boucraut, Olivier Casez, Michael Hahne, Jean Boutonnat, Corinne Sonrier, Benoit Manfroi, Laurie Baert, Patrice N. Marche, Nathalie Sturm, Marine Tessier, Patrice H. Lalive, Romain R. Vivès, Bertrand Huard, Cyril Rivat, Catherine Ghezzi, Hans Lassmann, Pascal Schneider, Natalia Popa, Gilda Raguenez, Alexis Broisat, Hugues Lortat-Jacob, Mitra Ahmadi, Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Department of Pathology and Immunology [Geneva, Switzerland] (Clinical Pathology Division), University of Geneva [Switzerland]-Geneva University Hospitals - HUG [Switzerland], Centre de recherche en neurobiologie - neurophysiologie de Marseille (CRN2M), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département d'anatomie et cythologie pathologique, CHU Grenoble-Hôpital Michallon, Centre Hospitalier Universitaire [Grenoble] (CHU), Centre de recherche en neurosciences de Lyon (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Radiopharmaceutiques biocliniques (LRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut de Génétique Moléculaire de Montpellier (IGMM), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Department of Clinical Immunology and Rheumatology [Academic Medical Center, Amsterdam], University of Amsterdam [Amsterdam] (UvA), Institut de biologie structurale (IBS - UMR 5075 ), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Department of Biochemistry [Lausanne], Université de Lausanne (UNIL), University of Vienna [Vienna], Department of Clinical Neurosciences [Geneva, Switzerland], Unit of Neuroimmunology and Neuromuscular Diseases [Geneva, Switzerland] (Division of Neurology), Geneva University Hospitals - HUG [Switzerland]-Geneva University Hospitals - HUG [Switzerland], This work was supported by Grenoble Alpes University (B.H.), the National Institute of Health and Medical Research (B.H.), the Association for Aid to Multiple Sclerosis Research (B.H.), the National Agency for Research (program center of excellence in neurodegeneration obtained within the Grenoble excellence in neurodegeneration network, B.H.), the Swiss National Science Foundation (310030_156961/310030_176256 to PS and 310030_153164/310030_176678 to PL), and the Swiss Multiple Sclerosis Society (P.L.)., Clinical Immunology and Rheumatology, AII - Inflammatory diseases, Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université de Genève = University of Geneva (UNIGE)-Geneva University Hospitals - HUG [Switzerland], Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut des Neurosciences de Montpellier (INM), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Université de Lausanne = University of Lausanne (UNIL), Grenoble Alpes University, the National Institute of Health and Medical Research, the Association for Aid to Multiple Sclerosis Research), the National Agency for Research (program center of excellence in neurodegeneration obtained within the Grenoble excellence in neurodegeneration network, the Swiss National Science Foundation (310030_156961/310030_176256 to PS and 310030_153164/310030_176678 )The Swiss Multiple Sclerosis Society, and MARCHE, Patrice
Subjects: Male, 0301 basic medicine, T-Lymphocytes, Mice, chemistry.chemical_compound, 0302 clinical medicine, B-Cell Activating Factor, Medicine, Mice, Knockout, Reverse Transcriptase Polymerase Chain Reaction, Chondroitin Sulfates, Middle Aged, Immunohistochemistry, Interleukin-10, 3. Good health, Interleukin 10, Neurology, Adult, Aged, Animals, Astrocytes/immunology, Astrocytes/metabolism, Astrocytes/pathology, B-Cell Activating Factor/metabolism, Cell Proliferation, Chondroitin Sulfate Proteoglycans/metabolism, Chondroitin Sulfates/metabolism, Cytokines/immunology, Disease Models, Animal, Encephalomyelitis, Autoimmune, Experimental/immunology, Encephalomyelitis, Autoimmune, Experimental/metabolism, Encephalomyelitis, Autoimmune, Experimental/pathology, Female, Humans, Interleukin-10/immunology, Macrophages/pathology, Multiple Sclerosis/immunology, Multiple Sclerosis/metabolism, Multiple Sclerosis/pathology, T-Lymphocytes/immunology, Tumor Necrosis Factor Ligand Superfamily Member 13/genetics, Tumor Necrosis Factor Ligand Superfamily Member 13/metabolism, Tumor Necrosis Factor Ligand Superfamily Member 13/pharmacology, Cytokines, [SDV.IMM]Life Sciences [q-bio]/Immunology, Tumor necrosis factor alpha, medicine.symptom, Encephalomyelitis, Autoimmune, Experimental, Multiple Sclerosis, [SDV.IMM] Life Sciences [q-bio]/Immunology, Tumor Necrosis Factor Ligand Superfamily Member 13, Inflammation, 03 medical and health sciences, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, B-cell activating factor, Autoimmune encephalitis, business.industry, Macrophages, Multiple sclerosis, medicine.disease, 030104 developmental biology, Chondroitin Sulfate Proteoglycans, chemistry, Chondroitin sulfate proteoglycan, Astrocytes, Immunology, Cytokine secretion, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: International audience; OBJECTIVE:The two related tumor necrosis factor members a proliferation-inducing ligand (APRIL) and B-cell activation factor (BAFF) are currently targeted in autoimmune diseases as B-cell regulators. In multiple sclerosis (MS), combined APRIL/BAFF blockade led to unexpected exacerbated inflammation in the central nervous system (CNS) of patients. Here, we investigate the role of the APRIL/BAFF axis in the CNS.METHODS:APRIL expression was analyzed in MS lesions by immunohistochemistry. The in vivo role of APRIL was assessed in the murine MS model, experimental autoimmune encephalitis (EAE). Functional in vitro studies were performed with human and mouse astrocytes.RESULTS:APRIL was expressed in lesions from EAE. In its absence, the disease was worst. Lesions from MS patients also showed APRIL expression upon infiltration of macrophages. Notably, all the APRIL secreted by these macrophages specifically targeted astrocytes. The upregulation of chondroitin sulfate proteoglycan, sometimes bearing chondroitin sulfate of type E sugar moieties, binding APRIL, in reactive astrocytes explained the latter selectivity. Astrocytes responded to APRIL by producing a sufficient amount of IL-10 to dampen antigen-specific T-cell proliferation and pathogenic cytokine secretion. Finally, an intraspinal delivery of recombinant APRIL before disease onset, shortly reduced EAE symptoms. Repeated intravenous injections of recombinant APRIL before and even at disease onset also had an effect.INTERPRETATION:Our data show that APRIL mediates an anti-inflammatory response from astrocytes in MS lesions. This protective activity is not shared with BAFF. ANN NEUROL 2019;85:406-420.© 2019 American Neurological Association.
Published: 2019

238. Efficacy and safety of oral alitretinoin as treatment for chronic hand eczema in France: a real-life open-label study

Author: Bruno, Halioua, Carle, Paul, Philippe, Berbis, Frédéric, Cambazard, Marie-Sylvie, Doutre, Pascal, Joly, Marie Aleth, Richard, Céline, Aubin, Alina, Gruber, Olivier, Chosidow, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Hôpital Nord [CHU - APHM], Service de dermatologie, CHU Saint-Etienne, CHU Grenoble-Hôpital Michallon, Service de dermatologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Physiopathologie, Autoimmunité, maladies Neuromusculaires et THErapies Régénératrices (PANTHER), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Laboratoire GlaxoSmithKline [ Marly-le-Roi], Epidemiology in Dermatology and Evaluation in Therapeutics (EpiDermE), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université de Rouen Normandie (UNIROUEN), and Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, safety, alitretinoin, [SDV]Life Sciences [q-bio], Eczema, Administration, Oral, effectiveness, Hand Dermatoses, Middle Aged, Quality of Life, Humans, Female, observational study, Dermatologic Agents, France, chronic hand eczema, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, [SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology
Abstract: Chronic hand eczema is an inflammatory dermatosis that results in a significant psychological and socio-economic burden. Alitretinoin (AL) is indicated in adults with severe chronic hand eczema (sCHE) unresponsive to potent topical corticosteroids.To assess AL effectiveness and safety in patients with sCHE under real-life conditions based on a prospective observational study in France (2010-2014).Clinical severity was assessed using Physician Global Assessment (PGA) and Modified Total Lesion Symptom Score (mTLSS) and quality of life by Skindex and visual analogue scales. Patients were treated with AL for 12-24 weeks and followed for 24 months. Responders were patients with clear/almost clear skin based on PGA at the end of treatment and the primary outcome was remission (clear, almost clear, or mild skin) at one and two years after treatment.A total of 394 patients with severe or moderate PGA were included in the study by 109 dermatologists. AL treatment duration was 5.4 ± 4.1 months (mean ± SD) and 112/274 patients evaluated at the end of treatment were responders. Of the 112 responders, 41/51 evaluable patients were in remission after one year and 36/46 after two years. At the end of treatment, Skindex improved from 48.8 ± 18.1% to 27.1 ± 23.2%. Among the 112 responders, 68/84 did not relapse (mTLSS increased75% from baseline). The most common adverse events were headache (24%) and dyslipidaemia (4%).This study supports a positive benefit/risk profile for AL for sCHE patients unresponsive to topical corticosteroids.
Published: 2019

239. French translation and linguistic validation of the Raynaud's condition score

Author: Yannick Allanore, Jean-Luc Cracowski, Charles Khouri, Patricia Senet, Sophie Blaise, M. Roustit, Claire Cracowski, Eric Hachulla, Alicia Guigui, Centre d'Investigation Clinique [Grenoble] (CIC Grenoble ), CHU Grenoble-Hôpital Michallon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2 ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], Patient interviews, Diagnostic Techniques, Cardiovascular, Condition score, Linguistic validation, 030226 pharmacology & pharmacy, Severity of Illness Index, Scleroderma, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Pharmacology (medical), cardiovascular diseases, skin and connective tissue diseases, Language, Scleroderma, Systemic, integumentary system, business.industry, Linguistics, Raynaud Disease, Translating, medicine.disease, body regions, Clinical trial, Patient Outcome Assessment, Treatment Outcome, Research Design, English version, Physical therapy, France, business
Abstract: Summary The Raynaud's condition score is a 11-point scale severity score used in Raynaud's phenomenon clinical trials since 1998. The Raynaud's condition score diary has been recommended for use in clinical trials assessing efficacy of interventions on scleroderma related Raynaud's phenomenon. However, this score has never been formally validated in French. We thus performed a translation and a linguistic validation of the Raynaud's condition score through a forward/backward translations process followed by an expert review and cognitive patient interviews. The translations led to a French version of the Raynaud's condition score that was linguistically valid, and conceptually equivalent to the original English version. This “Score de Raynaud” will be usable to perform and harmonize clinical trials in French-speaking patients with secondary Raynaud's phenomenon.
Published: 2019

240. Impact of the New MELD-based Allocation System on Waiting List and Post-Transplant Survival - A Cohort Analysis Using the French National CRISTAL Database

Author: Carine Jasseron, Claire Francoz, Corinne Antoine, Camille Legeai, François Durand, Sébastien Dharancy, null Collaborators, Christan Jacquelinet, Daniel Azoulay, Christophe Duvoux, Olivier Scatton, Yvon Calmus, Daniel Cherqui, Didier Samuel, Olivier Soubrane, Jean‐Yves Mabrut, Jérôme Dumortier, Christian Letoublon, Vincent Leroy, Denis Pezet, Armand Abergel, Antonio Iannelli, Rodolphe Anty, Francis Navarro, Georges Pageaux, François‐René Pruvot, Philippe Bachellier, Camille Besh, Georges Mantion, Vincent Di Martino, Nassim Kamar, Fabrice Muscari, Laurence Chiche, Martine Neau Cransac, Karim Boudjema, Pauline Houssel Debry, Ephrem Salame, Agence de la biomédecine [Saint-Denis la Plaine], Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris 8 Vincennes-Saint-Denis (UP8), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Claude Huriez [Lille], CHU Lille, Physiopathologie et traitement des maladies du foie, Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Henri Mondor, Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], 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), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Département de chirurgie digestive et de l'urgence, CHU Grenoble-Hôpital Michallon, Hôpital Michallon, Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Strasbourg, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Chirurgie Générale et Digestive [Rangueil], Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Biothérapies des maladies génétiques et cancers, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), CHU Henri Mondor [Créteil], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut National de la Recherche Agronomique (INRA)-Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030230 surgery, Liver transplantation, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Intubation, allocation system, Dialysis, Transplantation, business.industry, MELD score, discriminative capacity, Post transplant, 3. Good health, body regions, Waiting list, 030211 gastroenterology & hepatology, business, survival, Cohort study
Abstract: International audience; Concerns related to equity and efficacy of our previous center-based allocation system have led us to introduce a patient-based allocation system called the "Liver Score" that incorporates the MELD score. The main objective of this study was to compare waitlist and post-transplant survivals before and after implementation of the "Liver Score" using the French transplant registry (period before: 2004-2006 and period after: 2007-2012). Patients transplanted during the second period were sicker and had a higher MELD. One-year waitlist survival (74% versus 76%; p=0.8) and one-year post-transplant survival (86.3% vs 85.7%; p=0.5) were similar between the 2 periods. Cirrhotic recipients with MELD>35 had lower one-year post-transplant survival compared to those with MELD35, patients presenting 2 or 3 risk factors (dialysis, intubation or infection) had a lower 1-year survival compared to those with none of these risk factors (61.2% vs 92%; p35 should be completed to allow safe transplantation. This article is protected by copyright. All rights reserved.
Published: 2019

241. Biomarkers in Diagnosis and Prediction of Hepatocellular Carcinoma Recurrence (Review)

Author: Thomas Decaens, N. D. Yushchuk, I V Malov, V. V. Dvornichenko, Zuzana Macek-Jilkova, S. I. Malov, Patrice N. Marche, MARCHE, Patrice, Irkutsk State Medical University [Irkutsk, Russia], Irkutsk State Medical Academy of Postgraduate Education [Irkutsk, Russia], Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Département de Gastroentérologie et hépatologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, A.I. Yevdokimov Moscow State University of Medicine and Dentistry [Moscow, Russia], and Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Subjects: Oncology, medicine.medical_specialty, business.industry, screening, biomarkers, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, General Medicine, hepatocellular carcinoma, medicine.disease, Proteomics, General Biochemistry, Genetics and Molecular Biology, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 3. Good health, proteomics, Internal medicine, Hepatocellular carcinoma, Medicine, business
Abstract: International audience; Hepatocellular carcinoma (HCC) is the second leading cause of death in oncological patients. The prognosis of the disease outcome depends directly on its timely detection. Currently, in the majority of countries, the diagnostic algorithm at the preclinical stage of tumor development includes determination of alpha-fetoprotein in combination with instrumental imaging techniques. This approach allows the detection of about 65-80% of liver tumors at an early stage (A according to the BCLC classification), whereas at a very early stage (0 according to the BCLC classification) only 32-50% of cases, the result which cannot be considered satisfactory. In this regard, the search for effective biomarkers of hepatocellular carcinoma is an important challenge that faces the world healthcare. Advances in proteomics and genomics have led to the discovery of numerous promising markers which are now being clinically tested. Molecules of protein nature proposed as hepatocellular carcinoma tumor markers in different periods of time are described in this review. Comparative data on their effectiveness and specificity are also presented. The possibility of isolated or combined use of these biomarkers for risk assessment and early diagnosis of primary liver cancer is considered.
Published: 2019

242. Acyclovir for Mechanically Ventilated Patients With Herpes Simplex Virus Oropharyngeal Reactivation

Author: Luyt, Charles-Edouard, Forel, Jean-Marie, Hajage, David, Jaber, Samir, Cayot-Constantin, Sophie, Rimmelé, Thomas, Coupez, Elisabeth, Lu, Qin, Diallo, Mamadou Hassimiou, Penot-Ragon, Christine, Clavel, Marc, Schwebel, Carole, Timsit, Jean-François, Bedos, Jean-Pierre, Hauw-Berlemont, Caroline, Bourenne, Jérémy, Mayaux, Julien, Lefrant, Jean-Yves, Mira, Jean-Paul, Combes, Alain, Wolff, Michel, Chastre, Jean, Papazian, Laurent, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Département de Biostatistique, Santé Publique et Information Médicale [CHU Pitié-Salpêtrière] (BIOSPIM ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Salvator [CHU - APHM] (Hôpitaux Sud), Assistance Publique - Hôpitaux de Marseille (APHM), CHU Limoges, Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Service de réanimation [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital de la Timone [CHU - APHM] (TIMONE), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service de Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Institut de cardiologie [CHU Pitié-Salpêtrière], Institut National de la Santé et de la Recherche Médicale (INSERM), Reanimation Médicale et Infectieuse [Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bichat-Claude Bernard, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (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), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, 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), Sorbonne Université (SU), Aix Marseille Université (AMU), Hôpital Nord [CHU - APHM], Hôpital Saint Eloi (CHRU Montpellier), Hôpital Edouard Herriot [CHU - HCL], CHU Gabriel Montpied [Clermont-Ferrand], Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Hôpital Dupuytren [CHU Limoges], CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital Cochin [AP-HP], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], and Hôpital Sainte-Anne [Paris]
Subjects: [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV]Life Sciences [q-bio]
Abstract: International audience; Importance: The role of herpes simplex virus (HSV) reactivation on morbidity and mortality in patients in the intensive care unit requiring mechanical ventilation remains unknown.Objective: To determine whether preemptive treatment with intravenous acyclovir reduces the duration of mechanical ventilation in patients with HSV oropharyngeal reactivation.Design, setting, and participants: A double-blind, placebo-controlled randomized clinical trial was conducted in 16 intensive care units in France. Participants included 239 adults (age, >18 years) who received mechanical ventilation for at least 96 hours and continued to receive mechanical ventilation for 48 hours or more, with HSV oropharyngeal reactivation. Patients were enrolled between February 2, 2014, and February 22, 2018.Interventions: Participants were randomized to receive intravenous acyclovir, 5 mg/kg, 3 times daily for 14 days or a matching placebo.Main outcomes and measures: The primary end point was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included mortality at 60 days. Main analyses were conducted on an intention-to-treat basis.Results: Of 239 patients enrolled and randomized, 1 patient withdrew consent, leaving 238 patients, with 119 patients in both the acyclovir and placebo (control) groups (median [IQR] age, 61 [50-70] years; 76 [32%] women) available for primary outcome measurement. On day 60, the median (IQR) numbers of ventilator-free days were 35 (0-53) for acyclovir recipients and 36 (0-50]) for controls (P = .17 for between-group comparison). Among secondary outcomes, 26 patients (22%) and 39 patients (33%) had died at day 60 (risk difference, 0.11, 95% CI, -0.004 to 0.22, P = .06). The adverse event frequency was similar for both groups (28% in the acyclovir group and 23% in the placebo group, P = .40), particularly acute renal failure post randomization affecting 3 acyclovir recipients (3%) and 2 controls (2%). Four patients (3%) in the acyclovir group vs none in the placebo group stopped the study drug for treatment-related adverse events.Conclusions and relevance: In patients receiving mechanical ventilation for 96 hours or more with HSV reactivation in the throat, use of acyclovir, 5 mg/kg, 3 times daily for 14 days, did not increase the number of ventilator-free days at day 60, compared with placebo. These findings do not appear to support routine preemptive use of acyclovir in this setting.Trial registration: ClinicalTrials.gov identifier: NCT02152358.
Published: 2019

243. The Fami-life study: protocol of a prospective observational multicenter mixed study of psychological consequences of grieving relatives in French palliative care units on behalf of the family research in palliative care (F.R.I.P.C research network)

Author: Véronique Michonneau-Gandon, Laure Copel, Virginie Verliac, Dominique Gracia, Gaelle Ranchou, Willeme Kaczmarek, Emmanuel De Larivière, Maité Garrouste-Orgeas, Adrien Evin, Virginie Guastella, Catherine Verlaine, Frédéric Guirimand, Jean-François Timsit, Alaa Mhalla, Florent Bienfait, Licia Touzet, Guillaume Bouquet, Marie Sonrier, Laurence Birkui de Francqueville, Ségolène Perruchio, Cécile Flahault, Anne Vanbésien, Sébastien Bailly, Carmen Mathias, Virginie Fossez-Diaz, Edith Poulain, Stéphane Ruckly, Véronique Marché, Cécile Poupardin, Dominique Michel, Bruno Richard, Salvy-Córdoba, Nathalie, Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Psychopathologie et Processus de Santé (LPPS - EA 4057), Université Paris Descartes - Paris 5 (UPD5), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de recherche Versailles Saint-Quentin Institutions Publiques (VIP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CH de Troyes, Centre Hospitalier [Douai, Nord], Centre Hospitalier de la Dracénie [Draguignan], Centre Hospitalier Compiègne-Noyon, Centre Hospitalier Tourcoing, Groupe Hospitalier Diaconesses Croix Saint-Simon, Groupe hospitalier de la région de Mulhouse Sud-Alsace (GHRMSA), Hopital de Salon d eProvence, AP-HP Hôpital A. Chenevier [Créteil], Centre Hospitalier Intercommunal Castres-Mazamet, Service d'Hépato-Gastroentérologie, Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hopital de Périgueux (CH Périgueux), Hopital de Périgueux, Centre de Soins Palliatifs [CHU Clermont-Ferrand] (CSP), CHU Louise Michel [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Informatique et Distribution (ID-IMAG), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National Polytechnique de Grenoble (INPG)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon, CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)
Subjects: medicine.medical_specialty, Palliative care, media_common.quotation_subject, lcsh:Special situations and conditions, [SDV.NEU.PC] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Psychology and behavior, [SDV.CAN]Life Sciences [q-bio]/Cancer, Anxiety, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, [SDV.CAN] Life Sciences [q-bio]/Cancer, Surveys and Questionnaires, Humans, Medicine, Family, Prospective Studies, 030212 general & internal medicine, Psychiatry, Depression (differential diagnoses), media_common, Interpretative phenomenological analysis, [SDV.NEU.PC]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Psychology and behavior, business.industry, Minimal clinically important difference, Incidence (epidemiology), lcsh:RC952-1245, Post-traumatic, General Medicine, Stress disorders, Relatives, 3. Good health, 030220 oncology & carcinogenesis, Grief, Observational study, France, medicine.symptom, business
Abstract: Background Grieving relatives can suffer from numerous consequences like anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and prolonged grief. This study aims to assess the psychological consequences of grieving relatives after patients’ death in French palliative care units and their needs for support. Methods This is a prospective observational multicenter mixed study. Relatives of adult patients with a neoplasia expected to be hospitalized more than 72 h in a palliative care unit for end-of-life issues will be included within 48 h after patient admission. End-of-life issues are defined by the physician at patient admission. Relatives who are not able to have a phone call at 6-months are excluded. The primary outcome is the incidence of prolonged grief reaction defined by an ICG (Inventory Complicate Grief) > 25 (0 best-76 worst) at 6 months after patient’ death. Prespecified secondary outcomes are the risk factors of prolonged grief, anxiety and depression symptoms between day 3 and day 5 and at 6 months after patients’ death based on an Hospital Anxiety and Depression score (range 0–42) > 8 for each subscale (minimal clinically important difference: 2.5), post-traumatic stress disorder symptoms 6 months after patient’ death based on the Impact of Events Scale questionnaire (0 best-88 worst) score > 22, experience of relatives during palliative care based on the Fami-Life questionnaire, specifically built for the study. Between 6 and 12 months after the patient’s death, a phone interview with relatives with prolonged grief reactions will be planned by a psychologist to understand the complex system of grief. It will be analyzed with the Interpretative Phenomenological Analysis. We planned to enroll 500 patients and their close relatives assuming a 25% prolonged grief rate and a 6-month follow-up available in 60% of relatives. Discussion This study will be the first to report the psychological consequences of French relatives after a loss of a loved one in palliative care units. Evaluating relatives’ experiences can provide instrumental insights for means of improving support for relatives and evaluation of bereavement programs. Trial registration NCT03748225 registered on 11/19/2018. Recruiting patients.
Published: 2019

244. 2018 Consensus of the French Society of Endocrinology: endocrine toxicities of cancer immunotherapies

Author: Castinetti, Frederic, Borson-Chazot, Francoise, Aibarel, Frederique, Archambeaud, Francoise, Bertherat, Jerome, Bouillet, Benjamin, Buffier, Perrine, Briet, Claire, Cariou, Bertrand, Caron, Philippe, Chabre, Olivier, Chanson, Philippe, Cortet, Christine, Do Cao, Christine, Drui, Delphine, Haissaguerre, Magali, Hescot, Segolene, Illouz, Frederic, Kuhn, Emmanuelle, Lahlou, Najiba, Merlen, Emilie, Raverot, Veronique, Smati, Sarra, Verges, Bruno, 2018, Consensus SFE, Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Centre de médecine nucléaire, Groupement Hospitalier Lyon-Est (GHE), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Fédération d'endocrinologie, Service de Médecine interne B, Endocrinologie, Diabète, Maladies métaboliques [CHU Limoges], CHU Limoges, 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), Service d'Endocrinologie, Diabétologie et Maladies Métaboliques (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Department of Endocrinology [Nantes], Institut du Thorax [Nantes], Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service d'endocrinologie, CHU Grenoble-Hôpital Michallon, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service d’endocrinologie, diabétologie et maladies métaboliques [CHRU LIlle], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Département d'Endocrinologie [CHU Nantes] (Institut du Thorax), Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut du Thorax [Nantes], Service d'endocrinologie, diabétologie et nutrition (CHU de Bordeaux), CHU Bordeaux [Bordeaux], Récepteurs stéroïdiens : physiopathologie endocrinienne et métabolique, Université Paris-Sud - Paris 11 (UP11)-IFR93-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Endocrinologie, Diabétologie et Nutrition [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Laboratoire de Biologie hormonale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Saint-Vincent de Paul, Service de Biochimie et Biologie moléculaire [CH Lyon Sud], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Fédération d'endocrinologie-Groupement hospitalier Lyon-Est, Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR93-Université Paris-Sud - Paris 11 (UP11), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Gall, Valérie
Subjects: Thyroiditis, [SDV.GEN]Life Sciences [q-bio]/Genetics, Diabetes, [SDV.GEN] Life Sciences [q-bio]/Genetics, Immunotherapy, Hypophysitis, Adrenal insufficiency
Abstract: Immunotherapy induced side effects: Are frequent, usually well-tolerated, and can lead to thyroid, pituitary, and less frequently adrenals and pancreas (fulminant diabetes) disease,. Do not contra-indicate immunotherapy, and rarely require high dose glucocorticoids; Need to be screened for, as there are acute manifestations, and replacement treatments can be given lifelong; Require a pre-immunotherapy evaluation; Require a careful follow-up at least during the first 6 months of immunotherapy.
Published: 2019

245. Impact of the Primary Tumor Location on the Prognosis for Colon Cancer

Author: Faucheron, Jean-Luc, Girard, Edouard, Trilling, Bertrand, Unité de Chirurgie Colorectale, CHU Grenoble-Hôpital Michallon, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), Université Grenoble Alpes - UFR Médecine (UGA UFRM), and Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Subjects: [SDV]Life Sciences [q-bio], ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2019

246. Letter to the Editor: Protein phosphatase 1 subunit Ppplrl 5a/GADD34 is overexpressed in systemic lupus erythematosus and related to the expression of type I interferon response genes

Author: Plazy, Caroline, Dumestre-Perard, Chantal, Sarrot-Reynaud, Francoise, Audoin, Pierre, Quesada, Jean-Louis, Bouillet, Laurence, Cesbron, Jean-Yves, Clavarino, Giovanna, Pierre, Philippe, LABORATOIRE D'IMMUNOLOGIE, Centre Hospitalier Universitaire [Grenoble] (CHU), Barrière Naturelle et Infectiosité (TIMC-IMAG-BNI), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), CIC- Grenoble, CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique [Grenoble] (CIC Grenoble ), CHU Grenoble-Hôpital Michallon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre d'Immunologie de Marseille - Luminy (CIML), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), and Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: [SDV.IMM]Life Sciences [q-bio]/Immunology, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2019

247. Comment on 'What Expert Surgeons Never Tell You About Robot-assisted Surgery for Rectal Cancer?'

Author: Bertrand Trilling, Jean-Luc Faucheron, P.-Y. Sage, Unité de Chirurgie Colorectale, CHU Grenoble-Hôpital Michallon, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Grenoble Alpes - UFR Médecine (UGA UFRM), and Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Subjects: medicine.medical_specialty, Colorectal cancer, business.industry, General surgery, [SDV]Life Sciences [q-bio], medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, medicine, Robot, 030211 gastroenterology & hepatology, Surgery, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2019

248. Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database

Author: Morvan, Anne-Cécile, Hengy, Baptiste, Garrouste-Orgeas, Maïté, Ruckly, Stéphane, Forel, Jean-Marie, Argaud, Laurent, Rimmelé, Thomas, Bedos, Jean-Pierre, Azoulay, Elie, Dupuis, Claire, Mourvillier, Bruno, Schwebel, Carole, Timsit, Jean-François, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Medical-Surgical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Agressions vasculaires et réponses tissulaires, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Soins Intensifs [Versailles], Centre Hospitalier de Versailles (CHV), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7), Service d'Anesthésie et Soins Intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bichat, Centre Hospitalier Universitaire [Grenoble] (CHU), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Unité de Soins Intensifs [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Université Paris Diderot - Paris 7 (UPD7)-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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bichat, BRICHEUX, Genevieve, Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Male, Critical Care, Enterococcaceae, Peritonitis, Statistics, Nonparametric, Intraabdominal infections, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Humans, Mortality, Aged, Proportional Hazards Models, Retrospective Studies, Chi-Square Distribution, Enterococcus spp, Research, Incidence, Middle Aged, Antibiotic therapy, Anti-Bacterial Agents, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Intensive care, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract: Introduction Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp. Material and methods Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality. Results Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3–15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0–10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors. Conclusion An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months. Electronic supplementary material The online version of this article (10.1186/s13054-019-2581-8) contains supplementary material, which is available to authorized users.
Published: 2019

249. Systemic air embolism depicted on systematic whole thoracic CT acquisition after percutaneous lung biopsy: Incidence and risk factors

Author: Marie Christine Picot, Hélène Vernhet-Kovacsik, Sébastien Bommart, Juliette Vanoverschelde, Hamid Zarqane, Valérie Monnin-Bares, Guillaume Chassagnon, MORNET, Dominique, Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre de vision numérique (CVN), Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec, Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Université de Montpellier (UM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Target lesion, Male, medicine.medical_specialty, Percutaneous, air, Embolism, Lung biopsy, Air embolism, Image-guided biopsy, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Biopsy, medicine, Embolism, Air, Humans, Radiology, Nuclear Medicine and imaging, Tomography, Aged, Retrospective Studies, Lung, medicine.diagnostic_test, Interventional, business.industry, Incidence, Biopsy, Needle, General Medicine, Middle Aged, medicine.disease, Prone position, medicine.anatomical_structure, Risk factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 030220 oncology & carcinogenesis, X-Ray computed, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Female, Radiography, Thoracic, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Radiology, business, Tomography, X-Ray Computed
Abstract: International audience; Objectives: To evaluate the incidence and risk factors of systemic air embolism (SAE) depicted on systematic whole thoracic CT performed after percutaneous lung biopsy.Methods: A total of 559 CT-guided lung biopsies performed between April 2014 and May 2016 were retrospectively evaluated. SAE was defined by the presence of air in the aorta or left cardiac cavities seen on whole thorax CT images acquired after needle withdrawal. Analyzed data focused on patient (age, sex, spirometry data, emphysema on CT, therapeutics received), target lesion (location, depth, size and feature) and procedure (patient position, length of intrapulmonary needle path, number of pleural passes and of biopsy samples, operator’s experience). A regression logistic model was used to identify risk factors of SAE.Results: SAE was observed after 27 of the 559 lung biopsies, corresponding to a radiological incidence of 4.8% (95%CI: 3.3–7.0). Clinical incidence was 0.17% (n = 1). For 21/27 patients (78%), a targeted acquisition in the nodule area would not have included the cardiac cavities meaning SAE would have been missed. On multivariate analysis, the independent risk factors were needle path length through ventilated lung (OR: 1.13, 95%CI: 1.02–1.25, p = 0.024), number of samples (OR: 1.48, 95%CI: 1.01–2.17, p = 0.046) and prone position (OR: 3.12, 95%CI: 1.11–8.31, p = 0.031) or right-sided lateral decubitus (OR: 6.15, 95%CI: 1.66–22.85, p = 0.005).Conclusions: Asymptomatic systemic air embolism can be depicted in almost 5% of post biopsy CT examinations, when they are not limited to the targeted nodule area but include the entire thorax.
Published: 2019

250. Expert opinion on the use of biological therapy in non-infectious uveitis

Author: Damien Sène, David Saadoun, Bahram Bodaghi, Eleonore Diwo, Sébastien Abad, Pascal Sève, Jérémie Sellam, Antoine P. Brézin, Michel Weber, Isabelle Koné Paut, Patrice Cacoub, Christophe Chiquet, Salim Trad, Laurent Kodjikian, Pierre Quartier, Marie-Hélène Errera, Gilles Kaplanski, Sara Touhami, Philip Bielefeld, Service d'ophtalmologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Médecine Interne - Centre Hospitalier Lyon Sud, Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), AP-HP, Service de Médecine Interne, Hôpital Ambroise Paré, F-92100, Boulogne Billancourt, France, Hôpital Ambroise Paré [AP-HP], Service de médecine interne et maladies systémiques (SOC 2) [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de médecine interne [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de médecine interne [Avicenne], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], Centre de Recherche Claude Delorme [Jouy-en-Josas] (CRCD), Air Liquide [Siège Social], Service d'Ophtalmologie [Grenoble], Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Sorbonne Université - Faculté de Médecine - École de sages-femmes Saint-Antoine (SU ESF), Sorbonne Université (SU), Service de médecine interne et d'immunologie clinique [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), Médecine interne et immunologie clinique [Hôpital de la Conception - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Matériaux, ingénierie et science [Villeurbanne] (MATEIS), 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)-Centre National de la Recherche Scientifique (CNRS), AP-HP, Hôpital Ambroise Paré, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Hôpital Avicenne, CHU Cochin [AP-HP], Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Département de médecine interne et immunologie clinique [CHU Pitié-Salpêtrière] (DMIIC), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION)-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)
Subjects: 0301 basic medicine, medicine.medical_specialty, Clinical Biochemistry, Azathioprine, Review, Antibodies, Monoclonal, Humanized, [SPI.MAT]Engineering Sciences [physics]/Materials, 03 medical and health sciences, Infectious uveitis, chemistry.chemical_compound, tocilizumab, 0302 clinical medicine, Tocilizumab, Vitrectomy, adalimumab, Drug Discovery, Adalimumab, Humans, Medicine, human, Intensive care medicine, Sirolimus, Pharmacology, azathioprine, business.industry, rapamycin, steroid, mycophenolate mofetil, Antibodies, Monoclonal, interferon, Biological product, immunosuppressive agent, medicine.disease, Infliximab, 3. Good health, 030104 developmental biology, chemistry, biological therapy, 030220 oncology & carcinogenesis, Expert opinion, uveitis, business, infliximab, biological product, Immunosuppressive Agents, Uveitis, medicine.drug
Abstract: cited By 1; International audience; Introduction: Conventional immunosuppressive drugs, anti-TNF alpha treatments and biotherapies are increasingly being used in non-infectious uveitis. Areas covered: The present work was led by a multidisciplinary panel of experts, including internal medicine specialists, rheumatologists and ophthalmologists, and proposes an extensive review on the use of biological agents in non-infectious uveitis. Expert opinion: In case of dependency to steroids or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or biological therapies such as anti-TNF alpha treatments (adalimumab, infliximab) can be used to achieve and maintain disease quiescence. Interferon is an efficient immunomodulatory drug that can be proposed as second-line therapy in specific indications (eg. refractory macular edema, sight-threatening Behçet’s uveitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (steroids, sirolimus etc.) can be used as adjuvant therapies in case of unilateral relapse. Therapeutic response must always be evaluated by clinical examination and appropriate ancillary investigations. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Published: 2019

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