Search

Your search keyword '"Centre hospitalier Les Chanaux [Mâcon]"' showing total 16 results
Start Over Author "Centre hospitalier Les Chanaux [Mâcon]"
16 results on '"Centre hospitalier Les Chanaux [Mâcon]"'

1. Low performance of prognostic tools for predicting death before dialysis in older patients with advanced CKD

Author

Cécile Vigneau, C. Prelipcean, Pspa Study Investigators, Valéry Antoine, Cécile Couchoud, Julien Prouvot, Olivier Moranne, Maud Francois, Christophe Mariat, Emilie Pambrun, Sophie Roche, Daniela Babici, Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Agence de la biomédecine [Saint-Denis la Plaine], CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre hospitalier Les Chanaux [Mâcon], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), La Societe Francophone de Nephrologie et de Dialyse, La Societe Francaise de Nephrologie Dialyse Transplantation, l'Agence de BiomedecineFrench National Research Agency (ANR), Nimes University Hospital, Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Saint-Etienne, Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA)

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, 030232 urology & nephrology, Renal function, Disease, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, Elderly, Renal Dialysis, Risk Factors, Internal medicine, CKD, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, ESRD, Renal Insufficiency, Chronic, education, Dialysis, Aged, Aged, 80 and over, education.field_of_study, business.industry, Absolute risk reduction, medicine.disease, Prognosis, 3. Good health, Brier score, Nephrology, Cohort, Disease Progression, business, Kidney disease, Glomerular Filtration Rate
Abstract

International audience; Introduction Chronic kidney disease (CKD) is a disease which is spreading worldwide, especially among older patients. Several prognostic scores have been developed to predict death in older CKD patients, but they have not been validated. We aimed to evaluate the existing risk scores for predicting death before dialysis start, identified via an in-depth review, in a cohort of elderly patients with advanced CKD. Methods We performed a review to identify scores predicting death, developed in and applicable to CKD patients. Each score was evaluated with an absolute risk calculation from the patients' baseline characteristics. We used a French prospective multicentre cohort of elderly patients (> 75 years) with advanced CKD [estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m(2)], recruited from nephrological centres, with a 5-year follow-up. The outcome considered was death before initiating dialysis. Discrimination [area under curve (AUC)], calibration and Brier score were calculated for each score at its time frame. Results Our review found 6 equations predicting death before dialysis in CKD patients. Four of these (GOLDFARB, BANSAL, GRAMS 2 and 4 years) were evaluated. The validation cohort (Parcours de Soins des Personnes agees Parcours de Soins des Personnes agees, PSPA) included 573 patients, with a median age of 82 years and a median eGFR of 13 mL/min/1.73 m(2). At the end of follow-up, 287 (50%) patients had started dialysis and 238 (41%) patients had died before dialysis. The four equations evaluated showed average discrimination (AUC 0.61-0.70) and, concerning calibration, a global overestimation of the risk of death. Discussion The available scores predicting death before dialysis showed low performance among older patients with advanced CKD in a French multicentre cohort, indicating the need to upgrade them or develop new scores for this population.

Published
2021
Full Text
View/download PDF

2. Démocratie sanitaire : le patient partenaire de sa prise en charge

Author

A. Escande, F. Lorchel, T. Haaser, Jean-Léon Lagrange, S. Marty, S. Thureau, P. Le Tallec, Y. Constantinidès, Florence Huguet, Catherine Dejean, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Université Sorbonne Nouvelle - Paris 3, Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Centre de Recherche en Informatique, Signal et Automatique de Lille - UMR 9189 (CRIStAL), Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Laboratoire d'Informatique, de Traitement de l'Information et des Systèmes (LITIS), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA), Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre hospitalier Les Chanaux [Mâcon], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CCSD, Accord Elsevier, Equipe Quantification en Imagerie Fonctionnelle (QuantIF-LITIS), Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Université Le Havre Normandie (ULH), Normandie Université (NU), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut Universitaire de Cancérologie [Sorbonne Université] (IUC)

Subjects
Ethics, [SDV]Life Sciences [q-bio], Patient partnership, Radiation oncology, 3. Good health, [SDV] Life Sciences [q-bio], 03 medical and health sciences, Shared decision, 0302 clinical medicine, Oncology, 030220 oncology & carcinogenesis, Political science, Security, Radiology, Nuclear Medicine and imaging, Humanities
Abstract

Resume En 2019, le bureau de la Societe francaise de radiotherapie oncologique (SFRO) a cree une commission ethique. Sa mission est de proposer a notre communaute professionnelle des elements de reflexion a propos de questionnements ethiques, et d’en degager les specificites au sein des services d’oncologie radiotherapie. A l’occasion du congres annuel de 2020, la commission s’est penchee sur l’evolution de la relation soigne-soignant, et plus particulierement sur l’idee forte de partenariat patient. En effet, la redaction du Livre blanc du cancer a donne la parole aux personnes malades et souligne la necessite de nouveaux dispositifs, tels que le « temps d’accompagnement soignant ». Les patients ne peuvent plus etre consideres comme des objets de soin mais comme des personnes dont la dignite et l’autonomie doivent etre imperativement respectees. L’acquisition de connaissances autorise un echange bilateral, prerequis de la dynamique collaborative. Ils peuvent etre partenaires de leurs propres soins, partenaires de la formation et de la recherche (patient expert) mais egalement partenaires des institutions et politiques de sante. C’est cette notion de partenariat et d’implication de la personne dans son parcours de soin en oncologie radiotherapie que nous allons analyser ici. Il s’agira autant de la definir, en developpant la notion d’autonomie, que d’en faire emerger la complexite et l’ambivalence au travers notamment de deux exemples issus de notre pratique clinique : la demarche de decision partagee pour les patients ayant un cancer de la prostate localise et l’implication du patient dans le bon deroulement de sa radiotherapie.

Published
2020
Full Text
View/download PDF

3. Low performance of prognostic tools for predicting dialysis in elderly people with advanced CKD

Author

Julien, Prouvot, Emilie, Pambrun, Cecile, Couchoud, Cecile, Vigneau, Sophie, Roche, Vincent, Allot, Jerome, Potier, Maud, Francois, Daniela, Babici, Camelia, Prelipcean, Olivier, Moranne, Didier, Aguiléra, Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Agence de la biomédecine [Saint-Denis la Plaine], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre hospitalier Les Chanaux [Mâcon], CHU Limoges, Centre hospitalier Saint-Brieuc, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Societe Francaise de Nephrologie Dialyse Transplantation, Agence de Biomedecine, Societe Francophone de Nephrologie et de Dialyse, University hospital of Nimes, Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Nephrology, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, 030232 urology & nephrology, 030204 cardiovascular system & hematology, urologic and male genital diseases, End stage renal disease, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Risk Factors, Internal medicine, medicine, Humans, Renal replacement therapy, Prospective Studies, ESRD, Renal Insufficiency, Chronic, education, Dialysis, Aged, Nephrogeriatry, Aged, 80 and over, education.field_of_study, business.industry, Absolute risk reduction, medicine.disease, Prognosis, female genital diseases and pregnancy complications, Predictive model, Cohort, Disease Progression, Kidney Failure, Chronic, business, Kidney disease, Glomerular Filtration Rate
Abstract

International audience; Introduction Clinical decision-making about care plans can be difficult for very elderly people with advanced chronic kidney disease (CKD). Current guidelines propose the use of prognostic tools predicting end stage renal disease (ESRD) to assist in a patient-centered shared decision-making approach. Our objective was to evaluate the existing risk model scores predicting ESRD, from data collected for a French prospective multicenter cohort of mainly octogenarians with advanced CKD. Methods We performed a rapid review to identify the risk model scores predicting ESRD developed from CKD patient cohorts and evaluated them with data from a prospective multicenter French cohort of elderly (> 75 years) patients with advanced CKD (estimated glomerular filtration rate [eGFR] < 20 mL/min/1.75m(2)), followed up for 5 years. We evaluated these scores (in absolute risk) for discrimination, calibration and the Brier score. For scores using the same time frame, we made a joint calibration curve and compared areas under the curve (AUCs). Results The PSPA cohort included 573 patients; their mean age was 83 years and their median eGFR was 13 mL/min/1.73 m(2). At the end of follow-up, 414 had died and 287 had started renal replacement therapy (RRT). Our rapid review found 12 scores that predicted renal replacement therapy. Five were evaluated: the TANGRI 4-variable, DRAWZ, MARKS, GRAMS, and LANDRAY scores. No score performed well in the PSPA cohort: AUCs ranged from 0.57 to 0.65, and Briers scores from 0.18 to 0.25. Conclusions The low predictiveness for ESRD of the scores tested in a cohort of octogenarian patients with advanced CKD underlines the need to develop new tools for this population. Graphic abstract

Published
2020
Full Text
View/download PDF

4. L’hospitalisation de jour en addictologie

Author

Delphine Lefranc, Loetitia Rotheval, Sandrine Plattier, Pascal Menecier, Développement, Individu, Processus, Handicap, Éducation (DIPHE), Université Lumière - Lyon 2 (UL2), and Centre hospitalier Les Chanaux [Mâcon]

Subjects
Service (business), [SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT], medicine.medical_specialty, business.industry, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, media_common.quotation_subject, [SHS.PSY]Humanities and Social Sciences/Psychology, General Medicine, Abstinence, Harm, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Emergency medicine, Medicine, Day hospital, Pshychiatric Mental Health, Substance use, Hospital service, business, ComputingMilieux_MISCELLANEOUS, media_common
Abstract

The day hospital in addictology is a recent hospital service for patients with substance use disorders. It lies somewhere between an inpatient withdrawal unit and outpatient consultations. The day hospital service provides care ranging from withdrawal preparation, abstinence support, the reduction of risks or harm and long-term support for patients.

Published
2019
Full Text
View/download PDF

5. Alcool et crise suicidaire du sujet âgé

Author

Pascal Menecier, A. Sagne, Développement, Individu, Processus, Handicap, Éducation (DIPHE), Université Lumière - Lyon 2 (UL2), and Centre hospitalier Les Chanaux [Mâcon]

Subjects
[SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT], [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, [SHS.PSY]Humanities and Social Sciences/Psychology, 16. Peace & justice, 3. Good health, 030227 psychiatry, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Neurology (clinical), Geriatrics and Gerontology, 030217 neurology & neurosurgery, ComputingMilieux_MISCELLANEOUS
Abstract

Resume La crise suicidaire prend des aspects differents dans la vieillesse, avec moins de tentatives et plus de suicides accomplis. Les consommations d’alcool diminuent en quantite avec l’âge et la part d’abstinents s’accroit sans que le mesusage disparaisse. La consommation d’alcool a des effets negatifs sur la crise suicidaire : entre effets desinhibiteurs d’alcoolisations au moment du passage a l’acte suicidaire (augmentant l’impulsivite et la gravite des tentatives de suicide), ou role des consequences dysthymiques et psychosociales du mesusage d’alcool qui majorent le risque suicidaire. Reperer puis traiter les depressions et les troubles de l’usage d’alcool participent a la prevention du suicide du sujet âge. Rechercher des alcoolisations associees aux crises suicidaires participe a la prevention des recidives.

Published
2020
Full Text
View/download PDF

6. L’alcoolisme est-il toujours une maladie au XXI e siècle ?

Author

Pascal Menecier, Louis Ploton, Sandrine Plattier, Lydia Fernandez, Développement, Individu, Processus, Handicap, Éducation (DIPHE), Université Lumière - Lyon 2 (UL2), Centre hospitalier Les Chanaux [Mâcon], Institut de Psychologie, Laboratoire sur les Vulnérabilités et l'Innovation dans le Sport (EA 7428) (L-VIS), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon

Subjects
03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Arts and Humanities (miscellaneous), [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, [SHS.PSY]Humanities and Social Sciences/Psychology, ComputingMilieux_MISCELLANEOUS, 030217 neurology & neurosurgery, Applied Psychology, 030227 psychiatry
Abstract

Resume L’alcool est la substance psychoactive preeminente dans nos cultures, dont l’usage a ete etroitement lie a l’histoire de la societe. L’alcool peut etre consomme dans le cadre d’usage ou de mesusage. Cette necessaire distinction permet d’envisager les troubles de l’usage de l’alcool sous differents paradigmes, comme celui de l’alcoolisme, la maladie alcoolique ou l’addiction alcoolique. La notion de maladie alcoolique, operatoire ou alienante, conditionne l’adequation de l’accueil des sujets, relevant de ces troubles en tant que malades, par des professionnels de sante. En alternative, le concept d’addiction a l’alcool requiert des attentions pour tenter d’en preciser les avantages, les limites ou les exces, sans qu’il resolve les interrogations autour du concept de maladie alcoolique.

Published
2018
Full Text
View/download PDF

7. Safety and Efficacy of Immune Checkpoint Inhibitors in Patients with Cancer and Preexisting Autoimmune Disease: A Nationwide Multicenter Cohort Study

Author

François-Xavier Danlos, Club Rhumatismes et Inflammations, Catherine Dubos, Thierry Lesimple, Gilles Gonzales, Julie De Quatrebarbes, Laurent Misery, Florence Brunet-Possenti, Marie Kostine, Emmanuel Nowak, Mickaël Lambert, Elisa Funck-Brentano, Laurent Chiche, Stéphanie Martinez, Sandrine Mansard, Hélène Doubre, Marie Marcq, Camille Scalbert, Yohann Loriot, Olivier Lambotte, Sarah Maanaoui, Gwenaelle Le Garff, Marie Beylot-Barry, Christos Chouaid, Jean-Bernard Auliac, Anne Pham-Ledard, Emilie Routier, Damien Giacchero, Bertille Bonniaud, Hervé Vallerand, Gilles Quere, C. Stavris, Florian Guisier, François Aubin, Chantal Decroisette, Nathalie Beneton, Ouidad Zehou, Alice Tison, Caroline Robert, Christophe Roge, R. Veillon, Groupe de cancérologie cutanée, François Skowron, Catherine Michel, Divi Cornec, Ioana Carpiuc, Nora Kramkimel, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hôpital Ambroise Paré , Assistance Publique - Hôpitaux de Paris (AP - HP), Institut Gustave Roussy (IGR), Oncologie dermatologique, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Oncologie génito-urinaire, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Eugène Marquis (CRLCC), Hopital d'Aix en Provence, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), CHI Créteil, Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Européen [Fondation Ambroise Paré - Marseille], Centre Hospitalier Le Mans (CH Le Mans), CHU Clermont-Ferrand, CHU Rouen, Normandie Université (NU), Equipe Quantification en Imagerie Fonctionnelle (QuantIF-LITIS), Laboratoire d'Informatique, de Traitement de l'Information et des Systèmes (LITIS), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Université Le Havre Normandie (ULH), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA), Hôpital Foch [Suresnes], Centre Hospitalier de Valence (CH DE VALENCE), Centre hospitalier de Valence, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CHU Henri Mondor, CH Morlaix, CHU Bordeaux [Bordeaux], Hôpital Cochin [AP-HP], Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), CH, Mantes-La-Jolie, Centre hospitalier Les Chanaux [Mâcon], Hôpital de St Brieuc, Clinique des Cèdres, Service de Médecine Respiratoire [CHU Reims], Centre Hospitalier Universitaire de Reims (CHU Reims), Lymphocytes B, Autoimmunité et Immunothérapies (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-LabEX IGO Immunothérapie Grand Ouest-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), CHD Vendee (La Roche Sur Yon), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Lymphocyte B et Auto-immunité (LBAI), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM)

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Immunology, autoimmune disease, Inflammatory bowel disease, Autoimmune Diseases, immune checkpoint inhibitors, 03 medical and health sciences, 0302 clinical medicine, Antineoplastic Agents, Immunological, Rheumatology, Internal medicine, Psoriasis, Neoplasms, medicine, Immunology and Allergy, Humans, cancer, Progression-free survival, Survival rate, Aged, Retrospective Studies, Autoimmune disease, Aged, 80 and over, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Symptom Flare Up, Progression-Free Survival, 3. Good health, Discontinuation, Survival Rate, 030104 developmental biology, Treatment Outcome, 030220 oncology & carcinogenesis, Rheumatoid arthritis, immune-related adverse events, Female, immunotherapy, business, Immunosuppressive Agents
Abstract

Objective Immune checkpoint inhibitors (ICIs) for cancer therapy frequently induce immune-related adverse effects (IRAEs). Therefore, most patients with preexisting autoimmune diseases have been excluded from clinical trials of ICIs. This study was undertaken to evaluate the safety and efficacy of ICIs in patients with preexisting autoimmune disease and cancer. Methods A retrospective cohort study was conducted from January 2017 to January 2018 via 3 French national networks of experts in oncology and autoimmunity. Adults with preexisting autoimmune disease who were receiving ICIs were assessed for the occurrence of flare of preexisting autoimmune disease, other IRAEs, and cancer response. Results The study included 112 patients who were followed up for a median of 8 months. The most frequent preexisting autoimmune diseases were psoriasis (n = 31), rheumatoid arthritis (n = 20), and inflammatory bowel disease (n = 14). Twenty-four patients (22%) were receiving immunosuppressive therapy at ICI initiation. Autoimmune disease flare and/or other IRAE(s) occurred in 79 patients (71%), including flare of preexisting autoimmune disease in 53 patients (47%) and/or other IRAE(s) in 47 patients (42%), with a need for immunosuppressive therapy in 48 patients (43%) and permanent discontinuation of ICI in 24 patients (21%). The median progression-free survival was shorter in patients receiving immunosuppressive therapy at ICI initiation (3.8 months versus 12 months; P = 0.006), confirmed by multivariable analysis. The median progression-free survival was shorter in patients who experienced a flare of preexisting autoimmune disease or other IRAE, with a trend toward better survival in the subgroup without immunosuppressant use or ICI discontinuation. Conclusion Our findings indicate that flares or IRAEs occur frequently but are mostly manageable without ICI discontinuation in patients with a preexisting autoimmune disease. Immunosuppressive therapy at baseline is associated with poorer outcomes.

Published
2019
Full Text
View/download PDF

8. Efficacy and Safety of a Distraction-Rotation Knee Brace (odra) in Medial Knee Osteoarthritis - a Phase Iii Randomised Controlled Trial (ergonomie Study)

Author

Diaz, A., Morisset, Claire, Fournel, I., Soilly, A.-L., Bussiere, C., Cherasse, A., Conrozier, T., Loeuille, Damien, Timsit, Michèle, Wendling, Daniel, Casillas, Jean-Marie, Maillefert, Jean-Francis, Binquet, Christine, Ornetti, Paul, Service de Rhumatologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Plateforme d’Investigation Technologique [Centre d’Investigation Clinique 1432 module Plurithématique - Dijon] (PIT), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] (CAPS), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre d'Investigation Clinique 1432 (Dijon) - Module Plurithématique : Périnatalité Cancérologie Handicap et Ophtalmologie (CIC-P803), Institut National de la Santé et de la Recherche Médicale (INSERM)-Direction Générale de l'Organisation des Soins (DGOS)-Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Direction Générale de l'Organisation des Soins (DGOS), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'épidémiologie et d'hygiène hospitalières (CHU de Dijon), Délégation à la recherche clinique et à l'innovation [CHU Dijon] (DRCI), Centre orthopédique [Dracy-Le-Fort], Département de rhumatologie, Centre hospitalier de Macon, Centre hospitalier Les Chanaux [Mâcon], Centre Hospitalier de Belfort (Service de Rhumatologie), CH Belfort-Montbéliard, Service de Rhumatologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Clinique Provence Bourbonne, Service de Rhumatologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), and Pôle Rééducation - Réadaptation (Médecine Physique et Réadaptation) (CHU de Dijon)

Subjects
Medial knee osteoarthritis, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Distraction-rotation knee brace
Abstract

IF 12.3550; International audience; Background : According to EULAR and OARSI guidelines, evidence is inconclusive for the symptomatic benefits of an unloader knee brace in medial knee osteoarthritis (OA).Objectives : The objective of this multicenter randomised controlled trial (RCT) (ClinicalTrials Id. NCT02765685) was to compare the efficacy and safety of the ODRA brace, a distraction-rotation custom-made knee brace versus usual care over one year in medial knee OA.Methods : Patients with symptomatic medial knee OA (VAS pain scores at rest >40/100 for the medial compartment) and Kellgren-Lawrence (KL) grade II-IV were randomised in two groups: brace group (ODRA +usual care) vs usual care alone (UCA). Patients were followed up every two months for one year. Usual care consisted of all the pharmacological and non-pharmacological treatments used for the management of knee OA. The primary end-point was the difference of VAS-pain between M0 and M12. Secondary end-points included patient global assessment of disease severity (PGA) on VAS,% of patients reaching the PASS (VAS-pain 20/100) thresholds at M12, KOOS scores, OA-specific quality of life questionnaire (OAKHQOL), as well as drug intake. Safety and compliance were evaluated by recording side effects and average knee brace duration of wear, respectively.Results : Overall 120 patients (57% women) from 7 centres were included. Their characteristics were the following: mean age 63.6±11.4 years; BMI 29.6±5.5 kg/m2; OA duration 5.8±6 years; 52% KL III; 21% KL IV. The VAS pain decrease was statistically higher in the ODRA group (from 61.9±17.4 (M0) to 38.8±25.3 (M12) than in the UCA group (54.9±18.2 to 45.5±23.8) in the intent to treat bivariate and multivariate analyses (delta VAS-pain: 13.1±4.9, p

Published
2018
Full Text
View/download PDF

9. The transfer of multigene panel testing for hereditary breast and ovarian cancer to healthcare: What are the implications for the management of patients and families?

Author

Marie Eliade, Jeremy Skrzypski, Amandine Baurand, Caroline Jacquot, Geoffrey Bertolone, Catherine Loustalot, Charles Coutant, France Guy, Pierre Fumoleau, Yannis Duffourd, Laurent Arnould, Alexandra Delignette, Marie-Martine Padéano, Côme Lepage, Géraldine Raichon-Patru, Axelle Boudrant, Marie-Christine Bône-Lépinoy, Anne-Laure Villing, Aurélie Charpin, Karine Peignaux, Sandy Chevrier, Frédérique Vegran, François Ghiringhelli, Romain Boidot, Nicolas Sevenet, Sarab Lizard, Laurence Faivre, Centre de génétique - Centre de référence des maladies rares, anomalies du développement et syndromes malformatifs (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre Hospitalier d'Auxerre, Institut Bergonié - CRLCC Bordeaux, Plateforme de transfert en biologie cancérologique [Dijon], Centre d'épidémiologie des populations ( CEP ), Université de Bourgogne ( UB ) -Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ) -Université de Bourgogne ( UB ) -Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ), Imagerie Medicale Dijon Tour Elithis, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Service de radiothérapie [Centre Georges-François Leclerc], Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ), Centre Hospitalier Chalon-sur-Saône William Morey, Département d'oncologie médicale [Centre Georges-François Leclerc], Orphanomix, Université de Bourgogne ( UB ), Service d'hépato-gastroentérologie et cancérologie digestive (CHU de Dijon), Service de radiologie [Centre Georges-François Leclerc], Département de Biologie et pathologie des tumeurs [Centre Georges-François Leclerc], Lipides - Nutrition - Cancer [Dijon - U1231] ( LNC ), Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'oncologie et hépatologie [Centre Hospitalier de Mâcon : les Chanaux], Centre hospitalier Les Chanaux [Mâcon], Service d'hématologie et oncologie [Centre Hospitalier de Chalon-sur-Saône William Morey], Clinique Drévon, Service d'oncogénétique [Centre georges-François Leclerc], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Institut Bergonié [Bordeaux], UNICANCER, Centre d'épidémiologie des populations (CEP), Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), and Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
0301 basic medicine, Oncology, Male, Pediatrics, Candidate gene, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, Cohort Studies, Translational Research, Biomedical, 0302 clinical medicine, genomic capture, Gene Frequency, Professional-Family Relations, Family history, Practice Patterns, Physicians', Aged, 80 and over, next generation sequencing, High-Throughput Nucleotide Sequencing, Middle Aged, Penetrance, 3. Good health, Pedigree, Gene Expression Regulation, Neoplastic, 030220 oncology & carcinogenesis, Evidence-Based Practice, Practice Guidelines as Topic, Hereditary Breast and Ovarian Cancer Syndrome, Female, France, breast and ovarian cancer susceptibility genes, candidate genes, management, Adult, medicine.medical_specialty, Cancer-Predisposing Gene, PALB2, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, 03 medical and health sciences, Internal medicine, medicine, Biomarkers, Tumor, Humans, Genetic Predisposition to Disease, Genetic Testing, CHEK2, Aged, Physician-Patient Relations, business.industry, [ SDV.BC ] Life Sciences [q-bio]/Cellular Biology, Cancer, medicine.disease, 030104 developmental biology, business, Ovarian cancer, Transcriptome, Priority Research Paper
Abstract

IF 5.008 (2015/2016); International audience; Until recently, the molecular diagnosis of hereditary breast and ovarian cancer (HBOC) was mostly based on BRCA1/2 testing. Next generation sequencing and the recent discovery of new genes involved in HBOC now permit the transfer of genomic capture targeting multiple candidate genes from research to clinical use. However, the implications for the management of patients and their families have not been extensively studied, in particular since some of these genes are not well-established cancer predisposing genes. We studied 583 consecutive patients from Burgundy (France) fulfilling the criteria for BRCA testing using a next generation sequencing 25-genes panel including 20 well-established high-risk cancer genes as well as more recently identified predisposing HBOC cancer. A pathogenic BRCA1/2 mutation was found in 51 patients (9%). Besides, we found 37 pathogenic or likely pathogenic mutations in 10 different high to low-risk genes in 34 patients (6%). The most frequently mutated genes were CHEK2 (n = 12; 2%), ATM (n = 9; 1.5%), and PALB2 (n = 4; 0.6%). Three patients had a mutation in two different predisposing genes. The analysis of clinical actionability conducted in mutation-positive individuals revealed that additional disease-specific screening and/or prevention measures beyond those based on personal and family history alone had been recommended in 69% of cases. In conclusion, multigene panel testing is a powerful tool to identifying high to low-risk HBOC susceptibility genes. The penetrance and spectrum of cancers with these other genes are sometimes undefined, and further collaborative work is crucial to address this question.

Published
2017
Full Text
View/download PDF

10. Giant subperiosteal hematoma

Author

Pierre Pottecher, Paul Ornetti, Olivier Chevallier, Romaric Loffroy, Laurent Grimault, Service de Rhumatologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Laboratoire Electronique, Informatique et Image [UMR6306] (Le2i), Université de Bourgogne (UB)-Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure d'Arts et Métiers (ENSAM), Arts et Métiers Sciences et Technologies, HESAM Université (HESAM)-HESAM Université (HESAM)-Arts et Métiers Sciences et Technologies, HESAM Université (HESAM)-HESAM Université (HESAM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Département de rhumatologie, Centre hospitalier de Macon, Centre hospitalier Les Chanaux [Mâcon], Université de Bourgogne (UB)-École Nationale Supérieure d'Arts et Métiers (ENSAM), HESAM Université (HESAM)-HESAM Université (HESAM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Laboratoire Electronique, Informatique et Image ( Le2i ), and Université de Bourgogne ( UB ) -Centre National de la Recherche Scientifique ( CNRS ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement

Subjects
medicine.medical_specialty, business.industry, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Left thigh, Pulmonary infection, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, [ SDV.IB.MN ] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 3. Good health, 030218 nuclear medicine & medical imaging, Surgery, 03 medical and health sciences, Doppler sonography, 0302 clinical medicine, medicine, Mitochondrial encephalopathy, Subperiosteal hematoma, Radiology, Nuclear Medicine and imaging, Femur, Radiology, business, Letter to the Editor, [ SDV.IB.IMA ] Life Sciences [q-bio]/Bioengineering/Imaging, 030217 neurology & neurosurgery, ComputingMilieux_MISCELLANEOUS
Abstract

A 22-year-old patient, who had been bedridden since childhood following mitochondrial encephalopathy was hospitalized for a pulmonary infection. Following the discovery of a voluminous painless tumefaction of the left thigh, lower extremity Doppler examination and X-rays showed a well-defined soft-tissue mass surrounding the femur, with no signs of hypervascularization on the Doppler sonography.

Published
2016
Full Text
View/download PDF

11. Réflexions sur l’emprise et la possessivité dans la relation de soin en gérontologie

Author

Loetitia Rotheval, Pascal Menecier, Louis Ploton, Sandrine Plattier, Développement, Individu, Processus, Handicap, Éducation (DIPHE), Université Lumière - Lyon 2 (UL2), Centre hospitalier Les Chanaux [Mâcon], and Institut de Psychologie

Subjects
Psychiatry and Mental health, [SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT], Arts and Humanities (miscellaneous), [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, 05 social sciences, [SHS.PSY]Humanities and Social Sciences/Psychology, 050109 social psychology, 0501 psychology and cognitive sciences, 050108 psychoanalysis, Applied Psychology, ComputingMilieux_MISCELLANEOUS
Abstract

Resume Objectifs Aborder l’asymetrie de la relation entre soignants et soignes par un de ces possibles exces, sous la forme de relation d’emprise. Patients et methodes Analyse des formes du discours de 45 entretiens de recherche, par observation de la place de la locution de prise en charge (plutot que d’accompagnement) et le recours au possessif pour designer un intervenant ou un element du dispositif de soin. Resultats La prise en charge domine, designant aussi bien une situation, une maladie, qu’une personne (malade), tandis que le recours a un possessif apparait dans plus d’un tiers des entretiens. Conclusions Par le choix des mots, peut etre percue la place de l’appropriation et du pouvoir dans le soin, d’abord considere dans ses dimensions excessives d’emprise, de reification du soigne, qui ainsi peut participer a son alienation. Cependant, la place d’une forme moderee d’emprise positive ne peut etre exclue comme possible modalite d’attachement, de soutien, d’investissement de la relation.

Published
2016
Full Text
View/download PDF

12. Early rehospitalization of persons aged 75 years or older admitted to a post-emergency general medicine department: Rates and predictive factors

Author

Gauthier , J., Kisterman , J.P., Chapalain , F., Texier , A., Manckoundia , Patrick, Service de médecine gériatrique (CHU de Dijon - Centre gériatrique de Champmaillot - EHPAD), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de médecine interne et infectiologie [Centre hospitalier de Mâcon], Centre hospitalier Les Chanaux [Mâcon], Service des urgences [Centre hospitalier de Mâcon], Laboratoire de biologie médicale {Centre hospitalier de Mâcon], Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] (CAPS), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] ( CAPS ), and Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Médecine polyvalente, Polyvalent medicine, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Early rehospitalization, Personnes âgées, [ SDV.MHEP.GEG ] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Elderly person, Réhospitalisation précoce
Abstract

International audience; INTRODUCTION:Given the implications of rehospitalization at the individual and societal level, it seems important to identify elderly persons (EP) at risk. We analyzed the predictive factors of early rehospitalization in EP aged 75 years or more hospitalized in a medicine department.METHODS:A single-center retrospective study that included EP aged 75 years or more hospitalized in a polyvalent medical department following an emergency admission. Patients who died during the hospitalization, who had been transferred or hospitalized during the previous month, were excluded. The impact of sociodemographic, administrative and biomedical data on rehospitalization at one month was analyzed.RESULTS:A total of 319 hospitalizations were collected (mean age of patients: 84.7±5.7 years). Most lived at home (80.2%) and among these 8.4% had no home help. The rehospitalization rate was 16.3%, among which 2/3 were related to the reason for the initial hospitalization. Among the predictive factors found in the univariate analysis (male sex, multiple diseases, polypharmacy, multiple hospitalizations, cognitive disorders and calls to emergency services), only the presence of at least two previous hospitalizations in the year (odds ratio [OR]=2.10; 95% confidence interval [95%CI] [1.01-4.39]; P=0.048) and the presence of confusion without dementia (OR=3.78; IC 95% [1.09-13.06]; P=0.04) were significant. Discharge to a rehabilitation unit and increased support at home did not affect the likelihood of rehospitalization.CONCLUSION:The rehospitalization of EP is frequent and difficult to anticipate because there are few predictors and their impact is weak. The most important factors were medical: multiple hospitalizations and confusion without dementia.; IntroductionCompte tenu des implications de la réhospitalisation à l’échelon individuel et sociétal, le dépistage des personnes âgées (PA) à risque apparaît fondamental. Nous avons analysé les facteurs prédictifs de réhospitalisation précoce des PA d’au moins 75 ans hospitalisées en médecine.MéthodesÉtude rétrospective monocentrique ayant inclus des PA d’au moins 75 ans hospitalisées en médecine polyvalente via le service d’accueil des urgences. Les patients décédés durant l’hospitalisation, mutés et hospitalisés le mois précédent étaient exclus. L’influence sur la réhospitalisation à un mois de données sociodémographiques, administratives et biomédicales a été analysée.RésultatsAu total, 319 hospitalisations ont été colligées (âge moyen des patients : 84,7±5,7 ans), vivant majoritairement à domicile (80,2 %) dont 8,4 % sans aidant. Le taux de réhospitalisation était de 16,3 % dont deux tiers étaient liés au motif d’hospitalisation initial. Parmi les facteurs prédictifs retrouvés en analyse univariée (sexe masculin, polypathologie, polymédication, hospitalisations multiples, troubles cognitifs et recours au Centre 15), seules la présence d’au moins deux hospitalisations dans l’année (odds ratio [OR]=2,10 ; intervalle de confiance à 95 % [IC95 %] [1,01–4,39] ; p =0,048) et l’existence d’une confusion hors démence (OR=3,78 ; IC95 % [1,09–13,06] ; p =0,04) étaient significatives. La sortie vers un service de soins de suite et réadaptation (SSR) et la majoration des aides à domicile n’influençaient pas la réhospitalisation.ConclusionLes réhospitalisations de PA sont fréquentes et difficiles à anticiper car peu d’éléments sont prédictifs et leur effet est modeste. Les facteurs les plus influents sont médicaux : hospitalisations multiples et confusion sans démence.

Published
2016
Full Text
View/download PDF

13. Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment-Elevation Myocardial Infarction: The MIMI Study

Author

Belle, Loic, Motreff, Pascal, MANGIN, Lionel, Range, Grégoire, Marcaggi, Xavier, ANTOINE, Marie, FERRIER, nadine, Dubreuil, Olivier, ZEMOUR, GILLES, Souteyrand, Geraud, Caussin, Christophe, AMABILE, NICOLAS, Isaaz, Karl, Dauphin, Raphaël, Koning, René, Robin, Christophe, FAURIE, BENJAMIN, Bonello, Laurent, CHAMPIN, STANISLAS, Delhaye, Cédric, Cuilleret, François, Mewton, Nathan, Genty, Céline, Viallon, Magalie, Bosson, Jean Luc, Croisille, Pierre, MIMI INVESTIGATORS, ., DIGNAT-GEORGE, Françoise, Centre Hospitalier Annecy-Genevois, 74000-Annecy, France, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, HOPITAL CHARTRES - DEPT CARDIOL, Ctr Hosp Vichy, CTR HOSP ST LUC ST JOSEPH - DEPT CARDIOL, Centre Hospitalier de Cannes (Centre Hospitalier de Cannes), Centre Hospitalier de Cannes, Institut Mutualiste de Montsouris (IMM), Hôpital nord, St Etienne, Service de Cardiologie de l'hopital de la Croix Rousse, Hospices Civils de Lyon (HCL), Clinique St Hilaire ( Service de Cardiologie, Rouen), CLINIQUE CONVERT - CEPT CARDIOL, CRT HOSP MUTUALISTE - CARDIO INST, Vascular research center of Marseille (VRCM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Centre Hospitalier de Valence (CH DE VALENCE), Centre hospitalier de Valence, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier Les Chanaux [Mâcon], Services de Pneumologie, Exploration Fonctionnelle Respiratoire et Cardiologie (Hôpital Louis Pradel), Centre Hospitalier Universitaire [Grenoble] (CHU), RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-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-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-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
CARDIAC MAGNETIC-RESONANCE, [SDV]Life Sciences [q-bio], infarction, PERCUTANEOUS CORONARY INTERVENTION, THROMBECTOMY, RANDOMIZED-TRIAL, [SDV] Life Sciences [q-bio], myocardial infarction, ST-segment–elevation myocardial infarction, MICROVASCULAR OBSTRUCTION, MANAGEMENT, NO-REFLOW, stent, cardiovascular diseases, IMPLANTATION, THROMBUS ASPIRATION, METAANALYSIS
Abstract

Delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention aims to decrease the rate of distal embolization and impaired myocardial reperfusion after percutaneous coronary intervention. We sought to confirm whether a delayed stenting (DS) approach (24-48 hours) improves myocardial reperfusion, versus immediate stenting, in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention., In the prospective, randomized, open-label minimalist immediate mechanical intervention (MIMI) trial, patients (n=140) with ST-segment-elevation myocardial infarction ≤12 hours were randomized to immediate stenting (n=73) or DS (n=67) after Thrombolysis In Myocardial Infarction 3 flow restoration by thrombus aspiration. Patients in the DS group underwent a second coronary arteriography for stent implantation a median of 36 hours (interquartile range 29-46) after randomization. The primary end point was microvascular obstruction (% left ventricular mass) on cardiac magnetic resonance imaging performed 5 days (interquartile range 4-6) after the first procedure. There was a nonsignificant trend toward lower microvascular obstruction in the immediate stenting group compared with DS group (1.88% versus 3.96%; P=0.051), which became significant after adjustment for the area at risk (P=0.049). Median infarct weight, left ventricular ejection fraction, and infarct size did not differ between groups. No difference in 6-month outcomes was apparent for the rate of major cardiovascular and cerebral events., The present findings do not support a strategy of DS versus immediate stenting in patients with ST-segment-elevation infarction undergoing primary percutaneous coronary intervention and even suggested a deleterious effect of DS on microvascular obstruction size., URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360242.

Published
2016

14. Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine

Author

Bertrand Godeau, Julien Rohmer, Damien Sène, Pascal Sève, Philippe Remy, Noël Zahr, Nans Florens, Romain Euvrard, Jean Baptiste Palluy, Matthieu Mahévas, Mathilde Roumier, Julien Haroche, Fleur Cohen-Aubart, Etienne Rivière, Hans Yssel, Audrey Barrelet, Jean François Viallard, Alexis Mathian, Jehane Fadlallah, Mathilde Devaux, Jean Simon Virot, Neila Benameur, Laurent Juillard, Cecile Chauvet, Blanca Amador-Borrero, Zahir Amoura, Michel Delahousse, Raphael Lhote, Micheline Pha, Capucine Morélot-Panzini, T. Chazal, Gaelle Richard-Colmant, Thibault Maillet, Laurent Perard, Miguel Hie, Centre National de Référence du Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Maladies Auto-immunes Systémiques Rares [CHU Pitié Salpêtrière], Service de Médecine Interne 2, maladies auto-immunes et systémiques [CHU Pitié-Salpêtrière], Institut E3M [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)-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)-Institut E3M [CHU Pitié-Salpêtrière], 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 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), Centre d'Immunologie et des Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service de médecine interne [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Foch [Suresnes], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Grand Hôpital de l'Est Francilien (GHEF), Centre hospitalier Saint Joseph - Saint Luc [Lyon], CHI Poissy-Saint-Germain, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre hospitalier Les Chanaux [Mâcon], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Henri Mondor, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Pharmacologie médicale [CHU Pitié-Salpêtrière], CHU Henri Mondor, Gestionnaire, Hal Sorbonne Université, 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 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)-Institut E3M [CHU Pitié-Salpêtrière], 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)-Sorbonne Université (SU), Centre d'Immunologie et de Maladies Infectieuses (CIMI), 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), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Service de pharmacologie médicale [CHU Pitié-Salpêtrière]

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, hydroxychloroquine, [SDV]Life Sciences [q-bio], Pneumonia, Viral, Immunology, Lupus nephritis, Context (language use), Disease, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Internal medicine, medicine, Humans, Lupus Erythematosus, Systemic, Immunology and Allergy, skin and connective tissue diseases, Pandemics, ComputingMilieux_MISCELLANEOUS, Aged, 030203 arthritis & rheumatology, lupus nephritis, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, COVID-19, Outbreak, Hydroxychloroquine, Middle Aged, systemic, medicine.disease, 3. Good health, Clinical trial, [SDV] Life Sciences [q-bio], 030104 developmental biology, Female, Coronavirus Infections, business, Rheumatism, lupus erythematosus, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

The current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) represents a source of concern for the management of patients with systemic lupus erythematosus (SLE). Indeed patients with SLE have an increased risk of severe infections due to intrinsic perturbations of their immune response, the use of immunosuppressive drugs, as well as the potential presence of organ damage associated with their disease. In this context, hydroxychloroquine (HCQ), a drug that is currently part of the long-term, standard-of-care treatment for SLE, has been reported to possess antiviral activity in vitro, and recent results from a preliminary clinical trial might support its use in curative or even prophylactic treatment for COVID-19.1–3 During the first days of the COVID-19 outbreak in France, we launched an observational study with the aim to follow the clinical course of COVID-19 in patients with SLE who received long-term treatment with HCQ. To be eligible, patients with SLE had to (1) fulfil the 1997 criteria of the SLE classifications of the American College of Rheumatology or those of the 2019 European League Against Rheumatism/American College of Rheumatology4 5; (2) be on long-term treatment with HCQ; and (3) have SARS-CoV-2 carriage in their nasopharyngeal swab, as confirmed by real-time reverse transcription PCR analysis. Data …

Published
1970
Full Text
View/download PDF

15. [Fluoxetine dependence and tolerance. Apropos of a case].

Author

Menecier P, Menecier-Ossia L, and Bern P

Subjects
Adult, Dose-Response Relationship, Drug, Drug Tolerance, Female, Humans, Neurologic Examination drug effects, Substance Withdrawal Syndrome diagnosis, Substance Withdrawal Syndrome psychology, Substance Withdrawal Syndrome rehabilitation, Substance-Related Disorders diagnosis, Substance-Related Disorders rehabilitation, Antidepressive Agents, Second-Generation adverse effects, Fluoxetine adverse effects, Substance-Related Disorders psychology
Abstract

The authors relate a single case of fluoxetine misuse of a 31-year-old woman, with a previous history of multi drug addiction, and who weaned of all illicit substance and alcohol intake for several months. From a medical fluoxetine prescription at a dose of 20 mg per day, the patient increased to 280 mg per day within few months. Tolerance and dependency to the substance (according to DSM IV) and withdrawal syndrome occurred following fluoxetine discontinuation. This misuse keeps on for more than one year, and no symptom of a "serotonin syndrome" has ever been found. In our understanding, this exceptional case-report seems to be the first one related either in medical literature or drug monitoring centers.

Published
1997

16. [Diagnostic and therapeutic approach to plasma cell granuloma of the lung. Apropos of a case of favourable course under antibiotics].

Author

Piroth L, Menecier P, Charvillat L, Naouri A, and Kisterman JP

Subjects
Anti-Bacterial Agents, Drug Therapy, Combination therapeutic use, Humans, Male, Middle Aged, Plasma Cell Granuloma, Pulmonary diagnosis, Plasma Cell Granuloma, Pulmonary drug therapy, Plasma Cell Granuloma, Pulmonary therapy
Abstract

Plasma cell granulomas are more often solitary benign tumoral lesions, which need early surgery both for diagnostic and therapeutic reasons. The authors report a case of multiple plasma cell granuloma, diagnosed on biopsies obtained by thoracoscopy, and with a good response to a long-term antibiotic treatment. A review of the literature shows that this behaviour may represent an interesting alternative to systematical surgery in some cases.

Published
1996
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results