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31 results on '"MESH: Morbidity"'

1. Early and late morbidity of local excision after chemoradiotherapy for rectal cancer

Author

A. Valverde, Eric Rullier, M. Capdepont, B Lelong, F. Marchal, G. Portier, Jean-Luc Faucheron, M. Rivoire, Philippe Rouanet, M. Jafari, B. Meunier, B Teste, M Prudhomme, Quentin Denost, I Sielezneff, Jean-Jacques Tuech, A. Dubois, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM), CRLCC Val d'Aurelle - Paul Lamarque, Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Groupe Hospitalier Diaconesses Croix Saint-Simon, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre Léon Bérard [Lyon], Hôpital Michallon, Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Chirurgie Générale et Digestive [Purpan], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Pontchaillou [Rennes], Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Hôpital Hôtel-Dieu de Clermont-Ferrand, and CHU Clermont-Ferrand

Subjects
Local excision, medicine.medical_specialty, AcademicSubjects/MED00910, Colorectal cancer, medicine.medical_treatment, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030230 surgery, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Humans, Medicine, Neoadjuvant therapy, Neoplasm Staging, MESH: Chemoradiotherapy, MESH: Treatment Outcome, MESH: Humans, Rectal Neoplasms, business.industry, MESH: Rectal Neoplasms, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Chemoradiotherapy, MESH: Neoplasm Staging, General Medicine, medicine.disease, Total mesorectal excision, Surgical morbidity, Surgery, Treatment Outcome, MESH: Morbidity, 030220 oncology & carcinogenesis, Original Article, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, sense organs, Morbidity, AcademicSubjects/MED00010, business, Neoadjuvant chemoradiotherapy
Abstract

Background Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer. Method This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups. Results There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P Conclusion The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.

Published
2021

2. Impact of Oral Immunonutrition on Postoperative Morbidity in Digestive Oncologic Surgery

Author

Challine, Alexandre, Rives-Lange, Claire, Danoussou, Divya, Katsahian, Sandrine, Ait Boudaoud, Amel, Gaujoux, Sébastien, Dousset, Bertrand, Carette, Claire, Lazzati, Andrea, Czernichow, Sébastien, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), 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), Université Paris Cité (UPCité), CHU Pitié-Salpêtrière [AP-HP], Hôpital Cochin [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
MESH: Aged, MESH: Preoperative Care, MESH: Humans, MESH: Survival Rate, MESH: Digestive System Neoplasms, MESH: Immunologic Factors, MESH: Immunomodulation, MESH: Follow-Up Studies, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Length of Stay, MESH: Male, MESH: Prospective Studies, MESH: Population Surveillance, Immunonutrition, MESH: France, Digestive oncology, MESH: Morbidity, MESH: Postoperative Complications, Morbimortality, Surgery, MESH: Female, MESH: Digestive System Surgical Procedures, MESH: Treatment Outcome
Abstract

International audience; Objective: The objective of the present study was to assess the effect of preoperative immunonutrition on a nationwide scale.Background: According to international guidelines, immunonutrition should be prescribed before major oncologic digestive surgery to decrease postoperative morbidity. Nevertheless, this practice remains controversial.Methods: We used a prospective national health database named “Echantillon généraliste des Bénéficiaires.” Patients were selected with ICD10 codes of cancer and digestive surgery procedures from 2012 to 2016. Two groups were identified: with reimbursement of immunonutrition 45 days before surgery (IN-group) or not (no-IN-group). Primary outcome was 90-day severe morbidity. Secondary outcomes were postoperative length of stay (LOS) and overall survival. Logistic regression and survival analysis adjusted with IPW method were performed.Results: One thousand seven hundred seventy-one patients were included. The proportion of different cancers was as follows: 72% patients were included in the colorectal group, 14% in the hepato-pancreato-biliary group, and 12% in the upper gastrointestinal group. Patients from the IN-group (n = 606, 34%) were younger (67.1 ± 11.8 vs 69.2 ± 12.2 years, P < 0.001), with increased use of other oral nutritional supplements (49.5% vs 31.8%, P < 0.001) and had more digestive anastomoses (89.4% vs 83.0%, P < 0.001). There was no significant difference between the 2 groups for 90-day severe morbidity [odds ratio (OR): 0.91, 95% confidence interval (95% CI): 0.73–1.14] or in survival (hazard ratio: 0.89, 95% CI: 0.73–1.08). LOS were shorter in the IN-group [−1.26 days, 95% CI: −2.40 to −0.10)].Conclusion: The preoperative use of immunonutrition before major oncologic digestive surgery was not associated with any significant difference in morbidity or mortality. However, the LOS was significantly shorter in the IN-group.

Published
2021

3. Two-Year Scale-Up of Seasonal Malaria Chemoprevention Reduced Malaria Morbidity among Children in the Health District of Koutiala, Mali

Author

Moussa Djimde, Ogobara K. Doumbo, Amadou Bamadio, Boubou Sangare, Abdoulaye Djimde, Estrella Lasry, Alassane Dicko, Jean Gaudart, Hamma Maiga, Samba Coumare, Djibril Traore, Issaka Sagara, Aly Tembely, Yeyia Dicko, Modibo Diarra, Institut National de Recherche en Santé Publique [Bamako] (INRSP), Malaria Research and Training Center [Bamako, Mali], Université de Bamako, Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM] (BiosTIC ), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Médecins Sans Frontières - Doctors Without Borders [New York] (MSF-USA), Université des sciences, des techniques et des technologies de Bamako (USTTB), Service Biostatistique et Technologies de l’Information et de la Communication [AP-HM Hôpital de la Timone] (BioSTIC), Hôpital de la Timone [CHU - APHM] (TIMONE), and Dupuis, Christine

Subjects
MESH: Chemoprevention, Health, Toxicology and Mutagenesis, [SDV]Life Sciences [q-bio], lcsh:Medicine, morbidity, Controlled studies, Mali, 0302 clinical medicine, MESH: Child, Child, 0303 health sciences, musculoskeletal system, MESH: Infant, 3. Good health, seasonal malaria chemoprevention, [SDV] Life Sciences [q-bio], Drug Combinations, Pyrimethamine, Child, Preschool, cardiovascular system, Female, Seasons, medicine.drug, medicine.medical_specialty, Anemia, MESH: Pyrimethamine, 030231 tropical medicine, MESH: Malaria, malaria, Malaria morbidity, Amodiaquine, Chemoprevention, Article, Antimalarials, 03 medical and health sciences, MESH: Cross-Sectional Studies, Internal medicine, Sulfadoxine, parasitic diseases, medicine, Humans, MESH: Drug Combinations, MESH: Humans, 030306 microbiology, business.industry, lcsh:R, MESH: Child, Preschool, Public Health, Environmental and Occupational Health, Infant, MESH: Mali, medicine.disease, MESH: Antimalarials, Cross-Sectional Studies, MESH: Morbidity, Propensity score matching, business, MESH: Female, MESH: Seasons, Malaria, MESH: Sulfadoxine
Abstract

Background: Previous controlled studies demonstrated seasonal malaria chemoprevention (SMC) reduces malaria morbidity by &gt, 80% in children aged 3&ndash, 59 months. Here, we assessed malaria morbidity after large-scale SMC implementation during a pilot campaign in the health district of Koutiala, Mali. Methods: Starting in August 2012, children received three rounds of SMC with sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). From July 2013 onward, children received four rounds of SMC. Prevalence of malaria infection, clinical malaria and anemia were assessed during two cross-sectional surveys conducted in August 2012 and June 2014. Investigations involved 20 randomly selected clusters in 2012 against 10 clusters in 2014. Results: Overall, 662 children were included in 2012, and 670 in 2014. Children in 2014 versus those surveyed in 2012 showed reduced proportions of malaria infection (12.4% in 2014 versus 28.7% in 2012 (p = 0.001)), clinical malaria (0.3% versus 4.2%, respectively (p &lt, 0.001)), and anemia (50.1% versus 67.4%, respectively (p = 0.001)). A propensity score approach that accounts for environmental differences showed that SMC conveyed a significant protective effect against malaria infection (IR = 0.01, 95% CI (0.0001, 0.09), clinical malaria (OR = 0.25, 95% CI (0.06, 0.85)), and hemoglobin concentration (&beta, = 1.3, 95% CI (0.69, 1.96)) in 2012 and 2014, respectively. Conclusion: SMC significantly reduced frequency of malaria infection, clinical malaria and anemia two years after SMC scale-up in Koutiala.

Published
2020

4. Fréquence, prise en charge et issues des femmes enceintes en obésité morbide à l’AP-HP

Author

Chapron, Estelle, Université de Paris - École de sages-femmes Baudelocque (UP ESF Baudelocque), Université de Paris (UP), and Jacky Nizard

Subjects
Mode of Delivery, Mode d’accouchement, MESH: Morbidity, Obésité morbide, AP-HP, Morbidité, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: Obesity, Morbid, MESH: Parturition, MESH: Hospitals
Abstract

Context: obesity is a major public health problem, known for its adverse health consequences, especially when it is morbid. Pregnant women are not spared and present specific problems during pregnancy and childbirth. Objectives: thus, in a first step, we sought to find out how often and how morbidly obese parturients gave birth in the Paris Public Hospitals (AP-HP). Secondly, we assessed the maternal-fetal morbidity associated with this population, particularly after delivery. We then compared maternal and neonatal morbidity according to the care provided, with the aim of reducing their morbidity. Method: we carried out a descriptive observational study across the 13 maternity hospitals of the AP-HP over the whole year 2017. It includes all women with a pre-conceptional BMI ≥ 40 kg/m² who delivered at term ≥ 22 weeks of amenorrhea (AS) in AP-HP. Results: this is the second part of this study including all AP-HP maternity hospitals. A total of 278 patients were included, an average of 0.7% over the year 2017. They were mostly multiparous and under 35 years of age. We found on the one hand that this population presented over-risks of complications at all levels (maternal, fetal, obstetrical and neonatal). Morbid obesity has a strong impact on the mode of childbirth, leading to an increased caesarean section rate. At the end of childbirth, we have a greatly increased morbidity, mainly in the newborn. This reinforces most of the previous work on this subject. On the other hand, the term and method of delivery may have an influence on maternal and neonatal morbidity. Specialised, multidisciplinary care through reference centres seems to be an interesting prospect to help this already vulnerable population as much as possible.; Contexte : l’obésité est un problème de santé publique majeur, connue pour ses conséquences néfastes sur la santé, d’autant plus lorsqu’elle est morbide. Les femmes enceintes n’en sont pas épargnées, et présentent des problèmes spécifiques durant leur grossesse et leur accouchement. Objectifs : ainsi, dans un premier temps, nous avons cherché à savoir la fréquence et comment accouchaient les parturientes en obésité morbide au sein de l’Assistance Publique - Hôpitaux de Paris (AP-HP). Dans un deuxième temps, nous avons évalué la morbidité materno-fœtale associée à cette population, notamment à l’issue de l’accouchement. Puis, par la suite, comparé la morbidité maternelle et néonatale en fonction des prises en charge, dans le but de diminuer leur morbidité. Méthode : nous avons réalisé une étude descriptive observationnelle menée à travers les 13 maternités de l’AP-HP sur toute l’année 2017. Elle inclut l’ensemble des femmes avec un IMC pré-conceptionnel ≥ 40 kg/m² qui ont accouché à un terme ≥ 22 semaines d’aménorrhée (SA) au sein de l’AP-HP. Résultats : il s’agit de la deuxième partie de cette étude incluant l’ensemble des maternités de l’AP-HP. Au total 278 patientes ont été inclues, soit une moyenne de 0,7% sur l’année 2017. Elles étaient majoritairement multipares et âgées de moins de 35 ans. Nous avons constaté d’une part que cette population présentait des sur-risques de complications à tous les niveaux (maternel, fœtal, obstétrical et néonatal). L’obésité morbide impacte fortement le mode d’accouchement, aboutissant à un taux de césarienne augmenté. A l’issue de l’accouchement, nous avons une morbidité largement augmentée, principalement chez le nouveau-né. Ceci vient notamment renforcer la plupart des travaux précédents sur ce sujet. D’autre part, le terme et la méthode d’accouchement pourrait avoir une influence sur les morbidités maternelles et néonatales. Une prise en charge spécialisée, multidisciplinaire, à travers des centres de référence semble être une perspective intéressante pour aider au mieux ce public déjà vulnérable.

Published
2020

5. Laparoscopic Essure® Device Removal by En Bloc Salpingectomy-Cornuectomy with Intraoperative X-Ray Checking: A Retrospective Cohort Study

Author

Patrice Crochet, Léon Boubli, Aubert Agostini, Clara Compan, Laura Miquel, Sarah Francini, Service de Gynécologie et Obstétrique [Marseille], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Sterilization, Tubal, medicine.medical_treatment, MESH: Laparoscopy, Intraoperative X-ray, Cohort Studies, 0302 clinical medicine, MESH: Pregnancy, MESH: Sterilization, Tubal, Pregnancy, Salpingectomy, Laparoscopy, MESH: Cohort Studies, MESH: Radiography, Ultrasonography, MESH: Treatment Outcome, 030219 obstetrics & reproductive medicine, MESH: Middle Aged, medicine.diagnostic_test, MESH: Intrauterine Devices, Obstetrics and Gynecology, Middle Aged, 3. Good health, Treatment Outcome, Essure, 030220 oncology & carcinogenesis, Female, France, Cohort study, Adult, MESH: Salpingectomy, medicine.medical_specialty, MESH: Monitoring, Intraoperative, Hysteroscopy, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Pelvis, Resection, 03 medical and health sciences, MESH: X-Rays, Device removal, Monitoring, Intraoperative, medicine, Humans, Essure device removal, MESH: Device Removal, Device Removal, Retrospective Studies, MESH: Pelvis, MESH: Humans, business.industry, X-Rays, Retrospective cohort study, MESH: Adult, MESH: Retrospective Studies, MESH: Hysteroscopy, Surgery, Radiography, MESH: France, MESH: Morbidity, Feasibility Studies, Morbidity, Sterilization Reversal, business, MESH: Feasibility Studies, MESH: Female, MESH: Sterilization Reversal, Intrauterine Devices, MESH: Ultrasonography
Abstract

Study Objective To evaluate the feasibility, efficacy, and morbidity of Essure® device removal via laparoscopic en bloc salpingectomy-cornuectomy resection (LSC) and the utility of confirmation of complete removal with an intraoperative X-ray of the removed specimen (IX-S). Design Retrospective observational cohort study. Setting Academic hospitals of La Conception, Marseille, and Arnaud-de-Villeneuve, Montpellier, France. Patients Women who were not seeking future fertility seeking Essure® device removal by salpingectomy, between February 2017 and August 2018. Interventions All women underwent LSC. An IX-S was performed to confirm complete Essure® device removal. In the case of an unsatisfactory IX-S, an intraoperative pelvic X-ray control of the patient (IX-P) was performed. If IX-P diagnosed residual Essure® fragments, an additional resection was performed, and the removed tissue was checked by IX-S. Measurements and Main Results We included 72 women, and a total of 140 Essure® devices were removed. The IX-S confirmed complete Essure® device removal in 131 of 140 cases (93.6%) in 63 of 72 women (87.5%). Out of the 9 women with unsatisfactory IX-S, 6 had no residual Essure® fragments at IX-P, and Essure® device removal was considered complete. Three women had a persistent Essure® fragment at IX-P: an additional resection allowed complete removal in 2 cases and resulted in failure in 1 of 140 case (0.7%). There were 2 of 72 women (2.8%) intraoperative complications and 4 of 72 women (5.6%) postoperative grade 1 complications according to the Clavien–Dindo classification. Conclusion Essure® device removal by LSC appears to be an effective and safe procedure. IX-S is a useful method to evaluate whether the removal of Essure® device is complete during an LSC procedure.

Published
2020

6. Feasibility, complications, morbidity, and mortality results at 6 months for aneurysm treatment with the Flow Re-Direction Endoluminal Device: report of SAFE study

Author

Laurent Pierot, Mohamed Aggour, Michel Piotin, Xavier Barreau, Charbel Mounayer, Laurent Spelle, Denis Herbreteau, Jean-Yves Gauvrit, Chrisanthi Papagiannaki, Jean-Paul Lejeune, Vincent Costalat, Jérôme Berge, Alessandra Biondi, Anne-Christine Januel, Université de Reims Champagne-Ardenne (URCA), Service de Neuroradiologie Interventionnelle et Fonctionnelle, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [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), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], CHU Toulouse [Toulouse], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Saint-Etienne, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Neuroradiologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Department of Neuroradiology (X.B.), CHU Bordeaux, Service de Neurologie [CHU Limoges], CHU Limoges, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], CHU Montpellier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Gauvrit, Jean-Yves, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Service de radiologie et imagerie médicale [Rennes], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
Male, Time Factors, Aneurysm, Ruptured, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Prospective Studies, Interventional neuroradiology, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, Endovascular Procedures, General Medicine, Middle Aged, 3. Good health, Anterior communicating artery, Hemorrhagic Stroke, Treatment Outcome, Middle cerebral artery, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Female, Neurosurgery, Internal carotid artery, Adult, medicine.medical_specialty, MESH: Endovascular Procedures, MESH: Intracranial Aneurysm, Self Expandable Metallic Stents, 03 medical and health sciences, Aneurysm, medicine.artery, medicine, Anterior cerebral artery, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Mortality, Aged, MESH: Humans, MESH: Mortality, business.industry, MESH: Time Factors, MESH: Adult, Intracranial Aneurysm, medicine.disease, MESH: Prospective Studies, MESH: Male, Surgery, MESH: Self Expandable Metallic Stents, Clinical trial, MESH: Morbidity, aneurysm, Feasibility Studies, Neurology (clinical), Morbidity, business, MESH: Feasibility Studies, MESH: Aneurysm, Ruptured, MESH: Female, 030217 neurology & neurosurgery
Abstract

Background and purposeFlow diverters are increasingly used for the treatment of intracranial aneurysms. Evaluation of the first devices available for clinical use showed high efficacy of this treatment although safety results were worse compared with coiling or balloon-assisted coiling. The Safety and Efficacy Analysis of FRED Embolic Device in Aneurysm Treatment (SAFE) trial is a single-arm, multicenter, prospective study conducted to precisely analyze the safety and efficacy of the FRED and FRED Jr devices.MethodsUnruptured and recanalized aneurysms located in the anterior circulation treated with FRED and FRED Jr were prospectively included. Adverse events were independently evaluated by a Clinical Event Committee with a vascular neurosurgeon and an interventional neuroradiologist. Primary safety outcome measures were morbidity and mortality rates at 6 months after treatment.ResultsA total of 103 patients/aneurysms were included in 13 interventional neuroradiology (INR) centers. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 71 (68.9%), cavernous ICA in 15 (14.6%), anterior cerebral artery or anterior communicating artery in nine (8.7%), and middle cerebral artery in eight (7.8%). Aneurysms were small (ConclusionsAneurysm treatment with the FRED device is safe with low mortality (1.0%) and morbidity (2.0%).Clinical trial registrationNCT02921698.

Published
2018

7. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial

Author

Sonia S Anand, Jackie Bosch, John W Eikelboom, Stuart J Connolly, Rafael Diaz, Peter Widimsky, Victor Aboyans, Marco Alings, Ajay K Kakkar, Katalin Keltai, Aldo P Maggioni, Basil S Lewis, Stefan Störk, Jun Zhu, Patricio Lopez-Jaramillo, Martin O'Donnell, Patrick J Commerford, Dragos Vinereanu, Nana Pogosova, Lars Ryden, Keith A A Fox, Deepak L Bhatt, Frank Misselwitz, John D Varigos, Thomas Vanassche, Alvaro A Avezum, Edmond Chen, Kelley Branch, Darryl P Leong, Shrikant I Bangdiwala, Robert G Hart, Salim Yusuf, JORGELINA SALA, LUIS CARTASEGNA, MARISA VICO, MIGUEL ANGEL HOMINAL, EDUARDO HASBANI, ALBERTO CACCAVO, CESAR ZAIDMAN, DANIEL VOGEL, ADRIAN HRABAR, PABLO OMAR SCHYGIEL, CARLOS CUNEO, HUGO LUQUEZ, IGNACIO J. MACKINNON, RODOLFO ANDRES AHUAD GUERRERO, JUAN PABLO COSTABEL, INES PALMIRA BARTOLACCI, OSCAR MONTANA, MARIA BARBIERI, OSCAR GOMEZ VILAMAJO, RUBEN OMAR GARCIA DURAN, LILIA BEATRIZ SCHIAVI, MARCELO GARRIDO, ADRIAN INGARAMO, ANSELMO PAULINO BORDONAVA, MARIA JOSE PELAGAGGE, LEONARDO NOVARETTO, JUAN PABLO ALBISU DI GENNERO, LUZ MARIA IBANEZ SAGGIA, MOIRA ALVAREZ, NESTOR ALEJANDRO VITA, STELLA MARIS MACIN, RICARDO DARIO DRAN, MARCELO CARDONA, LUIS GUZMAN, RODOLFO JUAN SARJANOVICH, JESUS CUADRADO, SEBASTIAN NANI, MARCOS RAUL LITVAK BRUNO, CAROLINA CHACON, LAURA ELENA MAFFEI, DIEGO GRINFELD, NATALIA VENSENTINI, CLAUDIO RODOLFO MAJUL, HECTOR LUCAS LUCIARDI, PATRICIA DEL CARMEN GONZALEZ COLASO, FREDY ANTONI FERRE PACORA, PAUL VAN DEN HEUVEL, PETER VERHAMME, BAVO ECTOR, PHILIPPE DEBONNAIRE, PHILIPPE VAN DE BORNE, JEAN LEROY, HERMAN SCHROE, PASCAL VRANCKX, IVAN ELEGEERT, ETIENNE HOFFER, KARL DUJARDIN, CLARISSE INDIO DO BRASIL, DALTON PRECOMA, JOSE ANTONIO ABRANTES, EULER MANENTI, GILMAR REIS, JOSE SARAIVA, LILIA MAIA, MAURO HERNANDES, PAULO ROSSI, FABIO ROSSI DOS SANTOS, SERGIO LUIZ ZIMMERMANN, RAFAEL RECH, EDUARDO ABIB JR, PAULO LEAES, ROBERTO BOTELHO, OSCAR DUTRA, WEIMAR SOUZA, MARIA BRAILE, NILO IZUKAWA, JOSE CARLOS NICOLAU, LUIZ FERNANDO TANAJURA, CARLOS VICENTE SERRANO JUNIOR, CESAR MINELLI, LUIZ ANTONIO NASI, LIVIA OLIVEIRA, MARCELO JOSE DE CARVALHO CANTARELLI, RICHARD TYTUS, SHEKHAR PANDEY, EVA LONN, JAMES CHA, SAUL VIZEL, MOHAN BABAPULLE, ANDRE LAMY, KEVIN SAUNDERS, JOSEPH BERLINGIERI, BOB KIAII, RAKESH BHARGAVA, PRAVINSAGAR MEHTA, LAURIE HILL, DAVID FELL, ANDY LAM, FAISAL AL-QOOFI, CRAIG BROWN, ROBERT PETRELLA, JOSEPH A RICCI, ANTHONY GLANZ, NICOLAS NOISEUX, KEVIN BAINEY, FATIMA MERALI, MICHAEL HEFFERNAN, ANTHONY DELLA SIEGA, GILLES R DAGENAIS, FRANCOIS DAGENAIS, STEEVE BRULOTTE, MICHEL NGUYEN, MICHAEL HARTLEIB, RANDOLPH GUZMAN, RONALD BOURGEOIS, DENNIS RUPKA, YAARIV KHAYKIN, GILBERT GOSSELIN, THAO HUYNH, CLAUDE PILON, JEAN CAMPEAU, FRANCIS PICHETTE, ARIEL DIAZ, JAMES JOHNSTON, PRAVIN SHUKLE, GREGORY HIRSCH, PAUL RHEAULT, WLODZIMIERZ CZARNECKI, ANNIE ROY, SHAH NAWAZ, STEPHEN FREMES, DINKAR SHUKLA, GABRIEL JANO, JORGE LEONARDO COBOS, RAMON CORBALAN, MARCELO MEDINA, LEONARDO NAHUELPAN, CARLOS RAFFO, LUIS PEREZ, SERGIO POTTHOFF, BENJAMIN STOCKINS, PABLO SEPULVEDA, CHRISTIAN PINCETTI, MARGARITA VEJAR, HONGYAN TIAN, XUESI WU, YUANNAN KE, KAIYING JIA, PENGFEI YIN, ZHAOHUI WANG, LITIAN YU, SHULIN WU, ZONGQUI WU, SHAO WEN LIU, XIAO JUAN BAI, YANG ZHENG, PING YANG, YUN MEI YANG, JIWEI ZHANG, JUNBO GE, XIAO PING CHEN, JUNXIA LI, TAO HONG HU, RUIYAN ZHANG, ZHE ZHENG, XIN CHEN, LIANG TAO, JIANPING LI, WEIJIAN HUANG, GUOSHENG FU, CHUNJIAN LI, YUGANG DONG, CHUNSHENG WANG, XINMIN ZHOU, YE KONG, ARISTIDES SOTOMAYOR, JOSE LUIS ACCINI MENDOZA, HENRY CASTILLO, MIGUEL URINA, GUSTAVO AROCA, MARITZA PEREZ, DORA INES MOLINA DE SALAZAR, GREGORIO SANCHEZ VALLEJO, MANZUR J FERNANDO, HENRY GARCIA, LUIS HERNANDO GARCIA, EDGAR ARCOS, JUAN GOMEZ, FRANCISCO CUERVO MILLAN, FREDY ALBERTO TRUJILLO DADA, BORIS VESGA, GUSTAVO ADOLFO MORENO SILGADO, EVA ZIDKOVA, JEAN-CLAUDE LUBANDA, MARKETA KALETOVA, RADIM KRYZA, GABRIEL MARCINEK, MAREK RICHTER, JINDRICH SPINAR, JIRI MATUSKA, MARTIN TESAK, ZUZANA MOTOVSKA, MARIAN BRANNY, JIRI MALY, MARTIN MALY, MARTIN WIENDL, LENKA FOLTYNOVA CAISOVA, JOSEF SLABY, PETR VOJTISEK, JAN PIRK, LENKA SPINAROVA, MIROSLAVA BENESOVA, JULIA CANADYOVA, MIROSLAV HOMZA, JINDRICH FLORIAN, ROSTISLAV POLASEK, ZDENEK COUFAL, VLADIMIRA SKALNIKOVA, RADIM BRAT, MIROSLAV BRTKO, PETR JANSKY, JAROSLAV LINDNER, PAVEL MARCIAN, ZBYNEK STRAKA, MARTIN TRETINA, YAN CARLOS DUARTE, FREDDY POW CHON LONG, MAYRA SANCHEZ, JOSE LOPEZ, CARMITA PERUGACHI, RICARDO MARMOL, FREDDY TRUJILLO, PABLO TERAN, JAAKKO TUOMILEHTO, HENRI TUOMILEHTO, MARJA-LEENA TUOMINEN, ILKKA KANTOLA, GABRIEL STEG, VICTOR ABOYANS, FLORENCE LECLERCQ, EMILE FERRARI, FRANCK BOCCARA, EMMANUEL MESSAS, PATRICK MISMETTI, MARIE ANTOINETTE SEVESTRE, GUILLAUME CAYLA, PASCAL MOTREFF, STEFAN STOERK, HANS-DIRK DUENGEN, CHRISTOPH STELLBRINK, OSMAN GUEROCAK, CHRISTOPH KADEL, RUEDIGER BRAUN-DULLAEUS, MICHAEL JESERICH, CHRISTIAN OPITZ, HANS-FRIEDRICH VOEHRINGER, KARL-FRIEDRICH APPEL, BERNHARD WINKELMANN, THOMAS DORSEL, SIGRID NIKOL, HARALD DARIUS, JURGEN RANFT, SEBASTIAN SCHELLONG, WOLFGANG JUNGMAIR, PIROZE DAVIERWALA, MARC VORPAHL, LASZLO BAJNOK, ZOLTAN LASZLO, EBRAHIM NOORI, GABOR VERESS, ANDRAS VERTES, ANDRAS ZSARY, ERNO KIS, LASZLO KORANYI, JUDIT BAKAI, ZOLTAN BODA, FERENC POOR, ZOLTAN JARAI, VENDEL KEMENY, JOHN BARTON, BRENDAN MCADAM, ANDREW MURPHY, PETER CREAN, NIALL MAHON, RONAN CURTIN, BRIAIN MACNEILL, SEAN DINNEEN, MAJDI HALABI, REUVEN ZIMLICHMAN, DAVID ZELTSER, YOAV TURGEMAN, ELIEZER KLAINMAN, BASIL LEWIS, AMOS KATZ, SHAUL ATAR, EUGENIA NIKOLSKY, STEFANO BOSI, MONICA NALDI, POMPILIO FAGGIANO, DEBORA ROBBA, LUCIO MOS, GIANFRANCO SINAGRA, FRANCO COSMI, LUIGI OLTRONA VISCONTI, DE MATTEIS CARMINE, GIUSEPPE DI PASQUALE, MATTEO DI BIASE, SARA MANDORLA, MARINO BERNARDINANGELI, GIOVANNI CARLO PICCINNI, MICHELE MASSIMO GULIZIA, MARCELLO GALVANI, FLAVIO VENTURI, GIORGIO MOROCUTTI, MARIA GRAZIA BALDIN, CARLO OLIVIERI, GIAN PIERO PERNA, VINCENZO CIRRINCIONE, TAKAYASU KANNO, HIROYUKI DAIDA, YUKIO OZAKI, NAOMASA MIYAMOTO, SHINICHI HIGASHIUE, HIROSHI DOMAE, SHINOBU HOSOKAWA, HIROO KOBAYASHI, TAKEHIKO KURAMOCHI, KENSHI FUJII, KAZUAKI MIZUTOMI, KEIJIRO SAKU, KAZUO KIMURA, YOSHIHARU HIGUCHI, MITSUNORI ABE, HARUHITO OKUDA, TOSHIYUKI NODA, TERUAKI MITA, ATSUSHI HIRAYAMA, HARUHIKO ONAKA, MORIAKI INOKO, MITSUGU HIROKAMI, MUNENORI OKUBO, YUTAKA AKATSUKA, MIZUHO IMAMAKI, HARUO KAMIYA, MAMORU MANITA, TOSHIHARU HIMI, HIDEKI UENO, YUJI HISAMATSU, JUNYA AKO, YASUHIRO NISHINO, HIDEO KAWAKAMI, YUTAKA YAMADA, YUKIHIRO KORETSUNE, TAKAHISA YAMADA, TETSURO YOSHIDA, HIDEKI SHIMOMURA, NORIYUKI KINOSHITA, AKIHIKO TAKAHASHI, KHALID YUSOFF, WAN AZMAN WAN AHMAD, MUHAMMAD RADZI ABU HASSAN, SAZZLI KASIM, AIZAI AZAN ABDUL RAHIM, DIMON MOHD ZAMRIN, MASAHARU MACHIDA, YORIHIKO HIGASHINO, NORIAKI UTSU, AKIHIKO NAKANO, SHIGERU NAKAMURA, TETSUO HASHIMOTO, KENJI ANDO, TOMOHIRO SAKAMOTO, F.J. PRINS, DIRK LOK, JOHANNES GERT-JAN MILHOUS, ERIC VIERGEVER, FRANK WILLEMS, HENK SWART, MARCO ALINGS, ROB BREEDVELD, KEES-JAN DE VRIES, ROGER VAN DER BORGH, FANNY OEI, STIENEKE ZOET-NUGTEREN, HANS KRAGTEN, JEAN PAUL HERRMAN, PAUL VAN BERGEN, MARCEL GOSSELINK, EDUARD HOEKSTRA, ERWIN ZEGERS, EELKO RONNER, FRANK DEN HARTOG, GERARD BARTELS, PETER NIEROP, COEN VAN DER ZWAAN, JACOB VAN ECK, EDWIN VAN GORSELEN, BJORN GROENEMEIJER, PIETER HOOGSLAG, MARC ROBERT DE GROOT, ALDRIN LOYOLA, DENNIS JOSE SULIT, NANNETTE REY, MARIA TERESA ABOLA, DANTE MORALES, ELLEN PALOMARES, MARC EVANS ABAT, GREGORIO ROGELIO, PHILIP CHUA, JOSE CARLO DEL PILAR, JOHN DENNIS ALCARAZ, GERALDINE EBO, LOUIE TIRADOR, JOSEFINA CRUZ, JOHN ANONUEVO, ARTHUR PITARGUE, MARIANNA JANION, TOMASZ GUZIK, GRZEGORZ GAJOS, MACIEJ ZABOWKA, ANDRZEJ RYNKIEWICZ, MARLENA BRONCEL, ANDRZEJ SZUBA, DANUTA CZARNECKA, PAWEL MAGA, IRINA STRAZHESKO, YURY VASYUK, ZHANNA SIZOVA, YURY POZDNYAKOV, OLGA BARBARASH, MIKHAIL VOEVODA, TATIANA POPONINA, ALEXEY REPIN, IRINA OSIPOVA, ANNA EFREMUSHKINA, NINA NOVIKOVA, OLEG AVERKOV, DMITRY ZATEYSHCHIKOV, ARKADIY VERTKIN, AZA AUSHEVA, PATRICK COMMERFORD, SAADIYA SEEDAT, LOUIS VAN ZYL, JAN ENGELBRECHT, ELLEN MAKONLI MAKOTOKO, CATHARINA ELIZABETH PRETORIUS, ZAID MOHAMED, ADRIAN HORAK, THOMAS MABIN, ERIC KLUG, JANG-HO BAE, CHEOLHO KIM, CHONG-JIN KIM, DONG-SOO KIM, YONG JIN KIM, SEUNGJAE JOO, JONG-WON HA, CHUL SOO PARK, JANG YOUNG KIM, YOUNG-KWON KIM, CHRISTINA JARNERT, THOMAS MOOE, MIKAEL DELLBORG, INGEMAR TORSTENSSON, PER ALBERTSSON, LARS JOHANSSON, FARIS AL-KHALILI, HENRIK ALMROTH, TOMMY ANDERSSON, EMIL PANTEV, BENGT-OLOV TENGMARK, BO LIU, GUNDARS RASMANIS, CARL-MAGNUS WAHLGREN, TIZIANO MOCCETTI, ALEXANDER PARKHOMENKO, VIRA TSELUYKO, VOLODYMYR VOLKOV, OLENA KOVAL, LYUDMYLA KONONENKO, OLEKSANDR PROKHOROV, VALERIY VDOVYCHENKO, ANDRIY BAZYLEVYCH, LEONID RUDENKO, VADYM VIZIR, OLEKSANDR KARPENKO, YAROSLAV MALYNOVSKY, VALENTYNA KOVAL, BORYS STOROZHUK, JAMES COTTON, ASOK VENKATARAMAN, ANDREW MORIARTY, DEREK CONNOLLY, PATRICK DAVEY, ROXY SENIOR, INDERPAUL BIRDI, JOHN CALVERT, PATRICK DONNELLY, JASPER TREVELYAN, JUSTIN CARTER, AARON PEACE, DAVID AUSTIN, NEVILLE KUKREJA, THOMAS HILTON, SUNNY SRIVASTAVA, RONALD WALSH, RONALD FIELDS, JOSEPH HAKAS, EDWARD PORTNAY, HARINDER GOGIA, ABRAHAM SALACATA, JOHN J. HUNTER, J MICHAEL BACHARACH, NICOLAS SHAMMAS, DAMODHAR SURESH, RICKY SCHNEIDER, PAUL GURBEL, SUBHASH BANERJEE, PAUL GRENA, NOEL BEDWELL, STEPHEN SLOAN, STEVEN LUPOVITCH, ANAND SONI, KATHLEEN GIBSON, RENEE SANGRIGOLI, RAJENDRA MEHTA, PETER I-HSUAN TSAI, EVE GILLESPIE, STEPHEN DEMPSEY, GLENN HAMROFF, ROBERT BLACK, ELLIS LADER, JOHN B. KOSTIS, VERA BITTNER, WILLIAM MCGUINN, KELLEY BRANCH, VINAY MALHOTRA, STEPHEN MICHAELSON, MICHAEL VACANTE, MATTHEW MCCORMICK, RALUCA ARIMIE, ALAN CAMP, GEORGE DAGHER, N. MATHEW KOSHY, STEPHEN THEW, FREDERICK COSTELLO, MARK HEIMAN, ROBERT CHILTON, MICHAEL MORAN, FREDRIC ADLER, ANTHONY COMEROTA, ANDREW SEIWERT, WILLIAM FRENCH, HARVEY SEROTA, ROBERT HARRISON, FAISAL BAKAEEN, SHUAB OMER, LOKESH CHANDRA, ALAN WHELAN, ANDREW BOYLE, PHILIP ROBERTS-THOMSON, JAMES ROGERS, PATRICK CARROLL, DAVID COLQUHOUN, JAMES SHAW, PETER BLOMBERY, JOHN AMERENA, CHRIS HII, ALISTAIR ROYSE, BHUWAN SINGH, JOSEPH SELVANAYAGAM, SHIRLEY JANSEN, WINGCHI LO, CHRISTOPHER HAMMETT, ROHAN POULTER, SESHASAYEE NARASIMHAN, HENRIK WIGGERS, HENRIK NIELSEN, GUNNAR GISLASON, LARS KOBER, KIM HOULIND, VIBEKE BOENELYKKE SOERENSEN, ULRIK DIXEN, JENS REFSGAARD, ELISABETH ZEUTHEN, PETER SOEGAARD, MARIAN HRANAI, LUDOVIT GASPAR, DANIEL PELLA, KATARINA HATALOVA, ERIKA DROZDAKOVA, IOAN COMAN, DOINA DIMULESCU, DRAGOS VINEREANU, MIRCEA CINTEZA, CRINA SINESCU, CATALINA ARSENESCU, IMRE BENEDEK, ELENA BOBESCU, DAN DOBREANU, DAN GAITA, ADRIAN IANCU, ADRIANA ILIESIU, DANIEL LIGHEZAN, LUCIAN PETRESCU, OCTAVIAN PIRVU, IULIA TEODORESCU, DAN TESLOIANU, MARIUS MARCIAN VINTILA, OVIDIU CHIONCEL, Divisions of Cardiology and Thromboembolism McMaster University Hamiton, Population Health Research Institute, McMaster University [Hamilton, Ontario], Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri] (ANMCO Research Center), Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Department of Statistics, University of Haifa [Haifa], Cardiology, University and Emergency Hospital, University of Edinburgh, VA Boston Healthcare System, Hamilton General Hospital, Universidad Autonoma de Madrid (UAM), Cardiology Department, Dipartimento di Bioscienze, University of Parma, University of Barcelona, Hospital Clinic Barcelona, Laval University and Hospital Heart and Lung Institute, UVSQ - UFR des sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), University Hospital Brno, Masaryk University, Department of Public Health, Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Galilée, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Pasteur [Nice] (CHU), Service de Cardiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], 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), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), CHU Gabriel Montpied (CHU), CHU Clermont-Ferrand, Department of Medicine (DEBRECEN - Dpt Medicine), University of Debrecen, University of Trieste, Lab Dev Cell Biol,Bunkyo Ku, The University of Tokyo, The Netherlands Organisation for Applied Scientific Research (TNO), Regional Specialist Hospital in Wroclaw, Research and Development Centre, Kamienskiego, Division of Angiology, Wroclaw Medical University, Sahlgrenska University Hospital/Östra, Cardiocentro Ticino [Lugano], University of Zürich [Zürich] (UZH), Danylo Halytskyi Lviv National Medical University, Department of Cardiology, Sandwell General Hospital, Physiopathologie et thérapie des déficits sensoriels et moteurs, Université Montpellier 2 - Sciences et Techniques (UM2)-IFR76-Institut National de la Santé et de la Recherche Médicale (INSERM), Rigshospitalet [Copenhagen], Université de Médecine Carol Davila, Cardiology Department [Târgu Mureș], University of Medicine and Pharmacy of Târgu Mureș, Institute for Cardiovascular Diseases C.C. Iliescu, Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), Associazione Nazionale Medici Cardiologi Ospedalieri [Firenze] (ANMCO), University of Parma = Università degli studi di Parma [Parme, Italie], Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), 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), 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), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Gabriel Montpied [Clermont-Ferrand], The University of Tokyo (UTokyo), Universität Zürich [Zürich] = University of Zurich (UZH), and Copenhagen University Hospital

Subjects
Carotid Artery Diseases, Male, Myocardial Infarction, MESH: Lower Extremity, 030204 cardiovascular system & hematology, THERAPY, Stroke/epidemiology, MESH: Dose-Response Relationship, Drug, 0302 clinical medicine, Rivaroxaban, prevention, Hemorrhage/chemically induced, MESH: Peripheral Arterial Disease, MESH: Double-Blind Method, guidelines, MESH: Incidence, 030212 general & internal medicine, Cardiovascular Diseases/mortality, risk, RISK, MESH: Aged, MESH: Middle Aged, Incidence, General Medicine, Middle Aged, 3. Good health, Stroke, MESH: Myocardial Infarction, Lower Extremity, Cardiovascular Diseases, MESH: Platelet Aggregation Inhibitors, Factor Xa Inhibitors/administration & dosage, Drug Therapy, Combination, Female, MESH: Factor Xa Inhibitors, OUTPATIENTS, MESH: Rivaroxaban, management, MESH: Hemorrhage, metaanalysis, Lower Extremity/blood supply, Rivaroxaban/administration & dosage, Hemorrhage, MESH: Drug Administration Schedule, Amputation, Surgical, Drug Administration Schedule, MESH: Stroke, Peripheral Arterial Disease, 03 medical and health sciences, Double-Blind Method, atherothrombosis, Myocardial Infarction/epidemiology, MANAGEMENT, Humans, MESH: Amputation, MESH: Aspirin, Aspirin/administration & dosage, Platelet Aggregation Inhibitors/administration & dosage, METAANALYSIS, Aged, MESH: Humans, Aspirin, Dose-Response Relationship, Drug, MESH: Carotid Artery Diseases, MORTALITY, MESH: Cardiovascular Diseases, cardiovascular event rates, PREVENTION, CARDIOVASCULAR EVENT RATES, MESH: Male, outpatients, atrial-fibrillation, MESH: Drug Therapy, Combination, MESH: Morbidity, Carotid Artery Diseases/complications, lower-extremity amputation, Peripheral Arterial Disease/complications, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, MESH: Female, Platelet Aggregation Inhibitors, Amputation/statistics & numerical data, Factor Xa Inhibitors
Abstract

BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.FUNDING: Bayer AG.

Published
2018

8. La verbalisation de l'erreur par les sages-femmes

Author

Perchet, Pauline, Université Paris Descartes - École de sages-femmes Baudelocque (UPD ESF Baudelocque), Université Paris Descartes - Paris 5 (UPD5), and Pierre Raynal

Subjects
Revues morbi-mortalité, MESH: Mortality, MESH: Morbidity, Verbalization, Faute, MESH: Medical Errors, Erreur, Conséquence, Verbalisation, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: Systematic Reviews as Topic, Morbi-mortality reviews
Abstract

Context: error, unlike fault, is not intentional. Many errors are corrected spontaneously. In aeronautics, the risk of accidental death is lower compared to medicine. In this discipline, talking about mistakes, even those with no consequences, is advocated. This helps to prevent them from happening again. Some methods have begun to be developed in medicine such as morbi-mortality reviews, adverse event records with the possibility of anonymization... It is important to accept a reality: error is inherent in any human activity. It is not possible to eliminate error in a working environment with humans. Objectives: the main objective of this study was to assess midwives’ behaviour when confronted to a mistake they made. They can either talk about it, wait to find out if the mistake has a consequence to talk about it or not talk about it at all. A secondary objective of this assessment was to identify the determinants that could influence the verbalization of these mistakes.Population and method: We conducted a quantitative, observational study for salaried midwives in the hospital sector using a questionnaire in the form of an anonymous online form from October 7, 2018 to December 29, 2018. Main results: we collected 1009 responses for our questionnaire. Few midwives did not talk about their mistakes (0.4%), but 16.5% waited to know if the mistake had a consequence to talk about it. Midwives that are young, recently graduated or recently practiced in their maternity wards as well as those who have never attended morbi-mortality reviews were more likely to wait to know if the error had a consequence to talk about it (p≤0,002). When the atmosphere at the morning obstetrical staff was conducive to talking about their mistakes, midwives tended to talk about their mistakes without waiting to know if there were any consequences (p

Published
2019

9. Résultats fonctionnels et morbidité de l’énucléation endoscopique de la prostate au laser holmium (HoLEP) dans le traitement de l’hypertrophie bénigne de prostate

Author

Sapetti, Jordan, Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), and Nicolas Barry Delongchamps

Subjects
Incontinence, Enucléation, MESH: Hypertrophy, MESH: Morbidity, Hypertrophie, Prostate, Laser, MESH: Lasers, Morbidité, MESH: Prostate, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, MESH: Urinary Incontinence
Abstract

L’HoLEP est de plus en plus utilisée dans le traitement de l’hypertrophie bénigne de prostate en alternative aux techniques de référence. Cependant la morbidité de cette technique et en particulier la survenue d’une incontinence urinaire post opératoire n’est que peu étudiée dans la littérature. L’objectif de ce travail était d’évaluer la morbidité précoce avec au premier plan l’incontinence urinaire survenant après l’HoLEP, et d’en caractériser la nature, ainsi que l’évolution spontanée à 1, 3 et 6 mois postopératoire. Nous avons également recherché des facteurs pré ou peropératoires pouvant être associés à la survenue de celle-ci. Nous avons étudié de manière prospective 171 patients opérés par HoLEP dans notre centre entre novembre 2015 et janvier 2017. L’incontinence urinaire était de 43 % à 1 mois, 36 % à 3 mois et 33 % à 6 mois post opératoire. La proportion d’incontinence urinaire à l’effort était environ 3 fois plus élevée que celle par urgenturie. La survenue de cette complication semblait être associée à une énergie délivrée per opératoire trop importante ( OR = 1.07 {1.01-1.16} ; p = 0.045). Ces résultats impliquent une remise en question de la technique employée mais aussi une nouvelle réflexion sur les indications avec une mesure de la balance bénéfice-risque adaptée à chaque cas particulier.

Published
2017

10. Measuring malaria morbidity in an area of seasonal transmission: Pyrogenic parasitemia thresholds based on a 20-year follow-up study

Author

Cheikh Talla, Fatoumata Diene Sarr, Marion Dollat, Cheikh Sokhna, Jean-François Trape, Vincent Richard, Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), laboratoire de Paludologie, Institut de Recherche pour le Développement (IRD), The Dielmo and Ndiop Cohort was implemented by 'Institut Pasteur de Dakar' and 'Institut de recherche pour le développement' through their own budget funded by different sources (Institut Pasteur, Ministry of research…) since 1990. the combination of different funding was able to maintain the follow-up activities included in the annual budget of each institution. The staff of the IRD and Pasteur Institutes of Dakar and Paris contributed to the design, healthcare, data collection, and data treatment during the 20 years of the project., Vecteurs - Infections tropicales et méditerranéennes (VITROME), Institut de Recherche Biomédicale des Armées (IRBA)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées (IRBA), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA)

Subjects
Plasmodium, Quantitative Parasitology, Fevers, Parasitemia, Pathology and Laboratory Medicine, Logistic regression, 01 natural sciences, 010104 statistics & probability, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Child, Prevalence, Medicine and Health Sciences, MESH: Malaria, Falciparum/epidemiology, Malaria, Falciparum, Child, MESH: Senegal/epidemiology, Protozoans, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Multidisciplinary, Quinine, Transmission (medicine), Follow up studies, Eukaryota, Drugs, Chloroquine, MESH: Follow-Up Studies, MESH: Seasons, Parasitic diseases, Senegal, 3. Good health, Chemistry, Child, Preschool, Physical Sciences, MESH: Malaria, Falciparum/parasitology, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Medicine, Seasons, medicine.symptom, Research Article, MESH: Malaria, Falciparum/transmission, Fever, Science, Plasmodium falciparum, 030231 tropical medicine, Context (language use), Asymptomatic, Antimalarials, 03 medical and health sciences, Age Distribution, Signs and Symptoms, Alkaloids, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Diagnostic Medicine, Malarial parasites, Parasite Groups, parasitic diseases, medicine, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, 0101 mathematics, MESH: Age Distribution, MESH: Prevalence, Pharmacology, MESH: Humans, MESH: Plasmodium falciparum/physiology, business.industry, MESH: Child, Preschool, Organisms, Chemical Compounds, Biology and Life Sciences, MESH: Fever/complications, Tropical Diseases, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Parasitic Protozoans, Malaria, Logistic Models, Carriage, MESH: Morbidity, MESH: Parasitemia/epidemiology, Parasitology, Morbidity, business, Apicomplexa, Follow-Up Studies, Demography
Abstract

International audience; Asymptomatic carriage of P. falciparum is frequent in areas endemic for malaria and individual diagnosis of clinical malaria attacks is still difficult. We investigated the impact of changes in malaria endemicity on the diagnostic criteria for malaria attacks in an area of seasonal malaria transmission.METHODS: We analyzed the longitudinal data collected over 20 years from a daily survey of all inhabitants of Ndiop, a rural community in central Senegal, in a logistic regression model to investigate the relationship between the level of Plasmodium falciparum parasitemia and the risk of fever, with the aim of determining the best parasitemia thresholds for attributing to malaria a fever episode.RESULTS: A total of 34,136 observations recorded from July 1993 to December 2013 from 850 individuals aged from 1 day to 87 years were included. P. falciparum asymptomatic carriage declined from 36% to 1% between 1993 and 2013. A total of 9,819 fever episodes were associated with a positive blood film for P. falciparum. Using age-dependent parasitemia thresholds for attributing to malaria a fever episode, we recorded 6,006 malaria attacks during the study period. Parasitemia thresholds seemed to be lower during the low-to-zero transmission season and tended to decrease with changes in control policies. The number of clinical malaria attacks was overestimated for all age groups throughout the study when all fever episodes associated with P. falciparum parasitemia were defined as malaria attacks.CONCLUSION: Pyrogenic thresholds are particularly sensitive to changes in malaria epidemiology and are therefore an interesting tool to accurately assess the burden of malaria in the context of declining transmission.

Published
2019

11. Primary prevention of venous thromboembolism in elderly medical patients

Author

Dominique Mottier, Karine Lacut, Grégoire Le Gal, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)

Subjects
Disease, Review, 030204 cardiovascular system & hematology, Global Health, MESH: Venous Thromboembolism, medical settings, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, Global health, Medicine, 030212 general & internal medicine, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Incidence (epidemiology), General Medicine, 3. Good health, Primary Prevention, Survival Rate, Treatment Outcome, prophylaxis, medicine.medical_specialty, MESH: Survival Rate, venous thromboembolism, MEDLINE, MESH: Abscess, MESH: Anticoagulants, elderly patients, MESH: Splenic Diseases, 03 medical and health sciences, Humans, cardiovascular diseases, Intensive care medicine, Survival rate, Aged, MESH: Humans, business.industry, Public health, RC952-954.6, Anticoagulants, equipment and supplies, Clinical trial, MESH: Morbidity, MESH: Primary Prevention, Geriatrics, Physical therapy, Life expectancy, Geriatrics and Gerontology, Morbidity, business, MESH: Female, MESH: World Health, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Karine Lacut, Grégoire Le Gal, Dominique MottierGETBO EA 3878, CHU de Brest, Department of Internal Medicine and Chest Diseases, Hôpital Cavale Blanche, Brest, FranceAbstract: Primary prophylaxis with the use of an effective and safe intervention appears the best approach of venous thromboembolism (VTE) management in medical elderly patients, the most affected by VTE. With increasing life expectancy, prevention of VTE, particularly in elderly patients, will arise as a major public health problem. Few well designed clinical trials evaluating thromboprophylaxis in medical settings were conducted in the specific population of geriatric patients. However, among the several pharmacological treatments evaluated, low molecular weight heparins enoxaparin 40 mg daily or dalteparin 5000 IU daily appeared effective and safe in the prevention of VTE in elderly patients. Despite available data, and recommendations for VTE prevention in medical patients, thromboprophylaxis is underused or misused in practice. Heterogeneity of clinical studies, selected populations, concern about bleeding, and lack of a clear clinical benefit are some of the reasons that could explain the gap between theory and practice. In this review, after a brief report of epidemiologic data and specificities of VTE in elderly patients, the authors discuss the available results of VTE primary prevention trials for elderly medical patients, the limitations of these data, and the challenges to improve the practice and to reduce the incidence of this frequent but preventable disease.Keywords: venous thromboembolism, prophylaxis, elderly patients, medical settings, review

Published
2008

12. Geographic differences in heart failure trials

Author

Ferreira, Joao Pedro, Girerd, Nicolas, Rossignol, Patrick, Zannad, Faiez, Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Faculdade de Medicina da Universidade do Porto (FMUP), Universidade do Porto, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)

Subjects
MESH: Humans, MESH: Randomized Controlled Trials as Topic, MESH: Morbidity, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Geographic differences, MESH: Heart Failure, Randomized controlled trials, Treatment effect, Heart failure, Outcomes, MESH: Global Health, MESH: Cost of Illness, MESH: Disease Management
Abstract

International audience; Randomized controlled trials (RCTs) are essential to develop advances in heart failure (HF). The need for increasing numbers of patients (without substantial cost increase) and generalization of results led to the disappearance of international boundaries in large RCTs. The significant geographic differences in patients' characteristics, outcomes, and, most importantly, treatment effect observed in HF trials have recently been highlighted. Whether the observed regional discrepancies in HF trials are due to trial-specific issues, patient heterogeneity, structural differences in countries, or a complex interaction between factors are the questions we propose to debate in this review. To do so, we will analyse and review data from HF trials conducted in different world regions, from heart failure with preserved ejection fraction (HF-PEF), heart failure with reduced ejection fraction (HF-REF), and acute heart failure (AHF). Finally, we will suggest objective and actionable measures in order to mitigate regional discrepancies in future trials, particularly in HF-PEF where prognostic modifying treatments are urgently needed and in which trials are more prone to selection bias, due to a larger patient heterogeneity.

Published
2015

13. La pharmaco-épidémiologie pour évaluer les pratiques cliniques et leur impact sur la santé, à propos d’un exemple en néphrologie : l’étude AVENIR

Author

Thilly, Nathalie, Boini, Stephanie, Laurain, Emmanuelle, Ayav, Carole, Kessler, Michèle, Briançon, Serge, Frimat, Luc, Centre d'Epidémiologie Clinique (CIC-EC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), and 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)

Subjects
Male, MESH: Survival Rate, MESH: Renal Insufficiency, Chronic, MESH: Pharmacoepidemiology, MESH: Hospitalization, MESH: Prognosis, MESH: Aged, 80 and over, Renal Dialysis, Humans, MESH: Renal Dialysis, Prospective Studies, MESH: Quality of Health Care, Practice Patterns, Physicians', Renal Insufficiency, Chronic, Aged, Quality of Health Care, Aged, 80 and over, MESH: Aged, MESH: Humans, MESH: Middle Aged, Pharmacoepidemiology, MESH: Quality of Life, MESH: Nephrology, Middle Aged, Prognosis, MESH: Prospective Studies, MESH: Male, Hospitalization, Survival Rate, MESH: France, MESH: Morbidity, Nephrology, MESH: Practice Patterns, Physicians', Quality of Life, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Morbidity, MESH: Female
Abstract

International audience; The AVENIR study is a pharmaco-epidemiological study, lead in Lorraine region (France) between 1st January, 2005 and 31st December, 2006, which aim at: evaluating the quality of therapeutic practices, delivered by nephrologists, for chronic kidney disease patients during the year preceding dialysis onset, assessing the association between quality of predialysis therapeutic practices and survival and hospitalization during the first year of dialysis, and health-related quality of life at dialysis onset. Several data were collected for the AVENIR study: demographic, clinical, biological and therapeutic data before dialysis, morbidity and mortality during dialysis treatment. These data were used for secondary analyses investigating the decline in glomerular filtration rate over the year preceding dialysis, the management of hypertension and proteinuria before dialysis, and characteristics and outcomes of patients with delayed dialysis initiation. Results from the AVENIR study have been published in various international journals. The aim of this manuscript is to present a summary of these results and the lessons we can learn for the nephrological practice.; L’étude AVENIR est une étude de pharmaco-épidémiologie, conduite en 2005 et 2006 en région Lorraine, et dont les objectifs principaux étaient : d’évaluer la qualité des pratiques néphrologiques de prise en charge médicamenteuse chez les insuffisants rénaux chroniques au cours de l’année précédant le démarrage de la dialyse, de mesurer l’impact de la qualité de ces pratiques sur la morbimortalité pendant la première année de dialyse et la qualité de vie à l’initiation de la suppléance rénale. De nombreuses données démographiques, cliniques, biologiques et thérapeutiques avant dialyse et de morbidité et mortalité pendant la dialyse, ont été recueillies dans le cadre de cette étude. Ces données ont permis de réaliser des analyses répondant à des objectifs secondaires de l’étude ; ces objectifs portaient sur déclin au cours du temps du débit de filtration glomérulaire dans l’année précédant la suppléance rénale, la prise en charge de l’hypertension artérielle (HTA) et de la protéinurie avant dialyse, le retard à l’initiation de la dialyse et ses conséquences sur la morbidité et la mortalité. Les résultats, correspondant aux objectifs principaux et secondaires de l’étude AVENIR, ont été publiés dans différentes revues internationales. L’objectif de cet article est de présenter une synthèse de ses résultats et les leçons à en tirer pour la pratique néphrologique.

Published
2013

14. Younger donor's age and upfront tandem are two independent prognostic factors for survival in multiple myeloma patients treated by tandem autologous-allogeneic stem cell transplantation: a retrospective study from the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

Author

Jean-Henri Bourhis, Frédéric Garban, Mohamad Mohty, Nathalie Contentin, Gérard Socié, Sylvie François, Mauricette Michallet, Nathalie Fegueux, Madalina Uzunov, Serge Koscielny, Natacha Maillard, Ibrahim Yakoub-Agha, Simona Lapusan, Didier Blaise, Claire Fabre, Reza Tabrizi, Hématopoïèse normale et pathologique, Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Service d'hématologie et oncologie médicale, Hôpital Lapeyronie-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hôpital Haut-Lévêque, Université Sciences et Technologies - Bordeaux 1-CHU Bordeaux [Bordeaux], Service Hématologie, Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Hôpital Jean Bernard, Service d'hématologie [Hôpital Edouard Herriot - HCL], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'hématologie greffe [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), UAM Allogreffes de CSH, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), TheREx, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Département de cancérologie et d'hématologie, and CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon

Subjects
Male, Oncology, MESH: Tissue Donors, MESH: Registries, MESH: Multiple Myeloma, [SDV.IMM.II]Life Sciences [q-bio]/Immunology/Innate immunity, MESH: Cause of Death, 0302 clinical medicine, Recurrence, Cause of Death, Registries, Prospective cohort study, Multiple myeloma, Cause of death, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, Mortality rate, Age Factors, Hematopoietic Stem Cell Transplantation, Hematology, Middle Aged, Prognosis, Tissue Donors, MESH: Transplantation, Autologous, 3. Good health, Treatment Outcome, MESH: Young Adult, 030220 oncology & carcinogenesis, MESH: Survival Analysis, Female, Multiple Myeloma, Adult, medicine.medical_specialty, Transplantation, Autologous, MESH: Prognosis, Young Adult, 03 medical and health sciences, Internal medicine, medicine, MESH: Transplantation, Homologous, Humans, Transplantation, Homologous, Autologous transplantation, Survival analysis, MESH: Hematopoietic Stem Cell Transplantation, Aged, Retrospective Studies, MESH: Age Factors, MESH: Humans, business.industry, Retrospective cohort study, MESH: Adult, MESH: Retrospective Studies, medicine.disease, Survival Analysis, MESH: Male, Surgery, MESH: Recurrence, Transplantation, MESH: Morbidity, Original Articles and Brief Reports, Morbidity, business, MESH: Female, 030215 immunology
Abstract

International audience; BACKGROUND: How tandem autologous-allogeneic stem cell transplantation should be integrated in the treatment of multiple myeloma remains controversial. We examined the long-term outcome of patients with multiple myeloma managed with tandem autologous-allogeneic stem cell transplantation and present a prognostic factor analysis based on the experience of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC). DESIGN AND METHODS: This French, retrospective, registry-based study included 146 patients who had undergone tandem autologous-allogeneic transplantation for multiple myeloma at 20 SFGM-TC centers between 1998 and 2010. The patients included in the study had fully completed the two steps of a planned tandem autologous-allogeneic transplantation. No treatment had to be administered between the autologous and allogeneic parts of the tandem procedure. RESULTS: Seventy-seven patients (53%) underwent tandem autologous-allogeneic transplantation as part of upfront treatment, i.e. after a single line of treatment not including autologous transplantation. The median follow-up from the allogeneic transplant was 47.5 months (range, 1.2-132 months). At 4 years, the overall survival and event-free survival rates were 48% (95% CI 39-57 %) and 27% (95% CI 19-36), respectively. Eighteen patients (12%) experienced grade III-IV acute graft-versus-host disease and 43 patients (30%) had chronic graft-versus-host disease. The transplant-related mortality rate at 1 year was 15% (95% CI 10-22). Patients receiving tandem transplantation as upfront treatment had significantly improved event-free survival (36% versus 11%; P=0.005) and overall survival (56% versus 34%; P=0.02). Donor's age ≤ 50 years was associated with improved event-free survival (35% versus 16%; P=0.005) and overall survival (54% versus 41%; P=0.02). In the multivariable analysis, upfront tandem transplantation, donor's age ≤ 50 years and full chimerism were independent prognostic factors for better outcome. CONCLUSIONS: We confirmed the feasibility of tandem autologour-allogeneic transplantation in heavily treated patients with multiple myeloma. We identified younger donor's age and upfront tandem transplantation as two independent prognostic factors for survival which could be further explored in prospective studies.

Published
2012

15. Hospital discharge data can be used for monitoring procedures and intensive care related to severe maternal morbidity

Author

Marie-Hélène Bouvier-Colle, Catherine Quantin, Catherine Deneux-Tharaux, Anne A. Chantry, Anne Ego, Christine Cans, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Techniques pour l'Evaluation et la Modélisation des Actions de Santé (ThEMAS), CHU Grenoble, Unité de Recherche Clinique, Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 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), Chantry was supported by a doctoral grant from the French Ministry of Research, GRACE study group: G. Bal, G. Beucher, MJ. D'alche Gautier, AS. Ducloy-Bouthors, N. Lamendour, I. Le Fur, V. Tessier, J. Zeitlin, Université Pierre et Marie Curie - Paris 6 (UPMC), GENOME, 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 )-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 Joseph Fourier - Grenoble 1 (UJF)-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), Hôpital Jeanne de Flandre [Lille], Université de Bourgogne (UB), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Techniques pour l'Evaluation et la Modélisation des Actions de Santé ( ThEMAS ), Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), 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 ), 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), Laboratoire d'Analyse et de Techniques Economiques (LATEC), Université de Bourgogne (UB)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), and EGO, Anne

Subjects
MESH: Pulmonary Embolism, Epidemiology, Severe maternal morbidity, 030204 cardiovascular system & hematology, MESH : Intensive Care, MESH: Hospital Information Systems, 0302 clinical medicine, Sensitivity, MESH: Pregnancy, Pregnancy, Medicine, MESH : Female, 030212 general & internal medicine, Medical diagnosis, Hospital discharge data, ComputingMilieux_MISCELLANEOUS, Medical records, MESH: Middle Aged, Medical record, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Adult, Middle Aged, Patient Discharge, MESH: Postpartum Hemorrhage, 3. Good health, Pulmonary embolism, MESH: International Classification of Diseases, MESH: Pregnancy Complications, MESH: Young Adult, MESH : Pulmonary Embolism, MESH : Hypertension, Pregnancy-Induced, Hospital Information Systems, Female, France, MESH : Patient Discharge, MESH : Hospital Information Systems, Adult, MESH: Medical Records, medicine.medical_specialty, Adolescent, Critical Care, MEDLINE, MESH : Young Adult, MESH : Hospitals, Teaching, MESH : Postpartum Hemorrhage, MESH : Pregnancy Complications, MESH : Morbidity, Validity, 03 medical and health sciences, Young Adult, International Classification of Diseases, Intensive care, MESH : Adolescent, MESH : International Classification of Diseases, MESH : Medical Records, Humans, MESH : Middle Aged, MESH: Intensive Care, MESH: Hypertension, Pregnancy-Induced, Intensive care medicine, MESH : France, Hospitals, Teaching, MESH: Adolescent, Eclampsia, MESH: Humans, business.industry, MESH: Patient Discharge, Gold standard, MESH : Humans, Postpartum Hemorrhage, MESH: Adult, Hypertension, Pregnancy-Induced, MESH: Hospitals, Teaching, medicine.disease, Pregnancy Complications, MESH: France, MESH : Pregnancy, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, 26 Positive predictive value, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, business, Pulmonary Embolism, MESH: Female
Abstract

International audience; OBJECTIVE: To estimate the accuracy and reliability of the reporting of diagnoses and procedures related to severe acute maternal morbidity in French hospital discharge data. STUDY DESIGN AND SETTING: The study, conducted in four French tertiary teaching hospitals, covered the years 2006 and 2007 and 30,607 deliveries. We identified severe maternal morbid events-eclampsia, pulmonary embolism, procedures related to postpartum hemorrhages, and intensive care-in administrative hospital discharge data and medical records and compared their recording. Information from medical records was the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the hospital discharge data for these events were calculated. False positives and false negatives were examined to identify the reasons for misrecorded information. RESULTS: The PPV of the hospital discharge data was 20% for eclampsia. For procedures related to postpartum hemorrhages, the PPVs were high, but sensitivities were lower; however, 95% of recording errors could be corrected. All indicators for intensive care exceeded 98%. CONCLUSION: Intensive care and procedures seem reliably reported in the hospital administrative database, which, therefore, can be used to monitor them. Using these data for monitoring diagnoses will require a greater investment by clinicians in the accuracy of their reporting.

Published
2011

16. Hospital discharge data can be used for monitoring procedures and intensive care related to severe maternal morbidity

Author

Chantry, Anne, Deneux-Tharaux, Catherine, Cans, Christine, Ego, Anne, Quantin, Catherine, Bouvier-Colle, Marie-Hélène, Debs, Nayla, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Techniques pour l'Evaluation et la Modélisation des Actions de Santé (ThEMAS), CHU Grenoble, Unité de Recherche Clinique, Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 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), Chantry was supported by a doctoral grant from the French Ministry of Research, GRACE study group: G. Bal, G. Beucher, MJ. D'alche Gautier, AS. Ducloy-Bouthors, N. Lamendour, I. Le Fur, V. Tessier, and J. Zeitlin

Subjects
MESH: Medical Records, MESH: Pulmonary Embolism, Severe maternal morbidity, Validity, MESH: Hospital Information Systems, Sensitivity, MESH: Pregnancy, MESH: Intensive Care, Hospital discharge data, MESH: Hypertension, Pregnancy-Induced, MESH: Adolescent, Medical records, MESH: Middle Aged, MESH: Humans, MESH: Patient Discharge, MESH: Adult, MESH: Hospitals, Teaching, MESH: Postpartum Hemorrhage, MESH: International Classification of Diseases, MESH: France, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Pregnancy Complications, MESH: Young Adult, 26 Positive predictive value, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract

International audience; OBJECTIVE: To estimate the accuracy and reliability of the reporting of diagnoses and procedures related to severe acute maternal morbidity in French hospital discharge data. STUDY DESIGN AND SETTING: The study, conducted in four French tertiary teaching hospitals, covered the years 2006 and 2007 and 30,607 deliveries. We identified severe maternal morbid events-eclampsia, pulmonary embolism, procedures related to postpartum hemorrhages, and intensive care-in administrative hospital discharge data and medical records and compared their recording. Information from medical records was the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the hospital discharge data for these events were calculated. False positives and false negatives were examined to identify the reasons for misrecorded information. RESULTS: The PPV of the hospital discharge data was 20% for eclampsia. For procedures related to postpartum hemorrhages, the PPVs were high, but sensitivities were lower; however, 95% of recording errors could be corrected. All indicators for intensive care exceeded 98%. CONCLUSION: Intensive care and procedures seem reliably reported in the hospital administrative database, which, therefore, can be used to monitor them. Using these data for monitoring diagnoses will require a greater investment by clinicians in the accuracy of their reporting.

Published
2011

17. [Tubulo-interstitial fibrosis: an emerging major health problem]

Author

Julie, Klein, Mathieu, Miravete, Bénédicte, Buffin-Meyer, Joost P, Schanstra, Jean-Loup, Bascands, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), 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 Simon, Marie Francoise

Subjects
Kallikrein-Kinin System, MESH: Cell Hypoxia, Angiotensin-Converting Enzyme Inhibitors, MESH: Extracellular Matrix, Kidney, urologic and male genital diseases, Models, Biological, MESH: Lysophospholipids, Myoblasts, Renin-Angiotensin System, Angiotensin Receptor Antagonists, Mice, MESH: Proteinuria, MESH: Renin-Angiotensin System, Animals, Humans, MESH: Animals, MESH: Incidence, MESH: Myoblasts, MESH: Intercellular Signaling Peptides and Proteins, MESH: Mice, MESH: Cytokines, MESH: Humans, Incidence, Macrophages, MESH: Angiotensin-Converting Enzyme Inhibitors, MESH: Models, Biological, MESH: Macrophages, MESH: Kallikrein-Kinin System, MESH: Kidney, Fibroblasts, MESH: Chemokines, Cell Hypoxia, Extracellular Matrix, Proteinuria, MESH: Angiotensin Receptor Antagonists, MESH: Morbidity, MESH: Kidney Failure, Chronic, MESH: Fibroblasts, Disease Progression, Cytokines, Intercellular Signaling Peptides and Proteins, Kidney Failure, Chronic, Nephritis, Interstitial, MESH: Disease Progression, Chemokines, Lysophospholipids, Morbidity, MESH: Nephritis, Interstitial
Abstract

International audience; The incidence of chronic kidney disease leading to end-stage renal disease has significantly increased and may reach epidemic proportions over the next decade. Regardless of the initial insult, the progression of most forms of renal disease results in tubulo-interstitial fibrosis. This has been closely correlated to the future appearance of renal failure and has therefore been associated with poor long-term prognosis. New molecules and agents to limit the development of tubulo-interstitial fibrosis and slow down the progression towards end-stage renal disease are needed. In the past twenty years, many efforts have been made to understand the mechanisms of tubulo-intersititial fibrosis with the final goal to develop new therapeutic strategies. In this context, this review will focus on the mechanisms and factors involved in the development and the progression of renal fibrosis and will discuss the new promising therapeutic strategies in animal and humans.

Published
2011

18. Lipidomics as a tool for the study of lipoprotein metabolism

Author

Anatol Kontush, M. John Chapman, Dyslipidémies, inflammation et athérosclérose dans les maladies métaboliques, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), These studies were supported by the National Institute for Health and Medical Research (INSERM), University of Pierre and Marie Curie (UPMC), CODDIM Ile-de-France, the Fondation de France and the Fondation pour la Recherche Médicale (Paris, France). AK acknowledges the award of a Contrat d'Interface from Assistance Publique--Hôpitaux de Paris/INSERM (France)., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Chapman, John

Subjects
Very low-density lipoprotein, HDL, Lipoproteins, Blood lipids, 030204 cardiovascular system & hematology, Biology, Lipidome, LDL, 03 medical and health sciences, chemistry.chemical_compound, Plasma, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, MESH: Risk Factors, Lipidomics, medicine, Humans, Metabolomics, MESH: Metabolomics, 030304 developmental biology, Dyslipidemias, 0303 health sciences, MESH: Humans, Fatty liver, MESH: Dyslipidemias, MESH: Cardiovascular Diseases, Lipid metabolism, medicine.disease, MESH: Lipoproteins, Lipids, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Biochemistry, chemistry, MESH: Morbidity, Cardiovascular Diseases, Low-density lipoprotein, lipids (amino acids, peptides, and proteins), Morbidity, Cardiology and Cardiovascular Medicine, VLDL, Lipoprotein
Abstract

International audience; Although technologies for lipidomic and proteomic investigations have developed very recently, lipidomic and proteomic studies of plasma lipoproteins have already provided several impressive examples of detailed characterization of distinct metabolic pathways potentially involved in lipoprotein metabolism in both health and disease states (obesity, insulin resistance, fatty liver disease) as well as under lifestyle and dietary modification (fish consumption, carbohydrates, probiotics) and lipid-modifying treatments (statins, low-density lipoprotein apheresis). Available lipidomic methodologies have facilitated detailed characterization of lipid classes and molecular species present in plasma as well as in lipoprotein fractions. Together with emerging proteomic techniques, lipidomics of plasma lipoproteins will soon provide molecular details of lipoprotein composition, which will ultimately be translated into integrated knowledge of the structure, metabolism, and function of lipoproteins in health and disease.

Published
2010

19. Self-rated health before and after retirement in France (GAZEL): a cohort study

Author

Constanze Leineweber, Jane E. Ferrie, Jussi Vahtera, Markus Jokela, Maria Melchior, Jaana Pentti, Archana Singh-Manoux, Marie Zins, Marcel Goldberg, Hugo Westerlund, Mika Kivimäki, Stress Research Institute, Stockholm University, Department of Epidemiology and Public Health, University College of London [London] (UCL), Unit of Excellence for Psychosocial Factors, Finnish Institute of Occupational Health, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Psychology, Department of Public Health, University of Turku-Finnish Institute of Occupational Health-Turku University Hospital (TYKS), The Swedish Council for Working Life and Social Research (Sweden), The Academy of Finland (Finland), INSERM (France), The BUPA Foundation (UK), The Medical Research Council (UK), The European Science Foundation (EU), and The Economic and Social Research Council (UK)., Kaniewski, Nadine, Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Turku University Hospital (TYKS)-University of Turku-Finnish Institute of Occupational Health

Subjects
Gerontology, Male, Health Status, MESH: Retirement, Occupational safety and health, Cohort Studies, 0302 clinical medicine, Medicine, 030212 general & internal medicine, MESH: Cohort Studies, MESH: Health Status, Self-rated health, education.field_of_study, Retirement, MESH: Middle Aged, 030503 health policy & services, 1. No poverty, General Medicine, MESH: Sick Leave, Middle Aged, 3. Good health, 8. Economic growth, Cohort, Sick leave, Female, France, Sick Leave, 0305 other medical science, Cohort study, Adult, medicine.medical_specialty, Population, Job Satisfaction, 03 medical and health sciences, Humans, Occupations, education, MESH: Job Satisfaction, MESH: Occupations, MESH: Humans, business.industry, Public health, MESH: Quality of Life, MESH: Adult, Mental health, MESH: Male, MESH: France, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Quality of Life, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, business, MESH: Female
Abstract

International audience; BACKGROUND: Governments need to increase the proportion of the population in work in most developed countries because of ageing populations. We investigated longitudinally how self-perceived health is affected by work and retirement in older workers. METHODS: We examined trajectories of self-rated health in 14 714 employees (11 581 [79%] men) from the French national gas and electricity company, the GAZEL cohort, for up to 7 years before and 7 years after retirement, with yearly measurements from 1989 to 2007. We analysed data by use of repeated-measures logistic regression with generalised estimating equations. FINDINGS: Overall, suboptimum health increased with age. However, between the year before retirement and the year after, the estimated prevalence of suboptimum health fell from 19.2% (95% CI 18.5-19.9) to 14.3% (13.7-14.9), corresponding to a gain in health of 8-10 years. We noted this retirement-related improvement in men (odds ratio 0.68, 95% CI 0.64-0.73) and women (0.74, 0.67-0.83), and across occupational grades (low 0.72, 0.63-0.82; high 0.70, 0.63-0.77), and it was maintained throughout the 7 years after retirement. A poor work environment and health complaints before retirement were associated with a steeper yearly increase in the prevalence of suboptimum health while still in work, and a greater retirement-related improvement; however, people with a combination of high occupational grade, low demands, and high satisfaction at work showed no such retirement-related improvement. INTERPRETATION: These findings suggest that the burden of ill-health, in terms of perceived health problems, is substantially relieved by retirement for all groups of workers apart from those with ideal working conditions, and that working life for older workers needs to be redesigned to achieve higher labour-market participation. FUNDING: Swedish Council for Working Life and Social Research, Academy of Finland, INSERM (France), BUPA Foundation (UK), European Science Foundation, and Economic and Social Research Council (UK).

Published
2009

20. [Comparing fetal and maternal morbidities between operative deliveries by Teissier's spatulas and Minicup vacuum extractor]

Author

Aouar, Z., Ramanah, R., Mangin, M., Leung, F., Mulin, B., Courtois, L., Cossa, S., Maillet, R., Riethmuller, D., Centre d'études scientifiques et techniques d'Aquitaine ( CESTA ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Immunologie et Chimie Thérapeutiques (ICT), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Centre d'études scientifiques et techniques d'Aquitaine (CESTA), Direction des Applications Militaires (DAM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), 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), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Adult, Vacuum Extraction, Obstetrical, MESH : Retrospective Studies, MESH: Vacuum Extraction, Obstetrical, MESH : Episiotomy, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Urinary Tract Infections, MESH: Birth Injuries, Perineum, MESH : Perineum, Obstetrical Forceps, MESH : Morbidity, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Pregnancy, Pregnancy, Birth Injuries, Birth Weight, Humans, MESH: Obstetrical Forceps, MESH : Obstetrical Forceps, MESH : Urinary Tract Infections, MESH : Female, MESH: Birth Weight, MESH: Perineum, MESH : Birth Injuries, Retrospective Studies, MESH: Humans, MESH : Humans, MESH: Adult, MESH: Retrospective Studies, MESH : Birth Weight, MESH: Episiotomy, MESH : Adult, Delivery, Obstetric, body regions, MESH : Pregnancy, MESH: Morbidity, Episiotomy, Urinary Tract Infections, MESH : Vacuum Extraction, Obstetrical, Female, MESH: Delivery, Obstetric, MESH : Delivery, Obstetric, Morbidity, MESH: Female
Abstract

International audience; OBJECTIVE: To compare fetal and maternal morbidities between operative deliveries by long Teissier's spatulas and Minicup vacuum extractor. MATERIAL AND METHODS: A retrospective study was conducted from January 2003 to July 2008 at the maternity ward, Besançon teaching hospital. Operative deliveries in term cephalic singleton pregnancies performed by Teissier's spatulas (case group) were compared to previous deliveries by vacuum extractor Minicup (control group). RESULTS: During the study period, 69 operative deliveries by Teissier's spatulas have been performed. No significant difference was found between the two groups in terms of maternal characteristics. Two third-degree perineal tears occurred following delivery by Teissier's spatulas with no third-degree tear in the vacuum extractor group (p = ns). The episiotomy rate in the Teissier's spatulas group was 15,9% compared to 11.6% in the vacuum extractor group (p = ns). Duration of operative delivery was significantly shorter in the Teissier's spatulas group (3.4 min vs 4.95 min; p = 0.007). Fetal morbidity was identical in the two groups. CONCLUSION: This study found no significant difference in terms of fetal and maternal morbidities between operative deliveries by Teissier's spatulas and vacuum extractor. Moreover, as opposed to Thierry's spatulas, the long Tessier spatulas can be adequately used in accordance with patient's wish and practice guidelines recommending a policy of restrictive episiotomy. However, a larger study is needed to confirm these preliminary results.

Published
2009

21. Gender differences in the association between morbidity and mortality among middle-aged men and women

Author

Jane E. Ferrie, Michael Marmot, Archana Singh-Manoux, Pekka Martikainen, Marcel Goldberg, Alice Guéguen, Martin J. Shipley, Sébastien Bonenfant, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Epidemiology and Public Health, University College of London [London] (UCL), Equipe RPPC, CETAF, Kaniewski, Nadine, and Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, genetic structures, Research and Practice, Health Status, 030204 cardiovascular system & hematology, Cohort Studies, MESH: Proportional Hazards Models, 0302 clinical medicine, MESH: Health Surveys, Absenteeism, London, 030212 general & internal medicine, MESH: Cohort Studies, MESH: Health Status, Self-rated health, education.field_of_study, Sex Characteristics, MESH: Middle Aged, Hazard ratio, MESH: Sex Distribution, Men, Middle Aged, Cohort, Female, France, MESH: Life Expectancy, Cohort study, MESH: Sex Characteristics, Adult, medicine.medical_specialty, Population, MESH: Women, 03 medical and health sciences, Life Expectancy, Sex Factors, MESH: Sex Factors, MESH: Analysis of Variance, mental disorders, medicine, Whitehall Study, Humans, Women, Mortality, Sex Distribution, education, Proportional Hazards Models, Analysis of Variance, MESH: Humans, MESH: Mortality, business.industry, Public health, Public Health, Environmental and Occupational Health, MESH: Men, MESH: Adult, MESH: London, Health Surveys, MESH: Male, MESH: Absenteeism, MESH: France, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Life expectancy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, business, MESH: Female, Demography
Abstract

Objectives. We examined gender differences in mortality, morbidity, and the association between the 2. Methods. We used health data from 2 studies of middle-aged men and women: the British Whitehall II cohort of employees from 20 civil service departments in London and the 1989 French GAZEL (this acronym refers to the French gas and electric companies) of employees of France's national gas and electricity company. Participants were aged 35 to 55 years when assessed for morbidity and followed up for mortality over 17 years. Results. Male mortality was higher than female mortality in Whitehall II (hazard ratio [HR] = 1.56; 95% confidence interval [CI] = 1.28, 1.91) and the GAZEL cohort (HR = 1.99; CI = 1.66, 2.40). Female excess morbidity was observed for some measures in the Whitehall II data and for 1 measure in the GAZEL data. Only self-reported sickness absence in the Whitehall II data was more strongly associated with mortality among men (P = .01). Conclusions. Mortality was lower among women than among men, but morbidity was not consistently higher. The lack of gender differences in the association between morbidity and mortality suggests that this is not a likely explanation for the gender paradox, which refers to higher morbidity but lower mortality among women than among men.

Published
2008

22. How cytokines can influence the brain: A role for chemokines?

Author

Carole Rovère, Alice Guyon, Fabienne Massa, Jean-Louis Nahon, Institut de pharmacologie moléculaire et cellulaire (IPMC), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS), and Association pour la Recherche sur le Cancer, Fondation de France (Comité Parkinson), Centre National de la Recherche Scientifique (CNRS)

Subjects
Chemokine, 0302 clinical medicine, MESH: Risk Factors, MESH: Postoperative Complications, Immunology and Allergy, Hormone metabolism, MESH: Incidence, 0303 health sciences, MESH: Middle Aged, biology, Leptin, [SDV.BA]Life Sciences [q-bio]/Animal biology, Brain, Interleukin, food and beverages, MESH: Heart Transplantation, MESH: Immunosuppression, 3. Good health, MESH: Virus Diseases, medicine.anatomical_structure, Neurology, Cytokines, [SDV.IMM]Life Sciences [q-bio]/Immunology, Tumor necrosis factor alpha, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Chemokines, medicine.symptom, MESH: Bacterial Infections, Immunology, Inflammation, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, Blood–brain barrier, Models, Biological, MESH: Actuarial Analysis, 03 medical and health sciences, Immune system, medicine, Animals, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Neurons, Afferent, MESH: Prevalence, 030304 developmental biology, Afferent Pathways, MESH: Humans, MESH: Time Factors, Hormones, MESH: Male, MESH: Morbidity, biology.protein, Neurology (clinical), MESH: Female, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Following inflammation or infection, cytokines are released in the blood. Besides their effect on the immune system, cytokines can also act in the brain to modulate our behaviors, inducing for example anorexia when produced in large amount. This review focuses on our current knowledge on how cytokines can influence the brain and the behaviors through several possible pathways: modulating peripheral neurons which project to the brain through the vagus nerve, modulating the levels of hormones such as leptin which can act to the brain through the humoral pathway and possibly acting directly in the brain, through the local production of cytokines and chemokines such as SDF-1alpha/CXCL12.

Published
2008

23. Morbidity before and after HAART initiation in Sub-Saharan African HIV-infected adults: a recurrent event analysis

Author

Ahmadou Alioum, Xavier Anglaret, Eugène Messou, Delphine Gabillard, André Inwoley, Catherine Seyler, Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Centre de recherche et de Diagnostic sur le Sida [Abidjan, Côte d'Ivoire] (CeDreS), Centre Hospitalier Universitaire de Treichville [Abidjan, Côte d'Ivoire] (CHU de Treichville), and Equipe de Biostatistique

Subjects
sub-Saharan Africa, Male, Pediatrics, Multivariate analysis, HAART, MESH: CD4 Lymphocyte Count, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, MESH: Antiretroviral Therapy, Highly Active, Cohort Studies, 0302 clinical medicine, Immunopathology, Antiretroviral Therapy, Highly Active, adults, 030212 general & internal medicine, Prospective Studies, MESH: Anti-HIV Agents, Sida, Prospective cohort study, MESH: Cohort Studies, 0303 health sciences, biology, Incidence (epidemiology), MESH: HIV Infections, 3. Good health, Infectious Diseases, Female, Viral disease, Adult, medicine.medical_specialty, Anti-HIV Agents, Immunology, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Virology, medicine, Humans, MESH: Africa South of the Sahara, Africa South of the Sahara, MESH: Humans, recurrences, 030306 microbiology, business.industry, HIV, MESH: Adult, biology.organism_classification, medicine.disease, MESH: Prospective Studies, MESH: Male, Surgery, CD4 Lymphocyte Count, MESH: Morbidity, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, business, MESH: Female
Abstract

International audience; The incidence and determinants of severe morbidity recurrence in sub-Saharan African HIV-infected adults on antiretroviral therapy (ART) have never been reported. In a prospective cohort study of HIV-infected adults in Abidjan the association of severe morbidity occurrence and recurrence with follow-up CD4 counts and ART on/off status was analyzed by means of multivariate failure analysis for recurrent events (Prentice, Williams, and Peterson model). A total of 608 patients (median CD4 290/mm3 ) was followed off ART for 1824 person-years (PY). Of these 187 started HAART (median CD4 174/mm3 ) and were followed for 328 PY. The incidence of first, second, and third severe morbidity events was 40.6/100 PY, 68.4/100 PY, and 93.9/100 PY during the off-ART period, and 28.4/100 PY, 39.4/100 PY, and 37.6/100 PY during the on-ART period, respectively. The rates of recurrences were higher than the rates of first episodes for almost all diseases, even after stratifying by CD4 count and by ART on/off status. In multivariate analysis, the time-updated CD4 count was independently associated with increasing rates of morbidity first events and recurrences, after adjustment on other covariates (p > 10(4) ). By contrast, there was no association between the ART on/off status and the morbidity rates after adjustment for CD4 count (p = 0.37). Introducing ART led to a clear reduction in morbidity, mainly related to the ART-induced increase in CD4 count. In HIV-infected patients on ART, the incidence of severe morbidity varied with the past history of morbidity. The past history of morbidity should be taken into account when comparing HIV morbidity rates before and after ART initiation.

Published
2008

24. Morbidity before and after HAART initiation in Sub-Saharan African HIV-infected adults: a recurrent event analysis.: HIV morbidity recurrence in Abidjan

Author

Seyler, Catherine, Messou, Eugène, Gabillard, Delphine, Inwoley, André, Alioum, Ahmadou, Anglaret, Xavier, Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Centre de recherche et de Diagnostic sur le Sida [Abidjan, Côte d'Ivoire] (CeDreS), Centre Hospitalier Universitaire de Treichville [Abidjan, Côte d'Ivoire] (CHU de Treichville), and Equipe de Biostatistique

Subjects
sub-Saharan Africa, HAART, MESH: Humans, recurrences, MESH: CD4 Lymphocyte Count, HIV, morbidity, MESH: Adult, MESH: HIV Infections, MESH: Prospective Studies, MESH: Antiretroviral Therapy, Highly Active, MESH: Male, MESH: Morbidity, adults, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Africa South of the Sahara, MESH: Anti-HIV Agents, MESH: Cohort Studies, MESH: Female
Abstract

International audience; The incidence and determinants of severe morbidity recurrence in sub-Saharan African HIV-infected adults on antiretroviral therapy (ART) have never been reported. In a prospective cohort study of HIV-infected adults in Abidjan the association of severe morbidity occurrence and recurrence with follow-up CD4 counts and ART on/off status was analyzed by means of multivariate failure analysis for recurrent events (Prentice, Williams, and Peterson model). A total of 608 patients (median CD4 290/mm3 ) was followed off ART for 1824 person-years (PY). Of these 187 started HAART (median CD4 174/mm3 ) and were followed for 328 PY. The incidence of first, second, and third severe morbidity events was 40.6/100 PY, 68.4/100 PY, and 93.9/100 PY during the off-ART period, and 28.4/100 PY, 39.4/100 PY, and 37.6/100 PY during the on-ART period, respectively. The rates of recurrences were higher than the rates of first episodes for almost all diseases, even after stratifying by CD4 count and by ART on/off status. In multivariate analysis, the time-updated CD4 count was independently associated with increasing rates of morbidity first events and recurrences, after adjustment on other covariates (p > 10(4) ). By contrast, there was no association between the ART on/off status and the morbidity rates after adjustment for CD4 count (p = 0.37). Introducing ART led to a clear reduction in morbidity, mainly related to the ART-induced increase in CD4 count. In HIV-infected patients on ART, the incidence of severe morbidity varied with the past history of morbidity. The past history of morbidity should be taken into account when comparing HIV morbidity rates before and after ART initiation.

Published
2007

25. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality

Author

Cohen, At, Agnelli, Giancarlo, Anderson, Fa, Arcelus, Ji, Bergqvist, D, Brecht, Jg, Greer, Ia, Heit, Ja, Hutchinson, Jl, Kakkar, Ak, Mottier, D, Oger, E, Samama, Mm, Spannagl, M, VTE Impact Assessment Group in Europe, Calvez, Ghislaine, Vascular Medicine - Department or Surgery (ATC), King's College Hospital (KCH), School of Chemistry, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Serv. Hématologie Biologie Hôtel Dieu, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Internal Medicine, and University Hospital of Munich

Subjects
MESH: Pulmonary Embolism, Male, Risk, MESH: Registries, Hypertension, Pulmonary, MESH: Algorithms, MESH: Anticoagulants, MESH: Venous Thromboembolism, Postthrombotic Syndrome, Humans, cardiovascular diseases, Registries, Venous Thrombosis, MESH: Risk, MESH: Humans, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, MESH: Hypertension, Pulmonary, MESH: Postthrombotic Syndrome, Anticoagulants, Venous Thromboembolism, MESH: Hospitals, equipment and supplies, MESH: Male, Hospitals, Europe, MESH: Morbidity, MESH: Venous Thrombosis, Female, MESH: Europe, Morbidity, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Algorithms
Abstract

International audience; Venous thromboembolism (VTE) is often asymptomatic, mis-diagnosed, and unrecognized at death, and there is a lack of routine postmortem examinations. These factors are thought to result in marked underestimates ofVTE incidence. The objective of our study was to estimate the total burden of VTE within the European Union (EU) per annum. An epidemiological model was constructed to estimate the number of community- and hospital-acquired incidents and recurrent cases (attack rate) of nonfatal VTE and VTE-related deaths, as well as incident and prevalent cases of post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (PH) occurring in the EU per annum. Individual models were developed for six EU countries. The models were populated with data from published literature and, where necessary, expert opinions. The findings were tested using probabilistic sensitivity analyses. The estimated total number of symptomaticVTE events (range based on probabilistic sensitivity analysis) per annum within the six EU countries was 465,715 (404,664-538,189) cases of deep-vein thrombosis, 295,982 (242,450-360,363) cases of pulmonary embolism (PE), and 370,012 (300,193-483,108) VTE-related deaths. Of these deaths, an estimated 27,473 (7%) were diagnosed as being antemortem; 126,145 (34%) were sudden fatal PE, and 217,394 (59%) followed undiagnosed PE. Almost three-quarters of all VTE-related deaths were from hospital-acquired VTE. VTE is a major health problem in the EU, with over one million VTE events or deaths per annum in the six countries examined. Given the availability of effective VTE prophylaxis, many of these events and deaths could have been prevented. These results have important implications for the allocation of healthcare resources.

Published
2007

26. Morbidity and associated factors in rural and urban populations of South Lebanon: a cross-sectional community-based study of self-reported health in 2000

Author

Sabbah , Ibtissam, Vuitton , Dominique-Angèle, Droubi , Nabil, Sabbah , Sanaa, Mercier , Mariette, WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Laboratoire Pierre Süe (LPS), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Interactions et dynamique des environnements de surface (IDES), Université Paris-Sud - Paris 11 (UP11)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Université de Franche-Comté ( UFC ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Laboratoire Pierre Süe ( LPS ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Centre National de la Recherche Scientifique ( CNRS ), Interactions et dynamique des environnements de surface ( IDES ), and Université Paris-Sud - Paris 11 ( UP11 ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS )

Subjects
MESH: Socioeconomic Factors, MESH : Male, MESH : Public Health, MESH : Aged, MESH : Health Surveys, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Regression Analysis, MESH : Morbidity, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH : Sampling Studies, MESH : Cross-Sectional Studies, MESH: Aged, 80 and over, MESH: Cross-Sectional Studies, MESH: Health Surveys, MESH: Sampling Studies, MESH: Risk Factors, MESH : Adolescent, MESH : Regression Analysis, MESH : Socioeconomic Factors, MESH : Middle Aged, MESH : Female, MESH: Lebanon, MESH : Health Status, MESH : Aged, 80 and over, MESH: Health Status, MESH: Adolescent, MESH: Aged, MESH: Middle Aged, MESH: Humans, MESH : Humans, MESH: Adult, MESH : Adult, MESH : Risk Factors, MESH: Male, MESH: Morbidity, MESH : Lebanon, MESH: Public Health, MESH: Female
Abstract

International audience; OBJECTIVE: To assess self-reported morbidity and its determining factors in South Lebanon, with an emphasis on the influence of the habitat location (urban vs. rural) and gender. METHODS: Cross-sectional survey in 2000 among 524 South Lebanon residents >/=14 years sampled from a random sample of households using a multi-level cluster sampling technique. Data on self-reported morbidity, lifestyle and socioeconomic status were collected through interviews, using a standardized questionnaire. To evaluate deprivation, a new index was created; the modified 'Living Conditions Index'. Stepwise logistic regression analysis was performed to test the effect of habitat and gender on self-reported morbidity. RESULTS: People in one-fifth of the households lived in precarious conditions. Illiteracy was significantly higher in rural than urban settings. Urban residents reported obesity, varicose veins, anxiety/depression and visual disorders more often. Illiteracy, headaches, lumbar pain, varicose veins and anxiety/depression were more frequently reported by women, whereas ulcers, hearing disorders, cardio-vascular diseases and their risk factors were more frequently reported by men. Precarious living conditions were associated with headaches, lumbar pains and insomnia. Individuals covered by a health insurance sought care more often than the uninsured. CONCLUSION: Habitat location had only a minor influence on self-reported morbidity; women perceived their health as poorer than men and a number of disease conditions were influenced by deprivation. Our study confirms that the epidemiological transition phenomenon had occurred in South Lebanon in 2000. Our community-based data can serve as a baseline for monitoring changes in health in South Lebanon in the future and especially those because of the war that emerged in July 2006.

Published
2007

27. Phenotypic and genotypic risk factors for cardiovascular events in an incident dialysis cohort

Author

C. Jouet, Alberto Jeantet, Gilles Pernod, J.-P. Wauters, G. Bonfant, D. Cordonnier, J.-M. Hurot, Giacomo Forneris, Dela Golshayan, Martina G, Claire Barro, C. Turc-Baron, J. Theytaz, Jean-Luc Bosson, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), TIMB, VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CIC - Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche : innovation sociotechnique et organisations industrielles (CRISTO), and Université Pierre Mendès France - Grenoble 2 (UPMF)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Time Factors, medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Gastroenterology, Cohort Studies, MESH: Genotype, 0302 clinical medicine, MESH: Aged, 80 and over, Lp(a), Risk Factors, MESH: Risk Factors, Prevalence, MESH: Renal Dialysis, Prospective Studies, MESH: Incidence, MESH: Cohort Studies, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, education.field_of_study, MESH: Middle Aged, Incidence, Hazard ratio, MESH: Follow-Up Studies, Middle Aged, 3. Good health, Phenotype, Treatment Outcome, Italy, Cardiovascular Diseases, Nephrology, Cohort, Female, France, Hemodialysis, Switzerland, Cohort study, cardiovascular risk, Adult, medicine.medical_specialty, Genotype, Population, MESH: Switzerland, MESH: Phenotype, MESH: Multivariate Analysis, Peritoneal dialysis, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, Humans, Risk factor, education, Dialysis, MESH: Prevalence, Aged, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, MESH: Humans, business.industry, MESH: Time Factors, MESH: Biological Markers, MESH: Italy, MESH: Cardiovascular Diseases, MESH: Adult, homocysteine, mortality study, MESH: Male, MESH: Prospective Studies, MESH: France, Endocrinology, MESH: Morbidity, MTHFR, Multivariate Analysis, dialysis, Morbidity, business, MESH: Female, Biomarkers, Follow-Up Studies
Abstract

Cardiovascular disease (CVD) remains the major cause of death in patients with end-stage renal disease (ESRD). Traditional risk factors do not explain the high prevalence of CVD in this population, and other non-traditional cardiovascular (CV) risk markers have now been described. Therefore, the potential relationship between CVD and phenotypic and genotypic risk markers was investigated prospectively in incident dialysis patients cohort. The 279 patients (244 on hemodialysis, 35 on peritoneal dialysis) within the Diamant Alpin Dialysis Cohort Study were investigated. Phenotypic and genotypic parameters were determined at dialysis initiation, patients monitored over a 2-year period, and CV events (morbidity and mortality) recorded. Globally, 82 CV events occurred and 26 patients (9.3%) died from CVD, whereas 28 (10%) died from non-CV causes. Previous CV events were strongly predictive of CV events occurrence, whatever patients had had one (hazard ratio (HR) 2, 95% confidence intervals (CI) 1.1-3.5) or more (HR 3.9, 95% CI 2.1-7.1) CV accidents before starting dialysis. Both lipoprotein(a) (HR 1.67, 95% CI 1-2.5) and total plasma homocysteine at cutoff 30 micromol/l (HR 1.7, 95% CI 1.1-2.8) were independent predictors of CV events outcome. In the subgroup of patients with homocysteine < 30 micromol/l, methylenetetrahydrofolate reductase (MTHFR) TT was the sole biological parameter predictive of CV event outcome (HR 2.5, 95% CI 1.1-10, P = 0.03). ESRD patients who enter chronic dialysis with a previous CV event, high total homocysteinemia levels, or MTHFR 677TT genotype must be considered at high risk of incident CV events.

Published
2006

28. [The progression of lung cancer incidence in France (1978-2000)]

Author

Molinié, F., Velten, M., Remontet, L., Bercelli, P., Réseau Francim, Danzon, Arlette, Département d'Ingénierie des Systèmes (ex SIS) (DIS), Institut de Recherches sur les lois Fondamentales de l'Univers (IRFU), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Registre des cancers du Bas-Rhin, CRLCC Paul Strauss, Hospices Civils de Lyon, Service de Biostatistique, Université de Lyon, Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], 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)-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)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), 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), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), 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), Département d'Ingénierie des Systèmes (ex SIS) ( DIS ), Institut de Recherches sur les lois Fondamentales de l'Univers ( IRFU ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay, Laboratoire Biostatistique-Santé ( LBS ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ) -Centre National de la Recherche Scientifique ( CNRS ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), and Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO)

Subjects
MESH: Smoking, MESH: Registries, MESH : Male, MESH : Risk, MESH : Mortality, MESH : Age Distribution, MESH : Aged, MESH : Cohort Studies, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Morbidity, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH : Adenocarcinoma, MESH: Aged, 80 and over, MESH : Middle Aged, MESH : Female, MESH : Lung Neoplasms, MESH: Incidence, MESH : Carcinoma, Squamous Cell, MESH : France, MESH : Aged, 80 and over, MESH : Sex Distribution, MESH: Age Distribution, MESH: Cohort Studies, MESH: Aged, MESH: Humans, MESH: Middle Aged, MESH: Risk, MESH: Mortality, MESH : Humans, MESH: Adenocarcinoma, MESH: Sex Distribution, MESH: Adult, MESH: Carcinoma, Small Cell, MESH: Carcinoma, Squamous Cell, MESH : Adult, MESH : Incidence, MESH: Male, MESH : Carcinoma, Small Cell, MESH: Lung Neoplasms, MESH : Smoking, MESH: France, MESH: Morbidity, MESH : Carcinoma, Large Cell, MESH: Carcinoma, Large Cell, MESH: Female, MESH : Registries
Abstract

International audience; INTRODUCTION: Lung cancer is the most common cause of death from malignant disease in the world. Our objective was to describe the progression of this cancer's incidence, and the changing distribution of histological types in France between 1978 and 2000. METHODS: National incidence rates were obtained by modelling lung cancer incidence data provided by the French cancer registries, taking into account national mortality data. These registries also provided information about histological type. RESULTS: In the year 2000, with 28,000 estimated new diagnoses, lung cancer represented 10.0% of all incident cancers and was responsible for 18.1% of deaths from cancer. From 1980 to 2000, the incidence rose from 47.4 to 52.2 per hundred thousand in men and from 3.7 to 8.6 per hundred thousand in women. The risk of developing lung cancer, which remained constant in men, has increased considerably (+451%) between the generation of women born in 1953 and those born in 1913. The proportion of epidermoid cancers has dropped whilst that of adenocarcinomas has risen sharply. CONCLUSIONS: The last few years have seen a large increase in the incidence of lung cancer in women and an increasing incidence of adenocarcinoma in both men and women.

Published
2006

29. [Epidemiology of asthma and allergies. The prevalence of allergies increases worldwide, and asthma has reached his highest-ever prevalence in Europe: why?]

Author

Aubier, Michel, Neukirch, Françoise, Annesi-Maesano, Isabella, Pneumologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie et Epidemiologie de l'Insuffisance Respiratoire, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), M Aubier, Neukirch F, Annesi-Maesano je ., and Annesi-Maesano, Isabella

Subjects
Adult, Male, Adolescent, MESH: Asthma, MESH: Hypersensitivity, MESH: Environmental Exposure, Global Health, Th2 Cells, immune system diseases, MESH: Th2 Cells, MESH: Child, Hypersensitivity, Prevalence, Humans, MESH: Obesity, Anti-Asthmatic Agents, Obesity, MESH: Incidence, MESH: Drug Utilization, Child, MESH: Prevalence, MESH: Developed Countries, MESH: Adolescent, MESH: Environmental Pollution, MESH: Humans, Developed Countries, Incidence, MESH: Child, Preschool, MESH: Adult, Environmental Exposure, MESH: Anti-Asthmatic Agents, Asthma, Drug Utilization, MESH: Male, respiratory tract diseases, Europe, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Food, Child, Preschool, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, Morbidity, Environmental Pollution, MESH: Female, MESH: Food, MESH: World Health
Abstract

International audience; Up to 10% of adults and 35% of children worldwide suffer from asthma. The incidence of asthma is also higher in children than in adults, possibly owing to a "cohort" effect. Recent population-based studies show that the increase in the prevalence of asthma noted worldwide in the past 30 years has started to subside in industrialised countries. This phenomenon has been accompanied by a parallel increase in the use of asthma medications. Possible explanations for this increase include the "hygiene hypothesis", which implicates diminished exposure to microbial pathogens but was recently challenged by new biological and immunological findings. Asthma might result from the interactions between individual and environmental factors (diet, air pollution, etc.), but further investigations are needed to understand the precise pathophysiological mechanisms of asthma.

Published
2005

30. Le scandale des 4 millions de morts néonatales chaque année : bilan et actions possibles

Author

Dominique Labie, Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Maylin, Françoise

Subjects
[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, MESH: Humans, business.industry, MESH: Infant, Newborn, General Medicine, General Biochemistry, Genetics and Molecular Biology, MESH: Infant Care, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Medicine, MESH: Infant Mortality, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Une série de quatre articles parus récemment dans le Lancet attire l'attention sur le drame que représente dans le monde d'aujourd'hui, en 2005, la mortalité des nouveau-nés, et le fait avec des chiffres extrêmement impressionnants. Le premier de ces papiers, le plus important, sans doute, fait ce qu'on pourrait appeler un état des lieux [1]. Sur les 130 millions de naissances annuelles, 4 millions d'enfants meurent dans les quatre premières semaines de leur vie, et on doit compter un nombre sensiblement équivalent de mort-nés par suite d'un décès in utero dans les trois derniers mois de la grossesse. Une localisation de ces morts montre que 99 % d'entre elles ont lieu dans les pays les plus pauvres ou en cours de développement, la moitié environ faisant suite à un accouchement à domicile, contre 1 % seulement dans nos pays riches. Or, ce sont ces 1 % qui font l'objet d'enquêtes et éventuellement sont l'objet d'un scandale public si elles semblent dues à une insuffisance des services. C'est également cette très petite minorité qui fera l'objet de recherches et d'essais, alors que peu de progrès ont été réalisés depuis 10-15 ans dans les pays majoritairement concernés. Un projet global (MDG-4, millenium development goal-4) recherche ce que pourrait être une amélioration des systèmes de santé.

Published
2005

31. Is parenteral nutrition guilty?

Author

Richard D. Griffiths, Jean-Charles Preiser, Erich Roth, Jan Wernerman, Gérard Nitenberg, Xavier Leverve, Marek Pertkiewicz, René Chioléro, Claude Pichard, Peter Varga, Department of Statistics [Oxford], University of Oxford [Oxford], Service de médecine intensive adulte, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Bioénergétique fondamentale et appliquée, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Nutrition and Surgery, Orlowski University Hospital, Division of Surgical Research, Medizinische Universität Wien = Medical University of Vienna, Department of Anesthesiology and Intensive Care Medicine, Karolinska Institutet [Stockholm], Department of Clinical Nutrition, Geneva University Hospital (HUG), Service de réanimation, CHU de Liège, University of Oxford, and Hamant, Sarah

Subjects
MESH: Enteral Nutrition, medicine.medical_specialty, MESH: Combined Modality Therapy, 030309 nutrition & dietetics, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, MESH: Critical Care, MESH: Practice Guidelines as Topic, MESH: Risk Factors, Anesthesiology, Intensive care, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Medicine, MESH: Patient Selection, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, 030212 general & internal medicine, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, MESH: Treatment Outcome, 0303 health sciences, MESH: Humans, business.industry, Critically ill, 030208 emergency & critical care medicine, 3. Good health, Parenteral nutrition, MESH: Parenteral Nutrition, Total, Action (philosophy), MESH: Morbidity, MESH: Critical Illness, business, MESH: Evidence-Based Medicine
Abstract

“Death by parenteral nutrition” was the title of the controversial editorial published in the June issue of Intensive Care Medicine by P.E. Marik and M. Pinsky [1]. One might believe that a real event was being described by the authors. Imagine our astonishment, which quickly turned to dismay, when we read the words: “…a poison or toxin is a substance that through its chemical action usually kills, injures or impairs an organism… and by this definition TPN meets all criteria of a poison/toxin, in the critically ill patient receiving parenteral nutrition.” We are surprised and perturbed that the authors have missed some important issues regarding the nutrition of patients in intensive care units (ICUs), exchanging sensationalism for sound scientific discussion.

Published
2003

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