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Fathallah N, Akaffou M, Haouari MA, Spindler L, Alam A, Barré A, Pommaret E, Fels A, de Parades V. Deep remission improves the quality of life of patients with Crohn's disease and anoperineal fistula treated with darvadstrocel: results of a French pilot study. Tech Coloproctol 2023; 27:1201-1210. [PMID: 36811811 DOI: 10.1007/s10151-023-02765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The injection of allogeneic adipose tissue-derived mesenchymal stem cells (MSC) into anal fistulas in patients with Crohn's disease has never been evaluated in "real-life" conditions in France. METHODS We prospectively studied the first patients receiving MSC injections at our center and undergoing 12 months of follow-up. The primary endpoint was the clinical and radiological response rate. The secondary endpoints were symptomatic efficacy, safety, anal continence, quality of life (Crohn's anal fistula-quality of life scale, CAF-QoL), and predictive factors of success. RESULTS We included 27 consecutive patients. The complete clinical and radiological response rates at M12 were 51.9% and 50%, respectively. The combined complete clinical-radiological response (deep remission) rate was 34.6%. No major adverse effects or changes in anal continence were reported. The perianal disease activity index decreased from 6.4 to 1.6 (p < 0.001) for all patients. The CAF-QoL score also decreased from 54.0 to 25.5 (p < 0.001). At the end of the study, M12, the CAF-QoL score was significantly lower only in patients with a complete combined clinical-radiological response relative to those without a complete clinical-radiological response (15.0 versus 32.8, p = 0.01). Having a multibranching fistula and infliximab treatment were associated with a combined complete clinical-radiological response. CONCLUSIONS This study confirms reported efficacy data for the injection of MSC for complex anal fistulas in Crohn's disease. It also shows a positive impact on the quality of life of patients, particularly those for whom a combined clinical-radiological response was achieved.
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Affiliation(s)
- N Fathallah
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - M Akaffou
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - M A Haouari
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - L Spindler
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Alam
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Barré
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - E Pommaret
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Fels
- Clinical Research Centre, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V de Parades
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Skoufou M, Lefèvre JH, Fels A, Fathallah N, Benfredj P, de Parades V. Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma? J Visc Surg 2023; 160:330-336. [PMID: 36973105 DOI: 10.1016/j.jviscsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The goal was to compare fissurectomy with mucosal advancement flap anoplasty to fissurectomy alone in the surgical treatment of anal fissure. PATIENTS AND METHODS This study included patients who underwent surgery in 2019 for solitary, idiopathic, non-infected, posterior anal fissure, after failure of medical treatment. The choice to perform advancement flap anoplasty was based on surgeon preference and did not depend on the fissure itself. The main endpoint was the time to relief of pain. RESULTS Of 599 fissurectomies performed during the study period, 226 patients (37.6% women, mean age 41.7±12.0 years old) underwent fissurectomy alone (n=182) or associated with advancement flap anoplasty (n=44). The two groups differed as to their sex ratio (33.5 vs. 54.5% women, P=0.01), body mass index (25.3±4.0 vs. 23.6±3.9, P=0.013) and Bristol score (3.2 vs. 3.4, P=0.038). Time to relief of pain, time to disappearance of bleeding and time to healing were 1.1 (0.5-2.3), 1.0 (0.5-2.1) and 2.0 (1.1-3.6) months, respectively. The rate of healing was 93.8% and the complication rate was 6.2%. The differences between the two groups for these outcomes were not statistically significant. The risk factors associated with absence of healing were age ≥ 40 years (Odds ratio (OR): 3.84; 95% CI, 1.12-17.68) and pre-surgical duration of fissure<35.6 weeks (OR: 6.54; 95% CI: 1.69-43.21). CONCLUSION Mucosal advancement flap anoplasty does not provide any added value to fissurectomy alone.
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Affiliation(s)
- M Skoufou
- Medical and Surgical Proctology Department, Saint-Joseph Hospital Group, 75014 Paris, France.
| | - J H Lefèvre
- Department of Digestive Surgery, Sorbonne University, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - A Fels
- Clinical Research Department, Saint-Joseph Hospital Group, 75014 Paris, France
| | - N Fathallah
- Medical and Surgical Proctology Department, Saint-Joseph Hospital Group, 75014 Paris, France
| | - P Benfredj
- Medical and Surgical Proctology Department, Saint-Joseph Hospital Group, 75014 Paris, France
| | - V de Parades
- Medical and Surgical Proctology Department, Saint-Joseph Hospital Group, 75014 Paris, France
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Lebreton O, Fels A, Compagnon A, Lazareth I, Ghaffari P, Chatellier G, Emmerich J, Michon-Pasturel U, Priollet P, Yannoutsos A. Amputation-free survival in the long-term follow-up and gender-related characteristics in patients revascularized for critical limb ischemia. J Med Vasc 2023; 48:105-115. [PMID: 37914455 DOI: 10.1016/j.jdmv.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Patients with Critical Limb Ischemia (CLI) present a high risk of cardiovascular events and death. Revascularization is the cornerstone of therapy to relieve ischemic pain and prevent limb loss. Literature data suggest that women tend to present with worse outcomes after revascularization. The aim of the present study is to determine amputation-free survival in a long-term follow-up in women and men following endovascular revascularization procedure for CLI. METHODS From November 2013 to December 2020, 357 consecutive patients were retrospectively included. Clinical and biological parameters were recorded at baseline before endovascular revascularization. During follow-up until February 2023, overall survival and amputation-free survival (freedom from major amputation) were analysed using the Kaplan-Meier method. Univariate and multivariate analyses were performed to study the parameters associated with amputation-free survival. A P<0.05 was considered as statistically significant. RESULTS A total of 357 consecutive patients were included, 189 men and 168 women with CLI, with a mean age of 78.6±12 years. Treated hypertension (79%), diabetes mellitus (48%), coronary artery disease (39%) and protein malnutrition (61%) were the most prevalent comorbidities. Women were older than men with a mean age of 82.4±11.4 years (versus 75.4±11 years in men) and presented more frequently with protein malnutrition (70% of women). Prevalence of diabetes, tobacco use and history of coronary heart disease were significantly higher in men. During the 10-year follow-up period, 241 patients had died (68%) and 38 (11%) underwent major amputation, of whom 22 patients were still alive on February 2023. Median survival was 35.5 months [IQR: 29.5; 43] in the overall population, 38.5 [32; 50.4] months in women and 33.5 months [24.7; 43.5] in men. No gender-related differences were noted according to peri-procedural complications, survival probability and amputation-free survival. In multivariate analysis for amputation-free survival, age, previous coronary heart disease, C-reactive protein level, left ventricular ejection fraction (LVEF)<60% and albumin level<35g/L were correlated with poor outcome. In particular, protein malnutrition, as a treatable risk factor, appears significantly correlated with poor outcome in both men and women (HR=2.50 [1.16;5.38], P=0.0196 in men; HR=1.77 [1.00;3.13], P=0.049 in women). CONCLUSION The present results highlight that mortality in patients after endovascular revascularization remains high with a mortality rate of 28% at 1 year, 40% at 2 years and 51% at 3 years. Women represented a distinct population, almost 10-year older than their male counterparts, with more prevalent protein malnutrition. However, no gender-related difference was noted according to amputation-free survival on the long-term follow-up. Associated risk factors are mainly age, a history of coronary heart disease, pre-procedural inflammatory syndrome and protein malnutrition. Correction of malnutrition could have the potential to improve functional and general long-term prognosis in patients with CLI together with optimal medical and interventional management.
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Affiliation(s)
- O Lebreton
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Fels
- Clinical Research Center, groupe hospitalier Paris St-Joseph, Paris, France
| | - A Compagnon
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - I Lazareth
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Ghaffari
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - G Chatellier
- Clinical Research Center, groupe hospitalier Paris St-Joseph, Paris, France
| | - J Emmerich
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France; Université Paris Cité, Inserm CRESS UMR 1153, Paris, France
| | - U Michon-Pasturel
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Yannoutsos
- Vascular Medicine Department, groupe hospitalier Paris St-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France; Université Paris Cité, Inserm CRESS UMR 1153, Paris, France.
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Occhipinti JA, Hynes W, Geli P, Eyre HA, Song Y, Prodan A, Skinner A, Ujdur G, Buchanan J, Green R, Rosenberg S, Fels A, Hickie IB. Building systemic resilience, productivity and well-being: a Mental Wealth perspective. BMJ Glob Health 2023; 8:e012942. [PMID: 37748793 PMCID: PMC10533664 DOI: 10.1136/bmjgh-2023-012942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | - William Hynes
- New Approaches to Economic Challenges, Office of the Chief Economist, OECD, Paris, France
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Patricia Geli
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Reform for Resilience Commission, Secretariat, Boston, Massachusetts, USA
| | - Harris A Eyre
- Brain Capital Alliance, San Francisco, California, USA
- Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development, Paris, France
- Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University, Houston, Texas, USA
- Meadows Mental Health Policy Institute, Dallas, Texas, USA
- Euro-Mediterranean Economists Association, Barcelona, Spain
- Global Brain Health Institute, University of California, San Francisco (UCSF), San Francisco, California and Trinity College, Dublin, Dublin, Ireland
| | - Yun Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Ante Prodan
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
- School of Computer Science, Engineering and Mathematics, Western Sydney University, Penrith South, New South Wales, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Goran Ujdur
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | - John Buchanan
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Business School, University of Sydney, Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Roy Green
- University of Technology Sydney, Broadway, Sydney, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Allan Fels
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Melbourne Institute of Applied Economic and Social Research, Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
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Mottais-Cosnefroy V, Pecourt M, Yannoutsos A, Fels A, Beaussier H, Alran S, Priollet P, Hugon-Rodin J. Hormone-dependent gynaecological disorders and contraceptive modalities in women with a history of venous thromboembolic event: The THROMBOGYN study. J Med Vasc 2022; 47:228-237. [PMID: 36464417 DOI: 10.1016/j.jdmv.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
CONTEXT Hormone-dependent gynaecological disorders, such as polycystic ovary syndrome (PCOS) or endometriosis, have been recently discussed as potential risk factors for venous thromboembolism (VTE). Combined hormonal contraceptive (CHC) therapy, which is a well-known risk factor for VTE, is usually used to alleviate symptoms related to these gynaecological disorders. Nevertheless, prevalence of hormone-dependent gynaecological disorders at the time of VTE event and the management of hormonal contraceptives are not well known. OBJECTIVE To assess retrospectively the prevalence of hormone-dependent gynaecological disorders in patients with VTE event and the hormonal therapy at the time of VTE event and at the time of inclusion in the present study. METHODS Women aged between 18 to 50-year-old who were hospitalized at Saint-Joseph Hospital (Paris) for a VTE event from January 1st, 2016 to December 31st, 2020 were included in this retrospective observational study. RESULTS In total, 125 women were included. At the time of VTE event, mean age was 39-years-old (±8) and mean body mass index (BMI) 26kg/m2 (±8). Pulmonary embolism represented more than two third (68%) of VTE events. Fourteen women (11%) had PCOS and among them, 6 (43%) were using CHC. Eleven women (9%) had endometriosis and among them, 1 (9%) was using CHC. Women with PCOS appeared to be younger at the time of VTE compared to non-PCOS women (mean age 32 years (±6.0) vs. 40 years (±8.0), respectively, P<0.001), whereas women with endometriosis were older with a mean age of 43-year-old (±7.8), which did not differ significantly from women without endometriosis. Among PCOS women, 1 (7%) VTE event was idiopathic, whereas among those with endometriosis, 5 (46%) VTE events were idiopathic. Regarding contraceptive use at the time of inclusion, with a mean delay between VTE event and inclusion of 3 years (±1), 1 woman pursued CHC, 35 (28%) used non-hormonal contraceptive. Seventy-three women (58%) were aware of hormonal contraindications due to VTE event. CONCLUSION The present study, including 125 young women with a mean age of 39 years, allowed a description of gynecological pathologies and history of contraceptive use potentially involved in VTE events.
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Affiliation(s)
- V Mottais-Cosnefroy
- Department of Gynecological and Mammary Surgery, Saint-Joseph Hospital, Paris, France
| | - M Pecourt
- Vascular Medicine Department, Saint-Joseph Hospital, Paris, France
| | - A Yannoutsos
- Vascular Medicine Department, Saint-Joseph Hospital, Paris, France
| | - A Fels
- Department of Clinical Investigation, Saint-Joseph Hospital, Paris, France
| | - H Beaussier
- Department of Clinical Investigation, Saint-Joseph Hospital, Paris, France
| | - S Alran
- Department of Gynecological and Mammary Surgery, Saint-Joseph Hospital, Paris, France
| | - P Priollet
- Vascular Medicine Department, Saint-Joseph Hospital, Paris, France
| | - J Hugon-Rodin
- Inserm UMR 1153, Gynecological Endocrinology Unit, Gynecology department, EPOPE group Paris, Saint-Joseph Hospital, Paris, France.
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Compagnon A, Lazareth I, Fels A, Chatellier G, Emmerich J, Michon-Pasturel U, Priollet P, Yannoutsos A. Peri-procedural complications following endovascular revascularization for critical limb ischemia. J Med Vasc 2022; 47:175-185. [PMID: 36344028 DOI: 10.1016/j.jdmv.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Revascularization procedures are considered the cornerstone of therapy in patients with critical limb ischemia (CLI) and multiple procedures are often required to attain limb salvage. The aim of the present study is to determine the prevalence of peri-procedural complications after endovascular procedure, and to determine the clinical and biological characteristics of patients associated to the risk of peri-procedural complications. METHODS From November 2013 to May 2021, 324 consecutive patients were retrospectively included, of whom 99 underwent more than one revascularization procedure for contralateral CLI or clinical recurrence of CLI. A total of 532 revascularizations were performed. Clinical and biological parameters were recorded at baseline before endovascular revascularization. The occurrence of a peri-procedural complication (local complications, fatal and non-fatal major bleeding or cardiovascular events) was recorded up to 30days after revascularization. Univariate and multivariate analyses were performed to study the parameters associated with per-procedural complications. A P<0.05 was considered as statistically significant. RESULTS A total of 324 consecutive patients were included, 177 men and 147 women with CLI, with a mean age of 77.6±11.9years. Most of these patients had cardiovascular comorbidities (41% with a history of coronary heart disease, 78% treated hypertensive patients, 49% diabetic patients). Peri-procedural mortality occurred in 13 patients (4%) and 9 patients (2.8%) experienced major amputation at one-month following revascularization. Among the 532 revascularization procedures, 99 major bleeding events (22.8% of the cohort population) and 31 cardiovascular events (8.6% of the cohort population), were recorded in the peri-procedural period. Cardiovascular events were associated with peri-procedural mortality. Complications at the puncture site occurred during 38 of the 532 procedures (10.2% of the cohort population). Compared with patients undergoing a single revascularization procedure, patients with multiple procedures presented a higher risk of major bleeding events (48.5% vs. 11.6%, P<0.0001) and access site complications (20.2% vs. 5.78%, P<0.0001). In multivariate analysis, pulse pressure <60mmHg and hemoglobin level <10g/dl were correlated with the occurrence of major bleeding events; left ventricular ejection fraction<60% and the absence of statin treatment were correlated with the occurrence of cardiovascular complications; a high chronological rank of revascularization was correlated with the occurrence of local complication. Finally, age and gender were not associated with the occurrence of peri-procedural complication. CONCLUSION The present results highlight that multiple revascularization procedures for limb salvage are required in almost one third of the population with critical limb ischemia and were associated with the risk of major bleeding events and access site complications. The most frequent complications of peripheral vascular interventions were major bleeding events. Adverse cardiovascular events were related with peri-procedural mortality. Anemia, blood pressure, left ventricular ejection fraction and statin treatment are important parameters to consider for peri-procedural outcomes, independently of age, gender and the chronological rank of revascularization procedure.
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Affiliation(s)
- A Compagnon
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France; Department of Clinical Research, GH Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France
| | - I Lazareth
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France
| | - A Fels
- Department of Clinical Research, GH Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France
| | - G Chatellier
- Department of Clinical Research, GH Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France
| | - J Emmerich
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France; Inserm UMR 1153-CRESS, Université Paris Cité, Paris, France
| | - U Michon-Pasturel
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France
| | - P Priollet
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France
| | - A Yannoutsos
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France; Inserm UMR 1153-CRESS, Université Paris Cité, Paris, France.
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Occhipinti JA, Buchanan J, Skinner A, Song YJC, Tran K, Rosenberg S, Fels A, Doraiswamy PM, Meier P, Prodan A, Hickie IB. Measuring, Modeling, and Forecasting the Mental Wealth of Nations. Front Public Health 2022; 10:879183. [PMID: 35968431 PMCID: PMC9368578 DOI: 10.3389/fpubh.2022.879183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has exposed the deep links and fragility of economic, health and social systems. Discussions of reconstruction include renewed interest in moving beyond GDP and recognizing "human capital", "brain capital", "mental capital", and "wellbeing" as assets fundamental to economic reimagining, productivity, and prosperity. This paper describes how the conceptualization of Mental Wealth provides an important framing for measuring and shaping social and economic renewal to underpin healthy, productive, resilient, and thriving communities. We propose a transdisciplinary application of systems modeling to forecast a nation's Mental Wealth and understand the extent to which policy-mediated changes in economic, social, and health sectors could enhance collective mental health and wellbeing, social cohesion, and national prosperity. Specifically, simulation will allow comparison of the projected impacts of a range of cross-sector strategies (education sector, mental health system, labor market, and macroeconomic reforms) on GDP and national Mental Wealth, and provide decision support capability for future investments and actions to foster Mental Wealth. Finally, this paper introduces the Mental Wealth Initiative that is harnessing complex systems science to examine the interrelationships between social, commercial, and structural determinants of mental health and wellbeing, and working to empirically challenge the notion that fostering universal social prosperity is at odds with economic and commercial interests.
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Affiliation(s)
- Jo-An Occhipinti
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
| | - John Buchanan
- Mental Wealth Initiative, University of Sydney, Sydney, NSW, Australia
| | - Adam Skinner
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju C. Song
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Kristen Tran
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Rosenberg
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Allan Fels
- Melbourne Institute of Applied Economic and Social Research, Melbourne Law School, University of Melbourne, Melbourne, VIC, Australia
| | - P. Murali Doraiswamy
- Departments of Psychiatry and Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Petra Meier
- Systems Science in Public Health, University of Glasgow, Glasgow, United Kingdom
| | - Ante Prodan
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Ian B. Hickie
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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d’Ussel M, Fels A, Durand X, Lemogne C, Chatellier G, Castreau N, Adam F. Factors associated with psychological symptoms in hospital workers of a French hospital during the COVID-19 pandemic: Lessons from the first wave. PLoS One 2022; 17:e0267032. [PMID: 35482772 PMCID: PMC9049512 DOI: 10.1371/journal.pone.0267032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/31/2022] [Indexed: 01/30/2023] Open
Abstract
Purpose The COVID-19 pandemic has put hospital workers around the world in an unprecedented and difficult situation, possibly leading to emotional difficulties and mental health problems. We aimed to analyze psychological symptoms of the hospital employees of the Paris Saint-Joseph Hospital Group a few months after the 1st wave of the pandemic. Participants and methods From July 15 to October 1, 2020, a cross-sectional survey was conducted among hospital workers in the two locations of our hospital group using the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) to measure anxiety, depression, and PTSD symptoms. Factors independently associated with these symptoms were identified. Results In total, 780 participants (47% caregivers, 18% health administrative workers, 16% physicians, and 19% other professionals) completed the survey. Significant symptoms of anxiety, depression, and PTSD were reported by 41%, 21%, and 14% of the participants, respectively. Hierarchical regression analysis showed a higher risk of having psychological symptoms among those (1) who were infected by SARS-CoV-2 or had colleagues or relatives infected by the virus, (2) who retrospectively reported to have had an anxious experience during the first wave, and (3) with a previous history of burnout or depression. In contrast, job satisfaction appeared to be a protective factor. Overall, hospital workers showed the statistically same levels of anxiety, depression, and PTSD symptoms, regardless of their profession and whether they had worked in units with COVID-19 patients or not. Conclusions Our cross-sectional survey of 780 hospital workers shows that after the first wave, hospital employees had a significant burden of mental health symptoms. Specific preventive measures to promote mental well-being among hospital workers exposed to COVID-19 need to be implemented, first among particularly vulnerable staff, and then, for all hospital staff for whom anxiety is detected early, and not only those who were directly exposed to infected patients.
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Affiliation(s)
- M. d’Ussel
- Consultation Douleur Chronique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- * E-mail:
| | - A. Fels
- Centre de Recherche Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - X. Durand
- Service de Chirurgie Urologique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - C. Lemogne
- AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l’Adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Université de Paris, Paris, France
| | - G. Chatellier
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - N. Castreau
- Service de Santé au Travail, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - F. Adam
- Département d’Anesthésie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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9
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Coppola G, Grosso S, Franzoni E, Veggiotti P, Zamponi N, Parisi P, Spalice A, Habetswallner F, Fels A, Verrotti A, D’Aniello A, Mangano S, Balestri A, Curatolo P, Pascotto A. Rufinamide in refractory childhood epileptic encephalopathies other than Lennox–Gastaut syndrome. Eur J Neurol 2011; 18:246-251. [DOI: 10.1111/j.1468-1331.2010.03113.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. Coppola
- Clinic of Child Neuropsychiatry, Second University of Naples, Naples
| | - S. Grosso
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, Siena
| | - E. Franzoni
- Child Neuropsychiatry Unit, Bologna University, Bologna
| | - P. Veggiotti
- Department of Child Neurology and Psychiatry, C. Mondino Institute, University of Pavia, Pavia
| | - N. Zamponi
- Pediatric Neurology Department, G. Salesi Hospital, Ancona
| | - P. Parisi
- Chair of Pediatrics, Second Faculty of Medicine, Sapienza University
| | - A. Spalice
- Department of Pediatrics, First Faculty of Medicine, Sapienza University, Sapienza
| | | | - A. Fels
- Clinical Neurophysiology Unit, Cardarelli Hospital, Naples
| | - A. Verrotti
- Department of Pediatrics, University of Chieti, Chieti
| | - A. D’Aniello
- Clinic of Child Neuropsychiatry, Second University of Naples, Naples
| | - S. Mangano
- Child Neuropsychiatry, Palermo University, Palermo
| | - A. Balestri
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, Siena
| | - P. Curatolo
- Pediatric Neuroscience Unit, Tor Vergata University of Rome, Rome, Italy
| | - A. Pascotto
- Clinic of Child Neuropsychiatry, Second University of Naples, Naples
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10
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Affiliation(s)
- W. Borsche
- Allgemeinen chemischen Laboratorium der Universität Göttingen
| | - A. Fels
- Allgemeinen chemischen Laboratorium der Universität Göttingen
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11
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Affiliation(s)
- Allan Fels
- The Australia and New Zealand School of Government, Melbourne, VIC.
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12
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Abstract
Pospiviroidae, with their main representative potato spindle tuber viroid (PSTVd), are replicated via a rolling circle mechanism by the host-encoded DNA-dependent RNA polymerase II (pol II). In the first step, the (+)-strand circular viroid is transcribed into a (-)-strand oligomer intermediate. As yet it is not known whether transcription is initiated by promotors at specific start sites or is distributed non-specifically over the whole circle. An in vitro transcription extract was prepared from a non-infected potato cell culture which exhibited transcriptional activity using added circular PSTVd (+)-strand RNA as template. In accordance with pol II activity, transcription could be inhibited by alpha-amanitin. RT-PCR revealed the existence of at least two different start sites and primer extension identified these as nucleotides A(111) and A(325). The sequences of the first 7 nt transcribed are very similar, (105)GGAGCGA(111) and (319)GGGGCGA(325). GC-boxes are located at a distance of 15 and 16 nt upstream, respectively, in the native viroid structure, which may act to facilitate initiation. The GC-boxes may have a similar function to the GC-rich hairpin II in the (-)-strand intermediate, as described previously. The results are compared with the corresponding features of avocado sunblotch viroid, which belongs to a different family of viroids and exhibits different transcription initiation properties.
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Affiliation(s)
- A Fels
- Institut für Physikalische Biologie, Heinrich-Heine Universität Düsseldorf, Universitätsstrasse 1, D-40225 Düsseldorf, Germany
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13
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Abstract
The native structure of potato spindle tuber viroid (PSTVd) contains a series of short double helices and small internal loops that are organized into five structural domains. Nucleotides within the pathogenicity domain are known to play a critical role in modulating PSTVd symptom expression, and it has been suggested that disruption of a comparatively unstable "premelting region" within the pathogenicity domain may be required for disease induction. We have used a combination of quantitative bioassays, temperature gradient gel electrophoresis of circularized RNA transcripts, and thermodynamic calculations to compare the biological and structural properties of 12 representative PSTVd sequence variants. Certain mutations appeared to act indirectly, downregulating pathogenicity by suppressing the rate of PSTVd replication/accumulation. The effects of other mutations appeared to be more direct, but there was no consistent correlation between symptom severity and melting temperature. Taking into account the three-dimensional shape of RNA helices, comparison of the optimal secondary structures for these variants point to major differences in the geometry of their pathogenicity domains; i.e., variants producing intermediate symptoms possess a linear arrangement of three consecutive helices, whereas for variants producing mild or severe symptoms this domain is bent in opposing directions. Such alterations in RNA structure together with concomitant alterations in RNA-protein interaction(s) may be the primary cause of viroid pathogenicity.
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Affiliation(s)
- R A Owens
- Molecular Plant Pathology Laboratory, Plant Sciences Institute, U.S. Department of Agriculture/Agricultural Research Service, Beltsville, Maryland 20705, USA.
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14
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Abstract
After the unexpected appearance of lethal symptoms on tomato plants infected with the PSTVd strain Intermediate Di, viroids were isolated and sequenced. It was found that a new strain, named RG 1, had been generated spontaneously in our greenhouse. In a different series of plant passages two new strains, named QF A and QF B, were detected which coexisted with the wild-type strain Di. Strains QF A and QF B showed intermediate symptoms when inoculated separately. In order to confirm the working hypothesis that the more pathogenic strain outcompetes the less pathogenic strain but strains of similar pathogenicity might coexist in the host, strains of different pathogenicity were mixed for inoculation in a ratio from 1:1 to 1:100 (more pathogenic:less pathogenic). The concentrations of the individual strains were determined 6 weeks postinfection with the method of nondenaturing polyacrylamide gel electrophoresis, and the working hypothesis was confirmed. The total concentrations of viroids in infected plants were very similar, irrespective of whether severe, intermediate, or mild strains or mixtures of different strains were present. The mutations in all new strains (3 in RG 1, 2 in QF A, 3 in QF B) were located in the so-called virulence-modulating region. The mutations of strain RG 1 influenced dramatically the thermodynamic stability of the native rod-like structure, as determined experimentally by temperature-gradient gel electrophoresis. Since during replication a multihairpin structure is generated transiently which is transformed afterwards into the rod-like structure, a lower thermodynamic stability of the rod-like structure leads to a higher accumulation of the transient structure. It is assumed that the transient structure, which is active in replication as shown earlier, is essential also in pathogenesis. This model explains the experimentally determined interdependence between pathogenicity and replicability of PSTVd strains.
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Affiliation(s)
- R Gruner
- Heinrich-Heine-Universität Düsseldorf, Institut für Physikalische Biologie, FRG
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15
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Sacks M, Fels A, Munich R. VID (very important disease) syndrome. Lancet 1991; 337:1485. [PMID: 1675353 DOI: 10.1016/0140-6736(91)93179-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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16
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Emanuel D, Cunningham I, Jules-Elysee K, Brochstein JA, Kernan NA, Laver J, Stover D, White DA, Fels A, Polsky B. Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin. Ann Intern Med 1988; 109:777-82. [PMID: 2847609 DOI: 10.7326/0003-4819-109-10-777] [Citation(s) in RCA: 370] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
STUDY OBJECTIVE To assess the efficacy of the combination of the antiviral agent ganciclovir (9-1,3 dihydroxy-2-propoxymethylguanine) and high-dose intravenous immune globulin for treating cytomegalovirus interstitial pneumonitis after allogeneic bone marrow transplantation. DESIGN Nonrandomized prospective trial of combined treatment with two drugs; findings in these patients were compared with those in control patients treated with either of the two drugs alone. SETTING Medical, pediatric, and intensive care units of a tertiary-care cancer treatment center. PATIENTS Consecutive cases of 10 patients in the study group and of 11 patients in a historical control group with evidence of cytomegalovirus pneumonia after bone marrow transplantation for treatment of leukemia or congenital immune deficiency. INTERVENTIONS Study Group (10 patients): ganciclovir, 2.5 mg/kg body weight, three times daily for 20 days, plus intravenous immune globulin, 500 mg/kg every other day for ten doses. Patients were then given ganciclovir, 5 mg/kg.d three to five times a week for 20 more doses, and intravenous immune globulin, 500 mg/kg twice a week for 8 more doses. Control Group (11 patients): ganciclovir alone (2 patients), 5 mg/kg twice a day for 14 to 21 days; cytomegalovirus hyperimmune globulin (5 patients), 400 mg/kg.d for 10 days; and intravenous immune globulin (4 patients), 400 mg/kg.d for 10 days. MEASUREMENTS AND MAIN RESULTS Responses were observed in all patients treated with combination therapy; 7 of 10 patients were alive and well, and had no recurrence of disease at a median of 10 months after therapy. No therapeutic benefit was observed, and none of the 11 patients treated with either ganciclovir or intravenous immune globulin alone survived (P = 0.001 by Fisher exact test). CONCLUSIONS Ganciclovir, when combined with high-dose intravenous immune globulin, appears to have significantly altered the outcome of patients with cytomegalovirus pneumonia after allogeneic bone marrow transplantation.
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Affiliation(s)
- D Emanuel
- Memorial Sloan-Kettering Cancer Center, New York, New York
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17
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Striano S, De Falco FA, Zaccaria F, Fels A, Natale S, Vacca G. Paroxysmal lateralized epileptiform discharges (PLEDS). Clinical-EEG correlations in twenty cases. Acta Neurol (Napoli) 1986; 8:1-12. [PMID: 3962750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Pelosi L, Fels A, Petrillo A, Senatore R, Russo G, Lönegren K, Calace P, Caruso G. Friedreich's ataxia: clinical involvement and evoked potentials. Acta Neurol Scand 1984; 70:360-8. [PMID: 6507046 DOI: 10.1111/j.1600-0404.1984.tb00837.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In 15 patients definitely affected by Friedreich's ataxia, precocious SEP abnormalities were constantly recorded independent of the duration of symptoms and the severity of clinical involvement; VEPs were frequently involved, but neither VEP abnormalities, nor visual impairment could be correlated with the severity or duration of Friedreich's ataxia clinical involvement; BAEPs were, to different extents, abnormal. These were completely dissociated from hearing disorders and significantly correlated (P less than 0.001) with Friedreich's ataxia clinical disability. Our observation of increased latency of the VEP P100 component and the early disappearance of BAEP Wave V with persistence of Wave I is in contrast with the hypothesis that changes are related to primary axonal degeneration. For practical purposes SEPs could help in the early diagnosis of Friedreich's ataxia, and BAEPs could be used for the electrophysiological monitoring of its clinical progression.
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19
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Stabile M, Cavaliere ML, Scarano G, Fels A, Valiani R, Ventruto V. Abnormal B.A.E.P. in a family with Moebius syndrome: evidence for supranuclear lesion. Clin Genet 1984; 25:459-63. [PMID: 6723108 DOI: 10.1111/j.1399-0004.1984.tb02017.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A family with Moebius syndrome is presented. Neurological lesions in the affected members are various: complete VI and VII cranial nerves palsy associated with mental retardation in the proband; left convergent strabismus and mental retardation in a brother of the proband and only mental retardation in a sister of the proband. The brainstem auditory evoked potentials (B.A.E.P.), investigated in the proband and his affected sister, are abnormal. The presence of the anomaly after the 3rd wave is consistent with a disfunction of the auditory tract at a supranuclear level. The mental deficiency and the supranuclear site of the acoustic lesion are an indication for a more general involvement of C.N.S. than cranial nerve nuclei alone. Karyotype and dermatoglyphics of the three affected subjects were normal. The authors hypothesized the same disorganogenetic factor acting very early (4th-6th week of gestational age) on the metamerization process of limb buds mesoderm and brainstem gray matter.
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20
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Rossi V, Fels A, Dell'Aria V, Aliperta D, Cimino R. [Subclinical neuropathies during certain hemopathies]. Riv Neurobiol 1984; 30:268-80. [PMID: 6100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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21
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Fels A, Rossi V, Dell'Aria V, Casillo A. [Anomalous communication between the ulnar and median nerves in traumatic neuropathy. Electrophysiologic study]. Riv Neurobiol 1984; 30:317-23. [PMID: 6544484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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22
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Sepe Visconti O, De Falco FA, Zaccaria F, Viotti L, Fels A, Rossi V, Barbieri F. [Electromyographic and neurographic study of a family with HMSN (hereditary motor and sensory neuropathy) "plus"]. Riv Neurobiol 1984; 30:208-21. [PMID: 6100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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23
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Stella L, Fels A, Pillo G, Fragassi N, Buscaino GA, Striano S. "Primary reading epilepsy". Clinical and EEG study of a case and characteristics of the effective stimulus. Acta Neurol (Napoli) 1983; 5:426-431. [PMID: 6670599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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24
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De Falco FA, Vacca G, Fels A, Natale S, Striano S. An unusual EEG pattern in elderly subjects: subclinical rhythmic EEG discharge of adults ("SREDA"). Electroclinical study of six cases. Acta Neurol (Napoli) 1983; 5:373-9. [PMID: 6660060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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25
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Striano S, Grossi D, Chiacchio L, Fels A. Bilateral lesion of the occipital lobes. A case study. Course of recovery and neuropsychologic considerations. Acta Neurol (Napoli) 1981; 3:690-4. [PMID: 7315567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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26
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Striano S, Fels A, Vacca G, Cardona AM. Epileptic seizures on closing the eyes and upon the sudden disappearance of light. Acta Neurol (Napoli) 1979; 1:443-51. [PMID: 539479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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27
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Striano S, Fels A, Vacca G. Effects of intravenously administered clonazepam on the interictal paroxysmal activity in various electroclinical forms of epilepsy. Acta Neurol (Napoli) 1978; 33:426-35. [PMID: 116483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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28
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Striano S, Grasso A, Fels A, Gambardella A. [Unusual case of association of ichthyosis with photogenic epilepsy]. Acta Neurol (Napoli) 1975; 30:457-66. [PMID: 1229847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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29
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Borsche W, Fels A. Ueber die Einwirkung von Ammoniak auf α, β-Diacylcarbonsäureester, ein Beitrag zur Kenntniss der Pyrrolbildung aus 1.4-Diketonen. ACTA ACUST UNITED AC 1906. [DOI: 10.1002/cber.19060390465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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30
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