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Menard O, Lesmes U, Shani-Levi CS, Araiza Calahorra A, Lavoisier A, Morzel M, Rieder A, Feron G, Nebbia S, Mashiah L, Andres A, Bornhorst G, Carrière F, Egger L, Gwala S, Heredia A, Kirkhus B, Macierzanka A, Portman R, Recio I, Santé-Lhoutellier V, Tournier C, Sarkar A, Brodkorb A, Mackie A, Dupont D. Static in vitro digestion model adapted to the general older adult population: an INFOGEST international consensus. Food Funct 2023; 14:4569-4582. [PMID: 37099034 DOI: 10.1039/d3fo00535f] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Understanding the mechanisms of food digestion is of paramount importance to determine the effect foods have on human health. Significant knowledge on the fate of food during digestion has been generated in healthy adults due to the development of physiologically-relevant in vitro digestion models. However, it appears that the performance of the oro-gastrointestinal tract is affected by ageing and that a model simulating the digestive conditions found in a younger adult (<65 years) is not relevant for an older adult (>65 years). The objectives of the present paper were: (1) to conduct an exhaustive literature search to find data on the physiological parameters of the older adult oro-gastrointestinal tract, (2) to define the parameters of an in vitro digestion model adapted to the older adult. International experts have discussed all the parameters during a dedicated workshop organized within the INFOGEST network. Data on food bolus properties collected in the older adult were gathered, including food particle size found in older adult boluses. In the stomach and small intestine, data suggest that significant physiological changes are observed between younger and older adults. In the latter, the rate of gastric emptying is slowed down, the pH of the stomach content is higher, the amount of secretions and thus the hydrolytic activities of gastric and intestinal digestive enzymes are reduced and the concentration of bile salts lower. The consensus in vitro digestion model of the older adult proposed here will allow significant progress to be made in understanding the fate of food in this specific population, facilitating the development of foods adapted to their nutritional needs. Nevertheless, better foundational data when available and further refinement of the parameters will be needed to implement the proposed model in the future.
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Affiliation(s)
- O Menard
- INRAE - Institut Agro, STLO, Rennes, France.
| | - U Lesmes
- Technion Israel Institute of Technology, Israel
| | | | | | - A Lavoisier
- INRAE - Institut Agro, STLO, Rennes, France.
| | - M Morzel
- INRAE - Institut Agro, STLO, Rennes, France.
| | - A Rieder
- Nofima AS - Norwegian Institute of Food, Fisheries and Aquaculture, PB 210, N-1433 Ås, Norway
| | - G Feron
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
- INRAE, PROBE research infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - S Nebbia
- INRAE - Institut Agro, STLO, Rennes, France.
| | - L Mashiah
- Technion Israel Institute of Technology, Israel
| | - A Andres
- Institute of Food Engineering for Development, Universitat Politecnica de Valencia, Valencia, Spain
| | - G Bornhorst
- Department of Biological and Agricultural Engineering, University of California Davis, Davis, USA
| | - F Carrière
- Aix Marseille University, CNRS, UMR7281 Bioenergetics and Protein Engineering, Marseille, France
| | - L Egger
- Agroscope, Schwarzenburgstr, 161, 3003 Bern, Switzerland
| | - S Gwala
- Teagasc Food Research Centre, Fermoy, Co. Cork, Moorepark, Ireland
| | - A Heredia
- Institute of Food Engineering for Development, Universitat Politecnica de Valencia, Valencia, Spain
| | - B Kirkhus
- Nofima AS - Norwegian Institute of Food, Fisheries and Aquaculture, PB 210, N-1433 Ås, Norway
| | - A Macierzanka
- Gdansk University of Technology, Faculty of Chemistry, Department of Colloid and Lipid Science, 80-322 Gdansk, Poland
| | - R Portman
- Agroscope, Schwarzenburgstr, 161, 3003 Bern, Switzerland
| | - I Recio
- Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM, CEI UAM+CSIC), Nicolás Cabrera, 9, 28049 Madrid, Spain
| | - V Santé-Lhoutellier
- INRAE, France, QuaPA, UR370, Centre de Clermont Auvergne Rhône Alpes, F-63122 Saint Genes Champanelle, France
| | - C Tournier
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
- INRAE, PROBE research infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - A Sarkar
- Univ Leeds, Sch Food Sci & Nutr, Leeds LS2 9JT, W Yorkshire, UK
| | - A Brodkorb
- Teagasc Food Research Centre, Fermoy, Co. Cork, Moorepark, Ireland
| | - A Mackie
- Univ Leeds, Sch Food Sci & Nutr, Leeds LS2 9JT, W Yorkshire, UK
| | - D Dupont
- INRAE - Institut Agro, STLO, Rennes, France.
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Tournier C, Bernad C, Madrelle J, Delarue J, Cuvelier G, Schwartz C, Nicklaus S. Fostering infant food texture acceptance: A pilot intervention promoting food texture introduction between 8 and 15 months. Appetite 2020; 158:104989. [PMID: 33075444 DOI: 10.1016/j.appet.2020.104989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 01/29/2023]
Abstract
Healthy infant feeding practices form the basis of healthy eating behaviour later in life. The effect of providing parents with recommendations on textured food introduction between 8 and 15 months on children's experience with and acceptance of textured foods was studied. Sixty parent/child dyads were randomly assigned to a control group (CG) receiving current French recommendations and an intervention group (IG) receiving a brochure with supplementary advice, tips and monthly counselling on food texture introduction. After the intervention, parents completed self-report measures about the introduction of 188 food items, including purees, soft/small pieces, hard/large pieces and double textures. Children's acceptance of eight textured foods was assessed in a laboratory setting. Parents in the IG introduced more soft/small food pieces (P = 0.004) but not more complex textures (P = 0.15). There was no group difference in children acceptance for any of the textured foods offered in the laboratory. Independent of their study group, children's exposure to texture was associated with birth order, self-feeding with fingers, low gagging frequency and seldom use of commercial baby foods. Higher acceptance was associated with higher exposure to food pieces but not to pureed foods (either smooth or rough) and with children's eating behavioural traits (high food enjoyment, high food responsiveness and low food fussiness). This pilot intervention demonstrated that providing information can be effective in promoting the introduction of small and soft food pieces, but the most effective way to influence the introduction of more challenging textures (hard pieces and double texture) is uncertain. Further research should focus on the identification of barriers to complex texture introduction and on how building on this knowledge for a population-based public health intervention.
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Affiliation(s)
- C Tournier
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France.
| | - C Bernad
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - J Madrelle
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - J Delarue
- UMR SayFood, Université Paris-Saclay, INRAE, AgroParisTech, F-91300, Massy, France
| | - G Cuvelier
- UMR SayFood, Université Paris-Saclay, INRAE, AgroParisTech, F-91300, Massy, France
| | - C Schwartz
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - S Nicklaus
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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Bylicki O, Rivière F, Tournier C, Canoui-Poitrine F, Grassin F, Margery J, Prodel M, Vainchtock A, Assié JB, Chouaïd C. Factors Associated With Aggressiveness of End-of-Life Care for Lung Cancer Patients and Associated Costs of Care. Clin Lung Cancer 2020; 22:e320-e328. [PMID: 32646653 DOI: 10.1016/j.cllc.2020.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/14/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Results of previous studies demonstrated that high-intensity end-of-life (EOL) care improves neither cancer patients' survival nor quality of life. Our objective was to assess the incidence of and factors associated with aggressiveness of care during the last 30 days of life (DOL) of lung cancer (LC) patients and the impacts of aggressiveness of care in EOL-care costs. PATIENTS AND METHODS Using French national hospital database, all patients with LC who died between January 1, 2010, and December 31, 2011, or between January 1, 2015, and January 31, 2016, were included. EOL-care aggressiveness was assessed using the following criteria: chemotherapy administered within the last 14 DOL; more than one hospitalization within the last 30 DOL; admission to the intensive care unit within the last 30 DOL; and palliative care initiated < 3 days before death. Expenditures were limited to direct costs, from a health care payer's perspective. RESULTS Among 79,746 adult LC patients identified; 57% had at least one indicator of EOL-care aggressiveness (49% repeated hospitalizations, 12% intensive care unit admissions, 9% chemotherapy, 5% palliative care). It increased significantly between the 2 periods (56% vs. 58%, P < .001). Young age, male sex, shorter time since diagnosis, comorbidities, no malnutrition, type of care facility other than general hospital, social deprivation, and low-density population were independently associated with having one or more indicator of aggressive EOL care. The mean EOL cost was €8152 ± 5117 per patient, but the cost was significantly higher for patients with at least one EOL-care aggressiveness criterion (€9480 vs. €6376, P < .001). CONCLUSION In France, a majority of LC patients had at least one criterion of aggressive EOL care that had a major economic impact on the health care system.
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Affiliation(s)
- Olivier Bylicki
- Service de Pneumologie, Hôpital d'Instruction des Armées, Clamart, France; University Paris, Est Créteil (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, Paris-Est University UPEC, Créteil, France.
| | - Fréderic Rivière
- Service de Pneumologie, Hôpital d'Instruction des Armées, Clamart, France
| | | | - Florence Canoui-Poitrine
- University Paris, Est Créteil (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, Paris-Est University UPEC, Créteil, France; APHP, Department of Public Health and Clinical Research Unit (URC-Mondor), Henri-Mondor Hospital, Créteil, France
| | - Fréderic Grassin
- Service de Pneumologie, Hôpital d'Instruction des Armées, Clamart, France
| | - Jacques Margery
- Service de Pneumologie, Hôpital d'Instruction des Armées, Clamart, France
| | | | | | | | - Christos Chouaïd
- University Paris, Est Créteil (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, Paris-Est University UPEC, Créteil, France; Département de Pneumologie, CHI de Créteil, Créteil, France
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Assad-Bustillos M, Tournier C, Palier J, Septier C, Feron G, Della Valle G. Oral processing and comfort perception of soft cereal foods fortified with pulse proteins in the elderly with different oral health status. Food Funct 2020; 11:4535-4547. [PMID: 32396930 DOI: 10.1039/c9fo02993a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study investigated the oral processing and bolus formation mechanisms of two soft cereal products fortified with pulse proteins, sponge-cake (FSC) and brioche (FB), in the elderly population, and their relationship with the perception of oral comfort. Twenty subjects aged 65 and over participated in the study. They were classified in two groups according to dental status (poor vs. satisfactory) and presented varying stimulated salivary flow rate (SSF). Bolus properties (hydration ratio, apparent viscosity and particle size) were characterized after three chewing stages. Results showed that subjects with a poor dental status (DS) had a longer chewing duration for FB, while individuals with a higher SSF had a shorter duration for FSC. Compared to FSC, more saliva was added to the FB boli, and the viscosity and particle size of FB bolus were also higher. Based on the bolus particle size evolution during chewing, FB was considered to be more difficult to fragment than FSC, this latter showing a dramatic particle size reduction from the beginning of chewing. From the viscosity data, a model was used to represent the variations of the bolus structure index during chewing and a coefficient of interaction of saliva with food was defined. For both products, the perception of comfort depended more on the DS than on SSF. Bolus apparent viscosity was related to the perception of oral comfort in FSC, while the chewing duration and the bolus particle size at the beginning of chewing contributed to explain oral comfort in FB. Finally, the comparison of these results with those obtained previoulsy with standard (i.e. non enriched) sponge cake and brioche suggested that the proposed protein fortification did not challenge the oral comfort perception by the elderly.
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Affiliation(s)
- M Assad-Bustillos
- INRAE UR-1268 Biopolymères Interactions et Assemblages, La Géraudière, 44316 Nantes, France.
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Tournier C, Le Goff C, Septier C, Saint-Jalmes M, Feron G, Bonhomme C, Hazart E, Van Wymelbeke V. Formulation d’aliments à destination des séniors : exemple d’une approche in vivo multidisciplinaire intégrant physiologie orale, perception sensorielle, prise alimentaire et digestion. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bergot E, De Leotoing L, Bendjenana H, Tournier C, Vainchtock A, Nachbaur G, Humbert M. Hospital burden of pulmonary arterial hypertension in France. PLoS One 2019; 14:e0221211. [PMID: 31536491 PMCID: PMC6752797 DOI: 10.1371/journal.pone.0221211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023] Open
Abstract
Background & aims Pulmonary arterial hypertension is a severe disease associated with frequent hospitalisations. This retrospective analysis of the French medical information PMSI-MSO database aimed to describe incident cases of patients with pulmonary arterial hypertension hospitalised in France in 2013 and to document associated hospitalisation costs from the national health insurance perspective. Methods Cases of pulmonary arterial hypertension were identified using a diagnostic algorithm. All cases hospitalised in 2013 with no hospitalisation the previous two years were retained. All hospital stays during the year following the index hospitalisation were extracted, and classified as incident stays, monitoring stays or stays due to disease worsening. Costs were attributed from French national tariffs. Results 384 patients in France were hospitalised with incident pulmonary arterial hypertension in 2013. Over the following twelve months, patients made 1,271 stays related to pulmonary arterial hypertension (415 incident stays, 604 monitoring stays and 252 worsening stays). Mean age was 59.6 years and 241 (62.8%) patients were women. Liver disease and connective tissue diseases were documented in 62 patients (16.1%) each. Thirty-one patients (8.1%) died during hospitalisation and four (1.0%) received a lung/heart-lung transplantation. The total annual cost of these hospitalisations was € 3,640,382. € 2,985,936 was attributable to standard tariffs (82.0%), € 463,325 to additional ICU stays (12.7%) and € 191,118 to expensive drugs (5.2%). The mean cost/stay was € 2,864, ranging from € 1,282 for monitoring stays to € 7,285 for worsening stays. Conclusions Although pulmonary arterial hypertension is rare, it carries a high economic burden.
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Affiliation(s)
- Emmanuel Bergot
- Service de Pneumologie & Oncologie Thoracique, Centre Hospitalier Universitaire de Caen, Caen, France
- Unicaen, UFR santé, Caen, France
- * E-mail:
| | | | | | | | | | | | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
- Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Inserm UMR_S 999, Le Kremlin Bicêtre, France
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Assad-Bustillos M, Tournier C, Feron G, Guessasma S, Reguerre A, Della Valle G. Fragmentation of two soft cereal products during oral processing in the elderly: Impact of product properties and oral health status. Food Hydrocoll 2019. [DOI: 10.1016/j.foodhyd.2019.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lawton J, Achit H, Pouillon L, Boschetti E, Demore B, Matton T, Tournier C, Prodel M, Peyrin-Biroulet L, Guillemin F. Cost-of-illness of inflammatory bowel disease patients treated with anti-tumour necrosis factor: A French large single-centre experience. United European Gastroenterol J 2019; 7:908-913. [PMID: 31428415 DOI: 10.1177/2050640619853448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/06/2019] [Indexed: 12/22/2022] Open
Abstract
Background No study has evaluated the direct annual costs of inflammatory bowel disease patients treated with anti-tumour necrosis factor therapy. Objectives The purpose of this study was to identify annual direct costs and main cost drivers of anti-tumour necrosis factor-treated inflammatory bowel disease patients. Methods All inflammatory bowel disease patients treated with infliximab or adalimumab at Nancy University Hospital were consecutively screened for inclusion from November 2016-February 2017. Data about hospitalisation, surgery, medication, outpatient visits, investigations and transport over the previous 12 months were retrospectively collected. Results A total of 108 patients (n = 83 Crohn's disease; n = 25 ulcerative colitis) were included. The mean annual cost per patient was €15,775 (standard deviation €7221), with no difference between Crohn's disease and ulcerative colitis (p = 0.2). The main cost driver was medication, which accounted for 84% of the total direct cost. Hospitalisation and surgery represented 11% and 2% of the direct costs. History of switch to another anti-tumour necrosis factor treatment was identified as the only independent predictor of greater direct costs in the multivariate analysis (p = 0.0018). Conclusions In a French tertiary referral centre, direct costs of anti-tumour necrosis factor therapy-treated patients were mainly driven by medication, while hospitalisation and surgery represented only a minor part of the costs. There was no difference between Crohn's disease and ulcerative colitis patients.
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Affiliation(s)
- Jean Lawton
- Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Hamza Achit
- CIC 1433 Clinical Epidemiology, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - Lieven Pouillon
- Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.,Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium
| | | | - Béatrice Demore
- Department of Pharmacy, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Thierry Matton
- Department of Medical Information, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | | | - Martin Prodel
- HEVA, Health Economics and Outcomes Research, Lyon, France
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Francis Guillemin
- CIC 1433 Clinical Epidemiology, Nancy University Hospital, Université de Lorraine, Nancy, France
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Bylicki O, Tournier C, Canoui-Poitrine F, Blein C, Chouaid C. Coût du dernier mois de vie des patients décédés à hôpital d’un cancer du poumon : enquête nationale française. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bylicki O, Tournier C, Canoui-Poitrine F, Blein C, Chouaid C. Évaluation de l’agressivité des soins en fin de vie des patients atteints d’un cancer du poumon en France à partir des données PMSI. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Vandenberghe-Descamps M, Labouré H, Septier C, Prot A, Tournier C, Vigneau E, Feron G, Sulmont-Rossé C. Comportement alimentaire des seniors : impact des différents facteurs de santé orale sur les dimensions de l’acte alimentaire. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Scherpereel A, Durand-Zaleski I, Cotté FE, Fernandes J, Debieuvre D, Blein C, Gaudin AF, Tournier C, Vainchtock A, Chauvin P, Souquet PJ, Westeel V, Chouaïd C. Access to innovative drugs for metastatic lung cancer treatment in a French nationwide cohort: the TERRITOIRE study. BMC Cancer 2018; 18:1013. [PMID: 30348130 PMCID: PMC6196460 DOI: 10.1186/s12885-018-4958-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022] Open
Abstract
Background Territorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence. Methods All incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data. Results Overall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs. Conclusion Although access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed.
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Affiliation(s)
- Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, CHU de Lille, Lille University, Lille, France
| | - Isabelle Durand-Zaleski
- URCEco Île-de-France, Hôtel-Dieu Hospital, Paris, France.,Department of Public Health, Henri-Mondor Hospital, Créteil, France
| | - François-Emery Cotté
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France.
| | | | - Didier Debieuvre
- Department of Chest Medicine, GHRMSA, Emile Muller Hospital, Mulhouse, France
| | | | - Anne-Françoise Gaudin
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
| | | | | | - Pierre Chauvin
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Sorbonne Universités, UPMC Université Paris 06, INSERM, Paris, France
| | - Pierre-Jean Souquet
- Department of Chest Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Virginie Westeel
- Department of Chest Medicine, Jean Minjoz University Hospital, Besançon, France
| | - Christos Chouaïd
- Department of Chest Medicine, Créteil University Hospital, Créteil, France
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Bylicki O, Tournier C, Canoui-Poitrine F, Blein C, Chouaid C. P2.15-04 Costs of Cares on the Month Before Death of Patients with Lung Cancer: A French National Database Survey. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Girard N, Cozzone D, de Léotoing L, Tournier C, Vainchtock A, Tehard B, Cortot A. Extra-cost of brain metastases in patients with non-squamous non-small cell lung cancer (NSCLC): A French national hospital database analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Girard N, Cozzone D, de Leotoing L, Tournier C, Vainchtock A, Tehard B, Cortot AB. Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis. ESMO Open 2018; 3:e000414. [PMID: 30233822 PMCID: PMC6135444 DOI: 10.1136/esmoopen-2018-000414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/03/2022] Open
Abstract
Purpose To assess the incremental cost associated with the management of patients with primary non-squamous non-small cell lung cancer (NSCLC) with brain metastases at the time of diagnosis. Methods Data were extracted from the French Hospital medical information database (Programme de Médicalisation des Systèmes d'Information (PMSI)). Patients with non-squamous NSCLC were identified through a diagnosis of lung cancer and a prescription of bevacizumab or pemetrexed. All such patients hospitalised with lung cancer for the first time in 2013 and with metastases identified at the first hospitalisation were eligible. Two cohorts were identified, one with brain metastases (group B: n=971) and one with metastases at other sites (group A: n=1529). For each patient, total in-hospital medical resource consumption associated with the initial hospitalisation in 2013 and with any follow-up stays in the following 24 months was documented. Costs were attributed from official French national tariffs and expressed in 2017 euros. Results The mean number of hospitalisations per patient in the 24-moth follow-up period was 17 in group A and 21 in group B. >99% of patients in both groups received chemotherapy. 58% of patients in group B and 13% in group A were managed by radiotherapy. 37% in group B and 24% in group A received palliative care. The associated cost was €2979 per patient-month for patients in group B and €2426 for patients in group A, representing a differential cost of €553 per month. Radiotherapy (+€164/month) and palliative care (+€130/month) were the principal drivers of the incremental cost. Conclusions The presence of brain metastases at the time of diagnosis of non-squamous NSCLC carries a significant burden, and ways of lowering this burden are needed.
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Affiliation(s)
- Nicolas Girard
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Institut Curie, Paris, France
| | | | | | | | | | | | - Alexis B Cortot
- CHU Lille, Thoracic Oncology Department, Univ. Lille, Lille, France
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Prodel M, Tournier C, de Léotoing L. Une nouvelle méthodologie d’analyse pour trouver des profils de coûts atypiques au sein des patients vivants avec le VIH et à partir des données Sniiram. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Ebri BR, Wang W, Xia Z, Tournier C. PO-007 Investigating the hyperactivation of ERK5 signalling in skin cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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18
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Chouaid C, Assié JB, Andujar P, Blein C, Tournier C, Vainchtock A, Scherpereel A, Monnet I, Pairon JC. Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis. Cancer Med 2018; 7:1102-1109. [PMID: 29479845 PMCID: PMC5911629 DOI: 10.1002/cam4.1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 01/02/2023] Open
Abstract
This study was undertaken to determine the healthcare burden of malignant pleural mesothelioma (MPM) in France and to analyze its associations with socioeconomic deprivation, population density, and management outcomes. A national hospital database was used to extract incident MPM patients in years 2011 and 2012. Cox models were used to analyze 1- and 2-year survival according to sex, age, co-morbidities, management, population-density index, and social deprivation index. The analysis included 1,890 patients (76% men; age: 73.6 ± 10.0 years; 84% with significant co-morbidities; 57% living in urban zones; 53% in highly underprivileged areas). Only 1% underwent curative surgical procedure; 65% received at least one chemotherapy cycle, 72% of them with at least one pemetrexed and/or bevacizumab administration. One- and 2-year survival rates were 64% and 48%, respectively. Median survival was 14.9 (95% CI: 13.7-15.7) months. The mean cost per patient was 27,624 ± 17,263 euros (31% representing pemetrexed and bevacizumab costs). Multivariate analyses retained men, age >70 years, chronic renal failure, chronic respiratory failure, and never receiving pemetrexed as factors of poor prognosis. After adjusting the analysis to age, sex, and co-morbidities, living in rural/semi-rural area was associated with better 2-year survival (HR: 0.83 [95% CI: 0.73-0.94]; P < 0.01); social deprivation index was not significantly associated with survival. With approximately 1,000 new cases per year in France, MPMs represents a significant national health care burden. Co-morbidities, sex, age, and living place appear to be significant factors of prognosis.
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Affiliation(s)
- Christos Chouaid
- GRC OncoThoParisEstService de Pneumologie, CHI CréteilUPECCréteilFrance
| | | | - Pascal Andujar
- Inserm U955Institut Santé Travail Paris EstService de Pneumologie et de Pathologie ProfessionnelleCHI CréteilCréteilFrance
| | | | | | | | - Arnaud Scherpereel
- Thoracic Oncology DepartmentUniversity of LilleCHU Lille, CIIL, Inserm U1019CréteilFrance
| | - Isabelle Monnet
- GRC OncoThoParisEstService de Pneumologie, CHI CréteilUPECCréteilFrance
| | - Jean Claude Pairon
- Inserm U955Institut Santé Travail Paris EstService de Pneumologie et de Pathologie ProfessionnelleCHI CréteilCréteilFrance
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Assad-Bustillos M, Tournier C, Septier C, Della Valle G, Feron G. Relationships of oral comfort perception and bolus properties in the elderly with salivary flow rate and oral health status for two soft cereal foods. Food Res Int 2017; 118:13-21. [PMID: 30898347 DOI: 10.1016/j.foodres.2017.11.057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023]
Abstract
The aim of this study was to investigate food oral processing and bolus formation in the elderly population, and their relationship with the perception of oral comfort, for two soft cereal products of different composition: sponge-cake and brioche. Twenty subjects aged 65 and over participated in the study. They were classified in two groups according to dental status (poor vs. satisfactory) and presented various stimulated salivary flow rate (SSF) in each group. Food bolus properties (hydration ratio and apparent viscosity) were characterized after three chewing stages for both groups. Results showed that chewing duration did not depend on food product but rather on physiology: subjects with a poor dental status had a shorter chewing duration. For each chewing stage, sponge-cake boli showed a higher hydration ratio than brioche boli, which showed higher apparent viscosity. For sponge-cake, perception of oral comfort was primarily driven by SSF rate, irrespective of the dental status. In the case of brioche, oral comfort was also partially explained by SSF in the case of subjects with poor dental status. This result suggests that perception of oral comfort in brioche could be driven by product related attributes rather than oral health. For both foods, a phenomenological model of bolus viscosity as a function of stimulated salivary flow and chewing duration was proposed.
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Affiliation(s)
- M Assad-Bustillos
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, F-21000 Dijon, France; INRA UR-1268 Biopolymères Interactions et Assemblages, La Géraudière, 44316 Nantes, France; CERELAB®, La Sucrerie, 21110 Aiserey, France
| | - C Tournier
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - C Septier
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - G Della Valle
- INRA UR-1268 Biopolymères Interactions et Assemblages, La Géraudière, 44316 Nantes, France
| | - G Feron
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, F-21000 Dijon, France.
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Pearson A, Tournier C. The ERK5 signaling pathway regulates transcription in cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bataille S, Landrier JF, Astier J, Cado S, Sallette J, Serveaux M, Burtey S, Cohen J, Tournier C, Tourniaire F, Darmon P. Plasma Retinol Concentration Is Mainly Driven by Transthyretin in Hemodialysis Patients. J Ren Nutr 2017; 27:395-401. [PMID: 28688921 DOI: 10.1053/j.jrn.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/11/2017] [Accepted: 05/02/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Micronutrients deficiencies in hemodialysis patients are due to low dietary intakes and intradialytic losses for hydrophilic micronutrients. Conversely, lipophilic nondialyzable compounds might accumulate because of a lack of elimination through renal metabolism or dialysis. Other compounds have complex metabolism: their concentration is not explained by these phenomenons. The aim of this study was to report plasma concentrations of lipophilic micronutrients in hemodialysis patients and to analyze if these concentrations were predictive of mortality. DESIGN The design was monocentric observational longitudinal study. SUBJECTS A total of 123 hemodialysis patients included in this observational study. MAIN OUTCOME MEASURE Plasma concentration of lipophilic micronutrients retinol and its two co-transporters transthyretin and retinol-binding protein 4, tocopherol, and carotenoids (α-carotene and β-carotene, β-cryptoxanthin, lycopene, lutein, and zeaxanthin), and all factors associated with 1-year mortality. RESULTS Within the 123 patients of the study, median age (interquartile range) was 77.5 (69.5-84.5) years and 58.5% were male. Median retinol plasma concentration was 4.07 (2.65-5.51) μmol/L, and 91.9% of patient had high plasma retinol concentrations. In monovariate analysis, retinol levels were inversely correlated with mortality (hazard ratio = 0.57 [0.45-0.72]; P < .001). This effect remained significant after adjustment with several parameters. Nevertheless, the correlation between retinol and mortality disappeared as soon as transthyretin was added in the statistical model, suggesting an effect of transthyretin as confusing bias. Median tocopherol plasma concentration was 34.8 (28.3-42.9) μmol/L and 72.4% of patients had high plasma tocopherol concentration. Neither tocopherol plasma levels nor carotenoids concentrations were correlated with death in multivariate analysis. CONCLUSIONS In hemodialysis patients, the correlation between retinol plasma concentration and mortality represents the nutritional status but not a direct biological effect of retinol. Retinol is only a surrogate predictor of mortality. It might not represent vitamin A levels, but likely the transthyretin level. Plasma retinol levels should be interpreted cautiously in hemodialysis patients.
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Affiliation(s)
- Stanislas Bataille
- Phocean Nephrology Institute, Marseille, France; Nephrology Department, Clinique Bouchard, ELSAN, Marseille, France; Nephrology Dialysis Renal Transplantation Center, APHM, CHU Conception, Marseille, France.
| | | | - Julien Astier
- NORT, Aix-Marseille Université, INRA, INSERM, Marseille, France
| | - Sylvie Cado
- Laboratoire Cerba, Saint-Ouen l'Aumône, France
| | | | - Marianne Serveaux
- Phocean Nephrology Institute, Marseille, France; Nephrology Department, Clinique Bouchard, ELSAN, Marseille, France
| | - Stéphane Burtey
- Nephrology Dialysis Renal Transplantation Center, APHM, CHU Conception, Marseille, France; Aix Marseille Université, Inserm, Vascular Research Center of Marseille UMR_S 1076, Marseille, France
| | | | | | | | - Patrice Darmon
- NORT, Aix-Marseille Université, INRA, INSERM, Marseille, France
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Knafo J, Thelen T, Verdier D, Creppy L, Tournier C, Fabre T. Reproducibility of low-dose stereography measurements of femoral torsion after IM nailing of femoral shaft fractures and in intact femurs. Orthop Traumatol Surg Res 2016; 102:595-9. [PMID: 27364964 DOI: 10.1016/j.otsr.2016.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Rotational malunion is a complication of intramedullary (IM) nailing for femur fractures. Symptoms can appear with 15° or more of axial deformity. None of the currently available measurement methods have a satisfactory reliability/irradiation ratio. The purpose of this study was to study the reproducibility of measuring femoral torsion with an EOS(®) low-dose stereography (LDX) system. HYPOTHESIS LDX is a reproducible method for measuring post-traumatic femoral torsion. MATERIAL AND METHODS The intra- and inter-observer reproducibility was studied in 45 patients who had a femoral fracture treated by IM nailing. Both the injured and contralateral healthy femurs were modelled. Bland-Altman plots were used to analyze the measurements made by three different observers (two orthopedic surgeons and one radiologist). For a given comparison, the interval between the upper limit of agreement (ULA) and lower limit of agreement (LLA) had to be within [-5°; 5°] for the examination to qualify as reproducible. Measurements were made by three observers (A, B, C) on the injured and healthy femur. RESULTS With the fractured femurs (n=39), the intra-observer [LLA; ULA] interval was [-16.295; 12.977]; it was [-18.475; 16.744] for the A-B pairing, [-13.316; 13.532] for the B-C pairing and [-17.839; 19.355] for the A-C pairing. With the healthy femurs (n=37), the intra-observer [LLA; ULA] interval was [-7.909; 7.88]; it was [-11.924; 11.639] for the A-B pairing, [-12.654; 11.93] for the B-C pairing and [-11; 12.009] for the A-C pairing. DISCUSSION The [LLA; ULA] intervals were greater than the [-5; +5] interval in all cases. LDX reproducibility is not sufficient for measuring femoral torsion after fracture or in healthy femurs. Observer experience, cohort size and the perfectible image quality are likely sources of bias. Conversely, the use of Bland-Altman plots and the multidisciplinary training of observers are major strengths of this study. Reproducibility will likely improve as the software is developed further and the image acquisition improves.
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Affiliation(s)
- J Knafo
- CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - T Thelen
- CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - D Verdier
- CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - L Creppy
- CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - C Tournier
- CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - T Fabre
- CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Finegan K, Babur M, Forster D, O’Connor J, Tournier C, Williams K. A novel pre-clinical model for imaging cancer-associated inflammation. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Verdier N, Billaud A, Masquefa T, Pallaro J, Fabre T, Tournier C. EOS-based cup navigation: Randomised controlled trial in 78 total hip arthroplasties. Orthop Traumatol Surg Res 2016; 102:417-21. [PMID: 27052934 DOI: 10.1016/j.otsr.2016.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Minimising the risk of cup implantation outside the safe zone is among the objectives of navigation during total hip arthroplasty (THA). However, given the technical challenges raised by navigation when the patient is lying on the side, many surgeons still use the freehand technique. We conducted a randomised controlled trial to evaluate the new navigation system NAVEOS in the iliac plane, which is easily identified in the lateral decubitus position, with the objective of determining whether NAVEOS navigation decreased the frequency of cup implantation outside the safe zone compared to freehand cup positioning, without increasing the operative time or the frequency of complications. HYPOTHESIS NAVEOS navigation decreases the frequency of cup positioning outside the safe zone compared to freehand positioning. MATERIAL AND METHODS This randomised controlled trial compared cup positioning using NAVEOS navigation versus the freehand technique in patients undergoing primary THA. The safe zone was defined according to Lewinnek as 15±10° of radiological anteversion and 40±10° of radiological inclination. Cup position parameters were measured on computed tomography images obtained 3months after THA. The images were read by two independent observers who were blinded to group assignment. The primary evaluation criterion was cup position within the safe zone. RESULTS A 1:1 randomisation scheme was used to assign 78 patients (mean age, 68years; age range, 44-91years) to NAVEOS navigation or freehand cup positioning. The two groups were comparable for age, gender distribution, body mass index, and preoperative functional scores. In the NAVEOS group, navigation was discontinued prematurely in 6 patients, because of technical difficulties (n=2) or a marked discrepancy with clinical findings (n=4); however, the intention-to-treat approach was used for the analysis. The proportion of cups in the safe zone was 67% (28/39) in the NAVEOS group and 38% (17/39) in the freehand group (P=0.012). Anteversion was within the 5-25° range for 72% (28/39) cups in the NAVEOS group and 46% (18/39) in the freehand group (P=0.021). Inclination was within the 30-50° range for 95% (37/39) of cups with NAVEOS navigation and 85% (33/39) with freehand positioning (P=0.135). The odds ratio for cup implantation outside the safe zone was significantly lower with NAVEOS compared to freehand positioning (0.54; 95% confidence interval, 0.31-0.91). Mean operative time was 74 (range, 45-115) minutes with NAVEOS navigation and 70 (range, 40-105) minutes with freehand positioning (P=0.382). Complications consisted of 1 case each of anterior dislocation and infection, both in the freehand group. DISCUSSION Compared to freehand positioning, NAVEOS navigation significantly lowered the risk of cup positioning outside the safe zone, chiefly via improved achievement of the anteversion target. NAVEOS was not associated with increases in operative time or morbidity. LEVEL OF EVIDENCE II, randomised controlled trial with limited statistical power.
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Affiliation(s)
- N Verdier
- Service de chirurgie orthopédique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - A Billaud
- Service de chirurgie orthopédique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - T Masquefa
- Service de chirurgie orthopédique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J Pallaro
- Service de chirurgie orthopédique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - T Fabre
- Service de chirurgie orthopédique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - C Tournier
- Service de chirurgie orthopédique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Obert L, Saadnia R, Tournier C, Bonnevialle N, Saragaglia D, Sirveaux F. Four-part fractures treated with a reversed total shoulder prosthesis: Prospective and retrospective multicenter study. Results and complications. Orthop Traumatol Surg Res 2016; 102:279-85. [PMID: 26993853 DOI: 10.1016/j.otsr.2016.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/23/2015] [Accepted: 01/12/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The reversed shoulder prosthesis is becoming the gold standard for cases of complex fracture of the proximal humerus after 70 years of age. MATERIAL AND METHODS The French Society of Orthopaedic and Traumatology Surgery (SOFCOT) conducted a prospective and retrospective multicenter study to evaluate the results of the reversed shoulder prosthesis implanted in patients with a four-part fracture in nine centers. In the retrospective study (n=41 patients, 78 years of age, 14% ASA grade 3, 21% associated fractures) and in the prospective study (n=32 patients, 79 years of age, 37% ASA grade 3, 21% associated fractures) evaluation by independent surgeons was conducted to measure the QuickDASH score, the Constant score, the SSV (subjective shoulder value), and complications to correlate these measurements with radiological results. RESULTS In both studies, use of an autograft (75%) to perform an osteosuture of tuberosities (90%) and no postoperative immobilization (75%) were similar. In the retrospective study at 39 months (range: 24-62 months) of follow-up, the QuickDASH reached 28 (range: 0-59), the Constant scores (raw Constant=57, weighted Constant=83.4%), and SSV 75 (range: 35-100). Complications after the 1st month (7%) were nonunion or ossifications. In the prospective study at 11 months (range: 5-16.5 months) of follow-up, the QuickDASH reached 40 (range: 1-75), the Constant scores 50 (raw Constant) and 74.6% (weighted Constant), and SSV 69 (range: 10-100). Complications after the 1st month (21%) were stiffness and dislocation, with two patients who underwent revision surgery. In both studies, early complications reached 6% (palsy, dislocation). CONCLUSION This double (retrospective and prospective) study confirms the good results with a low level of complications of the reversed implant in cases of fracture but with osteosuture of tuberosities.
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Affiliation(s)
- L Obert
- Chirurgie orthopédique, traumatologique et plastique, centre hospitalier de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
| | - R Saadnia
- Chirurgie orthopédique, traumatologique et plastique, centre hospitalier de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - C Tournier
- Service d'orthopédie-traumatologie, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - N Bonnevialle
- Centre hospitalier universitaire de Toulouse, Institut de l'appareil locomoteur, place du Dr-Baylac, 31059, Toulouse, France
| | - D Saragaglia
- Service d'orthopédie-traumatologie, CHRU de Grenoble, 38000 Grenoble, France
| | - F Sirveaux
- Service d'orthopédie-traumatologie, centre chirurgical E.-Galle, 49, rue Hermite, 54000 Nancy, France
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Tournier C, Hours M, Charnay P, Chossegros L, Tardy H. Five years after the accident, whiplash casualties still have poorer quality of life in the physical domain than other mildly injured casualties: analysis of the ESPARR cohort. BMC Public Health 2016; 16:13. [PMID: 26733122 PMCID: PMC4702400 DOI: 10.1186/s12889-015-2647-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to compare health status and quality of life five years after a road accident between casualties with whiplash versus other mild injuries, to compare evolution of quality of life at 1 and 5 years after the accident, and to explore the relation between initial injury (whiplash vs. other) and quality of life. Methods The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 167 casualties with “pure” whiplash and a population of 185 casualties with other mild injuries (MAIS-1). All subjects with lesions classified as cervical contusion (AIS code 310402) or neck sprain (AIS code 640278) were considered as whiplash casualties. Diagnosis was made by physicians, at the outset of hospital care, based on interview, clinical findings and X-ray. Whiplash injuries were then classified following the Quebec classification (grades 1 and 2). Quality of life was assessed on the WHOQoL-Bref questionnaire. Correlations between explanatory variables and quality of life were explored by Poisson regression and variance analysis. Results Between 1 and 5 years, global QoL improved for both whiplash and non-whiplash casualties; but, considering the two whiplash groups separately, improvement in grade 2 was much less than in grade 1. At 5 years, grade-2 whiplash casualties were more dissatisfied with their health (39.4 %; p < 0.05) than non-whiplash (24.3 %) or grade-1 whiplash casualties (27.0 %). Deteriorated quality of life in the mental, social and environmental domains was mainly related to psychological and socioeconomic factors for both whiplash and other mildly injured road-accident casualties. While PTSD was a major factor for the physical domain, whiplash remained a predictive factor after adjustment on PTSD; unsatisfactory health at 5 years, with deteriorated quality of life in the physical domain, was observed specifically in the whiplash group, pain playing a predominant intermediate role. Conclusions Deteriorated quality of life in the physical domain remained 5 years after the accident, specifically in the grade-2 whiplash group, pain playing a predominant intermediate role, which may be in line with the hypothesis of neuropathic pain.
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Affiliation(s)
- Charlène Tournier
- Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR_T 9405), Université Lyon 1, Université de Lyon, Lyon, France
| | - Martine Hours
- Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR_T 9405), Université Lyon 1, Université de Lyon, Lyon, France.
| | - Pierrette Charnay
- Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR_T 9405), Université Lyon 1, Université de Lyon, Lyon, France
| | - Laetitia Chossegros
- Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR_T 9405), Université Lyon 1, Université de Lyon, Lyon, France
| | - Hélène Tardy
- Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR_T 9405), Université Lyon 1, Université de Lyon, Lyon, France
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Masquefa T, Verdier N, Gille O, Boissière L, Obeid I, Maillot C, Tournier C, Fabre T. Change in acetabular version after lumbar pedicle subtraction osteotomy to correct post-operative flat back: EOS® measurements of 38 acetabula. Orthop Traumatol Surg Res 2015; 101:655-9. [PMID: 26362041 DOI: 10.1016/j.otsr.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 06/13/2015] [Accepted: 07/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormalities in acetabular orientation can promote the development of hip osteoarthritis, femoro-acetabular impingement, or even acetabular cup malposition. The objective of the present study was to determine whether pedicle substraction osteotomy (PSO) to correct sagittal spinal imbalance affected acetabular orientation. HYPOTHESIS PSO performed to correct sagittal spinal imbalance affects acetabular orientation by changing the pelvic parameters. MATERIALS AND METHODS This was a descriptive study in which two observers measured the acetabular parameters on both sides in 19 patients (38 acetabula) before and after PSO for post-operative flat-back syndrome. Mean time from PSO to post-operative measurements was 19months. Measurements were taken twice at a 2-week interval, on standing images obtained using the EOS(®) imaging system and sterEOS(®) software to obtain 3D reconstructions of synchronised 2D images. Acetabular anteversion and inclination were measured relative to the vertical plane. Mean pre-PSO and post-PSO values were compared using the paired t-test, and P values lower than 0.05 were considered significant. To assess inter-observer and intra-observer reproducibility, we computed the intra-class correlation coefficients (ICCs). RESULTS The measurements showed significant acetabular retroversion after PSO, of 7.6° on the right and 6.5° on the left (P<0.001). Acetabular inclination diminished significantly, by 4.5° on the right and 2.5° on the left (P<0.01). Inclination of the anterior pelvic plane decreased by 8.4° (P<0.01). Pelvic incidence was unchanged, whereas sacral slope increased by 10.5° (P<0.001) and pelvic tilt decreased by 10.9° (P<0.001). The ICC was 0.98 for both inter-observer and intra-observer reproducibility. CONCLUSION Changing the sagittal spinal alignment modifies both the pelvic and the acetabular parameters. PSO significantly increases sacral slope, thus inducing anterior pelvic tilt with significant acetabular retroversion. The measurements obtained using sterEOS(®) showed good inter-observer and intra-observer reproducibility. To our knowledge, this is the first study of changes in acetabular version after PSO.
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Affiliation(s)
- T Masquefa
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France.
| | - N Verdier
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - O Gille
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - L Boissière
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - I Obeid
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - C Maillot
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - C Tournier
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - T Fabre
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
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Masquefa T, Dunet B, Verdier N, Pallaro J, Fabre T, Tournier C. Arthroscopic resection of benign tumors of the knee posterior compartment: a report of 15 cases. Orthop Traumatol Surg Res 2015; 101:543-6. [PMID: 26164542 DOI: 10.1016/j.otsr.2015.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/11/2014] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of tumors located in the posterior compartment of the knee, whatever the nature of the tumor, remains surgical excision and can be done by open surgery or under arthroscopic control. The objective of this study was to evaluate the arthroscopic management of intra-articular tumors of the posterior compartment of the knee. The hypothesis is that tumors or tumor-like lesions confined to the posterior compartment are accessible by arthroscopy with low iatrogenic risk. MATERIALS AND METHODS All patients with an intra-articular tumor of the posterior compartment of the knee were enrolled between 2009 and 2013. The surgical management consisted of arthroscopic resection. Patients underwent postoperative MRI, repeated at last follow-up. The outcomes were the occurrence of complications, functional evaluation using the Lysholm Knee Scoring Scale, and the recurrence rate. RESULTS Fifteen patients were included. All patients had a complete resection. One case of delayed healing of the arthroscopic entry point was observed. At a mean 22months, the mean Lysholm Knee Score increased from 74 (±8.5) preoperatively to 92 (±7.7) postoperatively, a significant increase of 18 points (P=0.001). One patient had a recurrence of osteochondromatosis, requiring removal of a foreign body. DISCUSSION Resection of posterior intra-articular tumors of the knee using arthroscopy is possible, subject to a learning curve.
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Affiliation(s)
- T Masquefa
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France.
| | - B Dunet
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - N Verdier
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - J Pallaro
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - T Fabre
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - C Tournier
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
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Schleich W, Tournier C, Campagnoli E, Era S. 1225 Potential long-term cost savings due to significant clinical benefit of pertuzumab in combination with trastuzumab for the neoadjuvant treatment of patients with HER2-positive, locally advanced, inflammatory or early stage breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pallaro J, Angelliaume A, Dunet B, Lavoinne N, Tournier C, Fabre T. Reconstruction of femoral bone loss with a monoplane external fixator and bone transport. Orthop Traumatol Surg Res 2015; 101:583-7. [PMID: 26045056 DOI: 10.1016/j.otsr.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/24/2015] [Accepted: 04/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment of femoral bone loss is difficult. Ilizarov described the bone lengthening technique using a circular external fixator, but this technique is uncomfortable on the femur because of the circular fixator. We have therefore opted for use of a monoplane external fixator to treat femoral bone loss with bone lengthening. The objectives of this study were to determine whether (1) bone union can be obtained with a monoplane external fixator; (2) infections can be treated; (3) the lower limb axes and alignment can be controlled; and (4) patient satisfaction is high. HYPOTHESIS A monoplane external fixator provides a high rate of bone union during bone transport with no risk of deformity over the long term. MATERIAL AND METHODS Between 2007 and 2012 seven patients were treated with bone transport using a monoplane external fixator for femoral bone loss measuring a mean 8.1cm (range, 6-10cm). All were infected (osteomyelitis) or contaminated following Gustilo type IIIB fractures. The mean time from initial injury to the beginning of bone loss management was 3.9months (range, 1.5-8 months) for six of them and 108 months for one patient. RESULTS At the mean follow-up of 4.7 years (range, 2-7 years), all of the patients showed union after a mean 11.1months (range, 8-18 months), i.e., 41.2 days/cm of transport, and all infections were resolved. Only one patient had unequal leg length measuring 2cm and another showed 3° varus. Five patients were satisfied despite disappointing functional results. All could fully extend the knee but the mean flexion was 50° (range, 20-90°). DISCUSSION This series confirms that use of the monoplane external fixation with descending bone transport to treat infected femoral bone loss is efficient and provides bone union, treatment of the infection, and control of bone axes and lengths. This technique does not allow recuperation of complete knee flexion. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- J Pallaro
- Service de chirurgie orthopédique et traumatologique, CHU Pellegrin de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - A Angelliaume
- Service de chirurgie orthopédique et traumatologique, CHU Pellegrin de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - B Dunet
- Service de chirurgie orthopédique et traumatologique, CHU Pellegrin de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - N Lavoinne
- Service de chirurgie orthopédique et traumatologique, CHU Pellegrin de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - C Tournier
- Service de chirurgie orthopédique et traumatologique, CHU Pellegrin de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - T Fabre
- Service de chirurgie orthopédique et traumatologique, CHU Pellegrin de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Dunet B, Erbland A, Abi-Chahla ML, Tournier C, Fabre T. The TASERed finger: A new entity. Case report and review of literature. ACTA ACUST UNITED AC 2015; 34:145-8. [DOI: 10.1016/j.main.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 02/18/2015] [Accepted: 04/11/2015] [Indexed: 11/25/2022]
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Arnaud C, Sivanandamoorthy S, Loschi S, Guedj R, Tournier C, Lecarpentier T, Petit A, Carbajal R, de Suremain N. P-152 – Apport de la simulation en équipe aux urgences pédiatriques. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tournier C, Rodrigues J, Canon F, Salles C, Feron G. A Method to Evaluate Chewing Efficiency in Infants Through Food Bolus Characterization: A Preliminary Study. J Texture Stud 2015. [DOI: 10.1111/jtxs.12116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- C. Tournier
- UMR6265 Centre des Sciences du Goût et de l'Alimentation; CNRS; Dijon F-21000 France
- UMR1324 Centre des Sciences du Goût et de l'Alimentation; INRA; Dijon F-21000 France
- UMR Centre des Sciences du Goût et de l'Alimentation; Université de Bourgogne; Dijon F-21000 France
| | - J. Rodrigues
- UMR6265 Centre des Sciences du Goût et de l'Alimentation; CNRS; Dijon F-21000 France
- UMR1324 Centre des Sciences du Goût et de l'Alimentation; INRA; Dijon F-21000 France
- UMR Centre des Sciences du Goût et de l'Alimentation; Université de Bourgogne; Dijon F-21000 France
| | - F. Canon
- UMR6265 Centre des Sciences du Goût et de l'Alimentation; CNRS; Dijon F-21000 France
- UMR1324 Centre des Sciences du Goût et de l'Alimentation; INRA; Dijon F-21000 France
- UMR Centre des Sciences du Goût et de l'Alimentation; Université de Bourgogne; Dijon F-21000 France
| | - C. Salles
- UMR6265 Centre des Sciences du Goût et de l'Alimentation; CNRS; Dijon F-21000 France
- UMR1324 Centre des Sciences du Goût et de l'Alimentation; INRA; Dijon F-21000 France
- UMR Centre des Sciences du Goût et de l'Alimentation; Université de Bourgogne; Dijon F-21000 France
| | - G. Feron
- UMR6265 Centre des Sciences du Goût et de l'Alimentation; CNRS; Dijon F-21000 France
- UMR1324 Centre des Sciences du Goût et de l'Alimentation; INRA; Dijon F-21000 France
- UMR Centre des Sciences du Goût et de l'Alimentation; Université de Bourgogne; Dijon F-21000 France
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Tournier C, Charnay P, Tardy H, Chossegros L, Carnis L, Hours M. A few seconds to have an accident, a long time to recover: consequences for road accident victims from the ESPARR cohort 2 years after the accident. Accid Anal Prev 2014; 72:422-432. [PMID: 25146496 DOI: 10.1016/j.aap.2014.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 01/30/2014] [Revised: 04/11/2014] [Accepted: 07/10/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of the present study was to describe the consequences of a road accident in adults, taking account of the type of road user, and to determine predictive factors for consequences at 2 years. DESIGN Prospective follow-up study. METHODS The cohort was composed of 1168 victims of road traffic accidents, aged ≥16 years. Two years after the accident, 912 victims completed a self-administered questionnaire. Weighted logistic regression models were implemented to compare casualties still reporting impact related to the accident versus those reporting no residual impact. Five outcomes were analysed: unrecovered health status, impact on occupation or studies, on familial or affective life, on leisure or sport activities and but also the financial difficulties related to the accident. RESULTS 46.1% of respondents were motorised four-wheel users, 29.6% motorised two-wheel (including quad) users, 13.3% pedestrians (including inline skate and push scooter users) and 11.1% cyclists. 53.3% reported unrecovered health status, 32.0% persisting impact on occupation or studies, 25.2% on familial or affective life, 46.9% on leisure or sport activities and 20.2% still had accident-related financial difficulties. Type of user, adjusted on age and gender, was linked to unrecovered health status and to impact on leisure or sport activities. When global severity (as measured by NISS) was integrated in the previous model, type of user was also associated with impact on occupation or studies. Type of user was further associated with impact on occupation or studies and on leisure or sport activities when global severity and the sociodemographic data obtained at inclusion were taken into account. It was not, however, related to any of the outcomes studied here, when the models focused on the injured body region. Finally, type of road user did not seem, on the various predictive models, to be related to financial difficulties due to the accident or to impact on familial or affective life. CONCLUSIONS Overall, victims were affected by their accident even 2 years after it occurred. The severity of lesions induced by the accident was the main predictive factor. However, considering lesion as intermediary factors between the accident and the recovery status at 2 year post-accident, impact on health status was lower for cyclists than M4W users or M2W users.
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Affiliation(s)
- Charlène Tournier
- Université de Lyon, F-69622 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France.
| | - Pierrette Charnay
- Université de Lyon, F-69622 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France.
| | - Hélène Tardy
- Université de Lyon, F-69622 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France.
| | - Laetitia Chossegros
- Université de Lyon, F-69622 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France.
| | | | - Martine Hours
- Université de Lyon, F-69622 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France.
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Batailler P, Hours M, Maza M, Charnay P, Tardy H, Tournier C, Javouhey E. Health status recovery at one year in children injured in a road accident: a cohort study. Accid Anal Prev 2014; 71:267-272. [PMID: 24956131 DOI: 10.1016/j.aap.2014.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 08/19/2013] [Revised: 05/14/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged <16 years, admitted to public or private sector hospitals in the Rhône administrative area of France following a road accident. Recovery of health status one year after the accident and information concerning quality of life and the consequences of the accident for the child or family 1 year after the accident were collected by questionnaire, usually completed by the parents. Victims were in majority male (64.6%) and had mild or moderate injuries (81.9% with Maximum Abbreviated Injury Scale (M-AIS) <3). One year after the accident, 75.0% of the mild-to-moderate and 34.8% of the severe cases estimated health status as fully recovered. After adjustment, severity score (M-AIS≥3) and lower limb injury (AIS>1) were associated with incomplete recovery of health status: weighted odds ratio (ORw), 4.3 [95% confidence interval (95% CI), 1.3-14.6] and ORw, 6.5 [95% CI, 1.9-21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r=0.46), especially body pain (r=0.48) and role/social-physical (r=0.50) and, to a lesser extent, quality of life psychosocial scores (r=0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.
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Affiliation(s)
- Pierre Batailler
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Martine Hours
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Maud Maza
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Pierrette Charnay
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Hélène Tardy
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Charlène Tournier
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Etienne Javouhey
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France; Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
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Tournier C, Charnay P, Luauté J, Hours M. Cohorte ESPARR : facteurs associés à l’état de santé des victimes trois ans après l’accident de la route. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Koura KG, Charnay P, Tournier C, Javouhey E, Luauté J, Hours M. Évolution de la qualité de vie après un traumatisme crânien par accident de la route : un suivi à cinq ans de la cohorte ESPARR, Lyon, France. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Vogels J, Pommier N, Cursolle JC, Belin C, Tournier C, Durandeau A. PreFix™ external fixator used to treat a floating shoulder injury caused by gunshot wound. ACTA ACUST UNITED AC 2014; 33:370-4. [PMID: 25267396 DOI: 10.1016/j.main.2014.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 01/19/2014] [Accepted: 07/14/2014] [Indexed: 12/15/2022]
Abstract
Open fractures of the shoulder are extremely rare, and their treatment is a major challenge for surgeons. Only cases encountered in military settings have been reported thus far. Such fractures are often the result of ballistic trauma, which causes extensive damage to both bony and soft tissues. Since these injuries are associated with a high risk of infection and the presence of comminuted fractures, external fixation is necessary for repair. Use of external fixators and revascularization techniques has reduced the number of cases requiring shoulder amputation or disarticulation. Injury to the proximal extremity of the humerus, acromion, and clavicle further complicates the treatment. No published studies have described the assembly of external fixators for fractures in the scapular region with significant bone loss. In addition, no cases have been described in civilian settings. However, with an increase in urban violence and the traffic of illegal arms, civilian surgeons are now encountering an increasing number of patients with these injuries. In this report, we not only present a rare case of floating shoulder injury in a civilian setting but also provide an overview of the existing treatment strategies for this type of trauma, with special focus on the use of external fixators in elective shoulder arthrodesis and on military cases.
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Affiliation(s)
- J Vogels
- Institut chirurgical de la main et du membre supérieur, 17, avenue Condorcet, 69100 Villeurbanne, France.
| | - N Pommier
- Service de chirurgie orthopédique et traumatologie, hôpital Pellegrin-Tripode, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - J-C Cursolle
- Chirurgie du rachis, Orthopole, 33520 Bruges, France
| | - C Belin
- Chirurgie orthopédique, clinique des 4 pavillons, 33310 Lormont, France
| | - C Tournier
- Service de chirurgie orthopédique et traumatologie, hôpital Pellegrin-Tripode, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Durandeau
- Service de chirurgie orthopédique et traumatologie, hôpital Pellegrin-Tripode, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
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Tournier C, Charnay P, Hours M. The ESPARR cohort: The future of serious injured aged 16years and over (M.AIS3+) with a traumatic brain injury (TBI) 3years after the crash. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tournier C, Charnay P, Hours M. Cohorte ESPARR : devenir des blessés graves âgés de 16ans et plus (M.AIS3+) atteints d’un traumatisme crânien (TC) trois ans après l’accident. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Suremain N, Marteau E, Leruste A, Tournier C, Delamar AL, Carbajal R. Parotidite aiguë néonatale suppurative : revue de la littérature à propos d’une observation. Arch Pediatr 2014; 21:223-5. [DOI: 10.1016/j.arcped.2013.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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Hours M, Khati I, Charnay P, Chossegros L, Tardy H, Tournier C, Perrine AL, Luauté J, Laumon B. One Year After Mild Injury: Comparison of Health Status and Quality of Life Between Patients with Whiplash Versus Other Injuries. J Rheumatol 2013; 41:528-38. [DOI: 10.3899/jrheum.130406] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective.To compare health status, effect on family, occupational consequences, and quality of life (QOL) 1 year after an accident between patients with whiplash versus other mild injuries, and to explore the relationship between initial injury (whiplash vs other) and QOL.Methods.This was a prospective cohort study. The study used data from the ESPARR cohort (a representative cohort of road accident victims) and included 173 individuals with “pure” whiplash and 207 with other mild injuries. QOL at 1-year followup was assessed on the World Health Organization Quality of Life questionnaire. Correlations between explanatory variables and QOL were explored by Poisson regression to provide adjusted relative risks, with ANOVA for the various QOL scores explored.Results.One year post-accident, more patients who had whiplash than other casualties complained of nonrecovery of health status (56% vs 43%) and of the occupational effect of pain (31% vs 23%). QOL and posttraumatic stress disorder (PTSD) were similar in the 2 groups. Impaired QOL did not correlate with whiplash when models were adjusted on sociodemographic variables and history of psychological distress. Whatever the initial lesion, PTSD was a determining factor for poorer QOL.Conclusion.Sociodemographic factors, preaccident psychological history prior to the accident, and PTSD were the main factors influencing QOL, rather than whether the injury was whiplash. PTSD may also be related to pain.
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Dunet B, Pallaro J, Boullet F, Tournier C, Fabre T. Isolated anterior interosseous nerve deficit due to a false aneurysm of the humeral artery: an unusual complication of penetrating arm injury. Case report and literature review. Orthop Traumatol Surg Res 2013; 99:973-7. [PMID: 24211126 DOI: 10.1016/j.otsr.2013.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/06/2013] [Accepted: 07/25/2013] [Indexed: 02/02/2023]
Abstract
Anterior interosseous nerve (AIN) injuries account for only 1% of all the nerve injuries at the upper limb. We report the case of a 22-year-old male who sustained a penetrating injury to the arm. No neurological deficit was found at the initial evaluation. However, 6 weeks later, he had a motor deficit confined to the territory of the AIN with weakness of the flexor pollicis longus and flexor digitorum longus to the index. He also reported paraesthesia. Tinel's test was positive over the pinpoint wound in the arm, where a painful swelling was felt. Electroneurophysiological testing indicated a deficit of the AIN. Surgical exploration identified a thrombosed false aneurysm of the humeral artery responsible for compression of the median nerve. One month later, the patient had achieved a full recovery. Immediate routine exploration of deep penetrating wounds, although mandatory, may fail to detect any lesions. Close monitoring must be provided subsequently, as gradual nerve compression can result in delayed neurological deficits.
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Affiliation(s)
- B Dunet
- Service de chirurgie orthopédique, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France.
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Koura K, Charnay P, Tournier C, Javouhey E, Luaute J, Hours M. Impact of traumatic brain injury on the evolution of quality of life during the five years following a road accident. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koura K, Charnay P, Tournier C, Javouhey E, Luaute J, Hours M. Évolution de la qualité de vie après un traumatisme crânien par accident de la route : un suivi à cinq ans de la cohorte ESPARR. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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de Suremain N, Thevenin-Lemoine C, Tournier C, Mary P, Armengaud JB, Vialle R, Carbajal R. Traumatisme de la cheville : épidémiologie et évaluation clinique. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nery J, Goudez R, Biourge V, Tournier C, Leray V, Martin L, Thorin C, Nguyen P, Dumon H. Influence of dietary protein content and source on colonic fermentative activity in dogs differing in body size and digestive tolerance. J Anim Sci 2012; 90:2570-80. [PMID: 22328724 DOI: 10.2527/jas.2011-4112] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low-consistency, high-moisture feces have been observed in large dogs (Canis lupus familiaris), compared with small dogs, and particularly in sensitive breeds (e.g., German Shepherd dogs). The aim of this work was to determine if greater colonic protein fermentation is responsible for poorer fecal quality in large sensitive dogs. Twenty-seven bitches were allotted to 4 groups based on size and digestive sensitivity: small, medium, large tolerant, and large sensitive. Five experimental diets varying in protein source [highly digestible wheat gluten (WG) vs. medium digestible poultry meal (PM), and protein concentration from 21.4 to 21.6 (LP) to 38.2 to 39.2% CP (HP)] were tested. Diets were fed for 14 d and followed by a 12-d transition period. Digestive fermentation by-products were investigated in fresh stools [ammonia, phenol, indole, and short chain fatty acids including acetate, propionate, and butyrate (C2 to C4 SCFA), branched-chain fatty acids (BCFA), and valerate] and in urine (phenol and indole). Bacterial populations in feces were identified. The PM diets resulted in greater fecal concentrations of ammonia, BCFA, valerate, indole, and C2 to C4 SCFA than WG diets (P = 0.002, P < 0.001, P = 0.039, P = 0.003, and P = 0.012, respectively). Greater concentrations of ammonia, BCFA, and valerate were found in the feces of dogs fed HP compared with LP diets (P < 0.001, P < 0.001, and P = 0.012, respectively). The concentrations of ammonia, valerate, phenol, and indole in feces of large sensitive dogs were greater (P < 0.001, P < 0.001, P = 0.002, and P = 0.019, respectively) compared with the other groups. The Enterococcus populations were greater in feces of dogs fed with PMHP rather than WGLP diets (P = 0.006). Urinary phenol and indole excretion was greater when dogs were fed PM than WG diets (P < 0.001 and P = 0.038, respectively) and HP than LP diets (P = 0.001 and P = 0.087, respectively). Large sensitive dogs were prone to excrete a greater quantity of phenol in urine (P < 0.001). A diet formulated with highly digestible protein, such as WG, led to reduced concentrations of protein-based fermentation products in feces together with improved fecal quality in dogs, especially in large sensitive ones. Poor fecal quality in large sensitive dogs could be partly related to the pattern of protein fermentation in the hindgut.
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Affiliation(s)
- J Nery
- Laboratory of Nutrition and Endocrinology, Food Science and Engineering, Nantes-Atlantic National College of Veterinary Medicine, ONIRIS, LUNAM Université, 44307 Nantes Cedex 3, France
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de Suremain N, Arnaud C, Agogue M, Tournier C, Armengaud JB, Carbajal R. [Traumatic lacerations: wound closure]. Arch Pediatr 2011; 18:344-8. [PMID: 21269815 DOI: 10.1016/j.arcped.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 01/03/2011] [Indexed: 11/27/2022]
Abstract
The suture, when possible, is the best method to close a simple wound. It must be preceded by debridement and performed with great care. A rigorous technique applied in the best possible environment is necessary but not always sufficient to achieve a good cosmetic result.
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Affiliation(s)
- N de Suremain
- Service d'accueil d'urgence, hôpital d'Enfants-Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Aunoble S, Meyrat R, Al Sawad Y, Tournier C, Leijssen P, Le Huec JC. Hybrid construct for two levels disc disease in lumbar spine. Eur Spine J 2009; 19:290-6. [PMID: 19888610 DOI: 10.1007/s00586-009-1182-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 06/02/2009] [Accepted: 09/16/2009] [Indexed: 11/29/2022]
Abstract
Prospective study. To study the validity of Hybrid construction (Anterior Lumbar Interbody Fusion) ALIF at one level and total disc arthroplasty (TDA) at adjacent, for two levels disc disease in lumbar spine as surgical strategy. With growing evidence that fusion constructs in the treatment of degenerative disc disease (DDD) may alter sagittal balance and contribute to undesirable complications in the long-term, total disc arthroplasty (TDA) slowly becomes an accepted treatment option for a selected group of patients. Despite encouraging early and intermediate term results of single-level total disc arthroplasty reported in the literature, there is growing evidence that two-level arthroplasty does not fare as well. Hybrid fusion is an attempt to address two-level DDD by combining the advantages of a single-level ALIF with those of a single-level arthroplasty. 42 patients (25 females and 17 males) underwent Hybrid fusion and had a median follow-up of 26.3 months. The primary functional outcomes were assessed before and after surgery with Oswestry Disability Index and the visual analogue score of the back and legs. Patients were divided into four groups according to the percentage improvement between preop and postop ODI scores. A total of 42 patients underwent a hybrid fusion as follows: 35 L5-S1 ALIF/L4-5 prosthesis, 3 L4-5 ALIF/L3-4 prosthesis, 2 L5-S1 ALIF/L4-5 prosthesis/L3-4 prosthesis, 1 L5-S1 prosthesis/L4-5 ALIF, and 1 L5-S1 ALIF/L4-5 ALIF/L3-4 prosthesis. At 2-years clinical outcomes, mean reduction in ODI is 24.9 points (53.0% improvement compared to preop ODI). The visual analogue score for the back is 64.6% improvement. At 2-year clinical outcomes, Hybrid fusion is a viable surgical alternative for the treatment of two-level DDD in comparison with two-level TDA and with two-level fusion.
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Nery J, Biourge V, Tournier C, Leray V, Martin L, Dumon H, Nguyen P. Influence of dietary protein content and source on fecal quality, electrolyte concentrations, and osmolarity, and digestibility in dogs differing in body size. J Anim Sci 2009; 88:159-69. [PMID: 19854997 DOI: 10.2527/jas.2008-1666] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
When fed the same diet, large-breed dogs tend to produce feces of poorer quality compared with small-breed dogs. Moreover, German shepherds, although having a BW similar to Giant Schnauzers, are particularly prone to digestive intolerance, producing feces of poor consistency and increased moisture. Digestive tolerance reflects the reaction of the animal to the diet, and it can be assessed by determining fecal quality (consistency, moisture, volume, odor, and color). This study was conducted to assess the effect of protein source and content on fecal quality, and to determine whether greater digestibility and lesser fecal osmolarity and electrolyte concentrations are associated with improved fecal quality in dogs differing in body size and digestive tolerance. Twenty-seven healthy female dogs were divided into 4 groups according to BW and digestive tolerance: small, medium, large tolerant, and large sensitive. Five diets, varying in protein source (wheat gluten, poultry meal, and a 50:50 mixture of both sources) and concentration (22, 29, and 39% CP on a DM basis for low, medium, and high, respectively) were tested. The present study was divided in 2 phases: 2 diets were studied in a crossover design in phase I, and 3 diets were studied in a Latin square design in phase II. Diets were fed for 14 d, followed by a 12-d transition period. Fecal score (1 = dry and hard feces, to 5 = liquid diarrhea), moisture, electrolytes (Na and K), and osmolarity, and digestibility of DM, energy, fat, CP, and ash were determined. Fecal score and moisture (P < 0.001) were less and overall digestibility (P < 0.001 for DM, CP, fat, ash, and energy) was greater for wheat gluten than for poultry meal diets. Large dogs had the greatest fecal score and moisture (P < 0.001), together with the greatest overall digestibility (P < 0.001 for DM, P = 0.054 for CP, P = 0.005 for ash, and P = 0.003 for energy). Osmolarity was less for wheat gluten-based diets (P < 0.001), and was not affected by dog size. Fecal electrolyte concentration varied mainly with dog group (P = 0.005 for Na, and P < 0.001 for K), being greater in large sensitive dogs compared with small dogs. Wheat gluten was proved to be a suitable protein source for modulating fecal quality in dogs, particularly in sensitive breeds. Poorer fecal quality in large sensitive dogs can be related to greater digestibility and greater fecal electrolyte concentrations, but not to fecal osmolarity.
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Affiliation(s)
- J Nery
- Laboratory of Nutrition and Endocrinology, National Veterinary School of Nantes, 44307 Nantes Cedex 3, France
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