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Pardo E, Jabaudon M, Godet T, Pereira B, Morand D, Futier E, Arpajou G, Le Cam E, Bonnet MP, Constantin JM. Dynamic assessment of prealbumin for nutrition support effectiveness in critically ill patients. Clin Nutr 2024; 43:1343-1352. [PMID: 38677045 DOI: 10.1016/j.clnu.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND & AIMS Serum prealbumin is considered to be a sensitive predictor of clinical outcomes and a quality marker for nutrition support. However, its susceptibility to inflammation restricts its usage in critically ill patients according to current guidelines. We assessed the performance of the initial value of prealbumin and dynamic changes for predicting the ICU mortality and the effectiveness of nutrition support in critically ill patients. METHODS This monocentric study included patients admitted to the ICU between 2009 and 2016, having at least one initial prealbumin value available. Prospectively recorded data were extracted from the electronic ICU charts. We used both univariable and multivariable logistic regressions to estimate the performance of prealbumin for the prediction of ICU mortality. Additionally, the association between prealbumin dynamic changes and nutrition support was assessed via a multivariable linear mixed-effects model and multivariable linear regression. Performing subgroup analysis assisted in identifying patients for whom prealbumin dynamic assessment holds specific relevance. RESULTS We included 3136 patients with a total of 4942 prealbumin levels available. Both prealbumin measured at ICU admission (adjusted odds-ratio (aOR) 0.04, confidence interval (CI) 95% 0.01-0.23) and its change over the first week (aOR 0.02, CI 95 0.00-0.19) were negatively associated with ICU mortality. Throughout the entire ICU stay, prealbumin dynamic changes were associated with both cumulative energy (estimate: 33.2, standard error (SE) 0.001, p < 0.01) and protein intakes (1.39, SE 0.001, p < 0.01). During the first week of stay, prealbumin change was independently associated with mean energy (6.03e-04, SE 2.32e-04, p < 0.01) and protein intakes (1.97e-02, SE 5.91e-03, p < 0.01). Notably, the association between prealbumin and energy intake was strongest among older or malnourished patients, those suffering from increased inflammation and those with high disease severity. Finally, prealbumin changes were associated with a positive mean nitrogen balance at day 7 only in patients with SOFA <4 (p = 0.047). CONCLUSION Prealbumin measured at ICU admission and its change during the first-week serve as an accurate predictor of ICU mortality. Prealbumin dynamic assessment may be a reliable tool to estimate the effectiveness of nutrition support in the ICU, especially among high-risk patients.
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Affiliation(s)
- Emmanuel Pardo
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-hôpitaux de Paris, 75012, Paris, France.
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France; iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France; Université Clermont Auvergne, Department of Healthcare Simulation, Clermont-Ferrand, F-63000, France; Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, F-63000, France
| | - Bruno Pereira
- Biostatistics and Data Management Unit, Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Dominique Morand
- Direction de la Recherche Clinique (DRCI), CHU de Clermont-Ferrand, Clermont-Ferrand, F-63003, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France; iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Gauthier Arpajou
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Elena Le Cam
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-hôpitaux de Paris, 75012, Paris, France
| | - Marie-Pierre Bonnet
- Sorbonne Université, Département Anesthésie-Réanimation, Hôpital Armand Trousseau, DMU DREAM, GRC 29, AP-HP, Paris, France; Université Paris Cité, INSERM, INRA, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Maternité Port Royal, 53 Avenue de l'Observatoire, F-75014, Paris, France
| | - Jean-Michel Constantin
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-hôpitaux de Paris, 75013, Paris, France
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Jalenques I, Guiguet-Auclair C, Morand D, Bourlot F, Lauron S, Mitelman N, Hartmann A, Rondepierre F. Agreement between self-, mother and father proxy-reports on health-related quality of life in adolescents with Tourette syndrome. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02418-6. [PMID: 38613676 DOI: 10.1007/s00787-024-02418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/13/2024] [Indexed: 04/15/2024]
Abstract
This study aimed to investigate agreement and discrepancies between parent proxy- and adolescent self-reports on assessments of adolescents' health-related quality of life (HRQoL), and the role that individual factors may play in parent-adolescent agreement, in a sample of adolescents with Tourette syndrome (TS) compared to a control group of healthy adolescents. Adolescents aged 12-18 years diagnosed with TS were recruited with their parents from primary and secondary referral centres. Adolescent healthy controls were matched for gender and age. Adolescents and each of their parents completed a set of questionnaires including a HRQoL evaluation of adolescent, the 'Vécu et Santé Perçue de l'Adolescent'. Mother-adolescent, father-adolescent and mother-father agreements on adolescents' HRQoL scores were investigated at individual and group level, both in TS and control groups. Data were available for 75 adolescents, 75 mothers and 63 fathers, in the TS group. Agreement between mother, father proxy-reports and TS adolescents self-reports of HRQoL varied from poor to good, without significant difference with the control group. In TS group, mothers and fathers underestimated adolescents' HRQoL in 'Psychological well-being' subscale and mothers underestimated it in 'Physical 'well-being' subscale, while controls overestimated adolescents' HRQoL in these subscales. Larger mother-adolescent discrepancies for 'Psychological well-being' and 'Physical well-being' subscales were associated with internalizing symptoms. Regarding future studies, comprehensive evaluation of the various dimensions of adolescents' HRQoL with TS requires the integration of the perspectives of both adolescents, mothers and fathers. Clinicians should take into account this point to provide comprehensive care and services.
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Affiliation(s)
- Isabelle Jalenques
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre de Compétences Gilles de la Tourette, CNRS, Institut Pascal, F-63000, Clermont-Ferrand Cedex, France.
| | - Candy Guiguet-Auclair
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Dominique Morand
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - Fabien Bourlot
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, Service de Psychiatrie de l'Adulte A Et Psychologie Médicale, CNRS, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Sophie Lauron
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, Service de Psychiatrie de l'Adulte A Et Psychologie Médicale, CNRS, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Nathan Mitelman
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, Service de Psychiatrie de l'Adulte A Et Psychologie Médicale, CNRS, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Andreas Hartmann
- Département de Neurologie, Pôle des Maladies du Système Nerveux, Groupe Hospitalier Pitié-Salpêtrière, Centre de Référence 'Syndrome Gilles de la Tourette', 75013, Paris, France
| | - Fabien Rondepierre
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre de Compétences Gilles de la Tourette, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France
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El Ouadih Y, Marques A, Pereira B, Luisoni M, Claise B, Coste J, Sontheimer A, Chaix R, Debilly B, Derost P, Morand D, Durif F, Lemaire JJ. Deep brain stimulation of the subthalamic nucleus in severe Parkinson's disease: relationships between dual-contact topographic setting and 1-year worsening of speech and gait. Acta Neurochir (Wien) 2023; 165:3927-3941. [PMID: 37889334 DOI: 10.1007/s00701-023-05843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) alleviates severe motor fluctuations and dyskinesia in Parkinson's disease, but may result in speech and gait disorders. Among the suspected or demonstrated causes of these adverse effects, we focused on the topography of contact balance (CB; individual, right and left relative dual positions), a scantly studied topic, analyzing the relationships between symmetric or non-symmetric settings, and the worsening of these signs. METHOD An observational monocentric study was conducted on a series of 92 patients after ethical approval. CB was specified by longitudinal and transversal positions and relation to the STN (CB sub-aspects) and totalized at the patient level (patient CB). CB was deemed symmetric when the two contacts were at the same locations relative to the STN. CB was deemed asymmetric when at least one sub-aspect differed in the patient CB. Baseline and 1-year characteristics were routinely collected: (i) general, namely, Unified Parkinson's Disease Rating Scores (UPDRS), II, III motor and IV, daily levodopa equivalent doses, and Parkinson's Disease Questionnaire of Quality of Life (PDQ39) scores; (ii) specific, namely scores for speech (II-5 and III-18) and axial signs (II-14, III-28, III-29, and III-30). Only significant correlations were considered (p < 0.05). RESULTS Baseline characteristics were comparable (symmetric versus asymmetric). CB settings were related to deteriorations of speech and axial signs: communication PDQ39 and UPDRS speech and gait scores worsened exclusively with symmetric settings; the most influential CB sub-aspect was symmetric longitudinal position. CONCLUSION Our findings suggest that avoiding symmetric CB settings, whether by electrode positioning or shaping of electric fields, could reduce worsening of speech and gait.
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Affiliation(s)
- Youssef El Ouadih
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Ana Marques
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Maxime Luisoni
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Béatrice Claise
- Service de Radiologie, Unité de Neuroradiologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jérôme Coste
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Anna Sontheimer
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Rémi Chaix
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Dominique Morand
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Franck Durif
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France.
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
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Blondonnet R, Simand LA, Vidal P, Borao L, Bourguignon N, Morand D, Bernard L, Roszyk L, Audard J, Godet T, Monsel A, Garnier M, Quesnel C, Bazin JE, Sapin V, Bastarache JA, Ware LB, Hughes CG, Pandharipande PP, Ely EW, Futier E, Pereira B, Constantin JM, Jabaudon M. Design and Rationale of the Sevoflurane for Sedation in Acute Respiratory Distress Syndrome (SESAR) Randomized Controlled Trial. J Clin Med 2022; 11:2796. [PMID: 35628922 PMCID: PMC9147018 DOI: 10.3390/jcm11102796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023] Open
Abstract
Preclinical studies have shown that volatile anesthetics may have beneficial effects on injured lungs, and pilot clinical data support improved arterial oxygenation, attenuated inflammation, and decreased lung epithelial injury in patients with acute respiratory distress syndrome (ARDS) receiving inhaled sevoflurane compared to intravenous midazolam. Whether sevoflurane is effective in improving clinical outcomes among patients with ARDS is unknown, and the benefits and risks of inhaled sedation in ARDS require further evaluation. Here, we describe the SESAR (Sevoflurane for Sedation in ARDS) trial designed to address this question. SESAR is a two-arm, investigator-initiated, multicenter, prospective, randomized, stratified, parallel-group clinical trial with blinded outcome assessment designed to test the efficacy of sedation with sevoflurane compared to intravenous propofol in patients with moderate to severe ARDS. The primary outcome is the number of days alive and off the ventilator at 28 days, considering death as a competing event, and the key secondary outcome is 90 day survival. The planned enrollment is 700 adult participants at 37 French academic and non-academic centers. Safety and long-term outcomes will be evaluated, and biomarker measurements will help better understand mechanisms of action. The trial is funded by the French Ministry of Health, the European Society of Anaesthesiology, and Sedana Medical.
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Affiliation(s)
- Raiko Blondonnet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
| | - Laure-Anne Simand
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Perine Vidal
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Lucile Borao
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Nathalie Bourguignon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Dominique Morand
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Lise Bernard
- Department of Clinical Research and Temporary Authorization, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Laurence Roszyk
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
- Department of Medical Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Jules Audard
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Antoine Monsel
- Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (A.M.); (J.-M.C.)
| | - Marc Garnier
- Department of Anesthesiology and Critical Care Medicine, DMU DREAM, Saint-Antoine University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France;
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, DMU DREAM, Tenon University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France;
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Vincent Sapin
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
- Department of Medical Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Julie A. Bastarache
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Christopher G. Hughes
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.G.H.); (P.P.P.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - Pratik P. Pandharipande
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.G.H.); (P.P.P.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
| | - Bruno Pereira
- Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (A.M.); (J.-M.C.)
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
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Julia M, Bonnin A, Croisier JL, Pereira B, Morand D, Peyrin JC, Dusfour B, Dupeyron A, Coudeyre E. Isokinetic thigh muscle strength testing in professional French Rugby Union players: A database as a reference in pre-season strength rehabilitation rather than the controlateral limb. Ann Phys Rehabil Med 2020; 64:101370. [PMID: 32201341 DOI: 10.1016/j.rehab.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/30/2019] [Accepted: 01/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Marc Julia
- Service de médecine physique et de réadaptation, CHRU Montpellier, hôpital Lapeyronie, 191, avenue du Doyen Gaston-Giraud, Montpellier cedex 5, France
| | - Armand Bonnin
- Service de médecine physique et de réadaptation, CHU Clermont-Ferrand, INRA, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Jean-Louis Croisier
- Department of physical medicine and rehabilitation, sports, FIFA medical center of eccellence Liege university hospital center, Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | - Bruno Pereira
- Unité de biostatistiques (DRCI), CHU Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex, France
| | - Dominique Morand
- Unité de biostatistiques (DRCI), CHU Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex, France
| | | | - Bernard Dusfour
- Commission médicale Ligue Nationale de Rugby, 75017 Paris, France
| | - Arnaud Dupeyron
- Département de médecine physique et de réadaptation, CHU Nîmes, université Montpellier-Nîmes, 30000 Nîmes, France
| | - Emmanuel Coudeyre
- Service de médecine physique et de réadaptation, CHRU Montpellier, hôpital Lapeyronie, 191, avenue du Doyen Gaston-Giraud, Montpellier cedex 5, France.
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Louis C, Godet T, Chanques G, Bourguignon N, Morand D, Pereira B, Constantin JM. Effects of dexmedetomidine on delirium duration of non-intubated ICU patients (4D trial): study protocol for a randomized trial. Trials 2018; 19:307. [PMID: 29866205 PMCID: PMC5987410 DOI: 10.1186/s13063-018-2656-x] [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: 11/21/2017] [Accepted: 04/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background Delirium during intensive care unit (ICU) stay is frequent and associated with significant morbidity, mortality and healthcare-related costs. International guidelines suggest its prevention. However, curative treatment remains unclearly established. Despite contradictory and ambiguous academic literature, international guidelines suggest the use of second-generation (atypical) antipsychotics over haloperidol. However, haloperidol remains the most widely used neuroleptic worldwide as a first-line treatment of agitation and/or delirium. Dexmedetomidine, an alpha2-adrenergic receptors agonist, has shown its efficiency in the treatment of delirium in intubated patients but also in its prevention. Dexmedetomidine represents a widely used alternative to haloperidol. Only few studies have compared the efficacy of dexmedetomidine in non-intubated ICU patients as a first-line curative treatment of delirium. The main objective of the 4D trial is to demonstrate that dexmedetomidine decreases delirium duration compared to placebo. Methods/design The 4D trial is an investigator-initiated, prospective, multicenter, randomized, double-blinded, two-arm trial, randomizing 300 non-intubated ICU patients with a diagnosis of agitated delirium to receive dexmedetomidine or placebo as a cure. In case of agitation (RASS≥ + 2), immediate haloperidol administration will be allowed, to protect patient and staff in charge, while waiting for study treatment action. The primary outcome measure is a composite of duration of agitation or delirium or the use of intubation with deep sedation and mechanical ventilation. Secondary outcomes include mortalities at 7 and 30 days, ICU length of stay and occurrence of adverse effects related to dexmedetomidine use (bradycardia or hypotension requesting any treatment; or haloperidol use (neuroleptic malignant syndrome, extrapyramidal syndrome, prolonged QTc). The sample size will allow the detection of a 50% decrease of agitation duration (120 min), of an absolute reduction of delirium duration (1 day) and of a 50% relative decrease of intubation and mechanical ventilation, with a type 1 error rate of 1.8% (error risk inflation due to components of composite) and power of 90%, assuming a 15% incidence of intubation and mechanical ventilation requirements, an agitation duration of 240 min and a delirium duration of 3 days. One hundred and ten patients by group will be needed. An intermediate analysis is scheduled and requires the inclusion of 150 patients. Discussion The 4D trial may provide important data on the safety of commonly used sedative dexmedetomidine and could have a significant impact on future treatment of non-intubated ICU patients presenting with agitated delirium. Trial registration ClinicalTrials.gov, ID: NCT 03317067. Registered on 23 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2656-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clémence Louis
- Département de Médecine Périopératoire (MPO), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - Thomas Godet
- Département de Médecine Périopératoire (MPO), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63003, Clermont-Ferrand, France. .,GReD; UMR/CNRS6293; Université Clermont-Auvergne; INSERM U1103, 63003, Clermont-Ferrand, France. .,Département de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, 63003, Clermont-Ferrand, France.
| | - Gérald Chanques
- Département d'Anesthésie-Réanimation B, Hôpital Saint-Eloi, Centre Hospitalier Universitaire (CHU) Montpellier, 34090, Montpellier, France
| | - Nathalie Bourguignon
- Département de Médecine Périopératoire (MPO), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - Dominique Morand
- Département de Médecine Périopératoire (MPO), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - Bruno Pereira
- Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation (DRCI), 63000, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Département de Médecine Périopératoire (MPO), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63003, Clermont-Ferrand, France.,GReD; UMR/CNRS6293; Université Clermont-Auvergne; INSERM U1103, 63003, Clermont-Ferrand, France
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Planche V, Munsch F, Pereira B, de Schlichting E, Vidal T, Coste J, Morand D, de Chazeron I, Derost P, Debilly B, Llorca PM, Lemaire JJ, Marques A, Durif F. Anatomical predictors of cognitive decline after subthalamic stimulation in Parkinson's disease. Brain Struct Funct 2018; 223:3063-3072. [PMID: 29736590 DOI: 10.1007/s00429-018-1677-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/18/2017] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
Abstract
We investigated whether pre-operative MRI measures of focal brain atrophy could predict cognitive decline occurring after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson's disease (PD). For that purpose, we prospectively collected data of 42 consecutive patients with PD who underwent bilateral STN-DBS. Normalized brain structure volumes and cortical thicknesses were measured on pre-operative T1-weighted MRI. Patients were tested for their cognitive performances before surgery and 1 year after. After controlling for age, gender, pre-operative disease severity, change in dopaminomimetic dose after surgery and contact location, we found correlations: (1) between the variation of the total Mattis dementia rating scale (MDRS) score and left lateral ventricle volume (p = 0.032), (2) between the variation of the initiation/perseveration subscore of the MDRS and the left nucleus accumbens volume (p = 0.042) and the left lateral ventricle volume (p = 0.017) and (3) between the variation of the backward digit-span task and the right and left superior frontal gyrus thickness (p = 0.004 and p = 0.007, respectively). Left nucleus accumbens atrophy was associated with decline in the initiation/perseveration subscore with the largest effect size (d = - 1.64). Pre-operative left nucleus accumbens volume strongly predicted postoperative decline in the initiation/attention subscore (AUC = 0.92, p < 0.001, 96.3% sensitivity, 80.0% specificity, 92.9% PPV and 92.9% NPV). We conclude that the morphometric measures of brain atrophy usually associated with cognitive impairment in PD can also explain or predict a part of cognitive decline after bilateral STN-DBS. In particular, the left accumbens nucleus volume could be considered as a promising marker for guiding surgical decisions.
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Affiliation(s)
- Vincent Planche
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
| | - Fanny Munsch
- Service de Neuroradiologie diagnostique et thérapeutique, CHU Bordeaux, Université Bordeaux, 33000, Bordeaux, France
| | - Bruno Pereira
- Unité de Biostatistiques, Direction à la Recherche Clinique et à l'Innovation (DRCI), CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Emmanuel de Schlichting
- Service de Neurochirurgie, CHU Clermont-Ferrand, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Tiphaine Vidal
- Centre Mémoire de Ressources et de Recherche (CMRR), CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jerome Coste
- Service de Neurochirurgie, CHU Clermont-Ferrand, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Dominique Morand
- Unité de Biostatistiques, Direction à la Recherche Clinique et à l'Innovation (DRCI), CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Ingrid de Chazeron
- Centre Médico-Psychologique B (CMP-B), CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Centre Médico-Psychologique B (CMP-B), CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Service de Neurochirurgie, CHU Clermont-Ferrand, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Ana Marques
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Franck Durif
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
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Vignaud M, Paugam-Burtz C, Garot M, Jaber S, Slim K, Panis Y, Lucet JC, Bourdier J, Morand D, Pereira B, Futier E. Comparison of intravenous versus combined oral and intravenous antimicrobial prophylaxis (COMBINE) for the prevention of surgical site infection in elective colorectal surgery: study protocol for a multicentre, double-blind, randomised controlled clinical trial. BMJ Open 2018; 8:e020254. [PMID: 29654027 PMCID: PMC5898320 DOI: 10.1136/bmjopen-2017-020254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) account for 30% of all healthcare-associated infections, with reported rates ranging from 8% and 30% after colorectal surgery and are associated with increased morbidity and mortality rates, length of hospital stay and costs in healthcare. Administration of systemic antimicrobial prophylaxis before surgery is recommended to reduce the risk of SSI, but the optimal regimen remains unclear. We aim to evaluate whether a combined oral and intravenous antimicrobial prophylaxis could be more effective to reduce the incidence of SSI after colorectal surgery, as compared with the standard practice of intravenous antimicrobial prophylaxis alone. METHODS AND ANALYSIS Comparison of intravenous versus combined oral and intravenous antimicrobial prophylaxis (COMBINE) trial is a randomised, placebo-controlled, parallel, double-blind, multicentre study of 960 patients undergoing elective colorectal surgery. Patients will be randomly allocated in a 1:1 ratio to receive either combined oral and intravenous antimicrobial prophylaxis or intravenous antibiotic prophylaxis alone, stratified by centre, the surgical procedure (laparoscopic or open surgery) and according to the surgical skin antisepsis (chlorexidine-alcohol or povidione-iodine alcoholic solution). The primary endpoint is the rate of SSI by day 30 following surgery, with SSI defined by the criteria developed by the Centers for Disease Control and Prevention. Data will be analysed on the intention-to-treat principle and a per-protocol basis. ETHICS AND DISSEMINATION COMBINE trial has been approved by an independent ethics committee for all study centres. Participant recruitment began in May 2016. Results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER EudraCT 2015-002559-84; NCT02618720.
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Affiliation(s)
- Marie Vignaud
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Catherine Paugam-Burtz
- Assistance publique-Hôpitaux de Paris (AP-HP), Département Anesthésie Réanimation, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Matthias Garot
- Pôle Anesthesie Réanimation, Centre Hospitalier Universitaire (CHU) Lille, Lille, France
| | - Samir Jaber
- Département Anesthesie Réanimation B (DAR B), Centre Hospitalier Regional Universitaire de Montpellier, Hôpital Saint-Eloi, and Inserm U-1046, Montpellier, France
| | - Karem Slim
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, CLERMONT-FERRAND, France
| | - Yves Panis
- Unité d’Hygiène et de Lutte contre l’Infection Nosocomiale, Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat-Claude Bernard, Paris, France
| | - Jean-Christophe Lucet
- Direction de la Recherche Clinique & Innovation (DRCI), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Justine Bourdier
- Departement de Chirurgie Colorectale, Assistance publique-Hôpitaux de Paris (AP-HP), Pôle des Maladies de l’Appareil Digestif (PMAD), Hôpital Beaujon, Clichy, France
| | - Dominique Morand
- Departement de Chirurgie Colorectale, Assistance publique-Hôpitaux de Paris (AP-HP), Pôle des Maladies de l’Appareil Digestif (PMAD), Hôpital Beaujon, Clichy, France
| | - Bruno Pereira
- Unité de Biostatistiques, Direction de la Recherche Clinique & Innovations (DRCI), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
- GreD, CNRS, Inserm U1103, Université Clermont Auvergne, Clermont-Ferrand, France
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Bulyez S, Pereira B, Caumon E, Imhoff E, Roszyk L, Bernard L, Bühler L, Heidegger C, Jaber S, Lefrant JY, Chabanne R, Bertrand PM, Laterre PF, Guerci P, Danin PE, Escudier E, Sossou A, Morand D, Sapin V, Constantin JM, Jabaudon M. Epidural analgesia in critically ill patients with acute pancreatitis: the multicentre randomised controlled EPIPAN study protocol. BMJ Open 2017; 7:e015280. [PMID: 28554928 PMCID: PMC5730003 DOI: 10.1136/bmjopen-2016-015280] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is associated with high morbidity and mortality in its most severe forms. Most patients with severe AP require intubation and invasive mechanical ventilation, frequently for more than 7 days, which is associated with the worst outcome. Recent increasing evidence from preclinical and clinical studies support the beneficial effects of epidural analgesia (EA) in AP, such as increased gut barrier function and splanchnic, pancreatic and renal perfusion, decreased liver damage and inflammatory response, and reduced mortality. Because recent studies suggest that EA might be a safe procedure in the critically ill, we sought to determine whether EA reduced AP-associated respiratory failure and other major clinical outcomes in patients with AP. METHODS AND ANALYSIS The Epidural Analgesia for Pancreatitis (EPIPAN) trial is an investigator-initiated, prospective, multicentre, randomised controlled two-arm trial with assessor-blinded outcome assessment. The EPIPAN trial will randomise 148 patients with AP requiring admission to an intensive care unit (ICU) to receive EA (with patient-controlled epidural administration of ropivacaine and sufentanil) combined with standard care based on current recommendations on the treatment of AP (interventional group), or standard care alone (reference group). The primary outcome is the number of ventilator-free days at day 30. Secondary outcomes include main complications of AP (eg, organ failure and mortality, among others), levels of biological markers of systemic inflammation, epithelial lung injury, renal failure, and healthcare-associated costs. ETHICS AND DISSEMINATION The study was approved by the appropriate ethics committee (CPP Sud-Est VI). Informed consent is required. If the combined application of EA and standard care proves superior to standard care alone in patients with AP in the ICU, the use of EA may become standard practice in experienced centres, thereby decreasing potential complications related to AP and its burden in critically ill patients. The results will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02126332.
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Affiliation(s)
- Stéphanie Bulyez
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Elodie Caumon
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Etienne Imhoff
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurence Roszyk
- Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Lise Bernard
- Department of Pharmacy, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont-Ferrand, France
| | - Leo Bühler
- Department of Surgery, Geneva university hospitals, Geneva, Switzerland
| | - Claudia Heidegger
- Division of Intensive Care, Geneva university hospitals, Geneva, Switzerland
| | - Samir Jaber
- Department of Anesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi teaching hospital, Montpellier university hospital, Montpellier, France
| | - Jean-Yves Lefrant
- Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes university hospital and EA 2992, Université Montpellier, Nîmes, France
| | - Russell Chabanne
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Pierre-François Laterre
- Department of Critical Care Medicine, Saint Luc university hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe Guerci
- Department of Anesthesiology and Intensive Care Medicine, Nancy university hospital, Nancy, France
| | - Pierre-Eric Danin
- Anesthesia and Surgical Intensive Care, Nice Archet 2 university hospital and INSERM U1065, team 8, Nice, France
| | - Etienne Escudier
- Intensive Care Unit, Annecy Genevois general hospital, Annecy, France
| | - Achille Sossou
- Department of Anesthesiology and Critical Care Medicine, Emile-Roux general hospital, Le Puy-en-Velay, France
| | - Dominique Morand
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
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Lemaire JJ, Pereira B, Derost P, Vassal F, Ulla M, Morand D, Coll G, Gabrillargues J, Marques A, Debilly B, Coste J, Durif F. Subthalamus stimulation in Parkinson disease: Accounting for the bilaterality of contacts. Surg Neurol Int 2016; 7:S837-S847. [PMID: 27990316 PMCID: PMC5134117 DOI: 10.4103/2152-7806.194066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/08/2016] [Accepted: 05/27/2016] [Indexed: 01/24/2023] Open
Abstract
Background: Deep brain stimulation (DBS) in Parkinson's disease uses bi-hemispheric high-frequency stimulation within the subthalamus, however, the specific impacts of bilaterality of DBS are still not clear. Thus, we aimed to study the individual-level clinical impact of locations of right-left contact pair-up accounting for each subthalamic nucleus (STN) anatomy. Methods: Contact locations and effects at 1 year were studied retrospectively in an unselected series of 53 patients operated between 2004 and 2010. Location of contacts was defined relatively to the main axis of STN used to map longitudinal and transversal positions, and STN membership (out meaning out-of-STN). Contact pairings were described via three methods: (i) Unified contact location (UCL) collapsing DBS into an all-in-one contact; (ii) balance of contact pair-up (BCPU), defined as symmetric or asymmetric regardless of laterality; (iii) hemisphere-wise most frequent contact pair-up (MFCP) regardless of BCPU. Clinical data were: mean levodopa equivalent dose, Unified Parkinson's Disease Rating Scale (UPDRS) motor score III without medication, UPDRS II and III speech sub-scores, UPDRS II freezing sub-score, 1 year versus preoperative values, with and without levodopa. Ad-hoc two-sided tests were used for statistical analysis. Results: Worsening speech, was more frequent for UCL_out patients and when the left MFCP contact was rear and/or superolateral, however, it less frequent for BCPU-asymmetric patients. Worsening freezing was more frequent when the right MFCP contact was rear and superolateral. Conclusions: These results point to strategies for minimizing dysarthria and freezing as adverse effects of DBS.
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Affiliation(s)
- Jean-Jacques Lemaire
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Bruno Pereira
- Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France; Biostatistics, Clinical Research Direction, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Derost
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - François Vassal
- Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Miguel Ulla
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Dominique Morand
- Biostatistics, Clinical Research Direction, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Coll
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Jean Gabrillargues
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Service of Radiology, Neuroradiology Unit, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Ana Marques
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérôme Coste
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Franck Durif
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Futier E, Biais M, Godet T, Bernard L, Rolhion C, Bourdier J, Morand D, Pereira B, Jaber S. Fluid loading in abdominal surgery - saline versus hydroxyethyl starch (FLASH Trial): study protocol for a randomized controlled trial. Trials 2015; 16:582. [PMID: 26690683 PMCID: PMC4687283 DOI: 10.1186/s13063-015-1085-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/26/2015] [Indexed: 12/29/2022] Open
Abstract
Background Inappropriate fluid therapy during surgery is associated with significant morbidity and mortality. Few studies have examined the effects of particular types of fluids (crystalloid or colloid solutions) in surgical patients, especially with the goal of hemodynamic optimization. Isotonic saline is the most commonly used fluid worldwide but may be associated with potential nephrotoxicity. Hydroxyethyl starch (HES) solutions are widely used in surgical patients as a component of goal-directed fluid optimization strategies, but several large multicenter studies have suggested increased rates of acute kidney injury and adverse events with the use of HES in ICU patients. Despite what may be inferred from physiological studies, the benefit and harm of 0.9 % saline and HES during hemodynamic therapy have not been clearly established in surgical patients. Methods/Design The FLASH trial is an investigator-initiated, prospective, multicenter, randomized, double-blinded, two-arm trial, randomizing 826 patients with moderate-to-high risk of postoperative complications to receive 6 % HES 130/0.4 or 0.9 % saline during individualized goal-directed fluid optimization. The primary outcome measure is a composite of death or major postoperative complications within 14 days following surgery. The sample size will allow the detection of a 10 % absolute between-group difference in the primary outcome measure with a type 1 error rate of 5 % and power of 95 %, assuming a 5 % mortality rate and 20 % morbidity (thus 25 % for the composite endpoint). Discussion The FLASH trial may provide important data on the efficacy and safety of commonly used fluid solutions and could have a significant impact on future treatment of surgical patients. Trial registration ClinicalTrials.gov Identifier: NCT02502773. Registered 16 June 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1085-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emmanuel Futier
- CHU de Clermont-Ferrand, Département Anesthésie et Réanimation, Pôle Médecine Périopératoire (MPO), Hôpital Estaing, 1 place Lucie Aubrac, 63001, Clermont-Ferrand cedex 1, France.
| | - Matthieu Biais
- CHU de Bordeaux, Service Anesthésie et Réanimation III, Unité de Neuro-Réanimation, Hôpital Pellegrin, Tripode, Bordeaux, F-33076, France.
| | - Thomas Godet
- CHU de Clermont-Ferrand, Département Anesthésie et Réanimation, Pôle Médecine Périopératoire (MPO), Hôpital Estaing, 1 place Lucie Aubrac, 63001, Clermont-Ferrand cedex 1, France.
| | - Lise Bernard
- CHU de Clermont-Ferrand, Pôle Pharmacie, et EA 467 C-BIOSENSS, BP 10448, Clermont-Ferrand, F-63003, France.
| | - Christine Rolhion
- CHU de Clermont-Ferrand, Direction de la Recherche Clinique (DRCI), Clermont-Ferrand, F-63003, France.
| | - Justine Bourdier
- CHU de Clermont-Ferrand, Direction de la Recherche Clinique (DRCI), Clermont-Ferrand, F-63003, France.
| | - Dominique Morand
- CHU de Clermont-Ferrand, Direction de la Recherche Clinique (DRCI), Clermont-Ferrand, F-63003, France.
| | - Bruno Pereira
- CHU de Clermont-Ferrand, Biostatistics unit, Direction de la Recherche Clinique (DRCI), Clermont-Ferrand, F-63003, France.
| | - Samir Jaber
- CHU de Montpellier, Département Anesthésie et Réanimation B (DAR B), Hôpital Saint-Eloi, et INSERM U-1046, Montpellier, F-34295, France.
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Marques A, Fantini ML, Morand D, Pereira B, Derost P, Ulla M, Debilly B, Lemaire JJ, Durif F. Emergence of restless legs syndrome after subthalamic stimulation in Parkinson's disease: a dopaminergic overstimulation? Sleep Med 2015; 16:583-8. [DOI: 10.1016/j.sleep.2014.11.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/13/2014] [Accepted: 11/19/2014] [Indexed: 11/27/2022]
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Lemaire JJ, Pereira B, Derost P, Coste J, Ulla M, Morand D, Gabrillargues J, Coll G, Durif F. Étude rétrospective de la localisation des contacts effectifs sous-thalamiques chez 53 parkinsoniens sévères : analyse des couples de contacts par une approche unifiée (droit-gauche) et indépendante (droit et gauche). Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.024] [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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Marques A, Chassin O, Morand D, Pereira B, Debilly B, Derost P, Ulla M, Lemaire JJ, Durif F. Central pain modulation after subthalamic nucleus stimulation: A crossover randomized trial. Neurology 2013; 81:633-40. [PMID: 23864314 DOI: 10.1212/wnl.0b013e3182a08d00] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the acute effect of subthalamic nuclei deep brain stimulation (STN-DBS) and levodopa on pain and tolerance thresholds in patients with Parkinson disease. We hypothesized that a modification of pain threshold after STN-DBS would suggest a central modification of pain perception, whereas the absence of pain threshold change after STN-DBS would correspond to a peripheral mechanism via a decrease of painful stimuli. METHODS Nineteen patients with Parkinson disease were included in this double-blind, randomized, crossover study. Postoperatively, we evaluated pain thresholds (thermal and mechanical) and motor symptoms under 3 acute conditions: stimulation on/medication off; stimulation off/medication on; and stimulation off/medication off. We also conducted a retrospective analysis of the data prospectively recorded during the follow-up of the cohort pre- and postoperatively (Unified Parkinson's Disease Rating Scale [UPDRS] score, Hoehn and Yahr stage, equivalent levodopa daily dose, and tapping test score). RESULTS We found a significant increase of pain and tolerance mechanical thresholds not only after acute STN-DBS but also after acute levodopa administration. We did not find any significant correlation between postoperative clinical pain improvement and UPDRS-III improvement after acute levodopa or STN-DBS, nor with motor complications improvement assessed with UPDRS-IV after chronic STN-DBS. No correlation was found between postoperative clinical pain improvement and mechanical pain threshold modification. CONCLUSION Clinical pain alleviation after STN-DBS cannot be considered merely as a consequence of motor complications improvement and could be attributable to a direct central modulation of pain perception, via increased mechanical pain and tolerance thresholds.
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Affiliation(s)
- Ana Marques
- Neurology Department, CHU Clermont-Ferrand; University Clermont 1, CH Vichy, Vichy, France.
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Jalenques I, Galland F, Malet L, Morand D, Legrand G, Auclair C, Hartmann A, Derost P, Durif F. Quality of life in adults with Gilles de la Tourette Syndrome. BMC Psychiatry 2012; 12:109. [PMID: 22888766 PMCID: PMC3517335 DOI: 10.1186/1471-244x-12-109] [Citation(s) in RCA: 47] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/16/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Few studies have used standardized QOL instruments to assess the quality of life (QOL) in Gilles de la Tourette Syndrome (GTS) patients. This work investigates the QOL of adult GTS patients and examines the relationships between physical and psychological variables and QOL. METHODS Epidemiological investigation by anonymous national postal survey of QOL of patients of the French Association of Gilles de la Tourette Syndrome (AFGTS) aged 16 years or older. The clinical and QOL measures were collected by four questionnaires: a sociodemographic and GTS-related symptoms questionnaire, the World Health Organization Quality Of Life questionnaire (WHOQOL-26), the Functional Status Questionnaire (FSQ), and a self-rating questionnaire on psychiatric symptoms (SCL-90), all validated in French. We used stepwise regression analysis to explicitly investigate the relationships between physical and psychological variables and QOL domains in GTS. RESULTS Questionnaires were posted to 303 patients, of whom 167 (55%) completed and returned them. Our results, adjusted for age and gender, show that patients with GTS have a worse QOL than the general healthy population. In particular, the "Depression" psychological variable was a significant predictor of impairment in all WHOQOL-26 domains, psychological but also physical and social. CONCLUSIONS The present study demonstrates a strong relationship between QOL in GTS and psychiatric symptoms, in particular those of depression.
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Affiliation(s)
- Isabelle Jalenques
- CHU Clermont-Ferrand, Pôle de Psychiatrie, Service de Psychiatrie de l'adulte et psychologie médicale A, Hôpital Gabriel Montpied, Clermont-Ferrand, F-63003, France.
| | - Fabienne Galland
- CHU Clermont-Ferrand, Pôle de Psychiatrie, Service de Psychiatrie de l’adulte et psychologie médicale A, Hôpital Gabriel Montpied, Clermont-Ferrand, F-63003, France
| | - Laurent Malet
- CHU Clermont-Ferrand, Pôle de Psychiatrie, Service de Psychiatrie de l’adulte B, Hôpital Gabriel Montpied, Clermont-Ferrand, F-63003, France
| | - Dominique Morand
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l’Innovation, Hôpital Gabriel Montpied, Clermont-Ferrand, F-63003, France
| | - Guillaume Legrand
- CHU Clermont-Ferrand, Pôle de Psychiatrie, Service de Psychiatrie de l’adulte et psychologie médicale A, Hôpital Gabriel Montpied, Clermont-Ferrand, F-63003, France,Clermont Université, Université Clermont 1, UFR Médecine, EA 3845, Clermont-Ferrand, F-63001, France
| | - Candy Auclair
- CHU Clermont-Ferrand, Santé Publique, Clermont-Ferrand, France
| | - Andreas Hartmann
- Département de Neurologie, Pôle des Maladies du Système Nerveux, Groupe Hospitalier La Pitié-Salpêtrière, Centre de référence ‘Syndrome Gilles de la Tourette, Paris, F-75013, France
| | - Philippe Derost
- CHU Clermont-Ferrand, Neurologie, Hôpital Gabriel Montpied, Clermont-Ferrand, F-63003, France,Clermont Université, Université Clermont 1, UFR Médecine, EA 3845, Clermont-Ferrand, F-63001, France
| | - Franck Durif
- CHU Clermont-Ferrand, Neurologie, Hôpital Gabriel Montpied, Clermont-Ferrand, F-63003, France,Clermont Université, Université Clermont 1, UFR Médecine, EA 3845, Clermont-Ferrand, F-63001, France
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Durif F, Morand D, Pereira B, Lemaire JJ, Derost P, Ulla M, Witjas T, Regis J, Fluchere F, Azulay J. Impact of Deep Brain Stimulation on Quality of Life in Parkinson's Disease: Long-Term Follow-Up (P02.238). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.238] [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: 11/15/2022] Open
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Jalenques I, Auclair C, Roblin J, Morand D, Tourtauchaux R, May R, Vaille-Perret E, Watts J, Gerbaud L, De Leo D. Cross-cultural evaluation of the French version of the LEIPAD, a health-related quality of life instrument for use in the elderly living at home. Qual Life Res 2012; 22:509-20. [PMID: 22476573 DOI: 10.1007/s11136-012-0166-y] [Citation(s) in RCA: 7] [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] [Accepted: 03/16/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE To cross-culturally adapt a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life (HRQoL) in adults aged 65 years and over living at home, and to evaluate its psychometric properties. METHODS After having translated LEIPAD in accordance with guidelines, we studied psychometric properties: reliability and construct validity-factor analysis, relationships between items and scales, internal consistency, concurrent validity with the Medical Outcome Study Short-Form 36 and known-groups validity. RESULTS The results obtained in a sample of 195 elderly from the general population showed very good acceptability, with response rates superior to 93 %. Exploratory factor analysis extracted eight factors providing a multidimensionality structure with five misclassifications of items in the seven theoretical scales. Good internal consistency (Cronbach's alpha ranging from 0.73 and 0.86) and strong test-retest reliability (ICCs higher than 0.80 for six scales and 0.70 for one) were demonstrated. Concurrent validity with the SF-36 showed small to strong expected correlations. CONCLUSION This first evaluation of the French version of LEIPAD's psychometric properties provides evidence in construct validity and reliability. It would allow HRQoL assessment in clinical and common practice, and investigators would be able to take part in national and international research projects.
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Affiliation(s)
- I Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie médicale, Pôle de Psychiatrie, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France.
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Dualé C, Guastella V, Morand D, Cardot JM, Aublet-Cuvelier B, Mulliez A, Schoeffler P, Escande G, Dubray C. Characteristics of the neuropathy induced by thoracotomy: a 4-month follow-up study with psychophysical examination. Clin J Pain 2011; 27:471-80. [PMID: 21368665 DOI: 10.1097/ajp.0b013e31820e12d4] [Citation(s) in RCA: 44] [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: 11/25/2022]
Abstract
OBJECTIVES To explore the role of neuropathy in persistent pain after thoracotomy, combining a clinical follow-up and a psychophysical examination of the operated area. METHODS Seventy-three patients were followed and examined at their discharge from hospital, 6 weeks and 4 months after pneumonectomy under thoracotomy. Spontaneous and evoked pain was assessed by clinical examination, a 7-day pain score, and the Neuropathic Pain Symptom Inventory. At the fourth month follow-up, pain and tolerance thresholds to pinprick, heat, and warm sensation threshold were measured on both sides of the thorax. RESULTS The rate of spontaneous pain was 40% at discharge and went up to 59% at the sixth week follow-up. Evoked pain was rare at discharge (11%), most cases appearing at the sixth week follow-up (47%). The evolution profiles of pain between the sixth week and the fourth month follow-up were heterogeneous with a tendency to decrease. Young age, female sex, and spontaneous pain observed at discharge from hospital were identified as early predictive factors of spontaneous pain persisting at the fourth month follow-up. On the side of operation, thresholds tended to increase for warm and hot stimuli, and to decrease for mechanical stimuli. At the fourth month follow-up, spontaneous pain and evoked pain were associated to static hyperalgesia, persisting hypoesthesia, low mechanical thresholds, altered sensation of heat, and impaired quality of life. DISCUSSION Peripheral neuropathy is common after thoracotomy, with variant characteristics, ranging from subclinical disturbances to severe pain. The process seems to develop between the discharge from hospital and the sixth week after thoracotomy.
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Affiliation(s)
- Christian Dualé
- CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, Centre de Pharmacologie Clinique, CHU Clermont-Ferrand, France.
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Roux A, Motreff P, Perriot J, Pereira B, Lusson JR, Duale C, Morand D, Dubray C. Early Improvement in Peripheral Vascular Tone following Smoking Cessation Using Nicotine Replacement Therapy: Aortic Wave Reflection Analysis. Cardiology 2010; 117:37-43. [PMID: 20881393 DOI: 10.1159/000319596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/29/2010] [Indexed: 02/05/2023]
Affiliation(s)
- Antoine Roux
- Pôle Cardiologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.
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Ernande L, Cachin F, Chabrot P, Durel N, Morand D, Boyer L, Maublant J, Lipiecki J. Rest and low-dose dobutamine Tc-99m-mibi gated-SPECT for early prediction of left ventricular remodeling after a first reperfused myocardial infarction. J Nucl Cardiol 2009; 16:597-604. [PMID: 19479315 DOI: 10.1007/s12350-009-9098-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 04/29/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Left ventricular (LV) remodeling after myocardial infarction (MI) occurs frequently despite successful percutaneaous coronary intervention (PCI) but cannot be predicted by simple clinical parameters. METHODS AND RESULTS This prospective study tested the value of rest and low-dose dobutamine (LDD) Tc-99m-mibi gated-SPECT for early prediction of LV remodeling in patients treated by PCI in the acute phase of a first MI. Infarct size, infarct severity, regional wall motion abnormality (RWMA), and wall thickening score (WTs) were assessed at rest and on LDD by SPECT 6 +/- 2 days after MI in 40 patients. LV remodeling was defined as 20% increase at 6 months in LV end-diastolic volume assessed by MRI. Infarct severity at rest showed the best predictive values for left remodeling (PPV: 86%, NPV: 88%, accuracy: 88%; AUC: 0.750). Functional parameters at neither rest nor LDD study further improved predictive values of the SPECT imaging. CONCLUSIONS Infarct severity assessed by Tc-99m-sestamibi gated-SPECT performed in the subacute phase of a first STEMI predicts LV remodeling with high accuracy without incremental value nor of functional parameters nor of LDD. Therefore, our results suggest that LDD should not be used in this setting.
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Affiliation(s)
- Laura Ernande
- Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
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Lipiecki J, Monzy S, Durel N, Cachin F, Chabrot P, Muliez A, Morand D, Maublant J, Ponsonnaille J. Effect of thrombus aspiration on infarct size and left ventricular function in high-risk patients with acute myocardial infarction treated by percutaneous coronary intervention. Results of a prospective controlled pilot study. Am Heart J 2009; 157:583.e1-7. [PMID: 19249433 DOI: 10.1016/j.ahj.2008.11.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Thrombus aspiration devices have been shown to improve reperfusion criteria and to reduce distal embolization in patients treated by percutaneous coronary interventions (PCI) in the acute phase of ST-elevation myocardial infarction (STEMI). There are, however, little data about their efficacy in the reduction of infarct size. METHODS We sought to assess in a prospective randomized trial the impact of thrombus aspiration on infarct size and severity and on left ventricular function in high-risk patients with a first STEMI. The primary end point was scintigraphic infarct size, and secondary end points were infarct severity and regional and global left ventricular function. Forty-four patients with completely occluded (Thrombolysis in Myocardial Infarction flow 0-1) proximal segments of infarct-related artery were randomly assigned to thrombus aspiration group with the Export catheter (n = 20) (Medtronic, Inc, Minneapolis, MN) or PCI-only group. A rest Tc-99-mibi gated single-photon emission computed tomographic and contrast-enhanced magnetic resonance imaging were performed 6 +/- 2 days later. RESULTS Infarct size was comparable in patients in the thrombus aspiration group and PCI-only group (30.6% +/- 15.8% vs 28.5% +/- 17.9% of the left ventricle, P = .7) as was infarct severity in infarct-related artery territory (55% +/- 12% vs 55% +/- 14%, P = .9). Transmurality score as assessed by magnetic resonance imaging was similar in both groups (2.03 +/- 1.05 vs 2.16 +/- 1.21, P = .7). There was no impact of thrombus aspiration on other secondary end points. CONCLUSION In our study, thrombus aspiration with the Export catheter performed as adjunctive therapy in high-risk patients with total occlusion of the proximal part of major coronary arteries does not decrease infarct size or severity and has no effect on left ventricular regional and global function.
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Derost PP, Ouchchane L, Morand D, Ulla M, Llorca PM, Barget M, Debilly B, Lemaire JJ, Durif F. Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population? Neurology 2007; 68:1345-55. [PMID: 17452578 DOI: 10.1212/01.wnl.0000260059.77107.c2] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the role of age in the results of bilateral deep brain stimulation in the subthalamic nucleus (DBS-STN), we carried out a study of two groups of patients regarding age at time of surgery. METHODS We compared, up to 2 years after surgery, the clinical effects, safety, and quality of life in parkinsonian patients younger than 65 years old (young patients) vs parkinsonian patients 65 years old or older (old patients). RESULTS The mean age was 57.4 +/- 4.9 years (n = 53) in young patients and 68.8 +/- 2.8 years (n = 34) in old patients. A dramatic improvement in motor complications was equally observed in both groups of patients. There was no significant difference between the groups regarding acute effects of DBS-STN on the motor score of the Unified Parkinson's Disease Rating Scale part III (UPDRS III). Time course evolution of UPDRS the motor score (p < 0.0001) and axial score (p = 0.0001) assessed postoperatively in "on" medication and "on" stimulation conditions appeared worse in old patients as compared to young patients. Improvement in the Schwab and England Scale score was better in young patients in "on" (p < 0.0003) and "off" state (p < 0.001). Quality of life assessed with the 39-item Parkinson's Disease Questionnaire showed an improvement in subscales evaluating mobility (p < 0.0001), activities of daily life (p < 0.0001), emotion and stigma (p = 0.0004), cognition (p < 0.0074), and communication (p = 0.0029) in young patients as compared to old patients. Side effects were similar in the two groups. CONCLUSIONS Although deep brain stimulation in the subthalamic nucleus reduces motor complications equally in both groups of patients, postoperative quality of life improved only in young patients.
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Affiliation(s)
- P-P Derost
- Univ Clermont 1, EA 3845, Service de Neurologie, Clermont-Ferrand CEDEX 1, France.
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Dionet E, Deeb T, Morand D, Derost P, Lemaire J, Durif F. D - 4 Effet de la stimulation du noyau sous thalamique sur la douleur au cours de la maladie de Parkinson. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90802-4] [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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Durif F, Debilly B, Galitzky M, Morand D, Viallet F, Borg M, Thobois S, Broussolle E, Rascol O. Clozapine improves dyskinesias in Parkinson disease: A double-blind, placebo-controlled study. Neurology 2004; 62:381-8. [PMID: 14872017 DOI: 10.1212/01.wnl.0000110317.52453.6c] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of clozapine in the treatment of levodopa-induced dyskinesias (LID) in patients with severe Parkinson disease (PD). METHODS Fifty patients were randomized to treatment in this 10-week, double-blind, parallel-group, placebo-controlled, multicenter trial. The principal measure of outcome was the diurnal change in the "on" time with LID assessed using a self-evaluation of the motor performance fluctuations performed every 2 weeks. An acute levodopa challenge was also performed at the beginning and end of the study. RESULTS A reduction in the duration of "on" periods with LID was noted in favor of the clozapine group at the end of the study (placebo group day 0: 4.54 +/- 0.53 hours, end: 5.28 +/- 0.70 hours; clozapine group day 0: 5.68 +/- 0.66 hours, end: 3.98 +/- 0.57 hours; p = 0.003). The mean clozapine dosage was 39.4 +/- 4.5 (SEM) mg/day. The maximal LID score at rest during the levodopa challenge was significantly decreased under clozapine treatment, with a variation from day 0 to day 70 in the placebo group of +0.15 +/- 1.01 and in the clozapine group of -2.22 +/- 0.52 (p < 0.05). Five patients receiving clozapine and seven receiving placebo discontinued on account of adverse events. Among them, three patients in the clozapine group developed eosinophilia, which rapidly resolved after withdrawal of the drug. CONCLUSION Clozapine is effective in the treatment of levodopa-induced dyskinesias in severe PD.
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Affiliation(s)
- F Durif
- Department of Neurology, Hôpital Gabriel Montpied, Clermont-Ferrand, France.
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Michalet-Doreau B, Morand D, Martin C. Effect of the microbial additive Levucell® SC on microbial activity in the rumen during the stepwise adaptation of sheep to high concentrate diet. ACTA ACUST UNITED AC 1997. [DOI: 10.1051/rnd:19970767] [Citation(s) in RCA: 6] [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: 11/14/2022]
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Michalet-Doreau B, Morand D. Effect of yeast culture, Saccharomyces cerevisiae, on ruminal fermentation during adaptation to high-concentrate feeding. ACTA ACUST UNITED AC 1996. [DOI: 10.1051/animres:19960666] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Roche-Poggi P, Meyere P, Morand D, Sauget Y. [Analysis of 184 clinical cases and temporomandibular joint orthography]. Chir Dent Fr 1991; 61:39-42. [PMID: 2004566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Bonfil JJ, Morand D, Paloudier G, Rocca JP, Susini G, Baran E. ["Tooth mortality" in a Marseille S.C.T.D. The effect of periodontal disease: comparison with some results of a national epidemiological study]. Rev Odontostomatol (Paris) 1989; 18:201-10. [PMID: 2633270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
1,247 avulsions have been noted for a year in the S.C.T.D. (tooth, age and sex of the patient). 44.6% were caused by tooth decay. However periodontal disease was responsible for 39.5% of tooth avulsions. The tooth lost because of periodontal disease were in most part extracted after 40 years. A weakness of some type of teeth regarding tooth mortality may be quoted. A sexual dimorphism of tooth mortality was present in the studied population.
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Abstract
This paper describes a narrow bandpass filter which is temperature controlled to maintain optical characteristic while operating in an ambient temperature range of -20 degrees C to +70 degrees C. Pertinent source of bandpass shift and means for their control are discussed. The analytical approach, resultant filter assembly configuration, and performance test results of the assembly are presented.
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