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Jamin C, Karam E, Marmouset F, Laure B, Moriniere S, Pare A. Tongue reconstruction after oncological resection: Analysis of the functional outcomes. J Stomatol Oral Maxillofac Surg 2024; 125:101707. [PMID: 38006946 DOI: 10.1016/j.jormas.2023.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
The curative management of oral squamous cell carcinoma can be responsible for swallowing and/or speech impairments. In this study, we analyzed the functional outcomes in patients who underwent an oncological resection and a primary reconstruction of the tongue and/or of the floor of the mouth (TFM). We also investigated the predictive factors for poor functional outcomes. This retrospective study included operated patients from October 2013 to May 2021 at the TOURS University Hospital. We assessed the functional results two years after the completion of the cancer treatment with self-administered questionnaires quantifying swallowing and speech disorders. Thirty-three patients were included and reconstructed with antebrachial free flap (N = 16), local flap (N = 8) or Biodesign ® membrane (N = 9). A higher proportion of pT1 tumor was observed in patient who had a Biodesign-based reconstruction (p = 0.001). There was no significant difference between the groups in terms of postoperative complications or for the duration of enteral feeding. The 21 patients who had an adjuvant radiation therapy had no significant more altered functions. Functional scores were significantly higher in the free flap reconstruction group (DHI =24 and SHI=21) (p = 0.008). No predictive factors for poor outcomes were observed. The repair of TFM defects must be adapted to the resection size. The reconstruction techniques allow to get acceptable functional outcomes even for the greater tumors or in case of radiation therapy. Further research would be required to better identify the predictive factors for poor outcomes.
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Affiliation(s)
- Cerise Jamin
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France
| | - Elias Karam
- Department of Visceral Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Franck Marmouset
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France
| | - Boris Laure
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Sylvain Moriniere
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Arnaud Pare
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France.
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Vu Trung K, Heise C, Abou-Ali E, Auriemma F, Karam E, van der Wiel SE, Bruno MJ, Caillol F, Giovannini M, Masaryk V, Will U, Anderloni A, Pérez-Cuadrado-Robles E, Dugic A, Meier B, Paik WH, Petrone MC, Wichmann D, Dinis-Ribeiro M, Gonçalves TC, Wedi E, Schmidt A, Gulla A, Hoffmeister A, Rosendahl J, Ratone JP, Saadeh R, Repici A, Deprez P, Sauvanet A, Souche FR, Fabre JM, Muehldorfer S, Caca K, Löhr M, Michl P, Krug S, Regner S, Gaujoux S, Hollenbach M. Endoscopic papillectomy for ampullary lesions of minor papilla. Gastrointest Endosc 2024; 99:587-595.e1. [PMID: 37951279 DOI: 10.1016/j.gie.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND AND AIMS Ampullary lesions (ALs) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla, but the role of EP for minor AL has not been accurately studied. METHODS We identified 20 patients with ALs of minor duodenal papilla in the multicentric database from the Endoscopic Papillectomy vs Surgical Ampullectomy vs Pancreatitcoduodenectomy for Ampullary Neoplasm study, which included 1422 EPs. We used propensity score matching (nearest-neighbor method) to match these cases with ALs of the major duodenal papilla based on age, sex, histologic subtype, and size of the lesion in a 1:2 ratio. Cohorts were compared by means of chi-square or Fisher exact test as well as Mann-Whitney U test. RESULTS Propensity score-based matching identified a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histologic subtype of lesions of minor papilla was an ampullary adenoma in 12 patients (3 low-grade dysplasia and 9 high-grade dysplasia). Five patients revealed nonneoplastic lesions. Invasive cancer (T1a), adenomyoma, and neuroendocrine neoplasia were each found in 1 case. The rate of complete resection, en-bloc resection, and recurrences were similar between the groups. There were no severe adverse events after EP of lesions of minor papilla. One patient had delayed bleeding that could be treated by endoscopic hemostasis, and 2 patients showed a recurrence in surveillance endoscopy after a median follow-up of 21 months (interquartile range, 12-50 months). CONCLUSIONS EP is safe and effective in ALs of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla.
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Affiliation(s)
- Kien Vu Trung
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Christian Heise
- Medical Department I, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Einas Abou-Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Elias Karam
- Department of Digestive Surgery, INSERM U1086 ANTICIPE, Centre Hospitalo-Universitaire de Caen, Caen, France
| | - Sophia E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Uwe Will
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Enrique Pérez-Cuadrado-Robles
- Interventional Endoscopy, Department of Gastroenterology, Hôpital Européen Georges-Pompidou, Paris, France; Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Benjamin Meier
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes, and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Maria C Petrone
- Endosonography Unit, Pancreatobiliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Dörte Wichmann
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal; RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal; Department of Community Medicine, Health Information, and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago C Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; School of Medicine, University of Minho, Braga/Guimarães, Portugal; PT Government Associate Laboratory, ICVS/3B, Braga/Guimarães, Portugal
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany; Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Arthur Schmidt
- Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Santaros Klinikos, Kaunas, Lithuania; General Surgery, MedStar Georgetown University Hospital, John Hopkins University, Washington, DC, USA
| | - Albrecht Hoffmeister
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Jonas Rosendahl
- Medical Department I, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | | | - Rita Saadeh
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pierre Deprez
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes, and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jean M Fabre
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes, and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Matthias Löhr
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Patrick Michl
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Krug
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Sara Regner
- Section for Surgery, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sebastien Gaujoux
- Department of Pancreatic and Endocrine Surgery, Pitié-Salpetriere Hospital, Médecine Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany; Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
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Bernard C, Bentellis I, El-Akri M, Durand M, Guérin O, Cornu JN, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Lecoanet P, Bruyère F, Capon G, Biardeau X, Karam E, Saussine C, Hermieu JF, Peyronnet B, Game X, Brierre T. Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures. Fr J Urol 2024; 34:102604. [PMID: 38417628 DOI: 10.1016/j.fjurol.2024.102604] [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] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Artificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation. MATERIAL AND METHODS Data from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS). RESULTS Median follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as "dry" in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively. CONCLUSION The penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Clémence Bernard
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France.
| | - Imad Bentellis
- Urology Department, Nice University Hospital, Nice, France
| | - Mehdi El-Akri
- Urology Department, Rennes University Hospital, Rennes, France
| | | | - Olivier Guérin
- Urology Department, Nice University Hospital, Nice, France
| | | | - Tiffany Cousin
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Hugo Dupuis
- Urology Department, CHU de Rouen, Rouen, France
| | | | | | - Pierre Lecoanet
- Urology Department, Nancy University Hospital, Nancy, France
| | | | - Grégoire Capon
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Biardeau
- Urology Department, Lille University Hospital, Lille, France
| | - Elias Karam
- Visceral Surgery and Liver Transplant Unit, CHU de Tours, Tours, France
| | | | | | | | - Xavier Game
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - Thibaut Brierre
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
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Kovess-Masfety V, Sabawoon A, Keyes K, Karam E. Prevalence, risk factors, and comorbidities of psychotic experiences in Afghanistan: a highly stressful environment. Soc Psychiatry Psychiatr Epidemiol 2024; 59:99-109. [PMID: 37558897 DOI: 10.1007/s00127-023-02539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To estimate the prevalence and demographic, psychiatric, and trauma-focused correlates of psychotic experiences (PEs) in the Afghan general population. METHODS Data were drawn from a cross-sectional household survey implemented in eight regions of Afghanistan (N = 4445). The CIDI structured instrument was administered to adults to assess psychiatric disorders and psychotic experiences; life events and PTSD were assessed using validated instruments. Weighted multivariate models integrated socio-demographics, regions, traumas as determinants of PE. RESULTS PEs were frequently reported in the Afghan population: 27.50% of the population reported a lifetime PE. PEs were more common among specific ethnic groups, and were associated with lower income in adjusted regression models. PEs were associated with mental health problems including major depressive disorders (OR = 3.43), PTSD (OR = 5.08), generalized anxiety (OR = 4.2); lifetime suicidal attempts (OR 6.04), lifetime suicidal thoughts (OR = 3.42), addiction (OR = 2.18); and psychological distress and impairment due to mental health (OR = 2.95 and 2.46, respectively). CONCLUSION Psychotic experiences in the Afghan general population confirm general population findings in other countries, that psychotic experiences are common and associated with economic and social marginalization, and part of a continuum of mental health problems experienced in populations. Efforts to reduce and treat psychotic experiences within a broad array of psychiatric conditions are needed.
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Affiliation(s)
- V Kovess-Masfety
- LPPS, University of Paris Cité, Paris, France.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - A Sabawoon
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Governance Institute of Afghanistan (GI-A), Kabul, Afghanistan
| | - K Keyes
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - E Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center University of Balamand, Beirut, Lebanon
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Rassy E, Karam E, Adeleke S, Okoli S, Galante J, Boussios S, Pavlidis N. Immune checkpoint inhibitors in patients with cancers of unknown primary. Eur J Cancer 2023; 195:113377. [PMID: 37890352 DOI: 10.1016/j.ejca.2023.113377] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Elie Rassy
- Gustave Roussy, Départements de Médecine Oncologique, F-94805 Villejuif, France; Université Paris-Saclay, Gustave Roussy, Institut national de la santé et de la recherche médicale (INSERM), U1018 Villejuif, France.
| | - Elias Karam
- Gustave Roussy, Départements de Médecine Oncologique, F-94805 Villejuif, France
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom; Department of Oncology, Guy's & St Thomas' Hospital, London, United Kingdom
| | - Somto Okoli
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Joao Galante
- Department of Oncology, Guy's & St Thomas' Hospital, London, United Kingdom
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK; Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, UK; Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK; AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
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Karam E, Hollenbach M, Abou Ali E, Auriemma F, Anderloni A, Barbier L, Belfiori G, Caillol F, Crippa S, Del Chiaro M, De Ponthaud C, Dahel Y, Falconi M, Giovannini M, Heling D, Inoue Y, Jarnagin WR, Leung G, Lupinacci RM, Mariani A, Masaryk V, Miksch RC, Musquer N, Napoleon B, Oba A, Partelli S, Petrone MC, Prat F, Repici A, Sauvanet A, Salzmann K, Schattner MA, Schulick R, Schwarz L, Soares K, Souche FR, Truant S, Vaillant JC, Wang T, Wedi E, Werner J, Weismüller TJ, Wichmann D, Will U, Zaccari P, Gulla A, Heise C, Regner S, Gaujoux S. Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study. Neuroendocrinology 2023; 113:1024-1034. [PMID: 37369186 DOI: 10.1159/000531712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. METHODS From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. RESULTS 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median tumor size was 17 mm (12-22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3-5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (n = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (p < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. CONCLUSION Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.
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Affiliation(s)
- Elias Karam
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Marcus Hollenbach
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Louise Barbier
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Stefano Crippa
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles De Ponthaud
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Yanis Dahel
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Massimo Falconi
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Dominik Heling
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Yosuke Inoue
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Rainer Christoph Miksch
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | | | | | - Atsushi Oba
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stefano Partelli
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Maria C Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Frédéric Prat
- Department of Digestive, hepatobiliary and endocrine surgery, Cochin Hospital, APHP, and Université de Paris, Paris, France
| | - Alessandro Repici
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Alain Sauvanet
- Departement of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Katrin Salzmann
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Mark A Schattner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kevin Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - François R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire De Lille, Lille, France
| | - Jean C Vaillant
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Tiegong Wang
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, Cangzhou Central Hospital, Cangzhou, China
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Tobias J Weismüller
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
| | - Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Will
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Piera Zaccari
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Aiste Gulla
- Institute of Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgery, MedStar Georgetown University Hospital, General Surgery, Georgetown, Washington, District of Columbia, USA
| | - Christian Heise
- Department of Medicine I - Gastroenterology, Pulmonology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sara Regner
- Section for Surgery, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Department of Surgery, Sorbonne University, Paris, France
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7
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Karam E, Tabutin M, Dupré A. Neither surveillance nor treatment showed significant survival benefit for lung metastases from colorectal cancer, imaging guided thermal ablation is a safe and efficient alternative to surgery. J Surg Oncol 2023; 127:513. [PMID: 36394424 DOI: 10.1002/jso.27148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Elias Karam
- Centre Hospitalier Régional Universitaire de Tours, Visceral Surgery and Liver Transplantation Department, Tours, France
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Kovess-Masfety V, Frounfelker RL, Keyes K, Karam E, Sabawoon A, Sarwari BA, Husky M, Kaur N, Rousseau C. Education as a protective factor for mental health risks among youth living in highly dangerous regions in Afghanistan. Child Adolesc Psychiatry Ment Health 2023; 17:12. [PMID: 36691033 PMCID: PMC9869819 DOI: 10.1186/s13034-022-00548-w] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Children in Afghanistan live in dangerous areas, and have been exposed to traumatic events and chaotic education. Progress has been made on access to education for girls who were the most affected by traditional attitudes against engagement in education. OBJECTIVES The objectives were to evaluate the mental health of Afghan children living in regions of conflict and the association of mental health with school attendance for girls and boys. METHOD The study included 2707 school aged children in eight regions of Afghanistan (16 provinces) residing in households recruited through a multi-stage stratified cluster sampling strategy in 2017. The level of terrorist threat was evaluated by the intensity of terrorist attacks recorded that year in each province. Child mental health was assessed with the parental report Strengths and Difficulties Questionnaire (SDQ) along with information on school attendance, sociodemographic characteristics and geographic location. RESULTS A total of 52.75% of children had scores above threshold for the SDQ total difficulties score, 39.19% for emotional difficulties, 51.98% for conduct challenges, and 15.37% for hyperactivity/inattention. Peer relationship problems were high (82.86%) and 12.38% reported that these problems impacted daily life. The level of terrorist threat was associated with SDQ total difficulties (Adjusted Odds Ratio [AOR] = 4.08, P < 0.0001), with youth in regions with high levels of terrorist threat more likely to have problems than youth in regions with low or medium levels of danger, independent of region and ethnicity. School attendance was negatively associated with emotional symptoms (AOR = 0.65, P < 0.0001) and mental health difficulties with impairment (AOR = 0.67, P = 0.007), but positively associated with peer relationships difficulties (AOR = 1.96, P > 0.0001). Conduct (AOR = 1.66, P < .0001) and SDQ total difficulties (AOR = 1.22, P = 0.019) were higher among boys. Overall, gender did not modify the relationship between school attendance and child mental health. CONCLUSION Attending school is essential for children's mental health, across gender, and should be supported as a priority in Afghanistan despite the return of the Taliban.
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Affiliation(s)
- V. Kovess-Masfety
- grid.10988.380000 0001 2173 743XLPPS, University of Paris, Paris, France ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, Canada
| | - R. L. Frounfelker
- grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, Canada ,grid.259029.50000 0004 1936 746XDepartment of Community and Population Health, College of Health, Lehigh University, Bethlehem, PA USA
| | - K. Keyes
- grid.21729.3f0000000419368729Mailman School of Public Health, Columbia University, New York, NY USA
| | - E. Karam
- grid.429040.bInstitute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon ,grid.416659.90000 0004 1773 3761Department of Psychiatry & Clinical Psychology, Faculty of Medicine, St. George Hospital University Medical Center University of Balamand, Beirut, Lebanon
| | - Ajmal Sabawoon
- Mailman School of Public Health, Columbia University, New York, NY, USA. .,Governance Institute of Afghanistan (GI-A), Kabul, Afghanistan. .,Kabul University of Medical Sciences (KUMS), Kabul, Afghanistan.
| | - Bashir Ahmad Sarwari
- grid.490670.cDepartment of Mental Health & Substance Abuse, Primary Health Care Directorate, Ministry of Public Health, Kabul, Afghanistan
| | - M. Husky
- grid.412041.20000 0001 2106 639XLaboratoire de Psychologie EA4139, Université de Bordeaux, Bordeaux, France
| | - N. Kaur
- grid.21729.3f0000000419368729Mailman School of Public Health, Columbia University, New York, NY USA
| | - C. Rousseau
- grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, Canada
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9
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Karam E, Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regner S, Gaujoux S, Regimbeau JM, Kähler G, Seyfried S, Vaillant JC, De Ponthaud C, Sauvanet A, Birnbaum D, Regenet N, Truant S, Pérez-Cuadrado-Robles E, Bruzzi M, Lupinacci RM, Brunel M, Belfiori G, Barbier L, Salamé E, Souche FR, Schwarz L, Maggino L, Salvia R, Gagniére J, Del Chiaro M, Leung G, Hackert T, Kleemann T, Paik WH, Caca K, Dugic A, Muehldorfer S, Schumacher B, Albers D. Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery 2023; 173:1254-1262. [PMID: 36642655 DOI: 10.1016/j.surg.2022.12.011] [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: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. METHODS Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. RESULTS A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. CONCLUSION Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.
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Affiliation(s)
- Elias Karam
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France.
| | - Marcus Hollenbach
- University of Leipzig Medical Center, Medical Department II-Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania; Johns Hopkins University, MedStar Georgetown University Hospital, General Surgery, Washington, DC
| | - Christian Heise
- Martin-Luther University Halle-Wittenberg Department of Medicine I-Gastroenterology, Pulmonology, Halle, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, France
| | | | - Jean M Regimbeau
- Department of Digestive Surgery, Center Hospitalo-Universitaire Amiens-Picardie, Amiens, France
| | - Georg Kähler
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Jean C Vaillant
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Charles De Ponthaud
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - David Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire de Lille, France
| | | | - Matthieu Bruzzi
- Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Martin Brunel
- Department of Digestive Surgery, Hôpital André Mignot, Versailles, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Louise Barbier
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Ephrem Salamé
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, France
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Johan Gagniére
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France; U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, CO
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, PA
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Germany
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | | | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
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10
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Karam E, Tabutin M, Mastier C, Crignis LD, Peyrat P, Martin V, Badon F, Muller X, Meeus P, Rivoire M, Dupré A. Curative-intent treatment of pulmonary metastases from colorectal cancer: A comparison between imaging-guided thermal ablation and surgery. J Surg Oncol 2023; 127:183-191. [PMID: 36169242 DOI: 10.1002/jso.27108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/02/2022] [Revised: 08/19/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pulmonary metastases (PM) are the most frequent extra-abdominal metastases from colorectal cancer. Lung resection and imaging-guided thermal ablation (IGTA) are used as curative-intent treatment. We compared the outcomes of patients with PM, treated with resection or ablation. METHODS We retrospectively analyzed data from patients who underwent surgery or IGTA for colorectal PM between April 2011 and November 2020. Surgery was performed for peripheral PM and IGTA for deep-located PM not in contact with major vessels. Patients who had both procedures were excluded. Patients were compared using propensity score matching (PSM) analysis, stratified according to number, size, and unilaterality of PM. RESULTS One hundred and fourty-six patients were included, 65 (44.5%) underwent surgery and 81 (55.5%) underwent IGTA. After PSM analysis, each group contained 46 patients. IGTA patients had a lower morbidity rate (13.1% vs. 15.2%, p = 0.028) and a shorter length of stay (5.13 vs. 2.63 days, p < 0.001). Oncological outcomes were similar in both groups with 5-year OS of 80% and 5-year progression-free survival (PFS) of 30% (p = 0.657 and p = 0.504, respectively) with similar recurrence patterns. CONCLUSION Lung resection and IGTA seem to have similar oncologic outcomes for both OS and PFS. IGTA could be an alternative effective treatment for small PM, whenever technically feasible.
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Affiliation(s)
- Elias Karam
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Mayeul Tabutin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Lucas De Crignis
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Patrice Peyrat
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Valentine Martin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Floriane Badon
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Xavier Muller
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Pierre Meeus
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France.,Univ Lyon, Université Lyon 1, Centre Léon Bérard, INSERM, LabTAU, Lyon, France
| | - Aurélien Dupré
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France.,Univ Lyon, Université Lyon 1, Centre Léon Bérard, INSERM, LabTAU, Lyon, France
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11
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Sekkat H, Souadka A, Courtot L, Rafik A, Amrani L, Benkabbou A, Peyrafort P, Giger-Pabst U, Karam E, Mohsine R, Majbar AM, Ouaissi M. Available prediction scores of conversion for laparoscopic rectal cancer surgery seem to be unsuitable for nowadays rectal cancer management. BMC Surg 2022; 22:162. [PMID: 35538528 PMCID: PMC9092680 DOI: 10.1186/s12893-022-01617-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aimed to externally evaluate the accuracy of four predictive scores for conversion to open surgery after rectal laparoscopic resection. None of the four scores achieved external validation previously. Methods This was a retrospective analysis of two prospectively maintained databases from two academic centers in France and Morocco. All consecutive patients who underwent laparoscopic resection for rectal adenocarcinoma between 2005 and 2020 were included. Logistic regression was used to assess the association between the factors present in the four scores and conversion. The accuracy of each score was assessed using the area under the curve (AUC). Observed and predicted conversion rates were compared for each score using the Chi-square goodness-of-fit test. Results Four hundred patients were included. There were 264 men (66%) with a mean age of 65.95 years (standard deviation 12.2). The median tumor height was 7 cm (quartiles 4–11) and 29% of patients had low rectal tumors. Conversion rate was 21.75%. The accuracy to predict conversion was low with an AUC lower than 0,62 for the four models. The observed conversion rates were significantly different from the predicted rates, except for one score. Conclusions The four models had low accuracy in predicting the conversion to open surgery for laparoscopic rectal resection. There is a need for new well-designed studies, analyzing more specific variables, in a multicentric design to ensure generalizability of the results for daily surgical practice.
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Affiliation(s)
- Hamza Sekkat
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Souadka
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Lise Courtot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Ali Rafik
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Laila Amrani
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Pierre Peyrafort
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Urs Giger-Pabst
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France.,EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
| | - Elias Karam
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Raouf Mohsine
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Anass M Majbar
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco. .,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco.
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France.,EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
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12
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Karam E, Bucur P, Gil C, Sindayigaya R, Tabchouri N, Barbier L, Pabst-Giger U, Bourlier P, Lecomte T, Moussata D, Chapet S, Calais G, Ouaissi M, Salamé E. Simultaneous or staged resection for synchronous liver metastasis and primary rectal cancer: a propensity score matching analysis. BMC Gastroenterol 2022; 22:201. [PMID: 35448953 PMCID: PMC9026992 DOI: 10.1186/s12876-022-02250-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Colorectal cancer is the third most common cancer in France and by the time of the diagnosis, 15–25% of patients will suffer from synchronous liver metastases. Surgery associated to neoadjuvant treatment can cure these patients, but few studies focus only on rectal cancer. This study was meant to compare the outcomes of patients who underwent a simultaneous resection to those who underwent a staged resection (rectum first or liver first) in the University Hospital of Tours, France. Methods We assessed retrospectively a prospective maintained data base about the clinical, pathological and survival outcomes of patients who underwent a simultaneous or a staged resection in our center between 2010 and 2018. A propensity score matching was used, considering the initial characteristics of our groups. Results There were 70 patients (55/15 males, female respectively) with median age 60 (54–68) years. After matching 48 (69%) of them underwent a staged approach and 22 (31%) a simultaneous approach were compared. After PSM, there were 22 patients in each group. No differences were found in terms of morbidity (p = 0.210), overall survival (p = 0.517) and disease-free survival (p = 0.691) at 3 years after matching. There were significantly less recurrences in the simultaneous group (50% vs 81.8%, p = 0.026). Conclusions Simultaneous resection of the rectal primary cancer and synchronous liver metastases is safe and feasible with no difference in terms of survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02250-9.
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Affiliation(s)
- Elias Karam
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Petru Bucur
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Camille Gil
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Remy Sindayigaya
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Nicolas Tabchouri
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Louise Barbier
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Urs Pabst-Giger
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
| | - Pascal Bourlier
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Chambray les Tours, France
| | - Driffa Moussata
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Chambray les Tours, France
| | - Sophie Chapet
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Gilles Calais
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Mehdi Ouaissi
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France.
| | - Ephrem Salamé
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
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Karam E, Sindayigaya R, Giger-Pabst U, Gabriel M, Michot N, Courtot L, Tabchouri N, Moussata D, Lecomte T, Chapet S, Calais G, Bourlier P, Salamé E, Ouaissi M. Impact of Modern Management Strategies on the Clinical Outcome of Patients With Low Rectal Cancer - A Retrospective, Monocentric Cohort Study. Anticancer Res 2022; 42:1949-1963. [PMID: 35347015 DOI: 10.21873/anticanres.15673] [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: 12/25/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively investigate the impact of intersphincteric resection (ISR) and Enhanced Recovery After Surgery (ERAS) protocols for rectal cancer. PATIENTS AND METHODS Since we implemented rectal ERAS protocol and ISR in 2016, we retrospectively assessed and compared clinical, pathological and survival outcomes of two groups of patients: group 1, treated 2000-2015 (n=242); and group 2, treated 2016-2020 (n=108). Propensity score matching using nearest-neighbor method was used to match each patient of group 1 to a patient of group 2. RESULTS Before and after matching, the American Society of Anesthesiology score for patients in group 1 was significantly lower than in group 2 (score of 3: 9.9% vs. 25.9%, p<0.0001) as were grade I-II complications (27.7% vs. 45.4% p<0.001). Before and after matching, the quality of the mesorectum excision was significantly lower in group 1 (complete in 31% vs. 59.2% p<0.0001). After matching, 3-year overall survival for groups 1 and 2 were similar (88.2% vs. 92.6%; p=0.988). CONCLUSION ERAS and ISR had no negative impact on the oncological outcome of our patients and increased the preservation of bowel continuity.
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Affiliation(s)
- Elias Karam
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Remy Sindayigaya
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Urs Giger-Pabst
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France.,Fliedner Fachhochschule, University of Applied Science, Düsseldorf, Germany
| | - Michel Gabriel
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Nicolas Michot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Lise Courtot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Nicolas Tabchouri
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Driffa Moussata
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France
| | - Sophie Chapet
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Gilles Calais
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Pascal Bourlier
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Ephrem Salamé
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France; .,EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
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14
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Karam S, Ghantous Z, Ibrahim R, Ghossoub E, Madaghjian P, Karam G, Karam E, Fares N, Khoury R. POS-738 ASSESSMENT OF DEPRESSION, ANXIETY, SUICIDALITY AND POST-TRAUMATIC STRESS DISORDER IN LEBANESE PATIENTS ON HEMODIALYSIS FOLLOWING THE BEIRUT EXPLOSION. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.773] [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: 10/19/2022] Open
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15
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Muller O, Sindayigaya R, Chomicki S, Karam E, Tabchouri N, Michot N, Moussata D, Lecomte T, Chapet S, Calais G, Giger-Pabst U, Salame E, Ouaissi M. Prognostic Impact of Upfront Surgery for Locally Advanced Upper Rectal Adenocarcinoma. Anticancer Res 2022; 42:155-164. [PMID: 34969721 DOI: 10.21873/anticanres.15469] [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: 10/30/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Impact of neoadjuvant chemoradiotherapy (CRT) in locally advanced upper rectal adenocarcinoma (LAURC) is debated. The aim of this study was to compare outcomes between LAURC and locally advanced sigmoid and recto-sigmoid junction cancer (LASC). PATIENTS AND METHODS This retrospective study included 149 consecutive patients [42 CRT/LAURC, 16 upfront surgery (US/LAURC) and 91 LASC]. Partial mesorectum excision (PME) was performed for all LAURC. Pathology results as well as short-and-long-term outcomes were compared between the three groups. RESULTS Overall mortality was nil. Morbidity was comparable (CRT/LAURC 23.8% vs. LASC: 20.8% vs. US/LAURC: 37.5%, p=0.2354). CRT was associated with a reduced risk of positive circumferential margin (CRT/LAURC: 9.5% vs. US/LAURC: 18.7%, p<0.0001). Recurrence rate, 5-year disease-free survival and overall survival were similar between the three groups. CONCLUSION CRT and PME did not improve LAURC oncological outcomes but were associated with improved margins. CRT for LAURC was not associated with increased morbidity.
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Affiliation(s)
- Olivier Muller
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Remy Sindayigaya
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Sandra Chomicki
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Elias Karam
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Nicolas Tabchouri
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Nicolas Michot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Driffa Moussata
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France
| | - Sophie Chapet
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Gilles Calais
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Urs Giger-Pabst
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France.,University of Applied Science Düsseldorf, Düsseldorf, Germany
| | - Ephrem Salame
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France
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16
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Sindayigaya R, Dogan C, Demtröder CR, Fischer B, Karam E, Buggisch JR, Tempfer CB, Lecomte T, Ouaissi M, Giger-Pabst U. ASO Visual Abstract: Clinical Outcome of Patients Managed with Low-Dose Cisplatin and Doxorubicin delivered as Pressurized Intraperitoneal Aerosol Chemotherapy for Unresectable Peritoneal Metastases of Gastric Cancer. Ann Surg Oncol 2021. [PMID: 34782972 DOI: 10.1245/s10434-021-10889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Rémy Sindayigaya
- Department of Digestive, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Hepato-Biliary, Oncological, EndocrineChambray les Tours, France
| | - Can Dogan
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Cédric Remy Demtröder
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany.,Department of General and Visceral Surgery, Therapy Center for Metabolic and Bariatric Surgery, St. Martinus Hospital Düsseldorf, Düsseldorf, Germany
| | - Britta Fischer
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Elias Karam
- Department of Digestive, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Hepato-Biliary, Oncological, EndocrineChambray les Tours, France
| | | | - Clemens B Tempfer
- Department of Obstetrics and Gynecology and Therapy Center for Peritoneal Carcinomatosis, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Tours, France
| | - Mehdi Ouaissi
- Department of Digestive, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Hepato-Biliary, Oncological, EndocrineChambray les Tours, France.
| | - Urs Giger-Pabst
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany.,Department of General-, Visceral- and Transplant Surgery, University Hospital of Münster, Münster, Germany
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17
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Ishac D, Matta S, Bin S, Aziz H, Karam E, Abche A, Nassar G. Objective Assessment of Covid-19 Severity Affecting the Vocal and Respiratory System Using a Wearable, Autonomous Sound Collar. Cell Mol Bioeng 2021; 15:67-86. [PMID: 34777597 PMCID: PMC8570400 DOI: 10.1007/s12195-021-00712-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Since the outbreak began in January 2020, Covid-19 has affected more than 161 million people worldwide and resulted in about 3.3 million deaths. Despite efforts to detect human infection with the virus as early as possible, the confirmatory test still requires the analysis of sputum or blood with estimated results available within approximately 30 minutes; this may potentially be followed by clinical referral if the patient shows signs of aggravated pneumonia. This work aims to implement a soft collar as a sound device dedicated to the objective evaluation of the pathophysiological state resulting from dysphonia of laryngeal origin or respiratory failure of inflammatory origin, in particular caused by Covid-19. Methods In this study, we exploit the vibrations of waves generated by the vocal and respiratory system of 30 people. A biocompatible acoustic sensor embedded in a soft collar around the neck collects these waves. The collar is also equipped with thermal sensors and a cross-data analysis module in both the temporal and frequency domains (STFT). The optimal coupling conditions and the electrical and dimensional characteristics of the sensors were defined based on a mathematical approach using a matrix formalism. Results The characteristics of the signals in the time domain combined with the quantities obtained from the STFT offer multidimensional information and a decision support tool for determining a pathophysiological state representative of the symptoms explored. The device, tested on 30 people, was able to differentiate patients with mild symptoms from those who had developed acute signs of respiratory failure on a severity scale of 1 to 10. Conclusion With the health constraints imposed by the effects of Covid-19, the heavy organization to be implemented resulting from the flow of diagnostics, tests and clinical management, it was urgent to develop innovative and safe biomedical technologies. This passive listening technique will contribute to the non-invasive assessment and dynamic observation of lesions. Moreover, it merits further examination to provide support for medical operators to improve clinical management. Supplementary Information The online version contains supplementary material available at 10.1007/s12195-021-00712-w.
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Affiliation(s)
- D Ishac
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - S Matta
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - S Bin
- College of Physics, University of Qingdao, Qingdao, China
| | - H Aziz
- Department of Pulmonary Pathology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - E Karam
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - A Abche
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - G Nassar
- IEMN - CNRS UMR 8520-INSA (HdF)-Lille academic, Lille, France
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18
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Sindayigaya R, Dogan C, Demtröder CR, Fischer B, Karam E, Buggisch JR, Tempfer CB, Lecomte T, Ouaissi M, Giger-Pabst U. Clinical Outcome for Patients Managed with Low-Dose Cisplatin and Doxorubicin Delivered as Pressurized Intraperitoneal Aerosol Chemotherapy for Unresectable Peritoneal Metastases of Gastric Cancer. Ann Surg Oncol 2021; 29:112-123. [PMID: 34611790 DOI: 10.1245/s10434-021-10860-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is increasingly used to manage gastric cancer peritoneal metastasis (GCPM). METHODS This study analyzed a prospective database of GCPM patients treated with cisplatin and doxorubicin PIPAC (PIPAC-C/D). The outcome criteria were adverse events, pathologic response [peritoneal regression grading score (PRGS)], and overall survival (OS). RESULTS The PIPAC-C/D procedure was scheduled for 144 patients with a median age of 57 years (range 22-88 years). Access to the abdominal cavity for the first PIPAC failed in 11 patients (7.7 %). A total of 296 procedures were performed for 131 patients. Of the 144 patients, 52 (36.1%) underwent one PIPAC, 32 (22.2%) underwent two PIPACs, 24 (16.7%) underwent three PIPACs, and 21 (14.6%) underwent four or more PIPACs. The overall morbidity/mortality was grade 1 for 22 patients (15.3%), grade 2 for 32 patients (22.2%), grade 3 for 7 patients (4.9%), grade 4 for no patients (0%), and grade 5 for 2 patients (1.4%). Of the 37 patients who had three or more PIPACs eligible for histopathologic response analysis, 27 (73%) had major or complete regression (PRGS 1/2). A median OS of 11 months (range 0-61 months) for the total study population and 16 months (range 2-61 months) for the patients with three or more PIPACs was observed. For 10 patients (7%) who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, the median OS was 15 months (minimum, 4 months; maximum, 27 months). Multivariate analysis showed three or more PIPACs to be an independent prognostic factor for improved OS (hazard ratio, 0.36; p < 0.0001). CONCLUSIONS Repetitive PIPAC-C/D ± systemic chemotherapy is associated with low morbidity and mortality rates. Prospective randomized trials are needed to confirm whether three or more PIPAC-C/Ds improve clinical outcome.
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Affiliation(s)
- Rémy Sindayigaya
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Can Dogan
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Cédric Remy Demtröder
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany.,Department of General and Visceral Surgery, Therapy Center for Metabolic and Bariatric Surgery, St. Martinus Hospital Düsseldorf, Düsseldorf, Germany
| | - Britta Fischer
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Elias Karam
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | | | - Clemens B Tempfer
- Department of Obstetrics and Gynecology and Therapy Center for Peritoneal Carcinomatosis, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Chambray les Tours, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France.
| | - Urs Giger-Pabst
- Department of Surgery and Therapy Center for Peritonealcarcinomatosis, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany.,Department of General, Visceral, and Transplant Surgery, University Hospital of Münster, Münster, Germany.,University of Applied Science Düsseldorf, Düsseldorf, Germany
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms 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Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Haddad FG, Karam E, Moujaess E, Kourie HR. Poly-(ADP-ribose) polymerase inhibitors: paradigm shift in the first-line treatment of newly diagnosed advanced ovarian cancer. Pharmacogenomics 2020; 21:721-727. [PMID: 32597301 DOI: 10.2217/pgs-2019-0178] [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] [Indexed: 01/30/2023] Open
Abstract
Debulking surgery associated with chemotherapy represent the backbone of ovarian cancer therapy. Adding bevacizumab has improved survival. Recently, PARP inhibitors were added in the first line as maintenance treatment for the patients who achieve a complete or partial response. These drugs act by blocking the activity of the PARP enzyme responsible for base-excision repair, and have shown positive responses when used for tumors lacking homologous recombination. Olaparib, niraparib and veliparib were evaluated and showed an increase in the duration of progression-free survival: 22.1 months (hazard ratio [HR] = 0.59), 13.8 (HR = 0.62) and 23.5 (HR = 0.68) with olaparib, niraparib and veliparib, respectively. This review describes the benefit of PARP inhibitors as maintenance therapy and discusses the efficacy according to breast cancer gene and homologous recombination status.
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Affiliation(s)
- Fady Gh Haddad
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elias Karam
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elissar Moujaess
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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François B, Cariou A, Clere-Jehl R, Dequin PF, Renon-Carron F, Daix T, Guitton C, Deye N, Legriel S, Plantefève G, Quenot JP, Desachy A, Kamel T, Bedon-Carte S, Diehl JL, Chudeau N, Karam E, Durand-Zaleski I, Giraudeau B, Vignon P, Le Gouge A. Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest. N Engl J Med 2019; 381:1831-1842. [PMID: 31693806 DOI: 10.1056/nejmoa1812379] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients who are treated with targeted temperature management after out-of-hospital cardiac arrest with shockable rhythm are at increased risk for ventilator-associated pneumonia. The benefit of preventive short-term antibiotic therapy has not been shown. METHODS We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving adult patients (>18 years of age) in intensive care units (ICUs) who were being mechanically ventilated after out-of-hospital cardiac arrest related to initial shockable rhythm and treated with targeted temperature management at 32 to 34°C. Patients with ongoing antibiotic therapy, chronic colonization with multidrug-resistant bacteria, or moribund status were excluded. Either intravenous amoxicillin-clavulanate (at doses of 1 g and 200 mg, respectively) or placebo was administered three times a day for 2 days, starting less than 6 hours after the cardiac arrest. The primary outcome was early ventilator-associated pneumonia (during the first 7 days of hospitalization). An independent adjudication committee determined diagnoses of ventilator-associated pneumonia. RESULTS A total of 198 patients underwent randomization, and 194 were included in the analysis. After adjudication, 60 cases of ventilator-associated pneumonia were confirmed, including 51 of early ventilator-associated pneumonia. The incidence of early ventilator-associated pneumonia was lower with antibiotic prophylaxis than with placebo (19 patients [19%] vs. 32 [34%]; hazard ratio, 0.53; 95% confidence interval, 0.31 to 0.92; P = 0.03). No significant differences between the antibiotic group and the control group were observed with respect to the incidence of late ventilator-associated pneumonia (4% and 5%, respectively), the number of ventilator-free days (21 days and 19 days), ICU length of stay (5 days and 8 days if patients were discharged and 7 days and 7 days if patients had died), and mortality at day 28 (41% and 37%). At day 7, no increase in resistant bacteria was identified. Serious adverse events did not differ significantly between the two groups. CONCLUSIONS A 2-day course of antibiotic therapy with amoxicillin-clavulanate in patients receiving a 32-to-34°C targeted temperature management strategy after out-of-hospital cardiac arrest with initial shockable rhythm resulted in a lower incidence of early ventilator-associated pneumonia than placebo. No significant between-group differences were observed for other key clinical variables, such as ventilator-free days and mortality at day 28. (Funded by the French Ministry of Health; ANTHARTIC ClinicalTrials.gov number, NCT02186951.).
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Affiliation(s)
- Bruno François
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Alain Cariou
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Raphaël Clere-Jehl
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Pierre-François Dequin
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Françoise Renon-Carron
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Thomas Daix
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Christophe Guitton
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Nicolas Deye
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Stéphane Legriel
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Gaëtan Plantefève
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Jean-Pierre Quenot
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Arnaud Desachy
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Toufik Kamel
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Sandrine Bedon-Carte
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Jean-Luc Diehl
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Nicolas Chudeau
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Elias Karam
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Isabelle Durand-Zaleski
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Bruno Giraudeau
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Philippe Vignon
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Amélie Le Gouge
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
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Rached G, Hobeika C, Karam E, Kourié HR, Kattan J. Urging medical students to publish: Advantages, disadvantages and new challenges. Bull Cancer 2018; 105:626-628. [PMID: 29801780 DOI: 10.1016/j.bulcan.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/11/2017] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 10/16/2022]
Abstract
As soon as they get accepted into medical school, students find themselves facing numerous expectations: coping with tremendous study burden, competing with others for the best rank, completing internships and participating in the race for publishing are only to name a few. This big juggle makes it hard for the medical student to focus on research. It is often easier to postpone publication and involvement in research to "later". In fact there are many advantages to publishing in the current publication system but there are many disadvantages as well. With the widespread of social media and open access systems, new challenges have arisen. The aim of this paper is to discuss the advantages and disadvantages of publishing in the current system while highlighting the new challenges that the students might need to overcome. Its aim is to provide medical students with information to enhance their understanding of the current publication system and thus most importantly, probe their desire to publish.
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Affiliation(s)
- Gaëlle Rached
- Saint Joseph University, Faculty of Medicine, Oncology Department, Beirut, Lebanon
| | - Charbel Hobeika
- Saint Joseph University, Faculty of Medicine, Oncology Department, Beirut, Lebanon
| | - Elias Karam
- Saint Joseph University, Faculty of Medicine, Oncology Department, Beirut, Lebanon
| | | | - Joseph Kattan
- Saint Joseph University, Faculty of Medicine, Oncology Department, Beirut, Lebanon
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23
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Bourguignon T, Espitalier F, Pantaleon C, Vermes E, El-Arid JM, Loardi C, Karam E, Candolfi P, Ivanes F, Aupart M. Bioprosthetic mitral valve replacement in patients aged 65 years or younger: long-term outcomes with the Carpentier–Edwards PERIMOUNT pericardial valve†. Eur J Cardiothorac Surg 2018; 54:302-309. [DOI: 10.1093/ejcts/ezy029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thierry Bourguignon
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Fabien Espitalier
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Clémence Pantaleon
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Emmanuelle Vermes
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Jean Marc El-Arid
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Claudia Loardi
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Elias Karam
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Pascal Candolfi
- Department of Biostatistics, Edwards Lifesciences, Nyon, Switzerland
| | - Fabrice Ivanes
- Department of Cardiology, Trousseau University Hospital, Tours, France
| | - Michel Aupart
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
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24
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Maalouf C, Bou-Merhi J, Karam E, Patocskai E, Danino A. The impact of autologous breast reconstruction using DIEP flap on the oncologic efficacy of radiation therapy. ANN CHIR PLAST ESTH 2017; 62:630-636. [DOI: 10.1016/j.anplas.2017.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
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25
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Karam E, Shivji FS, Bhattacharya A, Bryson DJ, Forward DP, Scammell BE, Ollivere BJ. A cross-sectional study of the impact of physiotherapy and self directed exercise on the functional outcome of internally fixed isolated unimalleolar Weber B ankle fractures. Injury 2017; 48:531-535. [PMID: 27889109 DOI: 10.1016/j.injury.2016.11.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/29/2016] [Accepted: 11/16/2016] [Indexed: 02/02/2023]
Abstract
This study aimed to measure the functional outcome and quality of life in a group of patients with the same fracture type (unimalleolar Weber B ankle fractures) treated operatively at various time points and to explore the determinants of such outcomes. A cross-sectional retrospective population study was conducted. Validated Patient Related Outcome Measures (PROMs) and patient interviews were used. Fifty-one patients were included with a mean age of 54.9 years. Mean follow-up was 25 months (range 4-46 months). Mean functional scores were high (mean AOFAS 79.2, O&M 75.7, VAS-FA 80.5). However, 32% of patients did not classify themselves as fully recovered during interviews. Patient reported self-directed exercise had a statistically significant positive effect on self-reported patient perceptions of outcome (p=0.022) and PROMs (AOFAS p=0.01, O&M p=0.016, VAS-FA p=0.011). Formal physiotherapy rehabilitation was found to have no effect on self-reported patient perceptions (p=0.242) or PROMs (AOFAS p=0.8, O&M p=0.73, VAS-FA p=0.46). Our finding that physical activity is associated with improved outcome would suggest structured exercise programmes should be considered in place of physiotherapy to optimise patient outcomes.
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Affiliation(s)
- E Karam
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - F S Shivji
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Bhattacharya
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J Bryson
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D P Forward
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - B J Ollivere
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
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26
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Scott KM, Lim CCW, Hwang I, Adamowski T, Al-Hamzawi A, Bromet E, Bunting B, Ferrand MP, Florescu S, Gureje O, Hinkov H, Hu C, Karam E, Lee S, Posada-Villa J, Stein D, Tachimori H, Viana MC, Xavier M, Kessler RC. The cross-national epidemiology of DSM-IV intermittent explosive disorder. Psychol Med 2016; 46:3161-3172. [PMID: 27572872 PMCID: PMC5206971 DOI: 10.1017/s0033291716001859] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This is the first cross-national study of intermittent explosive disorder (IED). METHOD A total of 17 face-to-face cross-sectional household surveys of adults were conducted in 16 countries (n = 88 063) as part of the World Mental Health Surveys initiative. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) assessed DSM-IV IED, using a conservative definition. RESULTS Lifetime prevalence of IED ranged across countries from 0.1 to 2.7% with a weighted average of 0.8%; 0.4 and 0.3% met criteria for 12-month and 30-day prevalence, respectively. Sociodemographic correlates of lifetime risk of IED were being male, young, unemployed, divorced or separated, and having less education. The median age of onset of IED was 17 years with an interquartile range across countries of 13-23 years. The vast majority (81.7%) of those with lifetime IED met criteria for at least one other lifetime disorder; co-morbidity was highest with alcohol abuse and depression. Of those with 12-month IED, 39% reported severe impairment in at least one domain, most commonly social or relationship functioning. Prior traumatic experiences involving physical (non-combat) or sexual violence were associated with increased risk of IED onset. CONCLUSIONS Conservatively defined, IED is a low prevalence disorder but this belies the true societal costs of IED in terms of the effects of explosive anger attacks on families and relationships. IED is more common among males, the young, the socially disadvantaged and among those with prior exposure to violence, especially in childhood.
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Affiliation(s)
- K. M. Scott
- Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - C. C. W. Lim
- Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - I. Hwang
- Department of Health Care Policy, Harvard University Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - T. Adamowski
- Medical University of Wroclaw, L. Pasteur Str. 10, 50-367 Wroclaw, Poland
| | - A. Al-Hamzawi
- Department of Psychiatry, College of Medicine, Qadisia University, Diwaniya 00964, Iraq
| | - E. Bromet
- Department of Psychiatry, State University of New York at Stony Brook, Putnam Hall – South Campus, Stony Brook, NY 11794-8790, USA
| | - B. Bunting
- University of Ulster, College Avenue, Londonderry BT48 7JL, UK
| | - M. P. Ferrand
- Universidad Peruana Cayetano Heredia, Facultad de Salud Pública y Administración, Honorio Delgado, Lima, Peru
| | - S. Florescu
- Health Services and Research Evaluation Center, National School of Public Health Management and Professional Development, 31 Vaselor Street, Bucharest, 021253, Romania
| | - O. Gureje
- Department of Psychiatry, University College Hospital, PMB 5116, Ibadan, Nigeria
| | - H. Hinkov
- National Center for Public Health Protection, 15 Acad. Ivan Ev. Geshov blvd, 1431 Sofia, Bulgaria
| | - C. Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, 13-15/F, Block B, No. 2019 Buxin Road, Luohu District, No. 1080 Cuizu Road, Luohu District, 518020, Guangdong Province, People's Republic of China
| | - E. Karam
- St. George Hospital University Medical Center, Balamand University, Faculty of Medicine, Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Medical Institute for Neuropsychological Disorders (MIND), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Institute for Development, Research Advocacy and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Ashrafieh 166378, Lebanon
| | - S. Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Flat 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - J. Posada-Villa
- Universidad Colegio Mayor de Cundinamarca, Cra 7 No. 119-14 Cons. 511, Bogotá D.C., Colombia
| | - D. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Private Bag X3, Rondebosch 7701, Cape Town, South Africa
| | - H. Tachimori
- National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Rua Dr Eurico de Aguiar 888/705, Vitoria, ES 29055-280, Brazil
| | - M. Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal
| | - R. C. Kessler
- Department of Health Care Policy, Harvard University Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
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Clavel M, Barraud O, Moucadel V, Meynier F, Karam E, Ploy MC, François B, Pichon N, Vignon P, Droual R, Duchiron C, Vignaud J, Chainier D, Mattei M, Sommabere A, Mercier E, Le Brun C, Desachy A, Garandeau C, Rodrigue M, Lacroix M, Prudent S, Jestin MA, Yugueros-Marcos J. Molecular quantification of bacteria from respiratory samples in patients with suspected ventilator-associated pneumonia. Clin Microbiol Infect 2016; 22:812.e1-812.e7. [DOI: 10.1016/j.cmi.2016.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
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Clavel M, Barraud O, Moucadel V, Ploy MC, Karam E, Meynier F. Concordance between a new molecular real-time approach and traditional culture in suspected VAP patients. Crit Care 2015. [PMCID: PMC4472708 DOI: 10.1186/cc14187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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29
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Karam E, Lévesque M, Jacquemin G, Delure A, Robidoux I, Laramée M, Odobescu A, Harris P, Danino A. Building a multidisciplinary team for burn treatment - Lessons learned from the Montreal tendon transfer experience. Ann Burns Fire Disasters 2014; 27:3-7. [PMID: 25249840 PMCID: PMC4150479] [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] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 06/03/2023]
Abstract
Multidisciplinary teams (MDTs) represent a recognized component of care in the treatment of complex conditions such as burns. However, most institutions do not provide adequate support for the formation of these teams. Furthermore, the majority of specialists lack the managerial skills required to create a team and have difficulties finding the proper tools. Our objective is to provide an insight for health care professionals, who wish to form a MDT for burn treatment, on the challenges that are likely to be faced, and to identify key elements that may facilitate the establishment of such a project. The setting for this was a plastic surgery department and rehabilitation center at a national reference center. A qualitative analysis was performed on all correspondences related to our tetraplegia project, from 2006 to 2008. To guide our thematic analysis, we used a form of systems theory known as the complexity theory. The qualitative analysis was performed using the NVivo software (Version 8.0 QSR International Melbourne, Australia). Lastly, the data was organized in chronologic order. Three main themes emerged from the results: knowledge acquisition, project organizational setup and project steps design. These themes represented respectively 24%, 50% and 26% of all correspondences. Project steps design and knowledge acquisition correspondences increased significantly after the introduction of the mentor team to our network. We conclude that an early association with a mentor team is beneficial for the establishment of a MDT.
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Affiliation(s)
- E. Karam
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
| | | | - G. Jacquemin
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - A. Delure
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - I. Robidoux
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - M.T. Laramée
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - A. Odobescu
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
| | - P.G.. Harris
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
| | - A.M. Danino
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
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30
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Pombo S, Jakovljevic M, Jovanovic M, Babic S, Rancic N, Lesch O, Salem B, Karam E, Walter H, Patek K. S08 * SUBGROUPS OF ADDICTION AND THEIR SPECIAL TREATMENT. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt081] [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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31
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Guiyedi V, Mattei M, Sommabere A, Karam E, Allard JB, Regouby Y, Okome-Nkoumou M, Lambert de Cursay G, Abraham BV. [Severe liver cytolysis could be a marker of the severity of hemorrhagic dengue: report of two cases]. Med Sante Trop 2012; 22:87-90. [PMID: 22868735 DOI: 10.1684/mst.2012.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report two cases of severe dengue fever in persons returned from stays in endemic areas during the summer outbreak of 2010. Both presented a hemorrhagic syndrome associated with primary hemostasis disorders, neutropenia, and severe hepatic cytolysis without any hepatocellular insufficiency. Three days after hospitalization, the first patient's AST and ALT levels rose to 80 and 12 times the upper reference values respectively, and the second patient's to 12 and 7 times those values. The second also presented signs of hemodynamic shock. Our observations suggest that the combination of severe hepatic cytolysis and hemostatic disorders may be a predictive marker of the severity of dengue fever. The pathophysiologic mechanisms explaining this severity remain unknown.
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Affiliation(s)
- V Guiyedi
- Service de médecine interne, rhumatologie, maladies infectieuses et tropicales, centre hospitalier de Brive-la-Gaillarde, France.
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Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, de Girolamo G, Demyttenaere K, Gasquet I, Haro JM, Karam E, Kessler RC, Levinson D, Medina Mora ME, Oakley Browne MA, Ormel J, Villa JP, Uda H, Von Korff M. Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes (Lond) 2007; 32:192-200. [PMID: 17712309 PMCID: PMC2736857 DOI: 10.1038/sj.ijo.0803701] [Citation(s) in RCA: 268] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES (1) To investigate whether there is an association between obesity and mental disorders in the general populations of diverse countries, and (2) to establish whether demographic variables (sex, age, education) moderate any associations observed. DESIGN Thirteen cross-sectional, general population surveys conducted as part of the World Mental Health Surveys initiative. SUBJECTS Household residing adults, 18 years and over (n=62 277). MEASUREMENTS DSM-IV mental disorders (anxiety disorders, depressive disorders, alcohol use disorders) were assessed with the Composite International Diagnostic Interview (CIDI 3.0), a fully structured diagnostic interview. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater; severe obesity as BMI 35+. Persons with BMI less than 18.5 were excluded from analysis. Height and weight were self-reported. RESULTS Statistically significant, albeit modest associations (odds ratios generally in the range of 1.2-1.5) were observed between obesity and depressive disorders, and between obesity and anxiety disorders, in pooled data across countries. These associations were concentrated among those with severe obesity, and among females. Age and education had variable effects across depressive and anxiety disorders. CONCLUSIONS The findings are suggestive of a modest relationship between obesity (particularly severe obesity) and emotional disorders among women in the general population. The study is limited by the self-report of BMI and cannot clarify the direction or nature of the relationship observed, but it may indicate a need for a research and clinical focus on the psychological heterogeneity of the obese population.
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Affiliation(s)
- K M Scott
- Wellington School of Medicine and Health Sciences, Otago University, Wellington, New Zealand.
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Karam E, Melhem N, Mansour C, Maalouf W, Saliba S, Chami A. Use and abuse of licit and illicit substances: prevalence and risk factors among students in Lebanon. Eur Addict Res 2000; 6:189-97. [PMID: 11124572 DOI: 10.1159/000052045] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims at examining the patterns of 'substance' use in Lebanon among an 'at risk' population, the university students. METHOD A stratified cluster sample of 1,851 students from two major universities was included in the study and the Diagnostic Interview Schedule (version 3) was administered. RESULTS The prevalence of nicotine users in the sample was 18.3% and of ever consuming alcohol 49.4%. 2.1% of the sample were alcohol abusers and 2.4% alcohol dependents according to DSM-III criteria. For the remaining substances, tranquilizers were found to have the highest rate of ever use (10.2%), whereas heroin had the lowest rate (0.4%); the rates of abuse and dependence in these categories (other than alcohol and nicotine) following DSM-III criteria ranged from 0.1 to 0.8%. CONCLUSION University students in Lebanon in this study have relatively low rates of use and abuse of substances but this might be changing.
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Affiliation(s)
- E Karam
- Department of Psychiatry, St. George Hospital, Beirut, Lebanon.
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Muci-Mendoza R, Arevalo JF, Ramella M, Fuenmayor-Rivera D, Karam E, Cardenas PL, Recio MV. Optociliary veins in optic nerve sheath meningioma. Indocyanine green videoangiography findings. Ophthalmology 1999; 106:311-8. [PMID: 9951483 DOI: 10.1016/s0161-6420(99)90055-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 11/21/2022] Open
Abstract
OBJECTIVE To report the indocyanine green videoangiography (ICG-V) characteristics of optociliary veins (OV) in optic nerve sheath meningioma (ONSM). DESIGN Case series. PARTICIPANTS Four eyes (patients) with OV and ONSM were examined. INTERVENTION Indocyanine green videoangiography and intravenous fluorescein angiography (IVFA) were prospectively performed. MAIN OUTCOME MEASURES The course of OV in ONSM cases was observed with ICG-V and IVFA. RESULTS On ICG-V, the course of OV was followed from their origin at small tributaries of the central retinal vein, their junction with choroidal veins, and finally to their drainage in the vortex venous system. The authors found an inverse relationship between the degree of optic disc edema and the development and ease of visualization of the optociliary veins and their draining course through the choroidal circulation. The mean time from the injection of indocyanine green to the visualization of OV's draining choroidal vessels was 35.4 seconds (range, 25.4-50 seconds). Intravenous fluorescein angiography allowed visualization of OV only at the margins of the optic disc in all cases. CONCLUSION Indocyanine green videoangiography provides important and new information in cases with OV and ONSM that is not obtained with IVFA. Such information may provide important knowledge regarding the hemodynamics of the choroidal circulation in normal and pathologic states.
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Affiliation(s)
- R Muci-Mendoza
- Neuro-Ophthalmology Unit, Hospital Vargas de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
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Abstract
Although there are 22 Arab countries in the Arab League, the mental health services provided in those countries show several forms of variation. Economic, political, social and cultural factors seem to play a major role in determining the state of the psychiatric profession and the access of the service to citizens. The different needs expressed by Arab colleagues at times seem incompatible with the available allocated resources. Some Arab countries enjoy the highest income per capita, yet this is inconsistent with the quality of mental health services available there. The per capita mental health services, the availability of a Mental Health Act, and the space allocated for mental health in medical curricula are but a few of the concerns that have been expressed by colleagues from the different countries of the Arab region. The following review will attempt to draw up a profile of the situation for mental health services and research in the region, and to suggest some measures for intervention.
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Affiliation(s)
- A Okasha
- Institute of Psychiatry, Ain Shams University, Cairo, Egypt
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Liu X, Sun Y, Constantinescu SN, Karam E, Weinberg RA, Lodish HF. Transforming growth factor beta-induced phosphorylation of Smad3 is required for growth inhibition and transcriptional induction in epithelial cells. Proc Natl Acad Sci U S A 1997; 94:10669-74. [PMID: 9380693 PMCID: PMC23442 DOI: 10.1073/pnas.94.20.10669] [Citation(s) in RCA: 314] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Drosophila Mad proteins are intracellular signal transducers of decapentaplegic (dpp), the Drosophila transforming growth factor beta (TGF-beta)/bone morphogenic protein (BMP) homolog. Studies in which the mammalian Smad homologs were transiently overexpressed in cultured cells have implicated Smad2 in TGF-beta signaling, but the physiological relevance of the Smad3 protein in signaling by TGF-beta receptors has not been established. Here we stably expressed Smad proteins at controlled levels in epithelial cells using a novel approach that combines highly efficient retroviral gene transfer and quantitative cell sorting. We show that upon TGF-beta treatment Smad3 becomes rapidly phosphorylated at the SSVS motif at its very C terminus. Either attachment of an epitope tag to the C terminus or replacement of these three serine residues with alanine abolishes TGF-beta-induced Smad3 phosphorylation; these proteins act in a dominant-negative fashion to block the antiproliferative effect of TGF-beta in mink lung epithelial cells. A Smad3 protein in which the three C-terminal serines have been replaced by aspartic acids is also a dominant inhibitor of TGF-beta signaling, but can activate plasminogen activator inhibitor 1 (PAI-1) transcription in a ligand-independent fashion when its nuclear localization is forced by transient overexpression. Phosphorylation of the three C-terminal serine residues of Smad3 by an activated TGF-beta receptor complex is an essential step in signal transduction by TGF-beta for both inhibition of cell proliferation and activation of the PAI-1 promoter.
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Affiliation(s)
- X Liu
- Whitehead Institute for Biomedical Research, Nine Cambridge Center, Cambridge, MA 02142, USA
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Abstract
Although a common medical instrument, the mechanical function of an occlusive arm cuff has not been fully described in an engineering sense. The occlusive arm cuff is examined here using a mathematical mechanics model and experimental measurements. Cuff stretch was modeled by a nonlinear pressure-volume function. Air compression was represented by Boyle's law. An apparatus was developed to measure pressure due to the air volume pumped into the cuff for fixed arm volume. Data were obtained for two different cuff designs, and reveal a nonlinear cuff pressure-volume relationship that could be represented accurately by the mathematical model. Calibration constants are provided for the two types of occlusive cuff. Thus, the cuff pressure was found to consist of a balance between that produced by stretch of the elastic cuff bladder and that of the compression of the air contained within the bladder. The use of the gas law alone was found to be inadequate to represent the cuff mechanics. When applying the cuff to measure change in arm volume, such as during plethysmography or oscillometry, it cannot be assumed that the cuff sensitivity is constant. More precisely, it was found that the occlusive cuff is a transducer with a volume sensitivity that increases with cuff pressure and volume until it becomes nearly constant at high levels of cuff pressure (150 mmHg). A hypothetical case of a linear elastic artery with constant pulse pressure was used as input to the cuff model to illustrate the change in cuff pressure oscillations that occurs while cuff pressure is released.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Drzewiecki
- Department of Biomedical Engineering, Rutgers, State University of New Jersey, Piscataway 08855
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Abstract
In the past, the dynamics of the left ventricle were studied by its response to altered venous and arterial load for a given heart. This led researchers to propose the concept of an arterioventricular match or optimal point of function. The model of this paper reverses that idea by fixing preload and afterload while computing cardiac function due to altered left ventricular size or shape, resulting from modification of the number of parallel and series sarcounits. A mathematical model of physiological hypertrophy is introduced. Series and parallel arrangements of sarcounits constitute a cylindrical model of the left ventricle. Filling occurs from a venous reservoir with constant pressure through a valve, while ejection takes place into a three-element model of the systemic arterial system through another valve. It is found that the dynamics of the myofibrils can be matched to those of the left ventricle by choosing a ventricular shape that results in a minimum in myocardial O2 consumption (MVO2) for any constant ventricular load. A unique solution for the size of the ventricle results if the rate of MVO2 is specified. The model is able to predict correctly hypertrophy due to hypoxia and due to pressure (concentric) and volume (eccentric) overloads.
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Affiliation(s)
- G M Drzewiecki
- Department of Biomedical Engineering, Rutgers, State University of New Jersey, College of Engineering, Piscataway 08855-1179
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Abstract
A relationship between ventricular pressure and volume is developed starting from basic cardiac muscle mechanics. The known and measurable properties of myocardium, such as the Hill law, the periodic excitation-contraction mechanism, and non-linear elasticity of the surrounding elastin and collagen structure, are formulated into a myofibril unit. A cylindrical geometry is chosen to represent the structure of the ventricle, using the myofibril unit as the basic building block. Pressure-volume isochrones computed from this model illustrate non-linear function in the heart which arises from both geometric effects and muscle effects. The above theory and model is linearized to provide a special study case. The behavior that resulted is that of a time-varying elastance, E(t), and, hence, can help in the interpretation of its meaning. It is found that the minimum in E(t) is the consequence of the stiffness of the myocardial fibrous network, adjusted by a geometric factor. In addition, the magnitude of E(t) is governed by myocardial contractility, a geometric factor, and the excitation-contraction mechanism, where time-dependency is imparted by periodic excitation. Since the elastic fibers are the only true elastic elements, the quantity of elastance is determined by controlled volume feedback. A circuit model is provided to illustrate this concept. The non-linear active and passive heart function curves are specified independently. These curves are required to intersect below the resting volume and result in a negative pressure at the intersection. This is found to explain the phenomenon of ventricular suction. In addition, they lead to a time-varying dead volume by virtue of time-dependent isochronal slope. Non-linear function is introduced to the model and is found to explain the variation in curvature of the ventricular isochrones.
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Affiliation(s)
- G M Drzewiecki
- Department of Biomedical Engineering, Rutgers, State University, Piscataway, New Jersey 08855
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Wetzel RD, Margulies T, Davis R, Karam E. Hopelessness, depression, and suicide intent. J Clin Psychiatry 1980; 41:159-60. [PMID: 7372577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Seventy-three inpatients completed Beck's Suicide Ideator Scale, Beck's Hopelessness Scale and the MMPI Depression Scale. As hypothesized, suicide intent was significantly more correlated with hopelessness than with depression. When the effect of hopelessness was removed statistically, there was no relationship between suicide intent and depression.
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