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Skinner S, Pascal L, Polazzi S, Chollet F, Lifante JC, Duclos A. Economic analysis of surgical outcome monitoring using control charts: the SHEWHART cluster randomised trial. BMJ Qual Saf 2024; 33:284-292. [PMID: 37553238 DOI: 10.1136/bmjqs-2022-015390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/27/2023] [Indexed: 08/10/2023]
Abstract
IMPORTANCE Surgical complications represent a considerable proportion of hospital expenses. Therefore, interventions that improve surgical outcomes could reduce healthcare costs. OBJECTIVE Evaluate the effects of implementing surgical outcome monitoring using control charts to reduce hospital bed-days within 30 days following surgery, and hospital costs reimbursed for this care by the insurer. DESIGN National, parallel, cluster-randomised SHEWHART trial using a difference-in-difference approach. SETTING 40 surgical departments from distinct hospitals across France. PARTICIPANTS 155 362 patients over the age of 18 years, who underwent hernia repair, cholecystectomy, appendectomy, bariatric, colorectal, hepatopancreatic or oesophageal and gastric surgery were included in analyses. INTERVENTION After the baseline assessment period (2014-2015), hospitals were randomly allocated to the intervention or control groups. In 2017-2018, the 20 hospitals assigned to the intervention were provided quarterly with control charts for monitoring their surgical outcomes (inpatient death, intensive care stay, reoperation and severe complications). At each site, pairs, consisting of one surgeon and a collaborator (surgeon, anaesthesiologist or nurse), were trained to conduct control chart team meetings, display posters in operating rooms, maintain logbooks and design improvement plans. MAIN OUTCOMES Number of hospital bed-days per patient within 30 days following surgery, including the index stay and any acute care readmissions related to the occurrence of major adverse events, and hospital costs reimbursed for this care per patient by the insurer. RESULTS Postintervention, hospital bed-days per patient within 30 days following surgery decreased at an adjusted ratio of rate ratio (RRR) of 0.97 (95% CI 0.95 to 0.98; p<0.001), corresponding to a 3.3% reduction (95% CI 2.1% to 4.6%) for intervention hospitals versus control hospitals. Hospital costs reimbursed for this care per patient by the insurer significantly decreased at an adjusted ratio of cost ratio (RCR) of 0.99 (95% CI 0.98 to 1.00; p=0.01), corresponding to a 1.3% decrease (95% CI 0.0% to 2.6%). The consumption of a total of 8910 hospital bed-days (95% CI 5611 to 12 634 bed-days) and €2 615 524 (95% CI €32 366 to €5 405 528) was avoided in the intervention hospitals postintervention. CONCLUSIONS Using control charts paired with indicator feedback to surgical teams was associated with significant reductions in hospital bed-days within 30 days following surgery, and hospital costs reimbursed for this care by the insurer. TRIAL REGISTRATION NUMBER NCT02569450.
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Affiliation(s)
- Sarah Skinner
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Léa Pascal
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Stéphanie Polazzi
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | | | - Jean-Christophe Lifante
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Department of Endocrine Surgery, Hospices Civils de Lyon, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA
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Chollet F, Leger JM. Long COVID and cognition. Eur J Neurol 2023; 30:3640-3641. [PMID: 37786966 DOI: 10.1111/ene.16082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Affiliation(s)
- François Chollet
- Neurology Department, Hopital Pierre Paul Riquet, Toulouse, France
- Académie Nationale de Médecine, Paris, France
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Chollet F, Planton M, Sailler L, De Almeida S, Alvarez M, Pariente J. [Neurological forms of long COVID in adults: Critical approach]. Bull Acad Natl Med 2023:S0001-4079(23)00187-5. [PMID: 37363154 PMCID: PMC10282979 DOI: 10.1016/j.banm.2023.06.009] [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: 03/17/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
Now recognized by health authorities, long COVID is identified as a frequent condition complicating the evolution of SARS-CoV-2 infection. Its polymorphic and sometimes disconcerting clinical expression raises questions about its mechanism. Patterns of clinical expression suggest extensive involvement of the nervous system through an almost ubiquitous cognitive complaint. This article reviews the neurological symptoms and forms of these patients, and the neuropsychological explorations aimed at objectifying a cognitive deficit. The studies published until now confronted with the clinical mode of expression, did not make it possible to define a deficit neuropsychological profile at the level of the groups, and evoked more a functional impairment than a lesion. However, each series mentions a small number of patients in whom a cognitive deficit is objectified. The uncertainties about the causes of the prolonged forms of COVID, the heterogeneity of the published studies, and the virtual absence of temporal evolution data should make one cautious about the interpretation of these data but should in no way delay or prevent taking into account care of these patients.
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Affiliation(s)
- François Chollet
- Département de neurologie, CHU de Toulouse, hôpital Pierre-Paul-Riquet, place Baylac, 31059 Toulouse cedex, France
| | - Mélanie Planton
- Département de neurologie, CHU de Toulouse, hôpital Pierre-Paul-Riquet, place Baylac, 31059 Toulouse cedex, France
| | - Laurent Sailler
- Service de médecine interne, CHU de Toulouse, hôpital Purpan, place Baylac, 31059 Toulouse cedex, France
| | - Sébastien De Almeida
- Service de médecine interne, CHU de Toulouse, hôpital Purpan, place Baylac, 31059 Toulouse cedex, France
| | - Muriel Alvarez
- Service des maladies infectieuses, CHU de Toulouse, hôpital Purpan, place Baylac, 31059 Toulouse cedex, France
| | - Jérémie Pariente
- Département de neurologie, CHU de Toulouse, hôpital Pierre-Paul-Riquet, place Baylac, 31059 Toulouse cedex, France
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Periole C, Blanc C, Calvière L, Fontaine L, Viguier A, Albucher JF, Chollet F, Bonneville F, Olivot JM, Raposo N. Prevalence and characterization of cerebral small vessel disease in young adults with intracerebral hemorrhage. Int J Stroke 2023; 18:102-108. [PMID: 35361018 DOI: 10.1177/17474930221093526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Cerebral small vessel disease (CSVD) is the main cause of intracerebral hemorrhage (ICH) in older individuals but has not been systematically studied in younger people. We aimed to evaluate the prevalence and characteristics of CSVD in young adults with symptomatic ICH. METHODS We conducted a cohort study of consecutive adults aged 18-50 years with non-traumatic ICH. All patients were evaluated with brain and vascular imaging. Using validated imaging markers (cerebral microbleeds (CMBs), white matter hyperintensities and/or lacunes), patients were categorized as having CSVD-related ICH or non-CSVD-related ICH. Factors associated with CSVD were evaluated using multivariable analyses. CSVD subtypes were characterized using pre-specified criteria. RESULTS Of 146 young adults with ICH (mean age = 37.7), CSVD was present in 41 patients (28.1%; 95% confidence interval (CI) = 21.0-36.1). In multivariable analysis, older age, male sex, and hypertension were independently associated with the presence of CSVD. Deep perforator arteriopathy (48.8%) and mixed CSVD (31.7%) were the most common CSVD subtypes. CONCLUSION Our results suggest that CSVD is a frequent cause of ICH in young adults and provide new insights into the characterization of the disease. These findings may have important implications since the treatment and management differ from other causes of ICH.
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Affiliation(s)
- Charlotte Periole
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Clémence Blanc
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Lionel Calvière
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Louis Fontaine
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Alain Viguier
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Jean-François Albucher
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - François Chollet
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Fabrice Bonneville
- Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France.,Department of Neuroradiology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Marc Olivot
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
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Sanchez-Sanchez JL, Giudici KV, Guyonnet S, Delrieu J, Li Y, Bateman RJ, Parini A, Vellas B, de Souto Barreto P, Vellas B, Guyonnet S, Carrié I, Brigitte L, Faisant C, Lala F, Delrieu J, Villars H, Combrouze E, Badufle C, Zueras A, Andrieu S, Cantet C, Morin C, Van Kan GA, Dupuy C, Rolland Y, Caillaud C, Ousset PJ, Lala F, Willis S, Belleville S, Gilbert B, Fontaine F, Dartigues JF, Marcet I, Delva F, Foubert A, Cerda S, Marie-Noëlle-Cuffi, Costes C, Rouaud O, Manckoundia P, Quipourt V, Marilier S, Franon E, Bories L, Pader ML, Basset MF, Lapoujade B, Faure V, Tong MLY, Malick-Loiseau C, Cazaban-Campistron E, Desclaux F, Blatge C, Dantoine T, Laubarie-Mouret C, Saulnier I, Clément JP, Picat MA, Bernard-Bourzeix L, Willebois S, Désormais I, Cardinaud N, Bonnefoy M, Livet P, Rebaudet P, Gédéon C, Burdet C, Terracol F, Pesce A, Roth S, Chaillou S, Louchart S, Sudres K, Lebrun N, Barro-Belaygues N, Touchon J, Bennys K, Gabelle A, Romano A, Touati L, Marelli C, Pays C, Robert P, Le Duff F, Gervais C, Gonfrier S, Gasnier Y, Bordes S, Begorre D, Carpuat C, Khales K, Lefebvre JF, El Idrissi SM, Skolil P, Salles JP, Dufouil C, Lehéricy S, Chupin M, Mangin JF, Bouhayia A, Allard M, Ricolfi F, Dubois D, Martel MPB, Cotton F, Bonafé A, Chanalet S, Hugon F, Bonneville F, Cognard C, Chollet F, Payoux P, Voisin T, Peiffer S, Hitzel A, Zanca M, Monteil J, Darcourt J, Molinier L, Derumeaux H, Costa N, Perret B, Vinel C, Caspar-Bauguil S, Olivier-Abbal P, Coley N. Plasma MCP-1 and changes on cognitive function in community-dwelling older adults. Alzheimers Res Ther 2022; 14:5. [PMID: 34996522 PMCID: PMC8742409 DOI: 10.1186/s13195-021-00940-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022]
Abstract
Background Monocyte Chemoattractant Protein-1 (MCP-1), a glial-derived chemokine, mediates neuroinflammation and may regulate memory outcomes among older adults. We aimed to explore the associations of plasma MCP-1 levels (alone and in combination with β-amyloid deposition—Aβ42/40) with overall and domain-specific cognitive evolution among older adults. Methods Secondary analyses including 1097 subjects (mean age = 75.3 years ± 4.4; 63.8% women) from the Multidomain Alzheimer Preventive Trial (MAPT). MCP-1 (higher is worse) and Aβ42/40 (lower is worse) were measured in plasma collected at year 1. MCP-1 in continuous and as a dichotomy (values in the highest quartile (MCP-1+)) were used, as well as a dichotomy of Aβ42/40. Outcomes were measured annually over 4 years and included the following: cognitive composite z-score (CCS), the Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR) sum of boxes (overall cognitive function); composite executive function z-score, composite attention z-score, Free and Cued Selective Reminding Test (FCSRT - memory). Results Plasma MCP-1 as a continuous variable was associated with the worsening of episodic memory over 4 years of follow-up, specifically in measures of free and cued delayed recall. MCP-1+ was associated with worse evolution in the CCS (4-year between-group difference: β = −0.14, 95%CI = −0.26, −0.02) and the CDR sum of boxes (2-year: β = 0.19, 95%CI = 0.06, 0.32). In domain-specific analyses, MCP-1+ was associated with declines in the FCSRT delayed recall sub-domains. In the presence of low Aβ42/40, MCP-1+ was not associated with greater declines in cognitive functions. The interaction with continuous biomarker values Aβ42/40× MCP-1 × time was significant in models with CDR sum of boxes and FCSRT DTR as dependent variables. Conclusions Baseline plasma MCP-1 levels were associated with longitudinal declines in overall cognitive and episodic memory performance in older adults over a 4-year follow-up. How plasma MCP-1 interacts with Aβ42/40 to determine cognitive decline at different stages of cognitive decline/dementia should be clarified by further research. The MCP-1 association on cognitive decline was strongest in those with amyloid plaques, as measured by blood plasma Aβ42/40. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00940-2.
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Bencivenga L, Strumia M, Rolland Y, Martinez L, Cestac P, Guyonnet S, Andrieu S, Parini A, Lucas A, Vellas B, De Souto Barreto P, Rouch L, Guyonnet S, Carrié I, Brigitte L, Faisant C, Lala F, Delrieu J, Villars H, Combrouze E, Badufle C, Zueras A, Andrieu S, Cantet C, Morin C, Van Kan GA, Dupuy C, Rolland Y, Caillaud C, Ousset PJ, Lala F, Willis S, Belleville S, Gilbert B, Fontaine F, Dartigues JF, Marcet I, Delva F, Foubert A, Cerda S, Marie-Noëlle-Cuffi, Costes C, Rouaud O, Manckoundia P, Quipourt V, Marilier S, Franon E, Bories L, Pader ML, Basset MF, Lapoujade B, Faure V, Tong MLY, Malick-Loiseau C, Cazaban-Campistron E, Desclaux F, Blatge C, Dantoine T, Laubarie-Mouret C, Saulnier I, Clément JP, Picat MA, Bernard-Bourzeix L, Willebois S, Désormais I, Cardinaud N, Bonnefoy M, Livet P, Rebaudet P, Gédéon C, Burdet C, Terracol F, Pesce A, Roth S, Chaillou S, Louchart S, Sudres K, Lebrun N, Barro-Belaygues N, Touchon J, Bennys K, Gabelle A, Romano A, Touati L, Marelli C, Pays C, Robert P, Le Duff F, Gervais C, Gonfrier S, Gasnier Y, Bordes S, Begorre D, Carpuat C, Khales K, Lefebvre JF, Idrissi SME, Skolil P, Salles JP, Dufouil C, Lehéricy S, Chupin M, Mangin JF, Bouhayia A, Allard M, Ricolfi F, Dubois D, Martel MPB, Cotton F, Bonafé A, Chanalet S, Hugon F, Bonneville F, Cognard C, Chollet F, Payoux P, Voisin T, Delrieu J, Peiffer S, Hitzel A, Allard M, Zanca M, Monteil J, Darcourt J, Molinier L, Derumeaux H, Costa N, Perret B, Vinel C, Caspar-Bauguil S, Olivier-Abbal P, Andrieu S, Cantet C, Coley N. Biomarkers of mitochondrial dysfunction and inflammaging in older adults and blood pressure variability. GeroScience 2022; 45:797-809. [PMID: 36454336 PMCID: PMC9886716 DOI: 10.1007/s11357-022-00697-y] [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: 06/27/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
Most physiopathological mechanisms underlying blood pressure variability (BPV) are implicated in aging. Vascular aging is associated with chronic low-grade inflammation occurring in late life, known as "inflammaging" and the hallmark "mitochondrial dysfunction" due to age-related stress. We aimed to determine whether plasma levels of the pleiotropic stress-related mitokine growth/differentiation factor 15 (GDF-15) and two inflammatory biomarkers, interleukin 6 (IL-6) and tumor necrosis factor receptor 1 (TNFR-1), are associated with visit-to-visit BPV in a population of community-dwelling older adults. The study population consisted of 1096 community-dwelling participants [median age 75 (72-78) years; 699 females, 63.7%] aged ≥ 70 years from the MAPT study. Plasma blood sample was collected 12 months after enrolment and BP was assessed up to seven times over a 4-year period. Systolic (SBPV) and diastolic BPV (DBPV) were determined through several indicators taking into account BP change over time, the order of measurements and formulas independent of mean BP levels. Higher values of GDF-15 were significantly associated with increased SBPV (all indicators) after adjustment for relevant covariates [adjusted 1-SD increase in GDF-15: β (SE) = 0.07 (0.04), p < 0.044, for coefficient of variation%]. GDF-15 levels were not associated with DBPV. No significant associations were found between IL-6 and BPV, whereas TNFR1 was only partially related to DBPV. Unlike inflammation biomarkers, higher GDF-15 levels were associated with greater SBPV. Our findings support the age-related process of mitochondrial dysfunction underlying BP instability, suggesting that BPV might be a potential marker of aging.
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Affiliation(s)
- Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Sergio Pansini 5, Napoli, Italy. .,Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.
| | - Mathilde Strumia
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France ,UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France ,UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | | | - Philippe Cestac
- Department of Pharmacy, Toulouse University, Toulouse, France
| | - Sophie Guyonnet
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France ,UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | | | - Angelo Parini
- Institut Des Maladies Métaboliques Et Cardiovasculaires (I2MC), Toulouse, France
| | - Alexandre Lucas
- Institut Des Maladies Métaboliques Et Cardiovasculaires (I2MC), Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France ,UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France ,UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | - Laure Rouch
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France ,UMR INSERM 1295, Université Toulouse III, Toulouse, France
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Leys D, Chollet F, Bousser MG, Mas J. Rapport 22-11. Prise en charge en urgence dans les unités neurovasculaires des personnes ayant un accident vasculaire cérébral. Bulletin de l'Académie Nationale de Médecine 2022. [DOI: 10.1016/j.banm.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bonkhoff AK, Hope T, Bzdok D, Guggisberg AG, Hawe RL, Dukelow SP, Chollet F, Lin DJ, Grefkes C, Bowman H. Recovery after stroke: the severely impaired are a distinct group. J Neurol Neurosurg Psychiatry 2022; 93:369-378. [PMID: 34937750 DOI: 10.1136/jnnp-2021-327211] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Stroke causes different levels of impairment and the degree of recovery varies greatly between patients. The majority of recovery studies are biased towards patients with mild-to-moderate impairments, challenging a unified recovery process framework. Our aim was to develop a statistical framework to analyse recovery patterns in patients with severe and non-severe initial impairment and concurrently investigate whether they recovered differently. METHODS We designed a Bayesian hierarchical model to estimate 3-6 months upper limb Fugl-Meyer (FM) scores after stroke. When focusing on the explanation of recovery patterns, we addressed confounds affecting previous recovery studies and considered patients with FM-initial scores <45 only. We systematically explored different FM-breakpoints between severe/non-severe patients (FM-initial=5-30). In model comparisons, we evaluated whether impairment-level-specific recovery patterns indeed existed. Finally, we estimated the out-of-sample prediction performance for patients across the entire initial impairment range. RESULTS Recovery data was assembled from eight patient cohorts (n=489). Data were best modelled by incorporating two subgroups (breakpoint: FM-initial=10). Both subgroups recovered a comparable constant amount, but with different proportional components: severely affected patients recovered more the smaller their impairment, while non-severely affected patients recovered more the larger their initial impairment. Prediction of 3-6 months outcomes could be done with an R2=63.5% (95% CI=51.4% to 75.5%). CONCLUSIONS Our work highlights the benefit of simultaneously modelling recovery of severely-to-non-severely impaired patients and demonstrates both shared and distinct recovery patterns. Our findings provide evidence that the severe/non-severe subdivision in recovery modelling is not an artefact of previous confounds. The presented out-of-sample prediction performance may serve as benchmark to evaluate promising biomarkers of stroke recovery.
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Affiliation(s)
- Anna K Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Hope
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada.,Mila - Quebec Artificial Intelligence Institute, Montreal, Québec, Canada.,Canadian Institute for Advanced Research (CIFAR), Montreal, Québec, Canada
| | - Adrian G Guggisberg
- Department of Clinical Neurosciences, Hopitaux Universitaires de Geneve Hopital de Beau-Sejour, Geneva, Switzerland
| | - Rachel L Hawe
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - François Chollet
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Grefkes
- Department of Neurology, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Howard Bowman
- School of Psychology, University of Birmingham, Birmingham, UK.,School of Computing, University of Kent, Canterbury, UK
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Nicolet G, Quantin C, Duclos A, Chollet F, Cottenet J, Mercier G. Développement d'un modèle prédictif du risque de réhospitalisation non programmée à partir des données PMSI nationales. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Michel N, Bui-Xuan B, Bapteste L, Rimmele T, Lilot M, Chollet F, Favre H, Duclos A, Michel P. Implementation of an in situ simulation-based training adapted from Morbidity and Mortality conference cases: effect on the occurrence of adverse events-study protocol of a cluster randomised controlled trial. Trials 2022; 23:106. [PMID: 35109900 PMCID: PMC8812171 DOI: 10.1186/s13063-022-06040-2] [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: 04/29/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Morbidity and Mortality conference provides the necessary improvement measures for patient safety. However, they are an underused resource mainly because the conclusions to be drawn from the discussion and their implications for practice are not always well integrated by inpatient care teams. We therefore propose in this study two interventions to optimise their effectiveness: a passive feedback with wide dissemination by e-mail and/or on paper of the results of the Morbidity and Mortality conference to inpatient care teams and an active feedback with in situ inter-professional simulation-training programme in which scenarios will be based on cases studied in Morbidity and Mortality conference. In the present study, we hypothesise that the greatest reduction the occurrence of adverse event will be in the active feedback arm. METHODS A cluster randomised controlled study will be performed at four study sites. The unit of randomisation is wards within the study sites. Fifteen wards will be randomly assigned to passive feedback, active feedback, or a standard MMC (control arm). Passive feedback and active feedback arms will be compared to standard arm in terms of occurrence of adverse events. The trigger tool methodology used to identify adverse events is a retrospective review of inpatient records using "triggers": an adverse event is defined as a patient's stay with at least one positive trigger. DISCUSSION The in situ simulation training based on cases processed in Morbidity and Mortality conference is built according to the main topics identified for the successful implementation of healthcare simulation in patient safety programmes: technical skills, nontechnical skills, assessment, effectiveness, and system probing. The in situ simulation-training programme conducted as part of the study has the potential to improve patient safety during hospitalisation. We therefore expect the greatest reduction in the occurrence of adverse events in patients hospitalised in the active feedback arm. This expected result would have a direct impact on patient safety and would place in situ simulation at the highest level of the Kirkpatrick model. TRIAL REGISTRATION Clinicaltrials.gov NCT02771613. Registered on May 12, 2016. All items from the WHO Trial Registration Data Set can be found within the protocol.
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Affiliation(s)
- Nicolas Michel
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France.
| | - Bernard Bui-Xuan
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France
| | - Lionel Bapteste
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France
| | - Thomas Rimmele
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France.,Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Pi3), Claude Bernard Lyon 1 University-Biomérieux-Hospices Civils of Lyon, Lyon, France
| | - Marc Lilot
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France.,Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France.,Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France
| | | | - Hélène Favre
- Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France
| | - Antoine Duclos
- Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France.,Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Philippe Michel
- Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France.,Quality Safety and Customer Relationship Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Hesper EA 7425, F -, 69003, Lyon, France
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11
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Duclos A, Chollet F, Pascal L, Ormando H, Carty MJ, Polazzi S, Lifante JC. Effect of monitoring surgical outcomes using control charts to reduce major adverse events in patients: cluster randomised trial. BMJ 2020; 371:m3840. [PMID: 33148601 PMCID: PMC7610189 DOI: 10.1136/bmj.m3840] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the effect of introducing prospective monitoring of outcomes using control charts and regular feedback on indicators to surgical teams on major adverse events in patients. DESIGN National, parallel, cluster randomised trial embedding a difference-in-differences analysis. SETTING 40 surgical departments of hospitals across France. PARTICIPANTS 155 362 adults who underwent digestive tract surgery. 20 of the surgical departments were randomised to prospective monitoring of outcomes using control charts with regular feedback on indicators (intervention group) and 20 to usual care only (control group). INTERVENTIONS Prospective monitoring of outcomes using control charts, provided in sets quarterly, with regular feedback on indicators (intervention hospitals). To facilitate implementation of the programme, study champion partnerships were established at each site, comprising a surgeon and another member of the surgical team (surgeon, anaesthetist, or nurse), and were trained to conduct team meetings, display posters in operating rooms, maintain a logbook, and devise an improvement plan. MAIN OUTCOME MEASURES The primary outcome was a composite of major adverse events (inpatient death, intensive care stay, reoperation, and severe complications) within 30 days after surgery. Changes in surgical outcomes were compared before and after implementation of the programme between intervention and control hospitals, with adjustment for patient mix and clustering. RESULTS 75 047 patients were analysed in the intervention hospitals (37 579 before and 37 468 after programme implementation) versus 80 315 in the control hospitals (41 548 and 38 767). After introduction of the control chart, the absolute risk of a major adverse event was reduced by 0.9% (95% confidence interval 0.4% to 1.4%) in intervention compared with control hospitals, corresponding to 114 patients (70 to 280) who needed to receive the intervention to prevent one major adverse event. A significant decrease in major adverse events (adjusted ratio of odds ratios 0.89, 95% confidence interval 0.83 to 0.96), patient death (0.84, 0.71 to 0.99), and intensive care stay (0.85, 0.76 to 0.94) was found in intervention compared with control hospitals. The same trend was observed for reoperation (0.91, 0.82 to 1.00), whereas severe complications remained unchanged (0.96, 0.87 to 1.07). Among the intervention hospitals, the effect size was proportional to the degree of control chart implementation witnessed. Highly compliant hospitals experienced a more important reduction in major adverse events (0.84, 0.77 to 0.92), patient death (0.78, 0.63 to 0.97), intensive care stay (0.76, 0.67 to 0.87), and reoperation (0.84, 0.74 to 0.96). CONCLUSIONS The implementation of control charts with feedback on indicators to surgical teams was associated with concomitant reductions in major adverse events in patients. Understanding variations in surgical outcomes and how to provide safe surgery is imperative for improvements. TRIAL REGISTRATION ClinicalTrials.gov NCT02569450.
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Affiliation(s)
- Antoine Duclos
- Health Services and Performance Research lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Léa Pascal
- Health Data Department, Hospices Civils de Lyon, France
| | - Hector Ormando
- Human Resource Department, EM Lyon Business School, France
| | - Matthew J Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stéphanie Polazzi
- Health Services and Performance Research lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Jean-Christophe Lifante
- Health Services and Performance Research lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, France
- Department of Digestive and Endocrine Surgery, Hospices Civils de Lyon, France
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12
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Raposo N, Planton M, Siegfried A, Calviere L, Payoux P, Albucher JF, Viguier A, Delisle MB, Uro-Coste E, Chollet F, Bonneville F, Olivot JM, Pariente J. Amyloid-β transmission through cardiac surgery using cadaveric dura mater patch. J Neurol Neurosurg Psychiatry 2020; 91:440-441. [PMID: 31959705 DOI: 10.1136/jnnp-2019-321927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/15/2019] [Accepted: 12/28/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France .,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
| | - Mélanie Planton
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
| | - Aurore Siegfried
- Department of Pathology, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,INSERM U1037, Cancer Research Centre of Toulouse (CRCT), Toulouse, France
| | - Lionel Calviere
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
| | - Pierre Payoux
- Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France.,Department of Nuclear Medicine, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France
| | - Jean-François Albucher
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
| | - Alain Viguier
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
| | - Marie-Bernadette Delisle
- Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France.,Department of Pathology, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France
| | - Emmanuelle Uro-Coste
- Department of Pathology, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,INSERM U1037, Cancer Research Centre of Toulouse (CRCT), Toulouse, France
| | - François Chollet
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
| | - Fabrice Bonneville
- Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France.,Department of Neuroradiology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France
| | - Jean-Marc Olivot
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
| | - Jérémie Pariente
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), Toulouse, France.,Toulouse NeuroImaging Centre, Université de Toulouse, Inserm, UPS, France
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13
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Duclos A, Chollet F, Pascal L, Polazzi S, Lifante JC. Suivi des résultats chirurgicaux par carte de contrôle pour réduire la morbi-mortalité des patients. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Cirillo C, Brihmat N, Castel-Lacanal E, Le Friec A, Barbieux-Guillot M, Raposo N, Pariente J, Viguier A, Simonetta-Moreau M, Albucher JF, Olivot JM, Desmoulin F, Marque P, Chollet F, Loubinoux I. Post-stroke remodeling processes in animal models and humans. J Cereb Blood Flow Metab 2020; 40:3-22. [PMID: 31645178 PMCID: PMC6928555 DOI: 10.1177/0271678x19882788] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 02/14/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 01/05/2023]
Abstract
After cerebral ischemia, events like neural plasticity and tissue reorganization intervene in lesioned and non-lesioned areas of the brain. These processes are tightly related to functional improvement and successful rehabilitation in patients. Plastic remodeling in the brain is associated with limited spontaneous functional recovery in patients. Improvement depends on the initial deficit, size, nature and localization of the infarction, together with the sex and age of the patient, all of them affecting the favorable outcome of reorganization and repair of damaged areas. A better understanding of cerebral plasticity is pivotal to design effective therapeutic strategies. Experimental models and clinical studies have fueled the current understanding of the cellular and molecular processes responsible for plastic remodeling. In this review, we describe the known mechanisms, in patients and animal models, underlying cerebral reorganization and contributing to functional recovery after ischemic stroke. We also discuss the manipulations and therapies that can stimulate neural plasticity. We finally explore a new topic in the field of ischemic stroke pathophysiology, namely the brain-gut axis.
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Affiliation(s)
- Carla Cirillo
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Nabila Brihmat
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Evelyne Castel-Lacanal
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Alice Le Friec
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | | | - Nicolas Raposo
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Jérémie Pariente
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Alain Viguier
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Marion Simonetta-Moreau
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Jean-François Albucher
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Jean-Marc Olivot
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Franck Desmoulin
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Philippe Marque
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - François Chollet
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Isabelle Loubinoux
- Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
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15
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Azzopardi CL, Chollet F, Manceau JF, Boireau W. Analyte capture in an array of functionalized droplets for a regenerable biosensor. Biomicrofluidics 2019; 13:054105. [PMID: 31592056 PMCID: PMC6768797 DOI: 10.1063/1.5115494] [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] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
We describe in this work an advanced microfluidic chip for the capture of bioanalyte on the surface of droplets arranged in a dense array. We show the procedure for generating, functionalizing, and arranging the droplets inside the device for capturing a specific bioanalyte. Then, we demonstrate the capacity of the array to capture analyte from a cross-flowing liquid, using a biotin/streptavidin model. The paper also proposes to use the droplets array, after integration with acoustic detection, as a regenerable detection interface for bioanalyte sensing. We model the arrangement of droplet in dense array and show that they present a larger effective capture surface and shorter capture distance than standard flat surface biosensor of the same footprint. As the droplets can be easily evacuated and replaced inside the device analysis chamber, the proposed biosensor would allow biointerface regeneration and chain measurement without dismounting the device.
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Affiliation(s)
- C-L Azzopardi
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comté CNRS, 15B av. des Montboucons, 25030 Besançon cedex, France
| | - F Chollet
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comté CNRS, 15B av. des Montboucons, 25030 Besançon cedex, France
| | - J-F Manceau
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comté CNRS, 15B av. des Montboucons, 25030 Besançon cedex, France
| | - W Boireau
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comté CNRS, 15B av. des Montboucons, 25030 Besançon cedex, France
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16
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Raposo N, Planton M, Payoux P, Péran P, Albucher JF, Calviere L, Viguier A, Rousseau V, Hitzel A, Chollet F, Olivot JM, Bonneville F, Pariente J. Enlarged perivascular spaces and florbetapir uptake in patients with intracerebral hemorrhage. Eur J Nucl Med Mol Imaging 2019; 46:2339-2347. [PMID: 31359110 DOI: 10.1007/s00259-019-04441-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/03/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Enlarged perivascular spaces in the centrum semiovale (CSO-EPVS) have been linked to cerebral amyloid angiopathy (CAA). To get insight into the underlying mechanisms of this association, we investigated the relationship between amyloid-β deposition assessed by 18F-florbetapir PET and CSO-EPVS in patients with acute intracerebral hemorrhage (ICH). METHODS We prospectively enrolled 18 patients with lobar ICH (suggesting CAA) and 20 with deep ICH (suggesting hypertensive angiopathy), who underwent brain MRI and 18F-florbetapir PET. EPVS were assessed on MRI using a validated 4-point visual rating scale in the centrum semiovale and the basal ganglia (BG-EPVS). PET images were visually assessed, blind to clinical and MRI data. We evaluated the association between florbetapir PET positivity and high degree (score> 2) of CSO-EPVS and BG-EPVS. RESULTS High CSO-EPVS degree was more common in patients with lobar ICH than deep ICH (55.6% vs. 20.0%; p = 0.02). Eight (57.1%) patients with high CSO-EPVS degree had a positive florbetapir PET compared with 4 (16.7%) with low CSO-EPVS degree (p = 0.01). In contrast, prevalence of florbetapir PET positivity was similar between patients with high vs. low BG-EPVS. In multivariable analysis adjusted for age, hypertension, and MRI markers of CAA, florbetapir PET positivity (odds ratio (OR) 6.44, 95% confidence interval (CI) 1.32-38.93; p = 0.03) was independently associated with high CSO-EPVS degree. CONCLUSIONS Among patients with spontaneous ICH, high degree of CSO-EPVS but not BG-EPVS is associated with amyloid PET positivity. The findings provide further evidence that CSO-EPVS are markers of vascular amyloid burden that may be useful in diagnosing CAA.
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Affiliation(s)
- Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France. .,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
| | - Mélanie Planton
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Pierre Payoux
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Nuclear Medicine, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean François Albucher
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Lionel Calviere
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Alain Viguier
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Vanessa Rousseau
- Department of Epidemiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne Hitzel
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Nuclear Medicine, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Chollet
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean Marc Olivot
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Fabrice Bonneville
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Neuroradiology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jérémie Pariente
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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17
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Viguier A, Raposo N, Patsoura S, Calviere L, Albucher JF, Ruidavets JB, Chollet F, Cognard C, Olivot JM, Bonneville F. Subarachnoid and Subdural Hemorrhages in Lobar Intracerebral Hemorrhage Associated With Cerebral Amyloid Angiopathy. Stroke 2019; 50:1567-1569. [PMID: 31136281 DOI: 10.1161/strokeaha.119.024837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Identifying underlying cerebral amyloid angiopathy (CAA) in patients with intracerebral hemorrhage (ICH) has important clinical implication. Convexity subarachnoid hemorrhage (cSAH) and subdural hemorrhage (SDH) are computed tomography features of CAA-related ICH. We explored whether cSAH and SDH could be additional magnetic resonance imaging markers of CAA in lobar ICH survivors. Methods- We analyzed data from consecutive patients with acute lobar ICH associated with CAA (CAA-ICH) or not attributed to CAA (non-CAA-ICH). Magnetic resonance imaging scans were analyzed for cSAH, SDH, and markers of small vessel disease. The associations of cSAH and SDH with the diagnosis of probable CAA based on the modified Boston criteria were explored using multivariable models. Results- We included 165 patients with acute lobar ICH (mean age 70±13 years): 72 patients with CAA-ICH and 93 with non-CAA-ICH. Patients with CAA-ICH had a higher prevalence of cSAH (73.6% versus 39.8%; P<0.001) and SDH (37.5% versus 21.5%; P=0.02) than non-CAA-ICH. In multivariate logistic regression analysis, the presence of cSAH was independently associated with CAA-ICH (odds ratio, 2.97; 95% CI, 1.26-6.99; P=0.013), whereas there was no association between SDH and CAA-ICH. Conclusions- Among survivors of acute lobar ICH, the presence of cSAH is associated with the magnetic resonance imaging-based diagnosis of CAA. Further studies should investigate whether cSAH help improve the sensitivity of magnetic resonance imaging for in vivo diagnosis of CAA.
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Affiliation(s)
- Alain Viguier
- From the Department of Neurology (A.V., N.R., L.C., J.F.A., F.C., J.M.O.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (A.V., N.R., L.C., J.F.A., F.C., J.M.O., F.B.)
| | - Nicolas Raposo
- From the Department of Neurology (A.V., N.R., L.C., J.F.A., F.C., J.M.O.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (A.V., N.R., L.C., J.F.A., F.C., J.M.O., F.B.)
| | - Sofia Patsoura
- Department of Neuroradiology (S.P., C.C., F.B.), Centre Hospitalier Universitaire de Toulouse, France
| | - Lionel Calviere
- From the Department of Neurology (A.V., N.R., L.C., J.F.A., F.C., J.M.O.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (A.V., N.R., L.C., J.F.A., F.C., J.M.O., F.B.)
| | - Jean François Albucher
- From the Department of Neurology (A.V., N.R., L.C., J.F.A., F.C., J.M.O.), Centre Hospitalier Universitaire de Toulouse, France
| | - Jean Bernard Ruidavets
- Hôpital Pierre-Paul Riquet, and Department of Epidemiology (J.B.R.), Centre Hospitalier Universitaire de Toulouse, France
| | - François Chollet
- From the Department of Neurology (A.V., N.R., L.C., J.F.A., F.C., J.M.O.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (A.V., N.R., L.C., J.F.A., F.C., J.M.O., F.B.)
| | - Christophe Cognard
- Department of Neuroradiology (S.P., C.C., F.B.), Centre Hospitalier Universitaire de Toulouse, France
| | - Jean Marc Olivot
- From the Department of Neurology (A.V., N.R., L.C., J.F.A., F.C., J.M.O.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (A.V., N.R., L.C., J.F.A., F.C., J.M.O., F.B.)
| | - Fabrice Bonneville
- Department of Neuroradiology (S.P., C.C., F.B.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France (A.V., N.R., L.C., J.F.A., F.C., J.M.O., F.B.)
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Pascal L, Polazzi S, Piriou V, Chollet F, Lifante JC, Duclos A. Réduction des durées de séjour à l’hôpital au cours du temps et risque de ré-hospitalisation pour évènements indésirables graves après chirurgie. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Raposo N, Albucher JF, Rousseau V, Acket B, Chollet F, Olivot JM. ED Referral Dramatically Reduces Delays of Initial Evaluation in a French TIA Clinic. Front Neurol 2018; 9:914. [PMID: 30416483 PMCID: PMC6212543 DOI: 10.3389/fneur.2018.00914] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background: The risk of recurrent brain infarction (BI) is high within the first hours after a transient ischemic attack (TIA). Emergent, specialized, and tailored patient management in a TIA program reduces the risk of recurrent BI after TIA by 80%. New antithrombotic strategies have been successfully tested within 12 h after TIA onset. We aim to investigate the factors associated with a delay of more than 12 h from TIA onset to evaluation in our TIA clinic. Methods: In consecutive patients evaluated in our TIA clinic from 01/2012 to 11/2013, we prospectively collected delays from onset to arrival, baseline characteristics, discharge diagnosis and recurrent BI at 1 week. Referring pathways were dichotomized between office-based physicians (OBP) and emergency departments (ED). Univariate and multivariate logistic regression were performed. Results: 354 patients were evaluated. Mean (+/– SD) age was 61 years (+/−18). Median (IQR) ABCD2 score was 3 (2–4). Median (IQR) delay from onset to evaluation was 8 h (4–48). Overall, 185 (52%) were referred by OBP vs. 169 (48%) by ED. Evaluation was initiated within 12 h among 201 (57%) patients. After logistic regression, OBP referral was by comparison with ED the only independent factor associated with an evaluation delay >12 h (OR 5.7, 95% CI: 3.5–9.3, p < 0.0001). Conclusion: Our results suggest that preliminary assessment by OBP may increase the delay to initiate the emergent evaluation of TIA patients. Promoting direct admission to TIA clinics through ED may be an efficient alternative for high risk TIAs.
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Affiliation(s)
- Nicolas Raposo
- Department of Neurology, Toulouse University Medical Center, Toulouse, France.,Toulouse University Neuro Imaging Center, UMR 1214, Toulouse, France.,Toulouse University Medical Center, Clinical Investigation Center, Toulouse, France
| | - Jean François Albucher
- Department of Neurology, Toulouse University Medical Center, Toulouse, France.,Toulouse University Neuro Imaging Center, UMR 1214, Toulouse, France.,Toulouse University Medical Center, Clinical Investigation Center, Toulouse, France
| | - Vanessa Rousseau
- Toulouse University Medical Center, Clinical Investigation Center, Toulouse, France
| | - Blandine Acket
- Department of Neurology, Toulouse University Medical Center, Toulouse, France.,Toulouse University Neuro Imaging Center, UMR 1214, Toulouse, France
| | - François Chollet
- Department of Neurology, Toulouse University Medical Center, Toulouse, France.,Toulouse University Neuro Imaging Center, UMR 1214, Toulouse, France
| | - Jean Marc Olivot
- Department of Neurology, Toulouse University Medical Center, Toulouse, France.,Toulouse University Neuro Imaging Center, UMR 1214, Toulouse, France.,Toulouse University Medical Center, Clinical Investigation Center, Toulouse, France
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20
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Haviari S, Chollet F, Polazzi S, Payet C, Beauveil A, Colin C, Duclos A. Effect of data validation audit on hospital mortality ranking and pay for performance. BMJ Qual Saf 2018; 28:459-467. [DOI: 10.1136/bmjqs-2018-008039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/27/2018] [Accepted: 10/05/2018] [Indexed: 01/10/2023]
Abstract
BackgroundQuality improvement and epidemiology studies often rely on database codes to measure performance or impact of adjusted risk factors, but how validity issues can bias those estimates is seldom quantified.ObjectivesTo evaluate whether and how much interhospital administrative coding variations influence a typical performance measure (adjusted mortality) and potential incentives based on it.DesignNational cross-sectional study comparing hospital mortality ranking and simulated pay-for-performance incentives before/after recoding discharge abstracts using medical records.SettingTwenty-four public and private hospitals located in FranceParticipantsAll inpatient stays from the 78 deadliest diagnosis-related groups over 1 year.InterventionsElixhauser and Charlson comorbidities were derived, and mortality ratios were computed for each hospital. Thirty random stays per hospital were then recoded by two central reviewers and used in a Bayesian hierarchical model to estimate hospital-specific and comorbidity-specific predictive values. Simulations then estimated shifts in adjusted mortality and proportion of incentives that would be unfairly distributed by a typical pay-for-performance programme in this situation.Main outcome measuresPositive and negative predictive values of routine coding of comorbidities in hospital databases, variations in hospitals’ mortality league table and proportion of unfair incentives.ResultsA total of 70 402 hospital discharge abstracts were analysed, of which 715 were recoded from full medical records. Hospital comorbidity-level positive predictive values ranged from 64.4% to 96.4% and negative ones from 88.0% to 99.9%. Using Elixhauser comorbidities for adjustment, 70.3% of hospitals changed position in the mortality league table after correction, which added up to a mean 6.5% (SD 3.6) of a total pay-for-performance budget being allocated to the wrong hospitals. Using Charlson, 61.5% of hospitals changed position, with 7.3% (SD 4.0) budget misallocation.ConclusionsVariations in administrative data coding can bias mortality comparisons and budget allocation across hospitals. Such heterogeneity in data validity may be corrected using a centralised coding strategy from a random sample of observations.
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Chollet F, Rigal J, Marque P, Barbieux-Guillot M, Raposo N, Fabry V, Albucher JF, Pariente J, Loubinoux I. Serotonin Selective Reuptake Inhibitors (SSRIs) and Stroke. Curr Neurol Neurosci Rep 2018; 18:100. [PMID: 30353288 DOI: 10.1007/s11910-018-0904-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The interest in SSRIs after stroke has increased in the past few years, with better knowledge of post-stroke depression and with the demonstrated capacity of some SSRIs to act on the functional recovery of non-depressed subjects. RECENT FINDINGS Arguments for the action of SSRIs in favour of post-stroke neurological function recovery have improved through new elements: basic science and preclinical data, positive clinical trials and repeated series of stroke patient meta-analysis, and confirmation of favourable safety conditions in post-stroke patients. Global coherence is appearing, showing that SSRIs improve stroke recovery in non-depressed patients when given for 3 months after the stroke, with highly favourable safety conditions and a favourable benefit/risk ratio. Large series are still needed.
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Affiliation(s)
- F Chollet
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. .,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France.
| | - J Rigal
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - P Marque
- Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France.,Rehabilitation Department, Hôpital de Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - M Barbieux-Guillot
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - N Raposo
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - V Fabry
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J F Albucher
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - J Pariente
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - I Loubinoux
- Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
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Payet C, Polazzi S, Sanchez S, Chollet F, Rabilloud M, Duclos A. Lien entre l’évolution du volume de procédures chirurgicales réalisées par les hôpitaux et la survenue de complications. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Haviari S, Chollet F, Polazzi S, Beauveil A, Colin C, Duclos A. Influence du codage des comorbidités sur le paiement à la performance des hôpitaux. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.101] [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: 10/17/2022] Open
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Raposo N, Calviere L, Cazzola V, Planton M, Patsoura S, Wargny M, Albucher JF, Sommet A, Olivot JM, Chollet F, Pariente J, Bonneville F, Viguier A. Cortical superficial siderosis and acute convexity subarachnoid hemorrhage in cerebral amyloid angiopathy. Eur J Neurol 2017; 25:253-259. [PMID: 29053885 DOI: 10.1111/ene.13484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Acute convexity subarachnoid hemorrhage (cSAH) and cortical superficial siderosis (cSS) are neuroimaging markers of cerebral amyloid angiopathy (CAA) that may arise through similar mechanisms. The prevalence of cSS in patients with CAA presenting with acute cSAH versus lobar intracerebral hemorrhage (ICH) was compared and the physiopathology of cSS was explored by examining neuroimaging associations. METHODS Data from 116 consecutive patients with probable CAA (mean age, 77.4 ± 7.3 years) presenting with acute cSAH (n = 45) or acute lobar ICH (n = 71) were retrospectively analyzed. Magnetic resonance imaging scans were analyzed for cSS and other imaging markers. The two groups' clinical and imaging data were compared and the associations between cSAH and cSS were explored. RESULTS Patients with cSAH presented mostly with transient focal neurological episodes. The prevalence of cSS was higher amongst cSAH patients than amongst ICH patients (88.9% vs. 57.7%; P < 0.001). In multivariable logistic regression analysis, focal [odds ratio (OR) 6.73; 95% confidence interval (CI) 1.75-25.81; P = 0.005] and disseminated (OR 11.68; 95% CI 3.55-38.35; P < 0.001) cSS were independently associated with acute cSAH, whereas older age (OR 0.93; 95% CI 0.87-0.99; P = 0.025) and chronic lobar ICH count (OR 0.45; 95% CI 0.25-0.80; P = 0.007) were associated with acute lobar ICH. CONCLUSIONS Amongst patients with CAA, cSS is independently associated with acute cSAH. These findings suggest that cSAH may be involved in the pathogenesis of the cSS observed in CAA. Longitudinal studies are warranted to assess this potential causal relationship.
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Affiliation(s)
- N Raposo
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - L Calviere
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - V Cazzola
- Neuroradiology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - M Planton
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - S Patsoura
- Neuroradiology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - M Wargny
- Epidemiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J F Albucher
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - A Sommet
- Epidemiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Department of Clinical Pharmacology, CIC1436, USMR, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J M Olivot
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - F Chollet
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - J Pariente
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - F Bonneville
- Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France.,Neuroradiology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - A Viguier
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France
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Raposo N, Planton M, Péran P, Payoux P, Bonneville F, Lyoubi A, Albucher JF, Acket B, Salabert AS, Olivot JM, Hitzel A, Chollet F, Pariente J. Florbetapir imaging in cerebral amyloid angiopathy-related hemorrhages. Neurology 2017; 89:697-704. [PMID: 28724587 DOI: 10.1212/wnl.0000000000004228] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/24/2017] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To assess whether 18F-florbetapir, a PET amyloid tracer, could bind vascular amyloid in cerebral amyloid angiopathy (CAA) by comparing cortical florbetapir retention during the acute phase between patients with CAA-related lobar intracerebral hemorrhage (ICH) and patients with hypertension-related deep ICH. METHODS Patients with acute CAA-related lobar ICH were prospectively enrolled and compared with patients with deep ICH. 18F-florbetapir PET, brain MRI, and APOE genotype were obtained for all participants. Cortical florbetapir standard uptake value ratio (SUVr) was calculated with the whole cerebellum used as a reference. Patients with CAA and those with deep ICH were compared for mean cortical florbetapir SUVr values. RESULTS Fifteen patients with acute lobar ICH fulfilling the modified Boston criteria for probable CAA (mean age = 67 ± 12 years) and 18 patients with acute deep ICH (mean age = 63 ± 11 years) were enrolled. Mean global cortical florbetapir SUVr was significantly higher among patients with CAA-related ICH than among patients with deep ICH (1.27 ± 0.12 vs 1.12 ± 0.12, p = 0.001). Cortical florbetapir SUVr differentiated patients with CAA-ICH from those with deep ICH (area under the curve = 0.811; 95% confidence interval [CI] 0.642-0.980) with a sensitivity of 0.733 (95% CI 0.475-0.893) and a specificity of 0.833 (95% CI 0.598-0.948). CONCLUSIONS Cortical florbetapir uptake is increased in patients with CAA-related ICH relative to those with deep ICH. Although 18F-florbetapir PET can label vascular β-amyloid and might serve as an outcome marker in future clinical trials, its diagnostic value in acute CAA-related ICH seems limited in clinical practice.
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Affiliation(s)
- Nicolas Raposo
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France.
| | - Mélanie Planton
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Patrice Péran
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Pierre Payoux
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Fabrice Bonneville
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Aicha Lyoubi
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Jean François Albucher
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Blandine Acket
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Anne Sophie Salabert
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Jean Marc Olivot
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Anne Hitzel
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - François Chollet
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Jérémie Pariente
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
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Colin C, Chollet F, Beauveil A, Buronfosse A, Saïd M, Duclos A. Étude de validité du ratio normalisé de mortalité hospitalière (RNMH). Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chollet F, Colin C, Beauveil A, Herquelot E, Polazzi S, Duclos A. Étude de validité des index de comorbidité de Charlson et d’Elixhauser. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Calviere L, Raposo N, Cazolla V, Pastoura S, Albucher JF, Ruidavets JB, Olivot JM, Chollet F, Larrue V, Cognard C, Bonneville F, Viguier A. Abstract WMP95: Cerebral Amyloid Angiopathy Patients With Convexity Subarachnoid Hemorrhage Present Higher Risk of Subsequent Hemorrhage Than Those With Lobar Intracranial Hemorrhage. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wmp95] [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] [Indexed: 11/16/2022]
Abstract
Background:
Acute convexity subarachnoid hemorrhage (cSAH) is increasingly recognized as a marker of cerebral amyloid angiopathy (CAA). Little is known about the risk of subsequent hemorrhage in such CAA presentation, whereas CAA-related lobar intracranial hemorrhage (ICH) is associated with a high risk of recurrence. The aim of this study was to compare clinical outcome among patients with an acute CAA related- cSAH to those with an acute CAA-related lobar ICH.
Hypothesis:
We hypothesized that the risk of subsequent hemorrhage is different between patients with acute cSAH and lobar ICH related to CAA.
Methods:
We retrospectively reviewed the clinical outcomes (death, subsequent transient focal neurological episodes (TFNE), rates of ICH and acute cSAH) of 45 consecutive patients (75 ± 7 years) with an acute cSAH related to probable CAA compared to 70 consecutive patients (78 ± 7 years) with an acute lobar ICH meeting the Boston criteria for probable CAA.
Results:
cSAH-patients presented essentially with TFNE (84.4% vs 0%; p<0.001) whereas ICH-patients had a persistent neurological deficit (98.6% vs 15.6%; p<0.001). Five patients with lobar ICH died in the first days. Thirty nine cSAH-patients and 60 lobar ICH-patients had available follow-up data. The mean time of follow-up (± SD) was 364 ± 358 days. Mortality did not differ between cSAH-patients and ICH-patients who survived (10.2 % vs 16.7%; p = 0.38). Patients with cSAH had a higher rate of TFNE (48.7 % vs 0 %; p<0.001) and acute cSAH recurrence (20.5 % vs 1.7 %; p = 0.002). In the other hand, 20.5 % of cSAH-patients presented a subsequent ICH, not different from patients with acute ICH (15.0 %; p = 0.45).
Conclusions:
In the context of CAA, patients with acute cSAH present more clinical recurrences than lobar ICH-patients, due to higher risk of subsequent TFNE and acute cSAH. Although the clinical presentation of cSAH-patients may appear benign, their outcome regarding the risk of incident ICH and mortality, does not seem different from CAA-related lobar ICH survivors.
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Raposo N, Calviere L, Cazzola V, Pastoura S, Albucher JF, Ruidavets JB, Olivot JM, Chollet F, Larrue V, Cognard C, Bonneville F, Viguier A. Abstract WMP93: Cortical Superficial Siderosis in Cerebral Amyloid Angiopathy: Higher Prevalence Among Convexity Subarachnoid Hemorrhage Than Among Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wmp93] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Cerebral amyloid angiopathy (CAA) is a major cause of both lobar intracerebral hemorrhage (ICH) and cerebral microbleeds (CMB), especially in the elderly. Recently, acute convexity subarachnoid hemorrhage (cSAH) and cortical superficial siderosis (cSS) has been identified as markers of CAA. Although the clinical feature and the increased risk of future lobar ICH of cSS is well established, little is known about the specific pattern of CAA-related cSAH.
Hypothesis:
We hypothesized that clinical and imaging characteristics of CAA-related cSAH differ from CAA-related lobar ICH.
Methods:
We retrospectively analyzed clinical and MRI data of a monocentric cohort of 45 consecutive patients with an acute cSAH related to probable CAA and a comparison group of 70 consecutive patients presenting with an acute lobar ICH meeting Boston criteria for probable CAA.
Results:
cSAH patients were younger than ICH patients (mean age +/-SD: 75 +/-7 vs 78 +/-7; p=0.046). Transient focal neurological episodes (TFNE) were common among cSAH patients (84.4% vs 0%; p<0.001). Persistent focal neurological deficits were frequent among ICH patients (15.6% vs 98.6%; p<0.001). Prevalence of cSS was significantly higher among cSAH patients than among ICH patients (88.9% vs 60%; p<0.001) especially disseminated (66.7% vs 37.1%; p=0.002) and bilateral cSS (48.9% vs 28.6%; p=0.027). Number of lobar macrobleeds (median number [IQR]: 0 [0-1] vs 1[1-2]; p=0.07) and lobar CMB (median number [IQR]: 3 [1-6] vs 6 [2-14.75]; p=0.405) did not differ between the two groups.
Conclusions:
In CAA, patients presenting with cSAH are characterized by a younger age, TFNE as presenting symptoms and a higher prevalence of cSS than those presenting with Lobar ICH. These findings suggest that restricted hemorrhage into the subarachnoid space may play a crucial role in cSS physiopathology.
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Affiliation(s)
- Nicolas Raposo
- Neurology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Lionel Calviere
- Neurology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Vanessa Cazzola
- Neuroradilogy, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Sofia Pastoura
- Neuroradiology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Jean François Albucher
- Neurology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | | | - Jean Marc Olivot
- Neurology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - François Chollet
- Neurology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Vincent Larrue
- Neurology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Christophe Cognard
- Neuroradiology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Fabrice Bonneville
- Neuroradiology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
| | - Alain Viguier
- Neurology, Hôpital Pierre-Paul Riquet, Cntr Hospier Universitaire de Toulouse, Toulouse, France
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Bonnet L, Raposo N, Blot-Souletie N, Faruch Bilfeld M, Chollet F, Mazière J, Olivot JM, Albucher JF. Stroke Caused by a Pulmonary Vein Thrombosis Revealing a Metastatic Choriocarcinoma. Circulation 2015; 131:2093-4. [DOI: 10.1161/circulationaha.114.011429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Louise Bonnet
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
| | - Nicolas Raposo
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
| | - Nathalie Blot-Souletie
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
| | - Marie Faruch Bilfeld
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
| | - François Chollet
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
| | - Julien Mazière
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
| | - Jean-Marc Olivot
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
| | - Jean-François Albucher
- From Stroke Unit, Department of Neurology, Besancon University Hospital, France (L.B.); Stroke Unit, Department of Neurology (N.R., F.C., J.-M.O., J.-F.A.), Department of Cardiology (N.B.-S.), and Department of Radiology (M.F.-B.), Purpan University Hospital, Toulouse, France; and Department of Pneumology, Larrey University Hospital, Toulouse, France (J.M.)
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Laplace N, Chollet F, Lifante JC, Peix JL, Colin C, Duclos A. Validité des indicateurs PMSI pour évaluer les résultats de la chirurgie thyroïdienne (Étude CATHY). Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.01.032] [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: 10/23/2022] Open
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Sanchez S, Payet C, Lifante JC, Polazzi S, Chollet F, Duclos A. Résultat des prises en charge chirurgicales urgentes réalisées en hiver en zone montagneuse. Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sattler V, Acket B, Raposo N, Albucher JF, Thalamas C, Loubinoux I, Chollet F, Simonetta-Moreau M. Anodal tDCS Combined With Radial Nerve Stimulation Promotes Hand Motor Recovery in the Acute Phase After Ischemic Stroke. Neurorehabil Neural Repair 2015; 29:743-54. [DOI: 10.1177/1545968314565465] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Objective. The question of the best therapeutic window in which noninvasive brain stimulation (NIBS) could potentiate the plastic changes for motor recovery after a stroke is still unresolved. Most of the previous NIBS studies included patients in the chronic phase of recovery and very few in the subacute or acute phase. We investigated the effect of transcranial direct current stimulation (tDCS) combined with repetitive peripheral nerve stimulation (rPNS) on the time course of motor recovery in the acute phase after a stroke. Methods. Twenty patients enrolled within the first few days after a stroke were randomized in 2 parallel groups: one receiving 5 consecutive daily sessions of anodal tDCS over the ipsilesional motor cortex in association with rPNS and the other receiving the same rPNS combined with sham tDCS. Motor performance (primary endpoint: Jebsen and Taylor Hand Function Test [JHFT]) and transcranial magnetic stimulation cortical excitability measures were obtained at baseline (D1), at the end of the treatment (D5), and at 2 and 4 weeks’ follow-up (D15 and D30). Results. The time course of motor recovery of the 2 groups of patients was different and positively influenced by the intervention (Group × Time interaction P = .01). The amount of improvement on the JHFT was greater at D15 and D30 in the anodal tDCS group than in the sham group. Conclusion. These results show that early cortical neuromodulation with anodal tDCS combined with rPNS can promote motor hand recovery and that the benefit is still present 1 month after the stroke.
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Affiliation(s)
- Virginie Sattler
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
- Université de Toulouse, Toulouse, France
| | - Blandine Acket
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
- Université de Toulouse, Toulouse, France
| | - Nicolas Raposo
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
| | - Jean-François Albucher
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
| | - Claire Thalamas
- Centre d’Investigation Clinique, CHU Purpan, Toulouse, France
| | - Isabelle Loubinoux
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
| | - François Chollet
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
- Université de Toulouse, Toulouse, France
| | - Marion Simonetta-Moreau
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
- Université de Toulouse, Toulouse, France
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Chollet F, Tardy J, Albucher JF, Raposo N, Acket B, Sattler V, Pariente J, Loubinoux I. Monoaminergic drugs for motor recovery after ischemic stroke. Ann Phys Rehabil Med 2014; 57:509-519. [DOI: 10.1016/j.rehab.2014.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 11/26/2022]
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Saint-Aubert L, Sagot C, Wallon D, Hannequin D, Payoux P, Nemmi F, Bezy C, Chauveau N, Campion D, Puel M, Chollet F, Pariente J. A Case of Logopenic Primary Progressive Aphasia with C9ORF72 Expansion and Cortical Florbetapir Binding. ACTA ACUST UNITED AC 2014; 42:413-20. [DOI: 10.3233/jad-140222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Laure Saint-Aubert
- Inserm, imagerie cérébrale et handicaps neurologiques, UMR 825; F-31059, Toulouse, France
- Université de Toulouse, UPS, imagerie cérébrale et handicaps neurologiques, UMR 825; CHU Purpan, Place du Dr Baylac, F-31059, Toulouse, Cedex 9, France
| | - Catherine Sagot
- Service de medecine geriatrique, CHU Pitié Salpêtrière, Paris, France
| | - David Wallon
- INSERM U1079, Université de Rouen, Institut de Recherche et d'Innovation Biomédicale, Rouen, France
- CNR-MAJ, Rouen University Hospital, Rouen, France
| | - Didier Hannequin
- INSERM U1079, Université de Rouen, Institut de Recherche et d'Innovation Biomédicale, Rouen, France
- CNR-MAJ, Rouen University Hospital, Rouen, France
| | - Pierre Payoux
- Inserm, imagerie cérébrale et handicaps neurologiques, UMR 825; F-31059, Toulouse, France
- Université de Toulouse, UPS, imagerie cérébrale et handicaps neurologiques, UMR 825; CHU Purpan, Place du Dr Baylac, F-31059, Toulouse, Cedex 9, France
- Service de Médecine Nucléaire, Pôle Imagerie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Federico Nemmi
- Inserm, imagerie cérébrale et handicaps neurologiques, UMR 825; F-31059, Toulouse, France
- Université de Toulouse, UPS, imagerie cérébrale et handicaps neurologiques, UMR 825; CHU Purpan, Place du Dr Baylac, F-31059, Toulouse, Cedex 9, France
| | - Catherine Bezy
- Service de neurologie, pôle neurosciences, Centre Hospitalier Universitaire de Toulouse, CHU Purpan, Place du Dr Baylac, Toulouse, France
| | - Nicolas Chauveau
- Inserm, imagerie cérébrale et handicaps neurologiques, UMR 825; F-31059, Toulouse, France
- Université de Toulouse, UPS, imagerie cérébrale et handicaps neurologiques, UMR 825; CHU Purpan, Place du Dr Baylac, F-31059, Toulouse, Cedex 9, France
| | - Dominique Campion
- INSERM U1079, Université de Rouen, Institut de Recherche et d'Innovation Biomédicale, Rouen, France
- CNR-MAJ, Rouen University Hospital, Rouen, France
| | - Michèle Puel
- Inserm, imagerie cérébrale et handicaps neurologiques, UMR 825; F-31059, Toulouse, France
- Université de Toulouse, UPS, imagerie cérébrale et handicaps neurologiques, UMR 825; CHU Purpan, Place du Dr Baylac, F-31059, Toulouse, Cedex 9, France
- Service de neurologie, pôle neurosciences, Centre Hospitalier Universitaire de Toulouse, CHU Purpan, Place du Dr Baylac, Toulouse, France
| | - François Chollet
- Inserm, imagerie cérébrale et handicaps neurologiques, UMR 825; F-31059, Toulouse, France
- Université de Toulouse, UPS, imagerie cérébrale et handicaps neurologiques, UMR 825; CHU Purpan, Place du Dr Baylac, F-31059, Toulouse, Cedex 9, France
- Service de neurologie, pôle neurosciences, Centre Hospitalier Universitaire de Toulouse, CHU Purpan, Place du Dr Baylac, Toulouse, France
| | - Jérémie Pariente
- Inserm, imagerie cérébrale et handicaps neurologiques, UMR 825; F-31059, Toulouse, France
- Université de Toulouse, UPS, imagerie cérébrale et handicaps neurologiques, UMR 825; CHU Purpan, Place du Dr Baylac, F-31059, Toulouse, Cedex 9, France
- Service de neurologie, pôle neurosciences, Centre Hospitalier Universitaire de Toulouse, CHU Purpan, Place du Dr Baylac, Toulouse, France
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Busigny T, Pages B, Barbeau EJ, Bled C, Montaut E, Raposo N, Albucher JF, Chollet F, Pariente J. A systematic study of topographical memory and posterior cerebral artery infarctions. Neurology 2014; 83:996-1003. [DOI: 10.1212/wnl.0000000000000780] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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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Pages B, Planton M, Buys S, Lemesle B, Birmes P, Barbeau EJ, Maziero S, Cordier L, Cabot C, Puel M, Genestal M, Chollet F, Pariente J. Neuropsychological outcome after carbon monoxide exposure following a storm: a case-control study. BMC Neurol 2014; 14:153. [PMID: 25048040 PMCID: PMC4118199 DOI: 10.1186/1471-2377-14-153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 07/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background The cognitive consequences of carbon monoxide (CO) poisoning are well described. However, most studies have been carried out without an ad-hoc group of control subjects. The main aim of this study was to evaluate cognitive and psychiatric outcome after CO exposure during the storm Klaus in the South West of France (January 2009) in a homogeneous group of patients compared to a group of 1:1 paired controls. Methods Patients and controls were asked to fill out questionnaires about quality of life and cognitive complaints. They then underwent a cognitive assessment derived from the Carbon Monoxide Neuropsychological Screening Battery. Psychiatric assessment was performed using subtests of the Mini International Neuropsychiatric Interview. Results 38 patients and 38 paired controls were included (mean age 38.8 years) and evaluated 51 days after the poisoning. No difference was found between groups on the cognitive complaint questionnaire but patients had a lower quality of life than controls. Patients showed significantly lower cognitive performance than controls on processing speed, mental flexibility, inhibition and working and verbal episodic memories. Patients were more depressed than controls, and suffered more from post-traumatic stress disorder. Conclusions We report the first study investigating cognitive and psychiatric outcome in consecutive patients after CO poisoning during a natural disaster, using a group comparison method. CO poisoning during storms needs to be dealt with adequately and clinicians should be aware of its possible consequences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jérémie Pariente
- Service de Neurologie, Pôle Neurosciences, Centre Hospitalier Universitaire de Toulouse, CHU Purpan, Place du Dr Baylac, Toulouse Cedex 9, France.
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Saint-Aubert L, Nemmi F, Péran P, Barbeau EJ, Payoux P, Chollet F, Pariente J. Comparison between PET template-based method and MRI-based method for cortical quantification of florbetapir (AV-45) uptake in vivo. Eur J Nucl Med Mol Imaging 2013; 41:836-43. [PMID: 24435769 PMCID: PMC3978219 DOI: 10.1007/s00259-013-2656-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/28/2013] [Indexed: 01/18/2023]
Abstract
PURPOSE Florbetapir (AV-45) has been shown to be a reliable tool for assessing in vivo amyloid load in patients with Alzheimer's disease from the early stages. However, nonspecific white matter binding has been reported in healthy subjects as well as in patients with Alzheimer's disease. To avoid this issue, cortical quantification might increase the reliability of AV-45 PET analyses. In this study, we compared two quantification methods for AV-45 binding, a classical method relying on PET template registration (route 1), and a MRI-based method (route 2) for cortical quantification. METHODS We recruited 22 patients at the prodromal stage of Alzheimer's disease and 17 matched controls. AV-45 binding was assessed using both methods, and target-to-cerebellum mean global standard uptake values (SUVr) were obtained for each of them, together with SUVr in specific regions of interest. Quantification using the two routes was compared between the clinical groups (intragroup comparison), and between groups for each route (intergroup comparison). Discriminant analysis was performed. RESULTS In the intragroup comparison, differences in uptake values were observed between route 1 and route 2 in both groups. In the intergroup comparison, AV-45 uptake was higher in patients than controls in all regions of interest using both methods, but the effect size of this difference was larger using route 2. In the discriminant analysis, route 2 showed a higher specificity (94.1 % versus 70.6 %), despite a lower sensitivity (77.3 % versus 86.4 %), and D-prime values were higher for route 2. CONCLUSION These findings suggest that, although both quantification methods enabled patients at early stages of Alzheimer's disease to be well discriminated from controls, PET template-based quantification seems adequate for clinical use, while the MRI-based cortical quantification method led to greater intergroup differences and may be more suitable for use in current clinical research.
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Affiliation(s)
- L Saint-Aubert
- Inserm, imagerie cérébrale et handicaps neurologiques UMR 825, Centre Hospitalier Universitaire de Toulouse, Pavillon Baudot CHU Purpan lace Dr Baylac, 31059, Toulouse, France,
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Abstract
Brain plasticity is an intrinsic characteristic of the nervous system that allows continuous remodeling of brain functions in pathophysiological conditions. Although normal aging is associated with morphological modifications and decline of cerebral functions, brain plasticity is at least partially preserved in elderly individuals. A growing body of evidence supports the notion that cognitive enrichment and aerobic training induce a dynamic reorganization of higher cerebral functions, thereby helping to maintain operational skills in the elderly and reducing the incidence of dementia. The stroke model clearly shows that spontaneous brain plasticity exists after a lesion, even in old patients, and that it can be modulated through external factors like rehabilitation and drugs. Whether drugs can be used with the aim of modulating the effects of physical training or cognitive stimulation in healthy aged people has not been addressed until now. The risk:benefit ratio will be the key question with regard to the ethical aspect of this challenge. We review in this article the main aspects of human brain plasticity as shown in patients with stroke, the drug modulation of brain plasticity and its consequences on recovery, and finally we address the question of the influence of aging on brain plasticity.
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Affiliation(s)
- François Chollet
- Department of Neurology and Institute for Neurosciences, CHU and Toulouse University, Hôpital Purpan, Toulouse, France.
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Saint‐Aubert L, Barbeau E, Peran P, Nemmi F, Payoux P, Bonneville F, Tafani M, Vincent C, Puel M, Chollet F, Pariente J. O5–02–01: Comparison of amyloid profiles using CSF and cortical florbetapir‐PET imaging in prodromal Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.04.475] [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: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Christian Vincent
- Laboratoire de Biologie Cellulaire et Cytologie, Pôle Biologie Toulouse France
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Chollet F, Acket B, Raposo N, Albucher JF, Loubinoux I, Pariente J. Use of antidepressant medications to improve outcomes after stroke. Curr Neurol Neurosci Rep 2013; 13:318. [PMID: 23263791 DOI: 10.1007/s11910-012-0318-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interest in the use of antidepressants after stroke has been renewed by better knowledge of poststroke depression, but mainly by the capacity of some of them to promote functional recovery of nondepressed subjects. Recombinant tissue plasminogen activator thrombolysis within the first few hours after the stroke is currently the only validated treatment able to improve the spontaneous--and most of the time incomplete--recovery of neurological functions after stroke. However, we have learned from research over the last decade, in part based on the considerable improvement of neuroimaging techniques, that spontaneous recovery of neurological functions is associated with a large intracerebral reorganization of the damaged human brain. The question of whether lesioned-brain plasticity can be modulated by external factors such as pharmacological antidepressant agents is now being addressed with the aim of improving recovery and reducing the final disability of patients. Poststroke depression is known to be frequent and deleterious for patient outcome. We review the interest in the use of antidepressants after stroke in classic but often neglected poststroke depression and we strongly underline the action of some antidepressants in promoting functional recovery of nondepressed patients after stroke.
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Affiliation(s)
- F Chollet
- Department of Neurology, Université Paul Sabatier, Purpan Hospital, Place Baylac, 31059, Toulouse, France.
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Abstract
OPINION STATEMENT The improvement of recovery after stroke remains one of the main priorities for patients with stroke. Acute de-occlusion of the artery should improve patient outcome and recovery. Recent data and meta-analysis confirmed the efficacy of IV thrombolysis when administered to selected patients less than 4.5 hours after the onset of ischemic stroke even in patients aged > 80 years. IV thrombolysis with rTPA is currently the only validated treatment for the acute phase of ischemic stroke. This has lead to a major public health effort to create stroke treatment units in developed countries. Mechanical thrombectomy is not yet validated despite major support from clinicians and the industry overall. Many other treatment options are currently being tested in various other therapeutic areas. Some data show clearly that some of these options are now close to clinical significance: specific and adapted rehabilitation procedures that will include a rationale in patients' care management, use of monoaminergic drugs like SSRIs with improvement of motor recovery through a specific action on cortical excitability, cortical stimulation or inhibition with magnetic or electric techniques with the aim of modifying functional inter cortical balance and connections, and clinical and bio markers of recovery that would help to ensure appropriate individual care of each patient. Finally, repair therapies with the aim of restoring the brain-damaged networks could be useful in patients with persistent severe deficits. Several classes are under study for brain repair, including the use of stem cells, growth factors, and small molecules, but these are still at a preclinical level of development.
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Affiliation(s)
- François Chollet
- Department of Neurology and Toulouse Institute for Neurosciences, Hôpital Purpan, Place du Docteur Baylac, 31059, Toulouse, France,
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Chollet F. Médicaments monoaminergiques dans la récupération motrice après accident vasculaire cérébral ischémique. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sattler V, Acket B, Gerdelat-Mas A, Raposo N, Albucher JF, Thalamas C, Loubinoux I, Chollet F, Simonetta-Moreau M. Effet sur la récupération motrice post-AVC, en phase aiguë, de sessions répétées de tDCS anodale du cortex moteur primaire couplée à une stimulation électrique périphérique répétitive. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.008] [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: 11/24/2022]
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Schmidt EA, Silva S, Albucher JF, Luzi A, Loubinoux I, Januel AC, Cognard C, Payoux P, Chollet F. Cerebral hemodynamic changes induced by a lumbar puncture in good-grade subarachnoid hemorrhage. Cerebrovasc Dis Extra 2012; 2:52-62. [PMID: 23139682 PMCID: PMC3493014 DOI: 10.1159/000339580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Patients with good-grade subarachnoid hemorrhage (SAH) are those without initial neurological deficit. However, they can die or present severe deficit due to secondary insult leading to brain ischemia. After SAH, in a known context of energy crisis, vasospasm, hydrocephalus and intracranial hypertension contribute to unfavorable outcome. Lumbar puncture (LP) is sometimes performed in an attempt to reduce intracranial pressure (ICP) and release headaches. We hypothesize that in good-grade SAH patients, a 20-ml LP releases headaches, reduces ICP and improves cerebral blood flow (CBF) as measured with O15 PET scan. Methods Six good-grade (WFNS grade 1or 2) SAH patients (mean age 48 years, 2 women, 4 men) were prospectively included. All aneurysms (4 anterior communicating artery and 2 right middle cerebral artery) were coiled at day 1. Patients were managed according to our local protocol. LP was performed for severe headache (VAS >7) despite maximal painkiller treatment. Patients were included when the LP was clinically needed. The 20-ml LP was done in the PET scan (mean delay between SAH and LP: 3.5 days). LP allows hydrostatic measurement of ICP. Arterial blood pressure (ABP) was noninvasively gauged with photoplethysmography. Every signal was monitored and analyzed off-line. Regional CBF (rCBF) was measured semiquantitatively with O15 PET before and after LP. Then we calculated the difference between baseline and post-LP condition for each area: positive value means augmentation of rCBF after the LP, negative value means reduction of rCBF. Individual descriptive analysis of CBF was first performed for each patient; then a statistical group analysis was done with SPM for all voxels using t statistics converted to Z scores (p < 0.01, Z score >3.2). Results A 20-ml LP yielded a reduction in pain (–4), a drop in ICP (24.3 ± 12.5 to 6.9 ± 4.7 mm Hg), but no change in ABP. Descriptive and statistical image analysis showed a heterogeneous and biphasic change in cerebral hemodynamics: rCBF was not kept constant and either augmented or decreased after the drop in ICP. Hence, cerebrovascular reactivity was spatially heterogeneous within the brain. rCBF seems to augment in the brain region roughly close to the bleed and to be reduced in the rest of the brain, with a rough plane of symmetry. Conclusions In good-grade SAH, LP releases headaches and lowers ICP. LP and the drop in ICP have a heterogeneous and biphasic effect on rCBF, suggesting that cerebrovascular reactivity is not spatially homogeneous within the brain.
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Affiliation(s)
- Eric A Schmidt
- Neurosurgery, Université de Toulouse, Toulouse, France ; INSERM 825, UMR 825, Université de Toulouse, Toulouse, France
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Saint-Aubert L, Puel M, Chollet F, Pariente J. [Early diagnosis of Alzheimer's disease]. Rev Neurol (Paris) 2012; 168:825-32. [PMID: 22989783 DOI: 10.1016/j.neurol.2012.07.006] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Diagnosis of Alzheimer's disease (AD) remains difficult to establish, and can only be considered as certain thanks to anatomopathological evidence, or genetic mutations. Current diagnostic criteria rely on innovative imaging and biological tools, in order to detect pathological cues from very early stages, and with best sensibility and sensitivity. STATE OF ART Advances in neuro-imaging enabled the development of different tools to help establishing the diagnosis, such as cerebral atrophy assessment on magnetic resonance imaging (MRI), and cerebral metabolism study on positron emission tomography (PET). Besides, the increasing use of in vivo biological markers, combined to clinical criteria, enables to discriminate patients from healthy controls at even earlier stages. This includes studies on tau and beta-amyloid proteins concentrations in the cerebrosinal fluid, and amyloid-specific radioligands uptake. Familial forms of Alzheimer represent a great model for studying early or even pre-symptomatic AD, as genetic analyses constitute a diagnosis of certainty, even though they usually evolve earlier and faster. PERSPECTIVES, CONCLUSION Diagnostic tools are more and more numerous and performant. According to patients' clinical heterogeneity, it appears essential to associate different method to investigate, in order to make a diagnosis as early and as reliable as possible.
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Affiliation(s)
- L Saint-Aubert
- Inserm, imagerie cérébrale et handicaps neurologiques UMR 825, CHU Purpan, place du Docteur-Baylac, Toulouse cedex 9, France
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Saint-Aubert L, Planton M, Hannequin D, Albucher JF, Delisle MB, Payoux P, Hitzel A, Viallard G, Péran P, Campion D, Laquerrière A, Barbeau EJ, Puel M, Raposo N, Chollet F, Pariente J. Amyloid imaging with AV45 ((18)F-florbetapir) in a cognitively normal AβPP duplication carrier. J Alzheimers Dis 2012; 28:877-83. [PMID: 22156048 DOI: 10.3233/jad-2011-111598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report the case of a 62-year-old asymptomatic carrier of AβPP gene duplication. He was investigated by MRI and the amyloid ligand (18)F-AV45, and compared to Alzheimer's disease patients (n = 11) and healthy controls (n = 11). The neuropsychological examination was normal. Cortical thickness and AV45 retention were comparable to Alzheimer's disease patients. AβPP duplication was diagnosed because cerebral amyloid angiopathy and Alzheimer's disease pathology were found on the neuropathological examination of his youngest brother, who died at 42 from intracerebral hemorrhage. This is the first description of a pre-symptomatic AβPP duplication carrier over 60, despite widespread cerebral amyloid angiopathy, "Alzheimer's like" atrophy, and amyloid deposition.
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Affiliation(s)
- Laure Saint-Aubert
- Inserm, Imagerie Cérébrale et Handicaps Neurologiques UMR 825, Toulouse, France
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Letamendia C, Leblanc NJ, Pariente J, Simon NM, Thomas CL, Chabrol H, Chollet F, Raposo N, Schmitt L, Birmes P, Bui E. Peritraumatic distress predicts acute posttraumatic stress disorder symptoms after a first stroke. Gen Hosp Psychiatry 2012; 34:e11-3. [PMID: 22542052 DOI: 10.1016/j.genhosppsych.2012.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 03/13/2012] [Accepted: 03/15/2012] [Indexed: 11/26/2022]
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Sagot C, Saint-Aubert L, Bezy C, Mirabel H, Payoux P, Dumas H, Vincent C, Peran P, Barbeau E, Puel M, Chollet F, Pariente J. Aphasia in Neurodegenerative Diseases: Can Language Impairment Predict the Underlying Pathology ? (P02.051). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.051] [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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Saint-Aubert L, Mirabel H, Vervueren C, Peran P, Payoux P, Puel M, Barbeau E, Chollet F, Pariente J. Heterogeneous Amyloid Profiles in Highly Selected Prodromal Alzheimer Patients (PD1.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd1.006] [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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