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Halfon P, Penaranda G, Ringwald D, Retornaz F, Boissel N, Bodard S, Feryn JM, Bensoussan D, Cacoub P. Laboratory tests for investigating anemia: From an expert system to artificial intelligence. Pract Lab Med 2024; 39:e00357. [PMID: 38404528 PMCID: PMC10883828 DOI: 10.1016/j.plabm.2024.e00357] [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: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024] Open
Abstract
Objective To compare the laboratory tests conducted in real-life settings for patients with anemia with the expected prescriptions derived from an optimal checkup. Methods A panel of experts formulated an "optimal laboratory test assessment" specific to each anemia profile. A retrospective analysis was done of the laboratory tests conducted according to the type of anemia (microcytic, normocytic or macrocytic). Using an algorithmic system, the laboratory tests performed in real-life practice were compared with the recommendations suggested in the "optimal laboratory test assessment" and with seemingly "unnecessary" laboratory tests. Results In the analysis of the "optimal laboratory test assessment", of the 1179 patients with microcytic anemia, 269 (22.8%) had had one of the three tests recommended by the expert system, and only 33 (2.8%) had all three tests. For normocytic anemia, 1054 of 2313 patients (45.6%) had one of the eleven recommended tests, and none had all eleven. Of the 384 patients with macrocytic anemia, 196 (51%) had one of the four recommended tests, and none had all four. In the analysis of "unnecessary laboratory tests", one lab test was unnecessarily done in 727/3876 patients (18.8%), i.e. 339 of 1179 (28.8%) microcytic, 171 of 2313 (7.4%) normocytic, and 217 of 384 (56.5 %) macrocytic anemias. Conclusion Laboratory investigations of anemia remain imperfect as more than half of the cases did not receive the expected tests. Analyzing other diagnostic domains, the authors are currently developing an artificial intelligence system to assist physicians in enhancing the efficiency of their laboratory test prescriptions.
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Affiliation(s)
- Philippe Halfon
- Pôle de Médecine Interne et Maladies infectieuses Hôpital Européen, 13000, Marseille, France
- Laboratoire Alphabio, 13000, Marseille, France
| | | | | | - Frederique Retornaz
- Pôle de Médecine Interne et Maladies infectieuses Hôpital Européen, 13000, Marseille, France
| | - Nicolas Boissel
- AP-HP, Service d'hématologie, Hôpital St Louis, Paris, France
| | - Sylvain Bodard
- Université Paris Cité, F-75006, Paris, France
- AP-HP, Service d’Imagerie Adulte, Hôpital Universitaire Necker - Enfants Malades, F-75015, Paris, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75006, Paris, France
| | | | - David Bensoussan
- Service de chirurgie vasculaire, Centre hospitalier, avenue des tamaris, 13100, Aix en Provence, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
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Queguiner F, Bezirganyan K, Courjaret JC, Curel L, Penaranda G, Bonomini J, Righini Chossegros M. Reliability of self-measurement of visual acuity in AMD patients with two electronic devices based on the ETDRS chart: A randomized study. J Fr Ophtalmol 2024; 47:103911. [PMID: 37648551 DOI: 10.1016/j.jfo.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) requires continuous visual acuity (VA) monitoring, increasing the burden on the health care system. Self-measurement VA tests are available on various devices. However, none of them have been based on an internationally validated benchmark chart, such as that of the Early Treatment Diabetic Retinopathy Study (ETDRS). The goal of this study was to assess the reliability of two digitized ETDRS charts adapted to two electronic devices for self-measurement of VA. MATERIAL AND METHODS A prospective, single-center, 1:1 randomized, two-arm, parallel group trial was conducted. The main objective was to compare VA variation as conventionally measured on a 4-m ETDRS chart versus self-measured with digitized ETDRS charts in patients treated for AMD. At each visit, conventional measurement and patient self-measurement, either on a computer at 80-cm (arm 1) or on a tablet at 40-cm (arm 2), were performed. RESULTS Eighty patients were included (25 men, 55 women, mean age 81.3±7.4 years). No significant differences were observed between VA variation, conventionally measured and self-measured on a computer (arm 1; P=0.914) or tablet (arm 2; P=0.913). CONCLUSION These results confirm the reliability of these two methods for self-measurement of VA, and will lead to the development of a wider "telemedicine" project extended to self-measurement of VA in various pathologies.
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Affiliation(s)
- F Queguiner
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France.
| | - K Bezirganyan
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - J C Courjaret
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
| | - L Curel
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - G Penaranda
- Biostatistics department, AlphaBio Laboratory, 13003 Marseille, France
| | - J Bonomini
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - M Righini Chossegros
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
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Halfon P, Jordana S, Blachier S, Cartlamy P, Kbaier L, Psomas CK, Philibert P, Antoniotti G, Allemand-Sourrieu J, Rebaudet S, Cavaille G, Stavris C, Retornaz F, Chiche L, Penaranda G. Anti-spike protein to determine SARS-CoV-2 antibody levels: Is there a specific threshold conferring protection in immunocompromised patients? PLoS One 2023; 18:e0281257. [PMID: 37115758 PMCID: PMC10146437 DOI: 10.1371/journal.pone.0281257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Identifying a specific threshold level of SARS-CoV-2 antibodies that confers protection in immunocompromised patients has been very challenging. The aim was to assess the threshold of 264 binding antibody units (BAU)/ml using four different SARS-CoV-2 antibody assays (Abbott, Beckman, Roche, and Siemens) and to establish a new optimal threshold of protection for each of the four antibody assays. METHODS This study was performed on data retrieved from 69 individuals, who received at least one dose of the Pfizer/BioNTech BNT162b2 or Moderna COVID-19 vaccine (Spikevax) at the Alphabio Laboratory in Marseille, France (European Hospital, Alphabio-Biogroup). The results were compared to the percent inhibition calculated using a functional surrogate of a standardized virus neutralization test (Genscript). RESULTS Samples from 69 patients were analyzed. For a reference cutoff of 264 BAU/ml, assays showed moderate to good overall concordance with Genscript: 87% concordance for Abbott, 78% for Beckman, 75% for Roche, and 88% for Siemens. Overall concordance increased consistently after applying new thresholds, i.e., 148 BAU/ml (Abbott), 48 (Beckman), 559 (Roche), and 270 (Siemens). CONCLUSION We suggest specific adjusted thresholds (BAU/ml) for the four commercial antibody assays that are used to assess pre-exposure prophylaxis in immunocompromised patients.
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Affiliation(s)
- Philippe Halfon
- Laboratoire Alphabio-Biogroup, Marseille, France
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | | | | | | | | | - Christina K Psomas
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | - Patrick Philibert
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | | | - Julie Allemand-Sourrieu
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | - Stanislas Rebaudet
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | - Guilhem Cavaille
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | - Chloé Stavris
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | - Frédérique Retornaz
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
| | - Laurent Chiche
- Department of Infectious Diseases and Internal Medicine, Hôpital Européen, Marseille, France
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Halfon P, Penaranda G, Ringwald D, Boissel N, Retornaz F, Bodard S, Feryn J, Cacoub P. Explorations biologiques des anémies : avantages d’un système expert vers l’intelligence artificielle. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.105] [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: 12/12/2022]
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Seitz J, Durdez TM, Albenque JP, Pisapia A, Gitenay E, Durand C, Monteau J, Moubarak G, Théodore G, Lepillier A, Zhao A, Bremondy M, Maluski A, Cauchemez B, Combes S, Guyomar Y, Heuls S, Thomas O, Penaranda G, Siame S, Appetiti A, Milpied P, Bars C, Kalifa J. Artificial intelligence software standardizes electrogram-based ablation outcome for persistent atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2250-2260. [PMID: 35989543 PMCID: PMC9826214 DOI: 10.1111/jce.15657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Multiple groups have reported on the usefulness of ablating in atrial regions exhibiting abnormal electrograms during atrial fibrillation (AF). Still, previous studies have suggested that ablation outcomes are highly operator- and center-dependent. This study sought to evaluate a novel machine learning software algorithm named VX1 (Volta Medical), trained to adjudicate multipolar electrogram dispersion. METHODS This study was a prospective, multicentric, nonrandomized study conducted to assess the feasibility of generating VX1 dispersion maps. In 85 patients, 8 centers, and 17 operators, we compared the acute and long-term outcomes after ablation in regions exhibiting dispersion between primary and satellite centers. We also compared outcomes to a control group in which dispersion-guided ablation was performed visually by trained operators. RESULTS The study population included 29% of long-standing persistent AF. AF termination occurred in 92% and 83% of the patients in primary and satellite centers, respectively, p = 0.31. The average rate of freedom from documented AF, with or without antiarrhythmic drugs (AADs), was 86% after a single procedure, and 89% after an average of 1.3 procedures per patient (p = 0.4). The rate of freedom from any documented atrial arrhythmia, with or without AADs, was 54% and 73% after a single or an average of 1.3 procedures per patient, respectively (p < 0.001). No statistically significant differences between outcomes of the primary versus satellite centers were observed for one (p = 0.8) or multiple procedures (p = 0.4), or between outcomes of the entire study population versus the control group (p > 0.2). Interestingly, intraprocedural AF termination and type of recurrent arrhythmia (i.e., AF vs. AT) appear to be predictors of the subsequent clinical course. CONCLUSION VX1, an expertise-based artificial intelligence software solution, allowed for robust center-to-center standardization of acute and long-term ablation outcomes after electrogram-based ablation.
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Baptiste F, Kalifa J, Durand C, Gitenay E, Bremondy M, Ayari A, Maillot N, Taormina A, Fofana A, Penaranda G, Siame S, Bars C, Seitz J. Right atrial appendage firing in atrial fibrillation. Front Cardiovasc Med 2022; 9:997998. [DOI: 10.3389/fcvm.2022.997998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe role of atrial fibrillation (AF) drivers located at the left atrium, superior vena cava, crista terminalis and coronary sinus (CS) is well established. While these regions are classically targeted during catheter ablation, the role of right atrial appendage (RAA) drivers has been incompletely investigated.ObjectiveTo determine the prevalence and electrophysiological characteristics of AF driver’s arising from the RAA.Materials and methodsWe conducted a retrospective analysis of clinical and procedural data of 317 consecutive patients who underwent an AF ablation procedure after bi-atrial mapping (multipolar catheter). We selected patients who presented with a per-procedural RAA firing (RAAF). RAAF was defined as the recording of a sustained RAA EGM with a cycle length shorter than 120 ms or 120 < RAAF CL ≤ 130 ms and ratio RAA CL/CS CL ≤ 0.75.ResultsRight atrial/atrium appendage firing was found in 22 patients. The prevalence was estimated at 7% (95% CI, 4–10). These patients were mostly men (72%), median age: 66 yo ± 8 without structural heart disease (77%). RAAFs were predominantly found in paroxysmal AF patients (63%, 32%, and 5% for paroxysmal, short standing and long-standing AF, respectively, p > 0.05). RAAF median cycle length was 117 ms ± 7 while CS cycle length was 180 ms ± 10 (p < 0.01).ConclusionIn 317 consecutive AF ablation patients (22 patients, 7%) the presence of a high-voltage short-cycle-length right atrial appendage driver (RAAF) may conclusively be associated with AF termination. This case series exemplifies the not-so-uncommon role of the RAA in the perpetuation of AF.
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Psomas CK, Penaranda G, Retornaz F, Khiri H, Delord M, Halfon P, Philibert P. A cohort analysis of sexually transmitted infections among different groups of men who have sex with men in the early era of HIV pre-exposure prophylaxis in France. J Virus Erad 2022; 8:100065. [PMID: 35251684 PMCID: PMC8891709 DOI: 10.1016/j.jve.2022.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background MSM are at particular risk of STIs due to sexual behavior and substance use. HIV PrEP use may increase this risk. Design Our aim was to comparatively assess incident STIs among different at-risk groups—PLWHIV, HIV-negative PrEP and no-PrEP users—seen at our center early after PrEP implementation. Methods Clinical data were retrospectively collected on 636 MSM seen at the Infectious Diseases Department between September 2016 and October 2018. STI incidence rate was assessed among groups for the whole period, as well as separately for each year of the study. Results Overall STI incidence rate ratio was higher in HIV-neg when compared to PLWHIV. In multivariate analysis, STI risk was significantly higher among HIV-neg no-PrEP users compared to PLWHIV, while not different between PLWHIV and PrEP users. STI incidence globally increased during the first 2 years after PrEP approval among PLWHIV and no-PrEP users, stated by odds ratio (OR = 1.77 [1.23–2.55], p = 0.0020 and OR = 2.29 [0.91–5.73], p = 0.0774 respectively) while it remained rather stable for HIV-neg PrEP users (OR = 1.19 [0.60–2.38], p = 0.6181). The HIV-neg no-PrEP group remained at higher risk of STI than PLWHIV and PrEP users during the two periods. Conclusion These results suggest that a proactive approach of an efficient follow-up of MSM participants since PrEP approval may have prevented an increase of the incidence of STIs among PrEP users.
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Camus C, Penaranda G, Khiri H, Camiade S, Molet L, Lebsir M, Plauzolles A, Chiche L, Blanc B, Quarello E, Halfon P. Acceptability and efficacy of vaginal self-sampling for genital infection and bacterial vaginosis: A cross-sectional study. PLoS One 2021; 16:e0260021. [PMID: 34793548 PMCID: PMC8601421 DOI: 10.1371/journal.pone.0260021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/30/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND & AIM Screening for genital infection (GI) such as bacterial vaginosis (BV) and yeast infection, for sexually transmitted infection (STI), and for asymptomatic carriage of group B streptococcus (GBS) in pregnant women are common reason for medical appointments. The diagnosis and control of GIs, STIs, and GBS are major issues, for fertility and overall well-being of affected women. Conventional testing is performed using vaginal/cervical classical sampling (VCS); this procedure requires pelvic examination performed by health care professionals which raises concerns among women. Vaginal-self-sampling (VSS), as an alternative to VCS, might capture more women. The aim was first to show non-inferiority of VSS compared with VCS to screen for GIs, STIs, and GBS; second to determine the feasibility of VSS. METHODS VSS and VCS from 1027 women were collected by health care professionals and simultaneously carried out on each patient. GIs, STIs, and GBS were systematically screened in both paired VSS and VCS samples. Non-inferiority of VSS compared with VCS was assessed using z statistic for binomial proportions. RESULTS Prevalence of GIs were 39.7% using VSS and 38.1% using VCS (p = 0.0016). Prevalence of STIs was 8.5% (VSS) vs 8.1% (VCS) (p = 0.0087). Prevalence of GBS was 13.4% (VSS) and 11.5% (VCS) (p = 0.0001). Most participants (84%) recommended the use of VSS. CONCLUSIONS This study shows that VSS was not inferior to VCS for the detection of GIs, STIs, and GBS. This study provides evidence that VSS can be used as a universal specimen for detection of lower genital tract infections in women. STUDY IDENTIFICATION NUMBER ID-RCB 2014-A01250-4.
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Affiliation(s)
- Claire Camus
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
- FCRIN INSERM US015, CHU de Toulouse, Hôpital PURPAN, Toulouse, France
| | - Guillaume Penaranda
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Hacène Khiri
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Sabine Camiade
- Bacteriology Department, Laboratoire Européen Alphabio - Biogroup, Marseille, France
| | - Lucie Molet
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Melissa Lebsir
- Bacteriology Department, Laboratoire Européen Alphabio - Biogroup, Marseille, France
| | - Anne Plauzolles
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
| | - Laurent Chiche
- Infectious and Internal Medicine Department, Hôpital Européen Marseille, Marseille, France
| | - Bernard Blanc
- Gynecology Department, Hôpital Européen Marseille, Marseille, France
| | - Edwin Quarello
- Prenatal Screening and Diagnostic Unit, Obstetrics and Gynecology Department, St Joseph Hospital, Marseille, France
- Image2 Center, Marseille, France
| | - Philippe Halfon
- Clinical Research and R&D Department, Laboratoire Européen, Alphabio - Biogroup, Marseille, France
- Infectious and Internal Medicine Department, Hôpital Européen Marseille, Marseille, France
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Benmiloud F, Penaranda G, Chiche L, Rebaudet S. Intraoperative Mapping Angiograms of the Parathyroid Glands Using Indocyanine Green During Thyroid Surgery: Results of the Fluogreen Study. World J Surg 2021; 46:416-424. [PMID: 34743241 DOI: 10.1007/s00268-021-06353-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND During thyroid surgery, preservation of parathyroid gland (PG) feeding vessels is often impossible. The aim of the Fluogreen study was to determine the feasibility of using indocyanine green (ICG)-based intraoperative mapping angiograms of the PG (iMAP) to improve vascular preservation. STUDY DESIGN This prospective study enrolled all patients undergoing thyroid lobectomy or total thyroidectomy at the Hôpital Européen Marseille between September and December 2018. After exploring the thyroid lobe by autofluorescence to locate the PGs, ICG solution was injected intravenously to locate the PG feeding vessels and guide dissection. A second ICG injection was administered at the end of the lobectomy to assess perfusion of the PGs. The primary outcome was the quality of the angiogram, scaled as iMAP 0 (not informative), iMAP 1 (general vascular pattern visible but no clear vascular pedicle flowing into the PG), or iMAP 2 (clear vascular pedicle flowing into the PG). The secondary outcome was the PG perfusion score at the end of surgery, scaled from ICG 0 (no perfusion) to ICG 2 (intense uptake). RESULTS A total of 47 adult patients were analyzed, including 34 total thyroidectomies and 13 lobectomies. ICG angiography assessed 76 PGs, which were scored as iMAP 2 in 24 cases (31.6%), iMAP 1 in 46 (60.5%) and iMAP 0 in six (7.9%). At the end of dissection, the ICG perfusion score was significantly better for the PGs with informative angiography (iMAP 1 or 2), than for the PGs with uninformative angiography (iMAP 0), or the PGs not evaluated by vascular angiography (p < 0.05). CONCLUSION iMAP is feasible and provides direct vascular information in one-third of the cases. Further improvements to this technology are necessary, and the influence of this technique on patient outcomes during thyroidectomy will need to be further evaluated.
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Affiliation(s)
- Fares Benmiloud
- Endocrine Surgery Unit, Département de Chirurgie, Hôpital Européen de Marseille, 6 Rue Désirée Clary, 13003, Marseille, France.
| | | | - Laurent Chiche
- Internal Medicine and Infectious Diseases Unit, Hôpital Européen Marseille, Marseille, France
| | - Stanislas Rebaudet
- Internal Medicine and Infectious Diseases Unit, Hôpital Européen Marseille, Marseille, France
- Aix-Marseille University, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
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Halfon P, Penaranda G, Khiri H, Garcia V, Drouet H, Philibert P, Psomas C, Delord M, Retornaz F, Charpin C, Gonzales T, Pegliasco H, Allardet-Servent J. An optimized stepwise algorithm combining rapid antigen and RT-qPCR for screening of COVID-19 patients. PLoS One 2021; 16:e0257817. [PMID: 34555117 PMCID: PMC8460002 DOI: 10.1371/journal.pone.0257817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background & aim We investigated the combination of rapid antigen detection (RAD) and RT-qPCR assays in a stepwise procedure to optimize the detection of COVID-19. Methods From August 2020 to November 2020, 43,399 patients were screened in our laboratory for COVID-19 diagnostic by RT-qPCR using nasopharyngeal swab. Overall, 4,691 of the 43,399 were found to be positive, and 200 were retrieved for RAD testing allowing comparison of diagnostic accuracy between RAD and RT-qPCR. Cycle threshold (Ct) and time from symptoms onset (TSO) were included as covariates. Results The overall sensitivity, specificity, PPV, NPV, LR-, and LR+ of RAD compared with RT-qPCR were 72% (95%CI 62%–81%), 99% (95% CI95%–100%), 99% (95%CI 93%–100%), and 78% (95%CI 70%–85%), 0.28 (95%CI 0.21–0.39), and 72 (95%CI 10–208) respectively. Sensitivity was higher for patients with Ct ≤ 25 regardless of TSO: TSO ≤ 4 days 92% (95%CI 75%–99%), TSO > 4 days 100% (95%CI 54%–100%), and asymptomatic 100% (95%CI 78–100%). Overall, combining RAD and RT-qPCR would allow reducing from only 4% the number of RT-qPCR needed. Conclusions This study highlights the risk of misdiagnosing COVID-19 in 28% of patients if RAD is used alone. A stepwise analysis that combines RAD and RT-qPCR would be an efficient screening procedure for COVID-19 detection and may facilitate the control of the outbreak.
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Affiliation(s)
- Philippe Halfon
- Laboratoire Alphabio, Marseille, France
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
- * E-mail:
| | | | | | | | - Hortense Drouet
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Patrick Philibert
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Christina Psomas
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Marion Delord
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Frédérique Retornaz
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Caroline Charpin
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Thomas Gonzales
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
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Halfon P, Ansaldi C, Penaranda G, Chiche L, Dukan P, Stavris C, Plauzolles A, Retornaz F, Bourliere M. Prospective screening of liver fibrosis in a primary care cohort using systematic calculation of fib-4 in routine results. PLoS One 2021; 16:e0254939. [PMID: 34293022 PMCID: PMC8297754 DOI: 10.1371/journal.pone.0254939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIM Liver fibrosis screening in primary care population is a major public health issue. The FIB-4 index is a simple non-invasive fibrosis test combining age, transaminases, platelets count, developed for the diagnosis of advanced fibrosis. The aim of our study was to evaluate the interest of liver fibrosis screening using systematic calculation of FIB-4 in routine blood analysis. METHODS Between December 2018 and May 2019, we conducted a prospective screening of liver fibrosis in 134 158 patients during a medical check-up including routine blood analysis. Among these patients, 29 707 had transaminases and platelets counts available and benefited from an automatic calculation of FIB-4. Results were obtained from 21 French clinical laboratories in the Bouches du Rhône region. RESULTS Among the 29 707 patients, 2161 (7.3%) had a high risk of advanced fibrosis (FIB-4>2.67). Individual investigation of patients with FIB-4>2.67 allowed to screen 1268 (1268/2161: 58.7%) patients who were not managed for any liver disease. CONCLUSIONS This work demonstrates the interest of FIB-4 for the screening of liver fibrosis in primary care population. Although additional clinical validation study is required to determine the utility and applicability of Fib-4 to daily practice, our study strongly supports this easy-to-implement strategy using a simple Fib-4 measure resulting from the use of available routine test results.
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Affiliation(s)
- Philippe Halfon
- Research & Development Department, Laboratoire Alphabio, Marseille, France
- Department of Internal Medicine, Hôpital Européen, Marseille, France
- * E-mail:
| | | | | | - Laurent Chiche
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | - Patrick Dukan
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | - Chloé Stavris
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | - Anne Plauzolles
- Research & Development Department, Laboratoire Alphabio, Marseille, France
| | | | - Marc Bourliere
- Hepato-Gastroenterology Department, Hôpital Saint-Joseph, Marseille, France
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Grimaud F, Penaranda G, Stavris C, Retornaz F, Brunel V, Cailleres S, Pegliasco H, Le Treut J, Grisoni V, Coquet E, Chiche L, Rognon A. Adverse Events Induced by PD-1/PD-L1 Inhibitors: A Real-World Single-Centre Experience with a Management-Based Approach. Ther Clin Risk Manag 2021; 17:669-677. [PMID: 34234443 PMCID: PMC8256379 DOI: 10.2147/tcrm.s308194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/08/2021] [Indexed: 01/11/2023] Open
Abstract
AIM To assess the efficacy and tolerance of programmed death-1 (PD-1) and PD-ligand 1 (PD-L1) inhibitors and the impact of a standardised management-based protocol in a real-world setting. PATIENTS AND METHODS Data from patients who had received anti-PD-(L)1 were collected from our pharmacy database. Clinical response and toxicity were assessed using RECIST criteria and CTCAE version 5.0, respectively. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method. Potential prognostic factors were identified using Cox's model. RESULTS A total of 196 patients and 201 lines of treatment were included (median age: 66 (range: 38-89) years). Types of cancer included non-small cell lung cancer (73%), transitional cell carcinoma (10%), renal cell carcinoma (6%), small cell lung cancer (5%), head and neck squamous cell carcinoma (4%) and classical Hodgkin's lymphoma (1%). Twenty-five (12%) patients had pre-existing autoimmune conditions. Our standardised management-based protocol included 129 (64%) patients. Objective response rate was 29%, median OS was 10 months (IQR: 7-15) and median PFS was 5 months (IQR: 1-22). Patients with an abnormal baseline complete blood count had a worse OS (HR=2.48 [95% CI: 1.24-4.96]; p=0.0103). Thirty-three (16%) patients experienced severe (grade 3 or 4) immune-related adverse event (irAE). There were three (1%) irAE-related deaths. AEs resolved faster when patients were assessed by an internist before anti-PD-(L)1 initiation (p=0.0205). CONCLUSION PD-1 and PD-L1 inhibitors are effective and safe in a real-world setting. Implementation of a standardised management-based protocol with internal medicine specialists is an effective way to optimise irAE management.
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Affiliation(s)
- Fabien Grimaud
- Department of Pharmacy, Hôpital Européen, Marseille, France
| | | | - Chloé Stavris
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | | | - Véronique Brunel
- Department of Haemato-Oncology, Hôpital Européen, Marseille, France
| | - Sylvie Cailleres
- Department of Haemato-Oncology, Hôpital Européen, Marseille, France
| | - Hervé Pegliasco
- Department of Pulmonology, Hôpital Européen, Marseille, France
| | | | | | - Emilie Coquet
- Department of Pharmacy, Hôpital Européen, Marseille, France
| | - Laurent Chiche
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | - Amélie Rognon
- Department of Pharmacy, Hôpital Européen, Marseille, France
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Adhoute X, Larrey E, Anty R, Chevallier P, Penaranda G, Tran A, Bronowicki JP, Raoul JL, Castellani P, Perrier H, Bayle O, Monnet O, Pol B, Bourliere M. Expected outcomes and patients’ selection before chemoembolization—“Six-and-Twelve or Pre-TACE-Predict” scores may help clinicians: Real-life French cohorts results. World J Clin Cases 2021; 9:4559-4572. [PMID: 34222423 PMCID: PMC8223847 DOI: 10.12998/wjcc.v9.i18.4559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/26/2020] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Careful selection of hepatocellular carcinoma (HCC) patients prior to chemoembolization treatment is a daily reality, and is even more necessary with new available therapeutic options in HCC.
AIM To propose two new models to better stratify patients and maximize clinical benefit: “6 and 12” and “pre/post-TACE-predict” (TACE, transarterial chemoembolization).
METHODS We evaluated and compared their performance in predicting overall survival with other systems {Barcelona Clinic Liver Cancer (BCLC), Albumin-Bilirubin (ALBI) and NIACE [Number of tumor(s), Infiltrative HCC, alpha-fetoprotein, Child-Pugh (CP), and performance status]} in two HCC French cohorts of different stages enrolled between 2010 and 2018.
RESULTS The cohorts included 324 patients classified as BCLC stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2). The majority of the patients had cirrhosis with preserved liver function. “Pre-TACE-predict” and “6 and 12” models identified three distinct categories of patients exhibiting different prognosis in cohort 1. However, their prognostic value was no better than the BCLC system or NIACE score. Liver function based on CP and ALBI grades significantly impacted patient survival. Conversely, the “post-TACE-predict” model had a higher predictive value than other models. The stratification ability as well as predictive performance of these new models in an intermediate/advanced stage population was less efficient (cohort 2).
CONCLUSION The newly proposed “Pre-TACE-predict” and “6 and 12” models offer an interesting stratification into three categories in a recommended TACE population, as they identify poor candidates, those with partial control and durable response. The models' contribution was reduced in a population with advanced stage HCCs.
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Affiliation(s)
- Xavier Adhoute
- Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
| | - Edouard Larrey
- Department of Gastroenterology and Hepatology, Hôpital Universitaire de l’Archet, Nice 06000, France
| | - Rodolphe Anty
- Department of Gastroenterology and Hepatology, Hôpital Universitaire de l’Archet, Nice 06000, France
| | - Patrick Chevallier
- Department of Radiology, Hôpital Universitaire de l’Archet, Nice 06000, France
| | | | - Albert Tran
- Department of Gastroenterology and Hepatology, Hôpital Universitaire de l’Archet, Nice 06000, France
| | - Jean-Pierre Bronowicki
- Department of Gastroenterology and Hepatology, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre les Nancy 54511, France
| | - Jean-Luc Raoul
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Site de Nantes, Nantes 44805, France
| | - Paul Castellani
- Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
| | - Hervé Perrier
- Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
| | - Olivier Bayle
- Department of Radiology, Hôpital Saint-Joseph, Marseille 13008, France
| | - Olivier Monnet
- Department of Radiology, Hôpital Saint-Joseph, Marseille 13008, France
| | - Bernard Pol
- Department of Hepatobiliary Surgery, Hôpital Saint-Joseph, Marseille 13008, France
| | - Marc Bourliere
- Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
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Chapal R, Penaranda G, Stavris C, Jammes Y, Retornaz F. Impact de la reconnaissance de handicap et des aménagements professionnels sur la situation professionnelle des travailleurs atteints d’Encéphalomyelite Myalgique/Syndrome de fatigue chronique (EM/SFC). Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Laquière AE, Privat J, Fumex F, Grandval P, Lecomte L, Curel L, Belle A, Trottier-Tellier F, Urena-Campos R, Penaranda G, Boustière C, Napoléon B. Performance of digital single-operator cholangiopancreatoscope for biliopancreatic diseases in real life: results from a prospective multicenter study. Scand J Gastroenterol 2020; 55:1381-1388. [PMID: 33095075 DOI: 10.1080/00365521.2020.1832143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Peroralcholangio-pancreatoscopy (POCP) is used for diagnosis and treatment of biliopancreatic disease when standard endoscopy (ERCP) or pre-operative imaging workup failed. We aimed to evaluate the diagnostic and therapeutic performance of POCP in complex biliary and pancreatic diseases. MATERIALS AND METHODS Patients with indeterminate biliary or pancreatic duct (PD) strictures, and patients with failure of complex biliary or pancreatic stones removal, were enrolled (six centers). The primary endpoint evaluated malignancy diagnostic performances (accuracy, sensitivity, specificity) and therapeutic performances (biliary or pancreatic stones extraction). Secondary endpoints evaluated: technical success in lesion visualization, ease of maneuvering, image quality and 30-days complications. RESULTS From November 2016 to March 2018, 66 patients were included: 29/37 women/men, median age (IQR): 73 (64-82). Fifty-three patients had diagnostic POCP and 13 patients therapeutic POCP. One endoscopist with one or two endoscopy nurses performed 94% of the POCP. The 'POCP visual impression' of malignancy showed 92.0% sensitivity, 92.9 % specificity and 92.5 % overall accuracy compared with the final diagnosis. 'POCP-guided samples histological analysis' showed 75.0 % sensitivity and 91.6% specificity. The technical success for lesion visualization was 98.5%. The median VAS scores for insertions in bile and PD were respectively 9.0 (8.1-9.6) and 9.0 (8.8-10.0). Median VAS score for access to the lesion and image quality were respectively 9.0 (7.7-9.6) and 9.0 (7.9-9.7). Only three 30-day minor complications occurred without any major complications. CONCLUSIONS POCP was an effective, safe and easy-to-use tool in routine clinical practice for the management of complex diagnostic and therapeutic biliary and pancreatic diseases (NCT03190343).
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Affiliation(s)
- Arthur E Laquière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Jocelyn Privat
- Department of Hepatogastroenterology, Centre Hospitalier Vichy, Vichy, France
| | - Fabien Fumex
- Department of Hepatogastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Philippe Grandval
- Digestive Endoscopy and Gastroenterology Department, AP-HM Hôpital de la Timone, Marseille, France
| | - Laurence Lecomte
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Laurence Curel
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Arthur Belle
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Félix Trottier-Tellier
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Romina Urena-Campos
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | | | - Christian Boustière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Bertrand Napoléon
- Department of Hepatogastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
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Benmiloud F, Godiris-Petit G, Gras R, Gillot JC, Turrin N, Penaranda G, Noullet S, Chéreau N, Gaudart J, Chiche L, Rebaudet S. Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg 2020; 155:106-112. [PMID: 31693081 DOI: 10.1001/jamasurg.2019.4613] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance Because inadvertent damage of parathyroid glands can lead to postoperative hypocalcemia, their identification and preservation, which can be challenging, are pivotal during total thyroidectomy. Objective To determine if intraoperative imaging systems using near-infrared autofluorescence (NIRAF) light to identify parathyroid glands could improve parathyroid preservation and reduce postoperative hypocalcemia. Design, Setting, and Participants This randomized clinical trial was conducted from September 2016 to October 2018, with a 6-month follow-up at 3 referral hospitals in France. Adult patients who met eligibility criteria and underwent total thyroidectomy were randomized. The exclusion criteria were preexisting parathyroid diseases. Interventions Use of intraoperative NIRAF imaging system during total thyroidectomy. Main Outcomes and Measures The primary outcome was the rate of postoperative hypocalcemia (a corrected calcium <8.0 mg/dL [to convert to mmol/L, multiply by 0.25] at postoperative day 1 or 2). The main secondary outcomes were the rates of parathyroid gland autotransplantation and inadvertent parathyroid gland resection. Results A total of 245 of 529 eligible patients underwent randomization. Overall, 241 patients were analyzed for the primary outcome (mean [SD] age, 53.6 [13.6] years; 191 women [79.3%]): 121 who underwent NIRAF-assisted thyroidectomy and 120 who underwent conventional thyroidectomy (control group). The temporary postoperative hypocalcemia rate was 9.1% (11 of 121 patients) in the NIRAF group and 21.7% (26 of 120 patients) in the control group (between-group difference, 12.6% [95% CI, 5.0%-20.1%]; P = .007). There was no significant difference in permanent hypocalcemia rates (0% in the NIRAF group and 1.6% [2 of 120 patients] in the control group). Multivariate analyses accounting for center and surgeon heterogeneity and adjusting for confounders, found that use of NIRAF reduced the risk of hypocalcemia with an odds ratio of 0.35 (95% CI, 0.15-0.83; P = .02). Analysis of secondary outcomes showed that fewer patients experienced parathyroid autotransplantation in the NIRAF group than in the control group: respectively, 4 patients (3.3% [95% CI, 0.1%-6.6%) vs 16 patients (13.3% [95% CI, 7.3%-19.4%]; P = .009). The number of inadvertently resected parathyroid glands was significantly lower in the NIRAF group than in the control group: 3 patients (2.5% [95% CI, 0.0%-5.2%]) vs 14 patients (11.7% [95% CI, 5.9%-17.4%], respectively; P = .006). Conclusions and Relevance The use of NIRAF for the identification of the parathyroid glands may help improve the early postoperative hypocalcemia rate significantly and increase parathyroid preservation after total thyroidectomy. Trial Registration ClinicalTrials.gov Identifier: NCT02892253.
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Affiliation(s)
- Fares Benmiloud
- Endocrine Surgery Unit, Hôpital Européen Marseille, Marseille, France
| | - Gaelle Godiris-Petit
- General and Endocrine Surgery Unit, Groupement Hospitalier Universitaire Pitié Salpêtrière, Paris, France
| | - Régis Gras
- Head and Neck Surgery Unit, Hôpital Saint-Joseph, Marseille, France
| | | | - Nicolas Turrin
- General and Endocrine Surgery Unit, Hôpital Saint-Joseph, Marseille, France
| | | | - Séverine Noullet
- General and Endocrine Surgery Unit, Groupement Hospitalier Universitaire Pitié Salpêtrière, Paris, France
| | - Nathalie Chéreau
- General and Endocrine Surgery Unit, Groupement Hospitalier Universitaire Pitié Salpêtrière, Paris, France
| | - Jean Gaudart
- Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Institut National de la Santé et de la Recherche Médicale, L'Institut de Recherche Pour le Développement, Sciences Économiques et Sociales de la Santé et Traitement de L'information Médicale, Hôpital Timone, BioSTIC, Biostatistics & Information and Communication Technology, Marseille, France
| | - Laurent Chiche
- Internal Medicine Unit, Hôpital Européen Marseille, Marseille, France
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Queguiner F, Bezirganyan K, Courjaret JC, Curel L, Penaranda G, Righini Chossegros M. Impact of switching from ranibizumab to aflibercept on the number of intravitreous injection and follow up visit in wet AMD: results of real life ELU study. Int J Ophthalmol 2020; 13:252-256. [PMID: 32090034 DOI: 10.18240/ijo.2020.02.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 08/14/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To study if one of the two molecules could lead to a lower number of follow up visits and intra-vitreous injection (IVI) with the same efficacy. METHODS ELU (or "elected" in French) study is a retrospective study conducted in real life in patients presenting suboptimal response after ranibizumab IVI (phase 1) and secondary switched to aflibercept (phase 2). The number of follow up visits and IVI were compared in both phases. Visual acuity (VA) evolution and "switching" reasons were secondary analyzed. RESULTS We retrospectively included data of 33 patients (38 eyes) with age-related macular degeneration (AMD; mean age: 77±7.7y). The number of monthly follow up visits [median (Q1; Q3)]: was significantly lower with aflibercept (phase 2), respectively 1.0 (0.81; 1.49) visits in phase 1, versus 0.79 (0.67; 0.86) visits in phase 2. The median number of monthly IVI also significantly decreased in phase 2, respectively 0.67 (0.55; 0.90) IVI in phase 1, versus 0.55 (0.45; 0.67) IVI in phase 2. The mean VA evolution (VA final-VA initial) was similar in both phases, (P>0.05). Whatever the reason for "switching" (loss of efficacy, tachyphylaxis, tolerance problems), there was no incidence on VA evolution over the time. CONCLUSION Our results show that switching from ranibizumab to aflibercept in "suboptimal" patients significantly reduce the number of follow up visits and IVI, with a comparable efficacy. This decrease in visit number could improve patients' quality of life and reduce surgical risk by reducing the number of injections.
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Affiliation(s)
- Frederic Queguiner
- Ophthalmology and Clinical Research Departments, Hôpital Saint Joseph, Marseille F-13008, France
| | - Kristina Bezirganyan
- Ophthalmology and Clinical Research Departments, Hôpital Saint Joseph, Marseille F-13008, France
| | | | - Laurence Curel
- Ophthalmology and Clinical Research Departments, Hôpital Saint Joseph, Marseille F-13008, France
| | | | - Maud Righini Chossegros
- Ophthalmology and Clinical Research Departments, Hôpital Saint Joseph, Marseille F-13008, France
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Stavris C, Retornaz F, Bourlière M, Penaranda G, Ansaldi C, Chiche L, Halfon P. Dépistage prospectif de la fibrose hépatique à l’aide du Fib-4 calculé automatiquement lors d’un bilan biologique chez 29 707 sujets français. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Raoul JL, Adhoute X, Penaranda G, Perrier H, Castellani P, Oules V, Bourlière M. Sorafenib: Experience and Better Manage-ment of Side Effects Improve Overall Survival in Hepatocellular Carcinoma Patients: A Real-Life Retrospective Analysis. Liver Cancer 2019; 8:457-467. [PMID: 31799203 PMCID: PMC6883434 DOI: 10.1159/000497161] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/20/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sorafenib is the first-line treatment for advanced hepatocellular carcinoma (HCC). The management of its side effects is improving. This study aimed to assess, in real life, if this translates into a better prognosis. METHODS This was a retrospective study of advanced HCC patients treated with sorafenib between 2007 and 2017. RESULTS 188 advanced HCC patients received > 4 weeks of sorafenib. Median treatment duration was 5.4 months and median overall survival (mOS) 10 months (95% confidence interval 15-27). Sorafenib was initiated in 65 patients in 2007-2012 and 123 in 2013-2017. Both groups were comparable except for Barcelona Clinic liver cancer class. Tumor progression, disease control (DC) rate, and incidence of toxicity were similar in the 2 periods, but the duration of treatment (4.3 vs. 5.9 months; p < 0.01) and mOS (8 vs. 12 months; p < 0.002) differed. Among progressive disease patients, mOS was similar (7 months) but for those who had DC at 8 weeks, mOS was longer in the recent period (13 vs. 27 months; p < 0.0001). In the univariate analysis of OS, the period of treatment had a prognostic value. CONCLUSION When comparing 2 periods of treatment in advanced HCC patients under sorafenib, duration of treatment and mOS were higher in the recent period. While mOS did not differ for patients who progressed, it was 2-fold higher in the recent period for those who had tumor control. Improvements in the use of sorafenib seem to be associated with better outcomes limited to patients with DC.
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Affiliation(s)
- Jean-Luc Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France,*Prof Jean-Luc Raoul, Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Bd J Monod, FR–44805 Saint-Herblain (France), E-Mail
| | - Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | | | - Hervé Perrier
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | - Paul Castellani
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | - Valérie Oules
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
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Adda J, Stanova V, Zenses AS, Clavel MA, Barragan P, Penaranda G, Habib G, Pibarot P, Rieu R. Discordant Grading of Aortic Stenosis Severity: New Insights from an In Vitro Study. Structural Heart 2019. [DOI: 10.1080/24748706.2019.1632507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Jérôme Adda
- Department of Cardiology, University Hospital Arnaud de Villeneuve, Montpellier, France
| | | | - Anne-Sophie Zenses
- Aix-Marseille University, LBA-UMRT24 IFSTTAR, Marseille, France
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Paul Barragan
- Department of Cardiology, Polyclinique les Fleurs, Ollioules, France
| | | | - Gilbert Habib
- Department of Cardiology, Hospital La Timone, Insuffisance Cardiaque et Valvulopathie, Marseille, France
| | - Philippe Pibarot
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Régis Rieu
- Aix-Marseille University, LBA-UMRT24 IFSTTAR, Marseille, France
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21
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Halfon P, Penaranda G, Ouzan D, Philibert P, Khiri H, Mohamed S. Clinical resistance to dolutegravir assessed by next generation sequencing in pre-exposed raltegravir patients. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30363-0] [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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22
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Philibert P, Penaranda G, Chiche L, Rebaudet S, Camus C, Khiri H, Delord M, Allemand-Sourrieu J, Halfon P. High Incidence of sexually transmitted infections in HIV negative MSM patients: a real-life prospective cohort study. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | | | - Jean Luc Raoul
- Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
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Adhoute X, Penaranda G, Raoul JL, Bourlière M. Prediction of benefit after transarterial chemoembolization (TACE): Subclassifications or scoring systems? Liver Int 2018; 38:184. [PMID: 28695577 DOI: 10.1111/liv.13516] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | | | - Jean-Luc Raoul
- Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
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Benmiloud F, Rebaudet S, Varoquaux A, Penaranda G, Bannier M, Denizot A. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery 2017; 163:23-30. [PMID: 29122325 DOI: 10.1016/j.surg.2017.06.022] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/15/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical impact of intraoperative autofluorescence-based identification of parathyroids using a near-infrared camera remains unknown. METHODS In a before and after controlled study, we compared all patients who underwent total thyroidectomy by the same surgeon during Period 1 (January 2015 to January 2016) without near-infrared (near-infrared- group) and those operated on during Period 2 (February 2016 to September 2016) using a near-infrared camera (near-infrared+ group). In parallel, we also compared all patients who underwent surgery without near-infrared during those same periods by another surgeon in the same unit (control groups). Main outcomes included postoperative hypocalcemia, parathyroid identification, autotransplantation, and inadvertent resection. RESULTS The near-infrared+ group displayed significantly lower postoperative hypocalcemia rates (5.2%) than the near-infrared- group (20.9%; P < .001). Compared with the near-infrared- patients, the near-infrared+ group exhibited an increased mean number of identified parathyroids and reduced parathyroid autotransplantation rates, although no difference was observed in inadvertent resection rates. Parathyroids were identified via near-infrared before they were visualized by the surgeon in 68% patients. In the control groups, parathyroid identification improved significantly from Period 1 to Period 2, although autotransplantation, inadvertent resection and postoperative hypocalcemia rates did not differ. CONCLUSION Near-infrared use during total thyroidectomy significantly reduced postoperative hypocalcemia, improved parathyroid identification and reduced their autotransplantation rate.
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Affiliation(s)
- Fares Benmiloud
- Endocrine Surgery Unit, Hôpital Européen de Marseille, Marseilles, France.
| | - Stanislas Rebaudet
- Internal Medicine Unit, Hôpital Européen de Marseille, Marseilles, France
| | - Arthur Varoquaux
- Radiology Unit, Hôpital La Timone, Hospital-APHM, Marseilles, France
| | | | - Marie Bannier
- Oncologic Surgery Unit, Institut Paoli-Calmettes, Marseilles, France
| | - Anne Denizot
- Endocrine Surgery Unit, Hôpital Européen de Marseille, Marseilles, France
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Adda J, Stanova V, Clavel MA, Barragan P, Penaranda G, Habib G, Pibarot P, Rieu R. P6332Hemodynamic determinants of low gradient severe aortic stenosis: an in vitro study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6332] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Seitz J, Bars C, Théodore G, Beurtheret S, Lellouche N, Bremondy M, Ferracci A, Faure J, Penaranda G, Yamazaki M, Avula UMR, Curel L, Siame S, Berenfeld O, Pisapia A, Kalifa J. AF Ablation Guided by Spatiotemporal Electrogram Dispersion Without Pulmonary Vein Isolation: A Wholly Patient-Tailored Approach. J Am Coll Cardiol 2017; 69:303-321. [PMID: 28104073 DOI: 10.1016/j.jacc.2016.10.065] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The use of intracardiac electrograms to guide atrial fibrillation (AF) ablation has yielded conflicting results. OBJECTIVES The authors evaluated the usefulness of spatiotemporal dispersion, a visually recognizable electric footprint of AF drivers, for the ablation of all forms of AF. METHODS The authors prospectively enrolled 105 patients admitted for AF ablation. AF was sequentially mapped in both atria with a 20-pole PentaRay catheter. The authors tagged and ablated only regions displaying electrogram dispersion during AF. Results were compared to a validation set in which a conventional ablation approach was used (pulmonary vein isolation/stepwise approach). To establish the mechanism underlying spatiotemporal dispersion of AF electrograms, the authors conducted realistic numerical simulations of AF drivers in a 2-dimensional model and optical mapping of ovine atrial scar-related AF. RESULTS Ablation at dispersion areas terminated AF in 95% of the 105 patients. After ablation of 17 ± 10% of the left atrial surface and 18 months of follow-up, the atrial arrhythmia recurrence rate was 15% after 1.4 ± 0.5 procedures per patient versus 41% in the validation set after 1.5 ± 0.5 procedures per patient (arrhythmia free-survival: 85% vs. 59%; log-rank p < 0.001). Compared with the validation set, radiofrequency times (49 ± 21 min vs. 85 ± 34.5 min; p = 0.001) and procedure times (168 ± 42 min vs. 230 ± 67 min; p < 0.0001) were shorter. In simulations and optical mapping experiments, virtual PentaRay recordings demonstrated that electrogram dispersion is mostly recorded in the vicinity of a driver. CONCLUSIONS The clustering of intracardiac electrograms exhibiting spatiotemporal dispersion is indicative of AF drivers. Their ablation allows for a nonextensive and patient-tailored approach to AF ablation. (Substrate Ablation Guided by High Density Mapping in Atrial Fibrillation [SUBSTRATE HD]; NCT02093949).
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Affiliation(s)
- Julien Seitz
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France.
| | - Clément Bars
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France; Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France
| | | | - Sylvain Beurtheret
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France
| | | | - Michel Bremondy
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France
| | - Ange Ferracci
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France
| | - Jacques Faure
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France
| | | | - Masatoshi Yamazaki
- Center for Arrhythmia Research, Cardiovascular Research Center, Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Uma Mahesh R Avula
- Center for Arrhythmia Research, Cardiovascular Research Center, Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Laurence Curel
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France
| | - Sabrina Siame
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France
| | - Omer Berenfeld
- Center for Arrhythmia Research, Cardiovascular Research Center, Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - André Pisapia
- Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph Marseille, France
| | - Jérôme Kalifa
- Center for Arrhythmia Research, Cardiovascular Research Center, Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
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Seitz J, Bars C, Beurtheret S, Penaranda G, Pisapia A, Kalifa J. Reply: History Repeating? The Logics of History. J Am Coll Cardiol 2017. [PMID: 28641804 DOI: 10.1016/j.jacc.2017.03.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Franques J, Sahuc P, Dussol B, Penaranda G, Swiader L, Froissart R, Attarian S, Stavris C, Chiche L, Pouget J. Peripheral nerve involvement in Fabry's disease: Which investigations? A case series and review of the literature. Rev Neurol (Paris) 2017; 173:650-657. [PMID: 28579207 DOI: 10.1016/j.neurol.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 01/05/2017] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral nerve system (PNS) involvement is common in Fabry's disease (FD), predominantly affecting the small nerve fibers that are difficult to investigate with conventional electrophysiological methods. PATIENTS AND METHODS Eighteen patients followed for Fabry's disease underwent a prospective series of electroneurophysiological explorations, including a study of the cardiac parasympathetic autonomic nervous system (ANS) and electrochemical skin conductance (ESC) tests. Data were compared with those obtained in 18 matched healthy controls. RESULTS All patients had at least one clinical sign suggestive of neuropathy: 16 reported an acrosyndrome and 12 had dyshidrosis. Cold hypoesthesia was found in 15 patients and heat hypoesthesia in 13. Electroneurophysiological investigations and study of the cardiac parasympathetic ANS were normal in all patients. The ESC was significantly lower in FD patients compared with controls. CONCLUSION PNS involvement is common in FD and should be suspected in patients exhibiting an acrosyndrome, dyshidrosis and/or cold hypoesthesia. Conventional electrophysiological investigations are normal. New techniques, such as ESC, provide early diagnosis of small fiber involvement that currently requires more sophisticated tests difficult to apply in routine practice.
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Affiliation(s)
- J Franques
- Centre de référence des maladies neuromusculaires et de la SLA, CHU La Timone, AP-HM, 13005 Marseille, France; Hopital privé La Casamance, 13400 Aubagne, France; Service de médecine interne, hôpital européen, 6, rue Desiree-Clary, 13003 Marseille, France
| | - P Sahuc
- Centre de référence des maladies neuromusculaires et de la SLA, CHU La Timone, AP-HM, 13005 Marseille, France
| | - B Dussol
- Service de néphrologie, CHU La Timone, AP-HM, 13005 Marseille, France
| | - G Penaranda
- Service de médecine interne, hôpital européen, 6, rue Desiree-Clary, 13003 Marseille, France
| | - L Swiader
- Service de médecine interne, CHU La Timone, AP-HM, 13005 Marseille, France
| | - R Froissart
- Service des maladies héréditaires du métabolisme et dépistage néonatal, centre de biologie et pathologie Est, CHU de Lyon-GH Est, hospices civils, 69677 Bron, France
| | - S Attarian
- Centre de référence des maladies neuromusculaires et de la SLA, CHU La Timone, AP-HM, 13005 Marseille, France
| | - C Stavris
- Service de médecine interne, hôpital européen, 6, rue Desiree-Clary, 13003 Marseille, France
| | - L Chiche
- Service de médecine interne, hôpital européen, 6, rue Desiree-Clary, 13003 Marseille, France.
| | - J Pouget
- Centre de référence des maladies neuromusculaires et de la SLA, CHU La Timone, AP-HM, 13005 Marseille, France
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Adda J, Stanova V, Clavel M, Barragan P, Penaranda G, Habib G, Pibarot P, Rieu R. Hemodynamic determinants of low gradient “severe” aortic stenosis: an in vitro study. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Laquiere A, Desilets E, Belle A, Castellani P, Grandval P, Laugier R, Penaranda G, Lecomte L, Boustiere C. Double guidewire endoscopic technique, a major evolution in endoscopic retrograde cholangiopancreatography: Results of a retrospective study with historical controls comparing two therapeutic sequential strategies. Dig Endosc 2017; 29:182-189. [PMID: 27638137 DOI: 10.1111/den.12740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/14/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic access to the common bile duct (CBD) remains difficult in 10% of cases, requiring alternative techniques .CBD access was difficult after either five unsuccessful attempts, five unintentional insertions into the pancreatic duct or >10-min-long unsuccessful attempts. This retrospective study with historical controls aimed to evaluate the benefit of the double guidewire (DGW) technique after failure of standard CBD cannulation. METHODS From January 2012 to December 2014, all patients requiring therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with difficult access to CBD were included in a Studied group. This group was compared to a historical ERCP control group from January 2009 to December 2011. In the Studied group, a sequential strategy including DGW technique was done when the guidewire was unintentionally passed into the pancreatic duct. In the control group, only pre-cut technique was used. RESULTS Among the 538 patients with naive papilla eligible for ERCP, 73 had difficult CBD access. Successful CBD access rate was higher in the Studied group: 91% (50/55) versus 67% (12/18) P = 0.0215. Complication rates were similar in both groups: 28% versus 20%, P = 0.5207. LOS was shorter in the Studied group (9.2 ± 8.5 vs 14.4 ± 7.4 days, P = 0.0028). Post-ERCP cholangitis were lower in the Studied group: 2% (1/55) versus 22% (4/18), P = 0.0118. CONCLUSION After standard cannulation failure, DGW technique increased successful CBD access rate and decreased LOS without increasing complications.
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Affiliation(s)
- Arthur Laquiere
- Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France
| | - Etienne Desilets
- Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France
| | - Arthur Belle
- Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France
| | - Paul Castellani
- Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France
| | | | - René Laugier
- Gastroenterology Department, La Timone Hospital, Marseille, France
| | | | - Laurence Lecomte
- Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France
| | - Christian Boustiere
- Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France
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Adhoute X, Penaranda G, Raoul JL, Bourlière M. HCC classification and HCC scoring system: a win-win combination for prognosis and treatment recommendations. Liver Int 2016; 36:1876-1877. [PMID: 27062075 DOI: 10.1111/liv.13140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | | | - Jean-Luc Raoul
- Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
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Adhoute X, Penaranda G, Raoul JL, Bourlière M. Nomogram of the Barcelona Clinic Liver Cancer System: external validation in European patients. Liver Int 2016; 36:1716-1717. [PMID: 27237085 DOI: 10.1111/liv.13171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/13/2023]
Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | | | - Jean-Luc Raoul
- Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
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Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, Marseille, France
| | | | - Jean Luc Raoul
- Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette Marseille, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, Marseille, France
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Halfon P, Mohamed S, Penaranda G, Khiri H, Chiche L, Nicolas C, Abergel A. Hepatitis C genotype 4R resistance-associated polymorphisms: The achilles heel of the nonstructural 5A inhibitors? Hepatology 2016; 64:697-8. [PMID: 27118238 DOI: 10.1002/hep.28611] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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)
- Philippe Halfon
- Européen Hospital, Marseille, France.,Alphabio Laboratory, Marseille, France
| | | | | | | | | | - Carine Nicolas
- Digestive and Hepato-biliary Medicine, CHU Estaing, Clermont-Ferrand, France
| | - Armand Abergel
- Digestive and Hepato-biliary Medicine, CHU Estaing, Clermont-Ferrand, France
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Adhoute X, Penaranda G, Raoul JL, Le Treut P, Bollon E, Hardwigsen J, Castellani P, Perrier H, Bourlière M. Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments. World J Hepatol 2016; 8:703-715. [PMID: 27330679 PMCID: PMC4911504 DOI: 10.4254/wjh.v8.i17.703] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
Therapeutic management of hepatocellular carcinoma (HCC) is quite complex owing to the underlying cirrhosis and portal vein hypertension. Different scores or classification systems based on liver function and tumoral stages have been published in the recent years. If none of them is currently “universally” recognized, the Barcelona Clinic Liver Cancer (BCLC) staging system has become the reference classification system in Western countries. Based on a robust treatment algorithm associated with stage stratification, it relies on a high level of evidence. However, BCLC stage B and C HCC include a broad spectrum of tumors but are only matched with a single therapeutic option. Some experts have thus suggested to extend the indications for surgery or for transarterial chemoembolization. In clinical practice, many patients are already treated beyond the scope of recommendations. Additional alternative prognostic scores that could be applied to any therapeutic modality have been recently proposed. They could represent complementary tools to the BCLC staging system and improve the stratification of HCC patients enrolled in clinical trials, as illustrated by the NIACE score. Prospective studies are needed to compare these scores and refine their role in the decision making process.
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Adhoute X, Penaranda G, Raoul JL, Bourlière M. Hepatocellular carcinoma scoring and staging systems. Do we need new tools? J Hepatol 2016; 64:1449-50. [PMID: 26912407 DOI: 10.1016/j.jhep.2016.01.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France.
| | | | - Jean-Luc Raoul
- Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
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Chiche L, Penaranda G, Savori P, Jourde-Chiche N, Halfon P, Camus C. THU0250 Dysregulation of Autophagy in Systemic Lupus Erythematosus Is Correlated To Transcriptional Interferon Signatures and Provides Candidate Biomarkers. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2790] [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: 11/04/2022]
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Dahari H, Canini L, Graw F, Uprichard SL, Araújo ESA, Penaranda G, Coquet E, Chiche L, Riso A, Renou C, Bourliere M, Cotler SJ, Halfon P. HCV kinetic and modeling analyses indicate similar time to cure among sofosbuvir combination regimens with daclatasvir, simeprevir or ledipasvir. J Hepatol 2016; 64:1232-9. [PMID: 26907973 PMCID: PMC5081285 DOI: 10.1016/j.jhep.2016.02.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/24/2015] [Accepted: 02/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Recent clinical trials of direct-acting-antiviral agents (DAAs) against hepatitis C virus (HCV) achieved >90% sustained virological response (SVR) rates, suggesting that cure often took place before the end of treatment (EOT). We sought to evaluate retrospectively whether early response kinetics can provide the basis to individualize therapy to achieve optimal results while reducing duration and cost. METHODS 58 chronic HCV patients were treated with 12-week sofosbuvir+simeprevir (n=19), sofosbuvir+daclatasvir (n=19), or sofosbuvir+ledipasvir in three French referral centers. HCV was measured at baseline, day 2, every other week, EOT and 12weeks post EOT. Mathematical modeling was used to predict the time to cure, i.e., <1 virus copy in the entire extracellular body fluid. RESULTS All but one patient who relapsed achieved SVR. Mean age was 60±11years, 53% were male, 86% HCV genotype-1, 9% HIV coinfected, 43% advanced fibrosis (F3), and 57% had cirrhosis. At weeks 2, 4 and 6, 48%, 88% and 100% of patients had HCV<15IU/ml, with 27%, 74% and 91% of observations having target not detected, respectively. Modeling results predicted that 23 (43%), 16 (30%), 7 (13%), 5 (9%) and 3 (5%) subjects were predicted to reach cure within 6, 8, 10, 12 and 13weeks of therapy, respectively. The modeling suggested that the patient who relapsed would have benefitted from an additional week of sofosbuvir+ledipasvir. Adjusting duration of treatment according to the modeling predicts reduced medication costs of 43-45% and 17-30% in subjects who had HCV<15IU/ml at weeks 2 and 4, respectively. CONCLUSIONS The use of early viral kinetic analysis has the potential to individualize duration of DAA therapy with a projected average cost saving of 16-20% per 100-treated persons.
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Affiliation(s)
- Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA; Theoretical Biology & Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Laetitia Canini
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom
| | - Frederik Graw
- Center for Modeling and Simulation in the Biosciences, BioQuant Center, Heidelberg University, Heidelberg, Germany
| | - Susan L Uprichard
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | | | | | - Emilie Coquet
- Internal Medicine and Infectious Disease, Hôpital Européen, Marseille, France
| | - Laurent Chiche
- Internal Medicine and Infectious Disease, Hôpital Européen, Marseille, France
| | - Aurelie Riso
- Division of Hepatology, Hôpital Saint Joseph, Marseille, France
| | | | - Marc Bourliere
- Division of Hepatology, Hôpital Saint Joseph, Marseille, France
| | - Scott J Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - Philippe Halfon
- Laboratoire Alphabio, Marseille, France; Internal Medicine and Infectious Disease, Hôpital Européen, Marseille, France.
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Philibert P, Penaranda G, Chiche L, Mboungou G, Halfon P. Comorbid diseases and risk factors assessment in people with HIV by systematic screening approach: results of a practice survey in a routine HIV clinic setting in the South of France. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)31120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Penaranda G, Halfon P, Scholtès C, Mohamed S, Leroy V, Bourlière M, Ouzan D, Pénaranda G, Khiri H, Polverel L, Zoulim F, Thélu MA, Larrat S. Prevalence and characterization of NS5A resistance associated variants (RAVs) in patients who relapsed following exposure to NS5A inhibitors. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)31123-7] [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: 11/24/2022] Open
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Dahari H, Canini L, Graw F, Uprichard SL, Araujo EA, Penaranda G, Coquet E, Riso A, Renou C, Bourlière M, Cotler SJ, Halfon P. HCV kinetic and modeling analyses indicate similar time to cure among sofosbuvir combination regimens with daclatasvir, simeprevir or ledipasvir. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)31122-5] [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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Philibert P, Penaranda G, Chiche L, Sow P, Mboungou G, Bidaut W, Mathieu D, Retornaz F, Allemand J, Halfon P. Combination of non-invasive methods for the assessment of liver fibrosis in patients with chronic liver diseases: results of the ELASTIC real life study. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)31121-3] [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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Mohamed S, Bourliere M, Benali S, Oules V, Castellani P, Khiri H, Camus C, Penaranda G, Chiche L, Gonzalez D, Sayada C, Olive D, Halfon P. Clinical relevance of the HCV protease inhibitor-resistant mutant viral load assessed by ultra-deep pyrosequencing in treatment failure. J Clin Virol 2016; 78:36-43. [PMID: 26971166 DOI: 10.1016/j.jcv.2016.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The detection of low frequency mutants in patients with hepatitis C virus (HCV) receiving direct-acting antivirals (DAAs) is still debated. The clinical relevance of the mutant viral load has not yet been evaluated. OBJECTIVES To assess the viral load of resistance associated variants (RAVs) in patients at different time points, including the baseline, virological failure and one year after the cessation of therapy. STUDY DESIGN The study included 22 patients who were previously treated with protease inhibitors (PI) (with telaprevir and boceprevir). For each patient, three time points were assessed using ultra-deep pyrosequencing (UDPS). RESULTS Baseline mutations were observed in 14/22 patients (64%). At virological failure, RAVs were detected in 18/22 patients (82%). Persistent RAVs were observed in four HCV GT 1a patients (18%). Persistence mutations were found only in HCV GT 1a patients. The baseline relative V36M, R155K, R155T and A156T mutation load of patients with persistent RAVs was significantly higher (P<0.001) than those of patients without persistent RAVs. CONCLUSION The UDPS follow-up analysis demonstrated that the presence of BOC or TLP-RAVs persist one year after therapy cessation only in HCV GT 1a patients. The relative mutant viral load should be considered prior to any PI based re-treatment. This concept of the baseline mutation viral load must be validated using current therapy and must be validated on a larger cohort.
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Affiliation(s)
- Sofiane Mohamed
- Laboratoire Alphabio, Marseille, France; CRCM, Immunity and Cancer, Inserm, U1068; Institut Paoli-Calmettes; Aix-Marseille Université, UM 105; CNRS, UMR7258, F-13009 Marseille, France
| | - Marc Bourliere
- Département d'hépato-gastroenterologie, Hôpital Saint Joseph, Marseille, France
| | - Souad Benali
- Département d'hépato-gastroenterologie, Hôpital Saint Joseph, Marseille, France
| | - Valerie Oules
- Département d'hépato-gastroenterologie, Hôpital Saint Joseph, Marseille, France
| | - Paul Castellani
- Département d'hépato-gastroenterologie, Hôpital Saint Joseph, Marseille, France
| | | | | | | | | | | | - Chalom Sayada
- Advanced Biological Laboratories (ABL), Luxembourg, Luxembourg
| | - Daniel Olive
- CRCM, Immunity and Cancer, Inserm, U1068; Institut Paoli-Calmettes; Aix-Marseille Université, UM 105; CNRS, UMR7258, F-13009 Marseille, France
| | - Philippe Halfon
- Laboratoire Alphabio, Marseille, France; Hôpital Européen, Marseille, France.
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Philibert P, Penaranda G, Chiche L, Sow P, Mboungou G, Bidaut W, Mathieu D, Retornaz F, Allemand J, Halfon P. Méthodes non invasives d’évaluation de la fibrose au cours des hépatopathies chroniques : quelle combinaison optimale dans la vraie vie ? Résultats de l’étude ELASTIC. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.246] [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: 11/27/2022]
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Adhoute X, Penaranda G, Naude S, Raoul JL, Perrier H, Bayle O, Monnet O, Beaurain P, Bazin C, Pol B, Folgoc GL, Castellani P, Bronowicki JP, Bourlière M. Retreatment with TACE: the ABCR SCORE, an aid to the decision-making process. J Hepatol 2015; 62:855-62. [PMID: 25463541 DOI: 10.1016/j.jhep.2014.11.014] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 10/23/2014] [Accepted: 11/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines. METHODS From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score. RESULTS In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (>200 ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from -3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients' prognosis. CONCLUSIONS The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.
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Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France
| | | | - Sebastien Naude
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nancy, France
| | - Jean Luc Raoul
- Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli Calmette Marseille, France
| | - Herve Perrier
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France
| | - Olivier Bayle
- Department of Radiology, Hôpital Saint-Joseph Marseille, France
| | - Olivier Monnet
- Department of Radiology, Hôpital Saint-Joseph Marseille, France
| | | | - Christophe Bazin
- Department of Radiology, Centre Hospitalier Universitaire de Nancy, France
| | - Bernard Pol
- Department of Surgery, Hôpital Saint-Joseph Marseille, France
| | - Gaelle Le Folgoc
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France
| | - Paul Castellani
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France
| | - Jean Pierre Bronowicki
- INSERM U954, Université de Lorraine, CHU de Nancy, Vandoeuvre les Nancy, France; Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nancy, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France.
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Adhoute X, Penaranda G, Castellani P, Perrier H, Bourliere M. Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system? World J Hepatol 2015; 7:521-31. [PMID: 25848475 PMCID: PMC4381174 DOI: 10.4254/wjh.v7.i3.521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/02/2014] [Accepted: 11/27/2014] [Indexed: 02/06/2023] Open
Abstract
Several hepatocellular carcinoma (HCC) staging systems have been established, and a variety of country-specific treatment strategies are also proposed. The barcelona - clinic liver cancer (BCLC) system is the most widely used in Europe. The Hong Kong liver Cancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization (TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC (BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.
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Affiliation(s)
- Xavier Adhoute
- Xavier Adhoute, Paul Castellani, Herve Perrier, Marc Bourliere, Department of Hepatology, Hopital Saint-Joseph, 13285 Marseille, France
| | - Guillaume Penaranda
- Xavier Adhoute, Paul Castellani, Herve Perrier, Marc Bourliere, Department of Hepatology, Hopital Saint-Joseph, 13285 Marseille, France
| | - Paul Castellani
- Xavier Adhoute, Paul Castellani, Herve Perrier, Marc Bourliere, Department of Hepatology, Hopital Saint-Joseph, 13285 Marseille, France
| | - Herve Perrier
- Xavier Adhoute, Paul Castellani, Herve Perrier, Marc Bourliere, Department of Hepatology, Hopital Saint-Joseph, 13285 Marseille, France
| | - Marc Bourliere
- Xavier Adhoute, Paul Castellani, Herve Perrier, Marc Bourliere, Department of Hepatology, Hopital Saint-Joseph, 13285 Marseille, France
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Adhoute X, Penaranda G, Bronowicki JP, Raoul JL. Usefulness of the HKLC vs. the BCLC staging system in a European HCC cohort. J Hepatol 2015; 62:492-3. [PMID: 25194894 DOI: 10.1016/j.jhep.2014.08.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/21/2014] [Accepted: 08/25/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Xavier Adhoute
- Department of Hepatology, Hopital Saint-Joseph, Marseille, France.
| | | | | | - Jean-Luc Raoul
- Department of Oncology, Institut Paoli Calmettes, Marseille, France
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Laquière A, Grandval P, Arpurt JP, Boulant J, Belon S, Aboukheir S, Laugier R, Penaranda G, Curel L, Boustière C. Interest of submucosal dissection knife for endoscopic treatment of Zenker's diverticulum. Surg Endosc 2014; 29:2802-10. [PMID: 25475517 DOI: 10.1007/s00464-014-3976-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 10/25/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Dual-Knife(®) (Olympus) and Hydride-Knife(®) are new needle knives frequently used for submucosal dissection because of their safety and precision. In this study we aimed to evaluate the efficacy and safety of such devices in the diverticulopexy by flexible endoscopy. METHODS From February 2009 to March 2013, 42 patients (25 men), mean age 74.5, with symptomatic Zenker's diverticulum, were included in a non-randomized prospective multicenter study. The symptoms described by all patients include dysphagia, regurgitation and/or swallowing disorders. The diverticulopexy was performed with the Dual-Knife(®) or Hydrid-Knife(®), after septum exposure with the diverticuloscope, and terminated with distal tip clips positioning. All complications were noted. Patients' symptoms were regularly assessed during follow-up visits or telephone interviews. RESULTS The first endoscopy treatment was successful for all patients. Thirty-seven patients (88%) had symptoms improvement after the first treatment. The recurrence rate was 14% (6 patients); a second endoscopic treatment was required 12 months on average after the first treatment, with 100% efficiency. Mid-term (16 months) efficiency was 91.67% after 1 to 3 endoscopic treatments. A total of 55 procedures were performed without perforation or significant bleeding and 3 patients underwent surgery. In multivariate analysis, the diverticulum size and the type of dissection knife were not risks factors for recurrence. CONCLUSIONS Endoscopic diverticuloscope-assisted diverticulotomy with submucosal dissection knives is a safe and effective alternative treatment for patients with a symptomatic Zenker's diverticulum measuring between 2 and 10 cm.
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Affiliation(s)
- A Laquière
- Hepato-Gastro-Enterology Department, Hôpital Saint Joseph, 26 bd de Louvain, 13008, Marseille, France,
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Mohamed S, Penaranda G, Gonzalez D, Camus C, Khiri H, Boulmé R, Sayada C, Philibert P, Olive D, Halfon P. Clinical impact of ultra deep versus Sanger sequencing detection of minority mutations on HIV-1 drug resistance genotype interpretation after virological failure. BMC Infect Dis 2014. [PMCID: PMC4220854 DOI: 10.1186/1471-2334-14-s2-o1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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