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Cañellas Dols F, Entrambasaguas M, Wix R, Alvarez A, Romero O, Carvajal P, Pujol J, Puertas F. Insomnia Subtypes. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.345] [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: 11/28/2022]
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Ojeda F, Tío L, Martinez-Vilavella G, Pujol J, Blanco-Hinojo L, Deus J, Monllau JC, Monfort J. POS0179 IMPLICATIONS OF BRAIN ACTIVITY IN THE TREATMENT DECISION OF KNEE OSTEOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2067] [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] [Indexed: 11/04/2022]
Abstract
BackgroundChronic pain related to knee osteoarthritis (KOA) is a common health problem and functional magnetic resonance imaging (fMRI) is a useful technique which can determine different brain activation (1).ObjectivesThe main purpose of our study was to observe whether there is different risk to central sensitization and different brain activation in patients with KOA according to the treatment followed (conservative (CNV) Vs. total knee replacement (TKR))MethodsPatients diagnosed of primary KOA following a CNV treatment or undergoing TKR were recruited. The two groups were matched by age, sex and BMI. Clinical central sensitization was considered if patients presented spread tenderness, evaluated with an algometer, in more than 1 site of the extended peripatellar map (2) (notice that pain at points 3, 7 and 8 were not counted) fMRI testing involved pressure painful stimulation to the articular interline and to a commonly sensitized site (tibial surface, point 10).To evaluate the associations between central sensitization and the risk to undergo a TKR; logistic regression was performed to estimate OR and 95% confidence intervals (95%CI). Models were adjusted by sex, age and BMI (R (R v.3.5.2).Whole-brain activation maps were compared between groups using Statistical Parametric Mapping software (SPM12 http://www.fil.ion.ucl.ac.uk/spm).ResultsWomen have a significant higher risk to present central sensitization than men (OD 12,11 (95% CI 4,32-33,95) p-value:2,09*106), but no differences were observed between CNV and TKR group (OR TKR 0,69 (95% CI 0,24-1,98)) (Table 1). The differences observed in brain activation between the treatment groups in the interline fMRI test (point 7) did not correspond to any specific brain area. However, TKR group showed a higher activation that implicated the region of the amygdala and anterior hippocampus during the tibial fMRI test (point 10).Table 1.Central sensitization Odds Ratio (OR) with 95% Confidence Interval (95%CI)O.R. (95% CI)p-valueTreatment0.69 (0.24- 1.98)0,494Sex12.11 (4.32- 33.95)2,09*10-6Age0.72 (0.26- 1.97)0,525BMI1.88 (0.69- 5.17)0,219ConclusionPresenting central sensitization is not a risk for KOA patients to undergo a TKR, but the mechanism underlaying sensitization in both treatment groups might be different, with amygdala playing an important role in TKR patients. The amygdala is an important element of the brain systems that both express emotions and modulate pain. The activation of the amygdala in response to pressure stimulation on a sensitized knee site is interpreted as a failure of the descending pain inhibitory systems, and the occurrence of a major emotional response during the painful experience in patients that ultimately received TKR.References[1]Pujol, J. et al., 2017. Brain imaging of pain sensitization in patients with knee osteoarthritis. Pain, 158(9), pp.1831–1838.[2]Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, Graven-Nielsen T. Sensitization in patients with painful knee osteoarthritis. Pain 2010;149:573-8Extended peripatellar map including the points tested for tenderness, and brain areas differently activated between both treatments groups during painful stimulation to point 7 (interline) and point 10 (tibial surface, a commonly sensitized site).Disclosure of InterestsNone declared
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Breinig S, Pinot A, Pujol J, Ikhlef H, Blasy C, Marcoux MO. The "3R Team" in action! Implementation of a program of learning from excellence in a neonatal and pediatric intensive care unit in France. Arch Pediatr 2022; 29:225-229. [PMID: 35120782 DOI: 10.1016/j.arcped.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/10/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The pursuit of improving quality of care and of patient safety is a crucial objective in intensive care units (ICUs). Classically, safety is characterized by analyzing adverse events. Neonatal and pediatric ICUs (NICUs/PICU) are highly technological units, with evidence of risk for elevated levels of emotional exhaustion and thus a significant level of staff turnover. We hypothesized that appreciative inquiry (AI), currently used in many organizations, could be introduced in our ICU. In the PICU and NICU, this new concept is termed "learning from excellence" (LFE). OBJECTIVE To assess the impact of the implementation of an LFE program on well-being and on an educational program in the NICU/PICU of a tertiary care center in France. METHODS We created a workgroup composed of caregivers called the "3R team" for "right resuscitations reviews," based on the concept of AI. Before and 1 year after implementation, we administered two validated surveys-the Maslach Burnout Inventory and the Siegrist survey-to the entire staff of the 22-bed unit. RESULTS The questionnaire on satisfaction revealed a high percentage (93%) of satisfaction with the work of the 3R team and that scores of well-being and burnout were improved. The educational program was highly enhanced, especially simulation. Benevolence and happiness were increased. CONCLUSION Implementation of an LFE program in a NICU and PICU is feasible, and tends to increase the well-being and self-confidence of all categories of caregivers. It promotes educational programs of dynamic learning, including simulation. The next important step will be to study the impact on staff turnover and on quality of care.
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Affiliation(s)
- S Breinig
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 avenue de Grande-Bretagne, Toulouse Cedex 9, France; INSERM, UMR 1027, SPHERE Team, Hôpital Paule de Viguier, 330 avenue de Grande-Bretagne TSA 70034, France.
| | - A Pinot
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 avenue de Grande-Bretagne, Toulouse Cedex 9, France
| | - J Pujol
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 avenue de Grande-Bretagne, Toulouse Cedex 9, France
| | - H Ikhlef
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 avenue de Grande-Bretagne, Toulouse Cedex 9, France
| | - C Blasy
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 avenue de Grande-Bretagne, Toulouse Cedex 9, France
| | - M O Marcoux
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 avenue de Grande-Bretagne, Toulouse Cedex 9, France
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Pifarré P, Simó M, Gispert JD, Plaza P, Fernández A, Pujol J. Diazepam and Jacobson's Progressive Relaxation Show Similar Attenuating Short-Term Effects on Stress-Related Brain Glucose Consumption. Eur Psychiatry 2020; 30:187-92. [DOI: 10.1016/j.eurpsy.2014.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/10/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractA non-pharmacological method to reduce anxiety is “progressive relaxation” (PR). The aim of the method is to reduce mental stress and associated mental processes by means of progressive suppression of muscle tension. The study was addressed to evaluate changes in brain glucose metabolism induced by PR in patients under a stressing state generated by a diagnostic medical intervention. The effect of PR was compared to a dose of sublingual diazepam, with the prediction that both interventions would be associated with a reduction in brain metabolism. Eighty-four oncological patients were assessed with 18F-fluorodeoxyglucose-positron emission tomography. Maps of brain glucose distribution from 28 patients receiving PR were compared with maps from 28 patients receiving sublingual diazepam and with 28 patients with no treatment intervention. Compared to reference control subjects, the PR and diazepam groups showed a statistically significant, bilateral and generalized cortical hypometabolism. Regions showing the most prominent changes were the prefrontal cortex and anterior cingulate cortex. No significant differences were identified in the direct comparison between relaxation technique and sublingual diazepam. Our findings suggest that relaxation induced by a physical/psychological procedure can be as effective as a reference anxiolytic in reducing brain activity during a stressful state.
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Porta-Casteràs D, Fullana MA, Tinoco D, Martínez-Zalacaín I, Pujol J, Palao DJ, Soriano-Mas C, Harrison BJ, Via E, Cardoner N. Prefrontal-amygdala connectivity in trait anxiety and generalized anxiety disorder: Testing the boundaries between healthy and pathological worries. J Affect Disord 2020; 267:211-219. [PMID: 32217221 DOI: 10.1016/j.jad.2020.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/17/2020] [Accepted: 02/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Current brain-based theoretical models of generalized anxiety disorder (GAD) suggest a dysfunction of amygdala-ventromedial prefrontal cortex emotional regulatory mechanisms. These alterations might be reflected by an altered resting state functional connectivity between both areas and could extend to vulnerable non-clinical samples such as high worriers without a GAD diagnosis. However, there is a lack of information in this regard. METHODS We investigated differences in resting state functional connectivity between the basolateral amygdala and the ventromedial prefrontal cortex (amygdala-vmPFC) in 28 unmedicated participants with GAD, 28 high-worriers and 28 low-worriers. We additionally explored selected clinical variables as predictors of amygdala-vmPFC connectivity, including anxiety sensitivity. RESULTS GAD participants presented higher left amygdala-vmPFC connectivity compared to both groups of non-GAD participants, and there were no differences between the latter two groups. In our exploratory analyses, concerns about the cognitive consequences of anxiety (the cognitive dimension of anxiety sensitivity) were found to be a significant predictor of the left amygdala-vmPFC connectivity. LIMITATIONS The cross-sectional nature of our study preclude us from assessing if functional connectivity measures and anxiety sensitivity scores entail an increased risk of GAD. CONCLUSIONS These results suggest a neurobiological qualitative distinction at the level of the amygdala-vmPFC emotional-regulatory system in GAD compared to non-GAD participants, either high- or low-worriers. At this neural level, they question previous hypotheses of continuity between high worries and GAD development. Instead, other anxiety traits such as anxiety sensitivity might confer a greater proneness to the amygdala-vmPFC connectivity alterations observed in GAD.
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Affiliation(s)
- D Porta-Casteràs
- Mental Health Department, Unitat de Neurociència Traslacional. Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Bellaterra, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - M A Fullana
- Institute of Neurosciences, Hospital Clinic, CIBERSAM, Barcelona, Spain
| | - D Tinoco
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, CIBERSAM, Carlos III Health Institute, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Pujol
- MRI Research Unit,Hospital del Mar, CIBERSAM G21, Barcelona,Spain
| | - D J Palao
- Mental Health Department, Unitat de Neurociència Traslacional. Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Bellaterra, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, CIBERSAM, Carlos III Health Institute, Barcelona, Spain; Department of Psychobiology and Methodology of Health Sciences. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Victoria, Australia
| | - E Via
- Mental Health Department, Unitat de Neurociència Traslacional. Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Bellaterra, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain; Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
| | - N Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional. Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Bellaterra, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Vilor-Tejedor N, Alemany S, Forns J, Cáceres A, Murcia M, Macià D, Pujol J, Sunyer J, González JR. Assessment of Susceptibility Risk Factors for ADHD in Imaging Genetic Studies. J Atten Disord 2019; 23:671-681. [PMID: 27535943 DOI: 10.1177/1087054716664408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE ADHD consists of a count of symptoms that often presents heterogeneity due to overdispersion and excess of zeros. Statistical inference is usually based on a dichotomous outcome that is underpowered. The main goal of this study was to determine a suited probability distribution to analyze ADHD symptoms in Imaging Genetic studies. METHOD We used two independent population samples of children to evaluate the consistency of the standard probability distributions based on count data for describing ADHD symptoms. RESULTS We showed that the zero-inflated negative binomial (ZINB) distribution provided the best power for modeling ADHD symptoms. ZINB reveals a genetic variant, rs273342 (Microtubule-Associated Protein [MAPRE2]), associated with ADHD ( p value = 2.73E-05). This variant was also associated with perivascular volumes (Virchow-Robin spaces; p values < 1E-03). No associations were found when using dichotomous definition. CONCLUSION We suggest that an appropriate modeling of ADHD symptoms increases statistical power to establish significant risk factors.
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Affiliation(s)
- N Vilor-Tejedor
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - S Alemany
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - J Forns
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain.,4 Norwegian Institute of Public Health, Oslo, Norway
| | - A Cáceres
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - M Murcia
- 3 CIBER Epidemiología y Salud Pública, Barcelona, Spain.,5 FISABIO-Universitat Jaume I-Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - D Macià
- 6 Hospital del Mar, Cibersam G21, Barcelona, Spain
| | - J Pujol
- 6 Hospital del Mar, Cibersam G21, Barcelona, Spain
| | - J Sunyer
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain.,7 Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J R González
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
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Parés D, Martínez-Vilalta M, Ortiz H, Soriano-Mas C, Maestre-Gonzalez Y, Pujol J, Grande L. Assessment of brain activity during voluntary anal sphincter contraction: Comparative study in women with and without fecal incontinence. Neurogastroenterol Motil 2018; 30:e13347. [PMID: 29655195 DOI: 10.1111/nmo.13347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Voluntary anal sphincter function is driven by an extended network of brain structures, most of which are still unknown. Disturbances in this function may cause fecal incontinence. The aim of this study was to characterize the cerebral areas involved in voluntary contraction of the anorectal sphincter in healthy women and in a group of patients with fecal incontinence by using a standardized functional magnetic resonance imaging (fMRI) protocol. METHODS This comparative study included 12 healthy women (mean age 53.17 ± 4.93 years) and 12 women with fecal incontinence (56.25 ± 6.94 years). An MRI-compatible anal manometer was used to register voluntary external anal sphincter contraction. During brain fMRI imaging, participants were cued to perform 10-s series of self-paced anal sphincter contractions at an approximate rate of 1 Hz. Brain structures linked to anal sphincter contractions were mapped and the findings were compared between the 2 study groups. KEY RESULTS There were no differences in the evoked brain activity between the 2 groups. In healthy women, group fMRI analysis revealed significant activations in medial primary motor cortices, supplementary motor area, bilateral putamen, and cerebellum, as well as in the supramarginal gyrus and visual areas. In patients with fecal incontinence, the activation pattern involved similar regions without significant differences with healthy women. CONCLUSIONS & INFERENCES This brain fMRI-anorectal protocol was able to map the brain regions linked to voluntary anal sphincter function in healthy and women with fecal incontinence.
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Affiliation(s)
- D Parés
- Department of General Surgery, Colorectal Surgery Unit, Hospital Germans Trias i Pujol, School of Medicine, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain
| | | | - H Ortiz
- Department of Engineering Design, Universitat Politècnica de Barcelona, Barcelona, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge Biomedical Research Institute - IDIBELL and CIBERSAM G-17, Barcelona, Spain.,Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Spain
| | | | - J Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - L Grande
- Department of Surgery, Parc de Salut Mar, Barcelona, Spain
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Via E, Fullana MA, Goldberg X, Tinoco-González D, Martínez-Zalacaín I, Soriano-Mas C, Davey CG, Menchón JM, Straube B, Kircher T, Pujol J, Cardoner N, Harrison BJ. Ventromedial prefrontal cortex activity and pathological worry in generalised anxiety disorder. Br J Psychiatry 2018; 213:437-443. [PMID: 29739481 DOI: 10.1192/bjp.2018.65] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pathological worry is a hallmark feature of generalised anxiety disorder (GAD), associated with dysfunctional emotional processing. The ventromedial prefrontal cortex (vmPFC) is involved in the regulation of such processes, but the link between vmPFC emotional responses and pathological v. adaptive worry has not yet been examined.AimsTo study the association between worry and vmPFC activity evoked by the processing of learned safety and threat signals. METHOD In total, 27 unmedicated patients with GAD and 56 healthy controls (HC) underwent a differential fear conditioning paradigm during functional magnetic resonance imaging. RESULTS Compared to HC, the GAD group demonstrated reduced vmPFC activation to safety signals and no safety-threat processing differentiation. This response was positively correlated with worry severity in GAD, whereas the same variables showed a negative and weak correlation in HC. CONCLUSIONS Poor vmPFC safety-threat differentiation might characterise GAD, and its distinctive association with GAD worries suggests a neural-based qualitative difference between healthy and pathological worries.Declaration of interestNone.
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Affiliation(s)
- E Via
- Department of Mental Health,Corporació Sanitaria Parc Taulí-i3PT,CIBERSAM,Sabadell,Spain
| | - M A Fullana
- Anxiety Unit,Institute of Neuropsychiatry and Addictions,Hospital del Mar,CIBERSAM,Barcelona,Spain
| | - X Goldberg
- Department of Mental Health,Corporació Sanitaria Parc Taulí-i3PT,CIBERSAM,Sabadell,Spain
| | | | - I Martínez-Zalacaín
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL,CIBERSAM,Barcelona,Spain
| | - C Soriano-Mas
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL,CIBERSAM,Barcelona,Spain
| | - C G Davey
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne and Melbourne Health,Victoria,Australia
| | - J M Menchón
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL,CIBERSAM,Barcelona,Spain
| | - B Straube
- Department of Psychiatry and Psychotherapy,Philipps-University Marburg,Marburg,Germany
| | - T Kircher
- Department of Psychiatry and Psychotherapy,Philipps-University Marburg,Marburg,Germany
| | - J Pujol
- MRI Research Unit,Hospital del Mar,CIBERSAM G21,Barcelona,Spain
| | - N Cardoner
- Department of Mental Health,Corporació Sanitaria Parc Taulí-i3PT,CIBERSAM,Sabadell,Spain
| | - B J Harrison
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne and Melbourne Health,Victoria,Australia
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Oriolo G, Egmond E, Mariño Z, Cavero M, Navines R, Zamarrenho L, Solà R, Pujol J, Bargallo N, Forns X, Martin-Santos R. Systematic review with meta-analysis: neuroimaging in hepatitis C chronic infection. Aliment Pharmacol Ther 2018. [PMID: 29536563 DOI: 10.1111/apt.14594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C is considered a systemic disease because of extra-hepatic manifestations. Neuroimaging has been employed in hepatitis C virus-infected patients to find in vivo evidence of central nervous system alterations. AIMS Systematic review and meta-analysis of neuroimaging research in chronic hepatitis C treatment naive patients, or patients previously treated without sustained viral response, to study structural and functional brain impact of hepatitis C. METHODS Using PRISMA guidelines a database search was conducted from inception up until 1 May 2017 for peer-reviewed studies on structural or functional neuroimaging assessment of chronic hepatitis C patients without cirrhosis or encephalopathy, with control group. Meta-analyses were performed when possible. RESULTS The final sample comprised 25 studies (magnetic resonance spectroscopy [N = 12], perfusion weighted imaging [N = 1], positron emission tomography [N = 3], single-photon emission computed tomography [N = 4], functional connectivity in resting state [N = 1], diffusion tensor imaging [N = 2] and structural magnetic resonance imaging [N = 2]). The whole sample was of 509 chronic hepatitis C patients, with an average age of 41.5 years old and mild liver disease. A meta-analysis of magnetic resonance spectroscopy studies showed increased levels of choline/creatine ratio (mean difference [MD] 0.12, 95% confidence interval [CI] 0.06-0.18), creatine (MD 0.85, 95% CI 0.42-1.27) and glutamate plus glutamine (MD 1.67, 95% CI 0.39-2.96) in basal ganglia and increased levels of choline/creatine ratio in centrum semiovale white matter (MD 0.13, 95% CI 0.07-0.19) in chronic hepatitis C patients compared with healthy controls. Photon emission tomography studies meta-analyses did not find significant differences in PK11195 binding potential in cortical and subcortical regions of chronic hepatitis C patients compared with controls. Correlations were observed between various neuroimaging alterations and neurocognitive impairment, fatigue and depressive symptoms in some studies. CONCLUSIONS Patients with chronic hepatitis C exhibit cerebral metabolite alterations and structural or functional neuroimaging abnormalities, which sustain the hypothesis of hepatitis C virus involvement in brain disturbances.
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Affiliation(s)
- G Oriolo
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - E Egmond
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Department of Health and Clinical Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Z Mariño
- Liver Unit, Hospital Clinic, IDIBAPS, Centro Investigación Biomédica en Red de Enfermedades hepáticas y digestivas, (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - M Cavero
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - R Navines
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - L Zamarrenho
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - R Solà
- Liver Unit, Parc de Salut Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, CIBERSAM, Barcelona, Spain
| | - N Bargallo
- Center of Diagnostic Image (CDIC), Hospital Clinic, Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
| | - X Forns
- Liver Unit, Hospital Clinic, IDIBAPS, Centro Investigación Biomédica en Red de Enfermedades hepáticas y digestivas, (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - R Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
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Cano M, Alonso P, Martínez-Zalacaín I, Subirà M, Real E, Segalàs C, Pujol J, Cardoner N, Menchón JM, Soriano-Mas C. Altered functional connectivity of the subthalamus and the bed nucleus of the stria terminalis in obsessive-compulsive disorder. Psychol Med 2018; 48:919-928. [PMID: 28826410 DOI: 10.1017/s0033291717002288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The assessment of inter-regional functional connectivity (FC) has allowed for the description of the putative mechanism of action of treatments such as deep brain stimulation (DBS) of the nucleus accumbens in patients with obsessive-compulsive disorder (OCD). Nevertheless, the possible FC alterations of other clinically-effective DBS targets have not been explored. Here we evaluated the FC patterns of the subthalamic nucleus (STN) and the bed nucleus of the stria terminalis (BNST) in patients with OCD, as well as their association with symptom severity. METHODS Eighty-six patients with OCD and 104 healthy participants were recruited. A resting-state image was acquired for each participant and a seed-based analysis focused on our two regions of interest was performed using statistical parametric mapping software (SPM8). Between-group differences in FC patterns were assessed with two-sample t test models, while the association between symptom severity and FC patterns was assessed with multiple regression analyses. RESULTS In comparison with controls, patients with OCD showed: (1) increased FC between the left STN and the right pre-motor cortex, (2) decreased FC between the right STN and the lenticular nuclei, and (3) increased FC between the left BNST and the right frontopolar cortex. Multiple regression analyses revealed a negative association between clinical severity and FC between the right STN and lenticular nucleus. CONCLUSIONS This study provides a neurobiological framework to understand the mechanism of action of DBS on the STN and the BNST, which seems to involve brain circuits related with motor response inhibition and anxiety control, respectively.
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Affiliation(s)
- M Cano
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
| | - P Alonso
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
| | - M Subirà
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
| | - E Real
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
| | - C Segalàs
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
| | - J Pujol
- CIBERSAM, Carlos III Health Institute, Madrid,Spain
| | - N Cardoner
- CIBERSAM, Carlos III Health Institute, Madrid,Spain
| | - J M Menchón
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
| | - C Soriano-Mas
- Department of Psychiatry,Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat,Barcelona,Spain
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11
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Casajoana A, Pujol J, Garcia A, Elvira J, Virgili N, de Oca FJ, Duran X, Fernández-Veledo S, Vendrell J, Vilarrasa N. Predictive Value of Gut Peptides in T2D Remission: Randomized Controlled Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy and Greater Curvature Plication. Obes Surg 2018; 27:2235-2245. [PMID: 28451931 DOI: 10.1007/s11695-017-2669-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our aim was to determine the predictive value of gut hormone changes for the improvement of type 2 diabetes (T2D) following metabolic Roux-en-Y gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP) in a randomized controlled trial. Contradictory results have been obtained regarding the role of gastrointestinal hormones (in particular GLP-1) in beneficial metabolic bariatric surgery outcomes. METHODS Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and area under the curve (AUC) of GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after surgery. RESULTS Twelve months after surgery, total weight loss percentage was higher and HbA1c lower in the mRYGB group than in the SG and GCP groups (-35.2 ± 8.1 and 5.1 ± 0.6% vs. -27.8 ± 5.4 and 6.2 ± 0.8% vs. -20.5 ± 6.8 and 6.6 ± 1.3%; p = 0.007 and p < 0.001, respectively). Moreover, GLP-1 AUC at months 1 and 12 was greater and T2D remission was higher in mRYGB (80 vs. 53.3 vs. 20%, p < 0.001). Insulin treatment (odds ratio (OR) 0.025, p = 0.018) and the increase in GLP-1 AUC from baseline to month 1 (OR 1.021, p = 0.013) were associated with T2D remission. CONCLUSIONS mRYGB achieves a superior rate of weight loss and T2D remission at month 12. Enhanced GLP-1 secretion 1 month after surgery was a determinant of glucose metabolism improvement. Registration number ( http://www.clinicaltrials.gov ): NCT14104758.
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Affiliation(s)
- Anna Casajoana
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Jordi Pujol
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Amador Garcia
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Jordi Elvira
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Francisco Javier de Oca
- Colorectal Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Xavier Duran
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Fernández-Veledo
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Vendrell
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain. .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain. .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
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12
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Vilarrasa N, Fabregat A, Toro S, Gordejuela AG, Casajoana A, Montserrat M, Garrido P, López-Urdiales R, Virgili N, Planas-Vilaseca A, Simó-Servat A, Pujol J. Nutritional deficiencies and bone metabolism after endobarrier in obese type 2 patients with diabetes. Eur J Clin Nutr 2018; 72:1447-1450. [PMID: 29352218 DOI: 10.1038/s41430-017-0074-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/11/2017] [Accepted: 12/04/2017] [Indexed: 01/25/2023]
Abstract
Endobarrier® is a minimally invasive, reversible endoscopic treatment for obesity. It provokes malabsorption along 60 cm of the small intestine, which can contribute to the development of vitamin deficiencies and to changes in bone mineral density (BMD). To determine the prevalence of nutrient deficiencies, changes in body composition and BMD during the first year after Endobarrier® placement. Twenty-one patients with type 2 diabetes met inclusion criteria. Levels of vitamins, micro and macronutrients were assessed prior and at 1, 3 and 12 months post-operatively. DEXA was performed before and 12 months after implant. Nineteen patients completed the 12 months follow-up. Vitamin D deficiency was the most prevalent finding before Endobarrier® implant. The percentage of patients with severe deficiency decreased from 19 to 5% at 12 months after supplementation. Microcytic anaemia was initially present in 9.5% of patients and increased to 26.3% at 12 months. Low ferritin and vitamin B12 levels were observed in 14.2 and 4.8% of patients before the implant and worsened to 42 and 10.5%. Low concentrations of magnesium and phosphorus were also common but improved along the study. A significant but not clinically relevant decrease in BMD of 4.14 ± 4.0% at the femoral neck was observed at 12 months without changes in osteocalcin levels. Vitamin deficiencies are common after Endobarrier® implant. It is therefore important to screen patients prior to and at regular intervals after the implant, and to encourage adherence to diet counselling and supplementation.
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Affiliation(s)
- Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain. .,CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Alexandra Fabregat
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Silvia Toro
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Anna Casajoana
- Bariatric Surgery Unit, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Mónica Montserrat
- Dietitian Nutricionist, Clinical Nutrition Unit, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Pilar Garrido
- Dietitian Nutricionist, Clinical Nutrition Unit, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Núria Virgili
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Alejandra Planas-Vilaseca
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Jordi Pujol
- Bariatric Surgery Unit, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
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13
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Cano M, Alonso P, Martínez-Zalacaín I, Subirà M, Real E, Segalàs C, Pujol J, Cardoner N, Menchón J, Soriano-Mas C. Altered functional connectivity of the subthalamus and the bed nucleus of the stria terminalis in obsessive-compulsive disorder. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.075] [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: 11/30/2022] Open
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14
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Cano M, Martínez-Zalacaín I, Bernabéu-Sanz Á, Contreras-Rodríguez O, Hernández-Ribas R, Via E, de Arriba-Arnau A, Gálvez V, Urretavizcaya M, Pujol J, Menchón JM, Cardoner N, Soriano-Mas C. Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression: a longitudinal neuroimaging study. Transl Psychiatry 2017; 7:e1023. [PMID: 28170003 PMCID: PMC5438019 DOI: 10.1038/tp.2016.267] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/12/2016] [Accepted: 11/13/2016] [Indexed: 02/08/2023] Open
Abstract
Recent research suggests that neuroplastic and neuroinflammatory changes may account for the mode of action of electroconvulsive therapy (ECT), although extant data do not allow for a clear disambiguation between these two hypotheses. Multimodal neuroimaging approaches (for example, combining structural and metabolic information) may help in clarifying this issue. Here we aimed to assess longitudinal changes in (i) regional gray matter (GM) volumes and (ii) hippocampal metabolite concentrations throughout an acute course of bitemporal ECT, as well as (iii) to determine the association between imaging changes and clinical improvement. We assessed 12 patients with treatment-resistant depression (TRD) at four time points (pre-treatment, after the first ECT session, after the ninth ECT session and 15 days after ECT course completion) and 10 healthy participants at two time points, 5 weeks apart. Patients with TRD showed bilateral medial temporal lobe (MTL) and perigenual anterior cingulate cortex volume increases. Left MTL volume increase was associated with (i) a hippocampal N-acetylaspartate concentration decrease, (ii) a hippocampal Glutamate+Glutamine concentration increase and (iii) significant clinical improvement. The observed findings are, in part, compatible with both neuroplastic and neuroinflammatory changes induced by ECT. We postulate that such phenomena may be interrelated, therefore reconciling the neuroplasticity and neuroinflammatory hypotheses of ECT action.
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Affiliation(s)
- M Cano
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Á Bernabéu-Sanz
- Magnetic Resonance Department, Inscanner SL, Alicante, Spain
| | - O Contreras-Rodríguez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain
| | - R Hernández-Ribas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain
| | - E Via
- Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - V Gálvez
- School of Psychiatry, University of New South Wales (UNSW) and Black Dog Institute, Randwick, Sydney, NSW, Australia
| | - M Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain
| | - J Pujol
- Carlos III Health Institute, CIBERSAM, Madrid, Spain,MRI Research Unit, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - J M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain E-mail:
| | - N Cardoner
- Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain,Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Parc Taulí 1, Sabadell, 08208 Barcelona, Spain. E-mail:
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain,Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vilarrasa N, de Gordejuela AGR, Casajoana A, Duran X, Toro S, Espinet E, Galvao M, Vendrell J, López-Urdiales R, Pérez M, Pujol J. Endobarrier® in Grade I Obese Patients with Long-Standing Type 2 Diabetes: Role of Gastrointestinal Hormones in Glucose Metabolism. Obes Surg 2016; 27:569-577. [DOI: 10.1007/s11695-016-2311-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Marques-Gil D, Pujol J, Lopez-Ruiz M, Llorente-Onaindia J, Orpinell Palacio L, Montañes F, Campillo M, Benito P, Martinez-Vilavella G, Macia D, Monfort J. SAT0426 Functional Connectivity Alterations in Knee OA Patients: An FMRI Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Solsona de la Serna E, Pujol J, Llistar S, Barbera E, Giménez N. Técnicas actorales e inteligencia emocional para profesionales de la salud: aprendizaje transformacional. Index Enferm 2015. [DOI: 10.4321/s1132-12962015000300011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Middleton G, Gridelli C, De Marinis F, Pujol J, Reck M, Ramlau R, Parente M, Pieters T, Visseren-Grul C, Antonio BS, John W, Zimmermann A, Chouaki N, Paz-Ares L. Evaluation of Changes in Renal Function in a Phase III Study of Maintenance (Mtc) Pemetrexed (Pem) Plus Best Supportive Care (Bsc) Versus Placebo (Plb) Plus Bsc After Induction Treatment (Tx) with Pem Plus Cisplatin for Advanced Nonsquamous Non-Small Cell Lung Cancer (Paramount). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Monfort J, Pujol J, Contreras-Rodríguez O, Llorente-Onaindia J, Lόpez-Solà M, Blanco-Hinojo L, Deus J, Ortiz H, Montañés F, Campillo M, Benito P, Sánchez L, Herrero M, Vergés J. OP0057 Effects of Chondroitin Sulfate on Brain Response to Painful Stimulation in Knee Osteoarthritis Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4908] [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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21
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Ceperuelo-Mallafré V, Duran X, Pachón G, Roche K, Garrido-Sánchez L, Vilarrasa N, Tinahones FJ, Vicente V, Pujol J, Vendrell J, Fernández-Veledo S. Disruption of GIP/GIPR axis in human adipose tissue is linked to obesity and insulin resistance. J Clin Endocrinol Metab 2014; 99:E908-19. [PMID: 24512489 DOI: 10.1210/jc.2013-3350] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Glucose-dependent insulinotropic peptide (GIP) has a central role in glucose homeostasis through its amplification of insulin secretion; however, its physiological role in adipose tissue is unclear. OBJECTIVE Our objective was to define the function of GIP in human adipose tissue in relation to obesity and insulin resistance. DESIGN GIP receptor (GIPR) expression was analyzed in human sc adipose tissue (SAT) and visceral adipose (VAT) from lean and obese subjects in 3 independent cohorts. GIPR expression was associated with anthropometric and biochemical variables. GIP responsiveness on insulin sensitivity was analyzed in human adipocyte cell lines in normoxic and hypoxic environments as well as in adipose-derived stem cells obtained from lean and obese patients. RESULTS GIPR expression was downregulated in SAT from obese patients and correlated negatively with body mass index, waist circumference, systolic blood pressure, and glucose and triglyceride levels. Furthermore, homeostasis model assessment of insulin resistance, glucose, and G protein-coupled receptor kinase 2 (GRK2) emerged as variables strongly associated with GIPR expression in SAT. Glucose uptake studies and insulin signaling in human adipocytes revealed GIP as an insulin-sensitizer incretin. Immunoprecipitation experiments suggested that GIP promotes the interaction of GRK2 with GIPR and decreases the association of GRK2 to insulin receptor substrate 1. These effects of GIP observed under normoxia were lost in human fat cells cultured in hypoxia. In support of this, GIP increased insulin sensitivity in human adipose-derived stem cells from lean patients. GIP also induced GIPR expression, which was concomitant with a downregulation of the incretin-degrading enzyme dipeptidyl peptidase 4. None of the physiological effects of GIP were detected in human fat cells obtained from an obese environment with reduced levels of GIPR. CONCLUSIONS GIP/GIPR signaling is disrupted in insulin-resistant states, such as obesity, and normalizing this function might represent a potential therapy in the treatment of obesity-associated metabolic disorders.
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Affiliation(s)
- Victòria Ceperuelo-Mallafré
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBERobn-Instituto de Salud Carlos III, 28029 Madrid, Spain) and Hospital Universitario Virgen de la Victoria (V.C.-M., L.G.-S., F.J.T.), 29010 Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM-Instituto de Salud Carlos III, 28029 Madrid, Spain) (X.D., G.P., K.R., N.V., J.V., S.F.-V.) and Hospital Universitari de Tarragona Joan XXIII-Institut d Investigació Sanitária Pere Virgili-Universitat Rovira i Virgili (G.P., K.R., V.V., J.V., S.F.-V.), 43007 Tarragona, Spain; and Hospital Universitari de Bellvitge (N.V., J.P.), 08907 Barcelona, Spain
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22
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Fullana MA, Cardoner N, Alonso P, Subirà M, López-Solà C, Pujol J, Segalàs C, Real E, Bossa M, Zacur E, Martínez-Zalacaín I, Bulbena A, Menchón JM, Olmos S, Soriano-Mas C. Brain regions related to fear extinction in obsessive-compulsive disorder and its relation to exposure therapy outcome: a morphometric study. Psychol Med 2014; 44:845-856. [PMID: 23773479 DOI: 10.1017/s0033291713001128] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The size of particular sub-regions within the ventromedial prefrontal cortex (vmPFC) has been associated with fear extinction in humans. Exposure therapy is a form of extinction learning widely used in the treatment of obsessive-compulsive disorder (OCD). Here we investigated the relationship between morphometric measurements of different sub-regions of the vmPFC and exposure therapy outcome in OCD. METHOD A total of 74 OCD patients and 86 healthy controls underwent magnetic resonance imaging (MRI). Cortical thickness and volumetric measurements were obtained for the rostral anterior cingulate cortex (rACC), the medial orbital frontal cortex and the subcallosal cortex. After MRI acquisition, patients were enrolled in an exposure therapy protocol, and we assessed the relationship between MRI-derived measurements and treatment outcome. Baseline between-group differences for such measurements were also assessed. RESULTS Compared with healthy controls, OCD patients showed a thinner left rACC (p = 0.008). Also, left rACC thickness was inversely associated with exposure therapy outcome (r - 0.32, p = 0.008), and this region was significantly thinner in OCD patients who responded to exposure therapy than in those who did not (p = 0.006). Analyses based on regional volumetry did not yield any significant results. CONCLUSIONS OCD patients showed cortical thickness reductions in the left rACC, and these alterations were related to exposure therapy outcome. The precise characterization of neuroimaging predictors of treatment response derived from the study of the brain areas involved in fear extinction may optimize exposure therapy planning in OCD and other anxiety disorders.
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Affiliation(s)
- M A Fullana
- Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar and Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
| | - N Cardoner
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - P Alonso
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - M Subirà
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - C López-Solà
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - J Pujol
- CRC Mar, Hospital del Mar, Barcelona, Spain
| | - C Segalàs
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - E Real
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - M Bossa
- Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - E Zacur
- Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - A Bulbena
- Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar and Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
| | - J M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - S Olmos
- Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
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Batalla A, Fagundo A, Blanco-Hinojo L, Soriano-Mas C, Navinés R, Farré M, Udina M, De la Torre R, Bhattacharyya S, Crippa J, Pujol J, Torrens M, Martín-Santos R. EPA-1084 - Catechol o-methyltransferase val158met genotype and neural mechanisms related to response inhibition in chronic cannabis users. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78362-2] [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: 11/15/2022] Open
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Pujol J, Giménez M, Ortiz H, Soriano-Mas C, López-Solà M, Farré M, Deus J, Merlo-Pich E, Harrison BJ, Cardoner N, Navinés R, Martín-Santos R. Neural response to the observable self in social anxiety disorder. Psychol Med 2013; 43:721-731. [PMID: 22895096 DOI: 10.1017/s0033291712001857] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Distorted images of the observable self are considered crucial in the development and maintenance of social anxiety. We generated an experimental situation in which participants viewed themselves from an observer's perspective when exposed to scrutiny and evaluation by others. Method Twenty patients with social anxiety disorder (SAD) and 20 control subjects were assessed using functional magnetic resonance imaging (fMRI) during the public exposure of pre-recorded videos in which they were each shown performing a verbal task. The examiners acted as the audience in the experiment and rated performance. Whole-brain functional maps were computed using Statistical Parametric Mapping. RESULTS Robust activation was observed in regions related to self-face recognition, emotional response and general arousal in both study groups. Patients showed significantly greater activation only in the primary visual cortex. By contrast, they showed significant deactivation or smaller activation in dorsal frontoparietal and anterior cingulate cortices relevant to the cognitive control of negative emotion. Task-related anxiety ratings revealed a pattern of negative correlation with activation in this frontoparietal/cingulate network. Importantly, the relationship between social anxiety scores and neural response showed an inverted-U function with positive correlations in the lower score range and negative correlations in the higher range. CONCLUSIONS Our findings suggest that exposure to scrutiny and evaluation in SAD may be associated with changes in cortical systems mediating the cognitive components of anxiety. Disorder severity seems to be relevant in shaping the neural response pattern, which is distinctively characterized by a reduced cortical response in the most severe cases.
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Affiliation(s)
- J Pujol
- Institut d'Alta Tecnologia-PRBB, CRC Mar, Hospital de Mar, Barcelona, Spain.
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Batalla A, Bhattachayyria S, Yucel M, Fusar-Poli P, Crippa J, Nogué S, Torrens M, Pujol J, Farré M, Martín-Santos R. 1301 – Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Pujol J, Paz-Ares L, Dediu M, Thomas M, Bidoli P, Corral J, Chouaki N, Visseren-Grul C, Zimmermann A, Gridelli C. Updated Safety and Quality of Life (QOL) Results of Paramount Study: Maintenance Pemetrexed (PEM) Plus Best Supportive Care (BSC) vs Placebo (PBO) Plus Bsc Immediately Following Induction Treatment with Pem Plus Cisplatin (CP) for Advanced Nonsquamous Non-Small Cell Lung Cancer (NS-NSCLC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33870-9] [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: 10/25/2022] Open
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Aldaba M, Vilaseca M, Díaz-Doutón F, Arjona M, Pujol J. Measuring the accommodative response with a double-pass system: Comparison with the Hartmann-Shack technique. Vision Res 2012; 62:26-34. [DOI: 10.1016/j.visres.2012.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/14/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Vellido A, Romero E, Julià-Sapé M, Majós C, Moreno-Torres Á, Pujol J, Arús C. Robust discrimination of glioblastomas from metastatic brain tumors on the basis of single-voxel (1)H MRS. NMR Biomed 2012; 25:819-828. [PMID: 22081447 DOI: 10.1002/nbm.1797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 08/01/2011] [Accepted: 09/13/2011] [Indexed: 05/31/2023]
Abstract
This article investigates methods for the accurate and robust differentiation of metastases from glioblastomas on the basis of single-voxel (1)H MRS information. Single-voxel (1)H MR spectra from a total of 109 patients (78 glioblastomas and 31 metastases) from the multicenter, international INTERPRET database, plus a test set of 40 patients (30 glioblastomas and 10 metastases) from three different centers in the Barcelona (Spain) metropolitan area, were analyzed using a robust method for feature (spectral frequency) selection coupled with a linear-in-the-parameters single-layer perceptron classifier. For the test set, a parsimonious selection of five frequencies yielded an area under the receiver operating characteristic curve of 0.86, and an area under the convex hull of the receiver operating characteristic curve of 0.91. Moreover, these accurate results for the discrimination between glioblastomas and metastases were obtained using a small number of frequencies that are amenable to metabolic interpretation, which should ease their use as diagnostic markers. Importantly, the prediction can be expressed as a simple formula based on a linear combination of these frequencies. As a result, new cases could be straightforwardly predicted by integrating this formula into a computer-based medical decision support system. This work also shows that the combination of spectra acquired at different TEs (short TE, 20-32 ms; long TE, 135-144 ms) is key to the successful discrimination between glioblastomas and metastases from single-voxel (1)H MRS.
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Affiliation(s)
- A Vellido
- Departamento de Llenguatges i Sistemes Informàtics, Universitat Politècnica de Catalunya, Barcelona, Spain.
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Paz-Ares LG, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed SA, John WJ, Chouaki N, Zimmerman A, Visseren Grul CM, Gridelli C. PARAMOUNT: Phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo plus BSC immediately following induction treatment with pem plus cisplatin for advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.cra7510] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CRA7510 Background: The PARAMOUNT trial investigated whether pem continuation maintenance therapy improves progression-free survival (PFS) after pem-cisplatin induction therapy in patients (pts) with advanced nonsquamous NSCLC. Methods: In this double-blind, placebo-controlled trial, 939 pts participated in the induction phase, specified as four cycles of induction pem (500 mg/m2) and cisplatin (75 mg/m2) on day 1 of a 21-day cycle. Pts who had not progressed during pem-cisplatin induction and had an Eastern Cooperative Oncology Group performance status (PS) of 0/1 (n=539; 57.4%) were randomized (2:1, stratified for disease stage, PS, and induction response) to maintenance pem (500 mg/m2 on day 1 of a 21-day cycle) plus BSC (n=359) or placebo plus BSC (n=180) until disease progression. All pts received vitamin B12, folic acid, and dexamethasone. The primary endpoint was PFS (target: HR=0.65, two-sided alpha=0.05; 90% power with minimum of 238 events). Results: Pt characteristics were balanced between arms: median age=61 years; 58% male; 95% Caucasian; 32% PS 0; 91% stage IV; 87% adenocarcinoma; and 45% induction complete/partial response. Pem continuation maintenance resulted in a 36% reduction in the risk of progression (HR=0.64, 95% CI: 0.51-0.81; P=0.00025). The median independently reviewed PFS (472 pts, 297 events), measured from randomization, was 3.9 months (95% CI: 3.0-4.2) on the pem arm, and 2.6 months (95% CI: 2.2-2.9) on the placebo arm. The disease control rate (% pts with response/stable disease) was 71.8% on the pem arm, and 59.6% on the placebo arm (P=0.009). The drug-related serious adverse event (AE) rate was 8.9% on the pem arm, and 9.2% of pts had grade 3/4 laboratory Common Toxicity Criteria AEs. On the placebo arm, the rates were 2.8% and 0.6%, respectively. Discontinuations due to AEs were 5.3% on the pem arm, 3.3% on the placebo arm. Conclusions: PARAMOUNT met its primary endpoint and showed that pem continuation maintenance following pem-cisplatin induction is an effective and well tolerated treatment for pts with advanced nonsquamous NSCLC.
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Affiliation(s)
- L. G. Paz-Ares
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - F. De Marinis
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Dediu
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Thomas
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - J. Pujol
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - P. Bidoli
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - O. Molinier
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - T. P. Sahoo
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - E. Laack
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Reck
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - J. Corral
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - S. A. Melemed
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - W. J. John
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - N. Chouaki
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - A. Zimmerman
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - C. M. Visseren Grul
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - C. Gridelli
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
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Mascaux C, Levallet G, Bergot E, Baudrin L, Antoine M, Anthoine G, Westeel V, Lavole A, Quoix EA, Debieuvre D, Mazieres J, Pujol J, Moro-Sibilot D, Morin F, Milleron B, Zalcman G. Use of a three-microRNA signature to discriminate prognostic groups in early-stage NSCLC patients in the IFCT-0002 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7007] [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: 11/20/2022] Open
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Paz-Ares LG, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed SA, John WJ, Chouaki N, Zimmerman A, Visseren Grul CM, Gridelli C. PARAMOUNT: Phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo plus BSC immediately following induction treatment with pem plus cisplatin for advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.cra7510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Martin-Carrasco M, Otermin P, Pérez-Camo V, Pujol J, Agüera L, Martín MJ, Gobartt AL, Pons S, Balañá M. EDUCA study: Psychometric properties of the Spanish version of the Zarit Caregiver Burden Scale. Aging Ment Health 2010; 14:705-11. [PMID: 20544413 DOI: 10.1080/13607860903586094] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The Zarit Caregiver Burden Scale, translated and validated into Spanish, is sensitive to the application of a Psychoeducational Intervention Program (PIP) for the prevention and reduction of burden in caregivers of Alzheimer's disease (AD) patients (EDUCA study). The data obtained in EDUCA was used to reanalyse its psychometric properties and the cut-off points of the Zarit scale. METHODS The scale was administered to 115 caregivers of patients with AD who were randomised to receive a PIP or standard care for four months. Internal reliability and a factorial analysis of principal components were assessed, and the impact of PIP on each of the subscales was evaluated. A cut-off point was defined for the Zarit scale to identify the caregivers most sensitive to receiving a PIP. RESULTS A good internal reliability (Cronbach alpha coefficient of 0.92) was obtained, with three principal components (burden, competency and dependence) explaining 54.75% of the variance. The application of PIP showed statistically significant differences versus standard care for the dependence subscale (p = 0.0082) (p = 0.062 for the burden scale). The Zarit scale cut-off points which combine better sensitivity and specificity were 56/57 and 59/60, for the 5/6 and 6/7 cut-off points of the General Health Questionnaire (GHQ-28) scale, respectively. CONCLUSIONS This study confirms the good psychometric properties of the Zarit scale found in previous studies. The dependence component appeared to be most influenced by the application of a PIP in the clinical trial. Caregivers with a Zarit scale score of 60 or more benefit most from the PIP.
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Abstract
Digital mammography is replacing conventional film-screen mammography. One of its advantages is to offer options of advanced processing such as tomosynthesis. Tomosynthesis allows to avoid the overlap of tissues depitected on mammograms, and potentially to improve the detection of subtle lesion such as architectural distortion, permits the characterization of masses and of density asymmetry and the accurate measurement of beast lesion by a better delineation of the lesion borders. Furthermore, in cases of superimposition mimicking an abnormality, it can show the lack of a significant finding and decrease the recall rate. However, additional studies are necessary to evaluate its added valve by comparison to mammography in consecutive patients and not only in retrospectively selectioned cases and to define its indication in diagnostic and screening.
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Affiliation(s)
- P Taourel
- Service d'Imagerie Médicale, CHU Montpellier, Hôpital Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5.
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Pujol J, Lynch T, Rosell R, Butts C, Shepherd F, Thatcher N, Vansteenkiste J, Manegold C, Groos J, Pirker R. 9009 A meta-analysis of four randomized phase II/III trials adding cetuximab to platinum-based chemotherapy as 1st-line treatment in patients with non-small cell lung cancer (NSCLC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71722-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Soriano-Mas C, Harrison BJ, Ortiz H, Lopez-Sola M, Deus J, Cardoner N, Hernandez-Ribas R, Pujol J. Structural correlations of the neostriatum with regional gray matter volumes. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71896-8] [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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Lopez-Sola M, Pujol J, Hernandez-Ribas R, Deus J, Harrison BJ, Ortiz H, Soriano C, Vallejo J, Menchon JM, Cardoner N. Dynamics of the right frontal cortex response to painful stimulation. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70292-7] [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: 11/28/2022] Open
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Pujol J, Harrison BJ, Ortiz H, Deus J, Soriano-Mas C, López-Solà M, Yücel M, Perich X, Cardoner N. Influence of the fusiform gyrus on amygdala response to emotional faces in the non-clinical range of social anxiety. Psychol Med 2009; 39:1177-1187. [PMID: 19154647 DOI: 10.1017/s003329170800500x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social anxiety often involves a combination of hypervigilance and avoidance to potentially warning signals including the facial expression of emotions. Functional imaging has demonstrated an increase in amygdala response to emotional faces in subjects with social anxiety. Nevertheless, it is unclear to what extent visual areas processing faces influence amygdala reactivity in different socially anxious individuals. We assessed the influence of the fusiform gyrus activation on amygdala response to emotional faces in the non-clinical range of social anxiety. METHOD Twenty-two normal subjects showing a wide range in social anxiety scores were examined using functional magnetic resonance imaging (fMRI) during the processing of happy and fearful faces. A dimensional analysis approach was used involving voxel-wise mapping of the correlation between subjects' social anxiety scores and amygdala activation, before and after controlling for fusiform gyrus activation. RESULTS We observed that only after controlling for subjects' level of activation of the fusiform gyrus was there an association between social anxiety ratings and amygdala response to both happy and fearful faces. The fusiform gyrus influence was more robust during the fear condition. Of note, fusiform gyrus response to fearful faces showed a negative correlation with additional behavioral assessments related to avoidance, including social anxiety scores, harm avoidance and sensitivity to punishment. CONCLUSIONS Relevant interactions among the emotional face-processing stages exist in the non-clinical range of social anxiety that may ultimately attenuate amygdala responses. Future research will help to establish the role of this effect in a clinical context.
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Affiliation(s)
- J Pujol
- Institut d'Alta Tecnologia-PRBB, Department of Magnetic Resonance, CRC Corporació Sanitària, Barcelona, Spain.
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Hernández-Ribas R, Soriano-Mas C, Pujol J, Deus J, Segalàs C, López-Solà M, Ortiz H, Harrison B, Menchón JM, Cardoner N. The modulating effect of repetitive transcranial magnetic stimulation (rTMS) on brain activity evoked by word generation in depressive patients. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70430-6] [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: 10/20/2022] Open
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Cardoner N, ópez-Sola M, Pujol J, Hernández-Ribas R, Deus J, Ortiz H, Martinez-Amoros E, Soriano-Mas C, Menchón JM, Harrison BJ. DULOXETINE MODULATES PAIN-RELATED BRAIN RESPONSE IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Barlesi F, Chouaid C, Crequit J, Lecaer H, Pujol J, Bérard H, Vergnenegre A, Letreut J, Fabre-Guillevin E, Loundou A. Randomized trial of adjuvant chemotherapy (Cx) with cisplatin plus gemcitabine (CG) versus cisplatin plus docetaxel (CD) in patients (pts) with completely resected non-small cell lung cancer (NSCLC) with quality of life (QoL) as the primary objective. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7532 Background: Adjuvant Cx with vinorelbine plus cisplatin (VC) improves survival of resected NSCLC but has an immediate negative impact on QoL (Bezjak, JCO 2008). In advanced stages NSCLC, GC and DC have comparable efficacy and might be superior to VC in QoL outcomes. This trial was designed to provide with data on other adjuvant Cx regimens for pts with resected NSCLC. Methods: Pts with stage IB to III resected (R0) NSCLC, without major postoperative complication, were eligible. Surgery has to be standardized. Cx consisted of cisplatin (75 mg/m2, D1) plus gemcitabine 1,250 mg/m2 (D1,8) or docetaxel (75 mg/m2 D1) for 3 cycles. The primary endpoint was QoL (EORTC QLQC30) and the trial was designed to detect a 10 points difference in QoL scores (α=0.05; power 80%). Relapse-free survival, overall survival (OS), safety profile and costs were the secondary endpoints. Results: 136 pts (median age: 57 yrs, 74% males, pTNM: 32% IB, 34% II, 34% III; histology: 55% ADC, 23% SCC) were included. 67 and 69 pts were randomized in the GC and DC arms, respectively. Surgery was a (bi)lobectomy in 85% of cases. No imbalance was found between arms regarding major pts characteristics. Overall, a Gr3/4 hematological toxicity occurs for 33.8% and 21.7% of pts (p=0.11) and a Gr3/4 non-hematological toxicity occurs for 33.8% and 26.1% of pts (p=0.33), in the GC and DC arms. Compliance to QoL assessment was good (93%). At inclusion, global health status (GHS) scores (/100) were comparable between arms (mean score, 63.5 and 62.7, in the GC and DC arms, p=0.8). At the end of treatment (3rd month), GHS scores have slightly improve (mean score, 64.5 and 65.4, in the GC and DC arms, p=0.8). At the time of analysis, 15 pts (7 GC, 8 DC) have died. At 1 year, 100 and 96.8% of the pts were alive in the GC and DC arms; At 2 years, 92.9 and 89.8% of the pts were alive in the GC and DC arms (log-rank, p=0.88). Conclusions: Adjuvant GC and DC have comparable effect on post-operative QoL and equivalent efficacy among pts with resected NSCLC. The GC and DC efficacy, safety profiles and QoL outcomes favorably compare with the results reported for the VC regimen. Detailed analyses will be presented at the meeting. [Table: see text]
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Affiliation(s)
- F. Barlesi
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - C. Chouaid
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - J. Crequit
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - H. Lecaer
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - J. Pujol
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - H. Bérard
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - A. Vergnenegre
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - J. Letreut
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - E. Fabre-Guillevin
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - A. Loundou
- Université de la Méditerranée—AP-HM, Marseille, France; Assistance Publique Hôpitaux de Paris, Paris, France; CHG Beauvais, Beauvais, France; CHG Draguignan, Draguignan, France; CHU Montpellier, Montpellier, France; HIA Saint-Anne, Toulon, France; CHU Limoges, Limoges, France; CHG Aix-en-Provence, Aix en Provence, France; Assistance Publique Hôpitaux de Marseille, Marseille, France
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Vilarrasa N, Gómez JM, Elio I, Gómez-Vaquero C, Masdevall C, Pujol J, Virgili N, Burgos R, Sánchez-Santos R, de Gordejuela AGR, Soler J. Evaluation of bone disease in morbidly obese women after gastric bypass and risk factors implicated in bone loss. Obes Surg 2009; 19:860-6. [PMID: 19412643 DOI: 10.1007/s11695-009-9843-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 04/08/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND In patients undergoing gastric bypass, massive weight loss and impairment of calcium intake and absorption in the duodenum and proximal jejunum may increase the risk of bone mass loss and fractures. However, few data are available regarding the impact of this surgery on the skeleton. The aim of our study was to examine the skeletal changes in a cohort of morbidly obese Caucasian women during the first year after gastric bypass and to analyse the factors implicated in the development of bone loss. METHODS Sixty-two morbidly obese white women aged 45.3 +/- 8.9 years were studied. Anthropometric measurements, bone mineral density (BMD) screening using dual-energy X- ray absorptiometry and plasma determinations of calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH) D(3)] and insulin-like growth factor-I (IGF-I) were made prior to and 12 months after surgery. RESULTS A year after surgery, BMD significantly decreased at the femoral neck (10.2 +/- 5.7%) and at the lumbar spine (3.2 +/- 4.4%). In the follow-up, 16.1% of women had osteopenia at the femoral neck and 19.3% at the lumbar spine, and 1.6% developed osteoporosis at the lumbar spine. Patients with bone disease were significantly older; the percentage of women with menopause was greater in this group and had lower initial and final values of lean mass. However, no differences in body mass index, weight loss, fat mass, calcium, PTH, 25(OH) D(3) or IGF-I values were found between groups. In the logistic regression analysis, lean mass 12 months after surgery and menopause were found to be the main determinants of osteopenia after adjusting for age with odds ratios of 0.82 and 9.13, respectively. CONCLUSIONS There is a significant BMD loss at the femoral neck and lumbar spine a year after gastric bypass. Menopausal patients and those with greater lean mass loss are at greater risk and, consequently, should be closely followed up with periodic densitometries.
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Affiliation(s)
- Nuria Vilarrasa
- Endocrinology Service, Hospital Universitario de Bellvitge, Barcelona, Spain.
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Affiliation(s)
- J Pujol
- Coordinador Unitat Psiquiatría Geriátrica, Institut Clínic de Neurociències. Universitat de Barcelona
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Buyse ME, Squifflet P, Laporte S, Fossella FV, Georgoulias V, Pujol J, Kubota K, Monnier A, Kudoh S, Douillard J. Prediction of survival benefits from progression-free survival in patients with advanced non small cell lung cancer: Evidence from a pooled analysis of 2,838 patients randomized in 7 trials. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Roé E, Barnadas MA, Bergua P, Sancho F, Matas L, Paredes R, Pujol J, Alomar A. Ano-genital granulomatosis treated with ciprofloxacin. J Eur Acad Dermatol Venereol 2008; 23:89-90. [PMID: 18384555 DOI: 10.1111/j.1468-3083.2008.02710.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vilarrasa N, Vendrell J, Sánchez-Santos R, Broch M, Megia A, Masdevall C, Gomez N, Soler J, Pujol J, Bettónica C, Aranda H, Gómez JM. Effect of weight loss induced by gastric bypass on proinflammatory interleukin-18, soluble tumour necrosis factor-alpha receptors, C-reactive protein and adiponectin in morbidly obese patients. Clin Endocrinol (Oxf) 2007; 67:679-86. [PMID: 17608757 DOI: 10.1111/j.1365-2265.2007.02945.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Interleukin-18 (IL-18) is a potent proinflammatory cytokine whose role in human obesity has recently been suggested. The aim of our study was to analyse in morbidly obese patients undergoing gastric bypass, the relationship of IL-18 with insulin resistance and with proinflammatory cytokines (tumour necrosis factor-alpha receptors, sTNFR), C-reactive protein (CRP) and with adiponectin. DESIGN Observational and prospective study. PATIENTS Sixty-five morbidly obese patients, aged 45 +/- 8.9 years, were studied before and 12 months after gastric bypass. MEASUREMENTS We analysed plasma concentrations of IL-18, sTNFR, CRP and adiponectin. RESULTS Plasma concentrations of sTNFR2, IL-18 and CRP were decreased and adiponectin significantly increased after bypass surgery. In the multiple regression analysis, preoperative values of IL-18 remained significantly associated with preoperative triglycerides (beta = 0.47, P = 0.005) and TNFR2 (beta = 0.47, P = 0.004). R(2) for the model = 0.38. Postoperative IL-18 concentrations in the multiple regression analysis were significantly associated with postoperative homeostasis model assessment of insulin resistance (HOMA-IR) (beta = 0.092, P = 0.019) and triglycerides (beta = 0.40, P = 0.036). R(2) for the model = 0.46. IL-18 did not correlate with body mass index, fat mass, fat-free mass or body fat. No relationship was either found between adiponectin and IL-18, TNFR1 and -2 and CRP. CONCLUSIONS Massive weight loss induced by gastric bypass reduces IL-18, TNFR2 and CRP. IL-18 might be a marker of the chronic inflammatory process underlying insulin resistance but its lack of association with anthropometric and body composition parameters does not support a major secretion by human adipocytes. IL-18 and sTNFR1 and -2 do not play a main role in the inhibition of the secretion of adiponectin.
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MESH Headings
- Adiponectin/blood
- Adult
- C-Reactive Protein/analysis
- Cholesterol, HDL/blood
- Cholesterol, LDL/blood
- Female
- Gastric Bypass
- Humans
- Interleukin-18/blood
- Male
- Middle Aged
- Obesity, Morbid/blood
- Obesity, Morbid/immunology
- Obesity, Morbid/surgery
- Prospective Studies
- Receptors, Tumor Necrosis Factor/blood
- Receptors, Tumor Necrosis Factor, Type I/blood
- Receptors, Tumor Necrosis Factor, Type II/blood
- Regression Analysis
- Weight Loss
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Affiliation(s)
- N Vilarrasa
- Endocrinology and Diabetes Unit, Hospital Universitari de Bellvitge, Barcelona, Spain.
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Sánchez-Santos R, Ruiz de Gordejuela AG, Gómez N, Pujol J, Moreno P, Francos JM, Rafecas A, Masdevall C. [Factors associated with morbidity and mortality after gastric bypass. Alternatives for risk reduction: sleeve gastrectomy]. Cir Esp 2007; 80:90-5. [PMID: 16945306 DOI: 10.1016/s0009-739x(06)70929-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim of this study was to analyze factors related to morbidity and mortality after gastric bypass and to evaluate lower-risk alternatives in selected patients. PATIENTS AND METHODS A prospective cohort of 761 patients who underwent gastric bypass was included. Prognostic factors were studied using a logistic regression model with SPSS 11.0. Independent variables were age, sex, body mass index (BMI), comorbidities, and the laparoscopic approach. Dependent variables consisted of medical complications, surgical complications, and mortality. We performed a preliminary descriptive study of morbidity and weight loss at 3 months after sleeve gastrectomy. RESULTS In the postoperative period, 2.8% of patients presented medical complications and 5.4% presented surgical complications. Mortality was 0.52%. Surgical complications were significantly associated with age > 45 years (P = .04; OR = 2.00 [1.03-3.8]) and male sex (P = .041; OR = 2.40 [1.12-5.14]). Medical complications were significantly associated with a BMI of > 50 kg/m2 (P = .012; OR = 3.32 [1.23-8.98]), and mortality was significantly associated with a BMI of > 50 kg/m2 (P = .006) and male sex (P = .006). Sleeve gastrectomy was performed in eight patients with a BMI of > 60 kg/m2, in three patients with a BMI of > 50 kg/m2, cardiopulmonary disease and android fat distribution, and in four patients with a BMI of between 35 and 40 kg/m2 and major comorbidity. Morbidity consisted of self-limited febrile syndrome in one patient. There was no mortality. Weight loss at 3 months was 39.8 +/- 5.36% of excess BMI in superobese patients (n = 4) and was 50.2 +/- 11.05% of excess BMI in morbidly obese patients (n = 4). CONCLUSIONS Postoperative morbidity and mortality was significantly higher in male patients, in patients aged more than 45 years, and in those with a BMI of > 50 kg/m2. Sleeve gastrectomy in selected patients could be a lower-risk alternative.
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Affiliation(s)
- Raquel Sánchez-Santos
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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Sanchez-Santos R, Del Barrio MJ, Gonzalez C, Madico C, Terrado I, Gordillo ML, Pujol J, Moreno P, Masdevall C. Long-term health-related quality of life following gastric bypass: influence of depression. Obes Surg 2006; 16:580-5. [PMID: 16687025 DOI: 10.1381/096089206776945084] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Severe obesity has been associated with impaired quality of life (QoL). We evaluated the long-term health-related quality of life (HRQoL) after gastric bypass. METHODS A cross-sectional study was conducted on 50 morbidly obese patients >5 years after gastric bypass and on a control group of 78 non-operated morbidly obese patients. Both groups were evaluated for the EuroQol 5D measure and the Goldberg General Health Questionnaire. In addition, the Bariatric Analysis of Reporting Outcome System (BAROS) was applied to the surgical group. Depression and severe life events were included in the analysis. Logistic Regression Model was used, and age was included in the analysis. RESULTS Groups were similar except for mean age (lower in the surgical group: 40.5+/-9.0 vs 46.1+/-8.8 years, P=0.026). 86.5% of patients had >50% Excess Weight Loss. 85.7% showed an improvement in co-morbid conditions. BAROS Global score: 22% excellent, 56% very good, 18% good, 2% fair and 2% failure. After surgery, significant improvements were reported in self-esteem (94%), work conditions (72.6%), physical activity (66.7%), and sexual interest/activity (50.9%). The control group showed poorer results for the EuroQol 5D in mobility (55% vs 21.6%, P=0.005), difficulty with daily activity (55% vs 13.7%, P=0.005) and self-evaluation of well-being (59.2% vs 78.1%, P=0.005). Patients with depression or insufficient weight loss following surgery presented poorer global evaluation in HRQoL. CONCLUSION Gastric bypass resulted in significant long-term improvements in co-morbidities, sustained weight loss and increased HRQoL. Depression and insufficient weight loss were associated with poorer HRQoL in surgical patients.
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Affiliation(s)
- Raquel Sanchez-Santos
- Department of Digestive and General Surgery, Bariatric Surgery Division, Hospital de Bellvitge, 08907 Hospitalet de Llobregat, Feixa Llarga s/n, Barcelona, Spain.
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Le Chevalier T, Thezenas S, Breton J, Pujol J, Coudert B, Sun X, Laza M, Quoix E, Schott R, Geneve J. Randomized phase II study of gemcitabine-oxaliplatin or gemcitabine-cisplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC)-CLEO 05. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7097 Background: Gemcitabine-cisplatin is one of the reference doublets used in NSCLC. Oxaliplatin is a platin analog which offers a promising efficacy/tolerance profile in NSCLC. The combination of gemcitabine and oxaliplatin has been proven feasible and active in solid tumors. Methods: Patients with chemonaive, measurable, PS 0 or 1, stage IIIB/ IV NSCLC were randomized to receive either gemcitabine 1,250 mg/m2 day 1 & 8 plus oxaliplatin 130 mg/m2 day 1 (GEMOX) or gemcitabine 1,250 mg/m2 day 1 & 8 plus cisplatin 80 mg/m2day 1 (GEMCIS). Cycles were given every 3 weeks. The primary endpoint of the study was the response rate according to the RECIST criteria. Secondary endpoints included tolerance, survival and quality of life. Results: Between October 2003 and December 2004, 130 patients (66 in GEMOX and 64 in GEMCIS) were accrued at 12 centres. Baseline patient characteristics were similar in the 2 groups. Mean age was 61. There were 96 males and 34 females; 27% of patients were PS 0 and 73% were PS 1; 15% had stage IIIB and 85% had stage IV. Median number of cycles was 5 in each group. Objective response rates were 36% in GEMOX (CI 95%: 25%-50%) and 39% in GEMCIS (CI 95%: 28%-54%) respectively. Time to progression was 173 days in the GEMOX group and 163 days in the GEMCIS group. Median survival was 10.8 months in the GEMOX group and 10.4 months in the GEMCIS group. Grade III/IV neutropenia was observed in 38% of patients after GEMOX and 41% after GEMCIS; thrombocytopenia was observed in 40% and 33% of cases respectively. Grade 2+ neurotoxicity was more frequent after GEMOX (18% vs 3%). Conclusions: GEMOX has an activity comparable to GEMCIS and may be an alternative for those patients with advanced NSCLC who have a contra-indication to cisplatin. [Table: see text]
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Affiliation(s)
- T. Le Chevalier
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - S. Thezenas
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - J. Breton
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - J. Pujol
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - B. Coudert
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - X. Sun
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - M. Laza
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - E. Quoix
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - R. Schott
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
| | - J. Geneve
- Institut Gustave Roussy, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; CHG Belfort, Belfort, France; CHR A. de Villeneuve, Montpellier, France; Centre François Leclerc, Dijon, France; C.H., Montbeliard, France; Hôpital Liautey, Strasbourg, France; Centre Paul Strauss, Strasbourg, France; FNCLCC, Paris, France
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Abstract
BACKGROUND The rapid development of language abilities in early childhood coincides with a similarly accelerated progression in brain maturation. OBJECTIVE To quantitate myelination in the lateral part of the verbal left hemisphere from birth to 3 years in the living human brain. METHODS One hundred children (mean age 16.6 months) were examined using three-dimensional MRI, and a subgroup of 40 children were also evaluated behaviorally. The volume of myelinated white matter was measured in language-related temporal and frontal regions and in the central sensorimotor region. A method was developed to compose a movie sequence for all the myelination process using volumetric data. RESULTS A plot of age against relative volume of myelinated white matter graphically detailed the myelination progress in the lateral brain. The changes started in sensorimotor white matter and the Heschl gyrus and ultimately extended to the language-related areas. Both comprehension and production regions showed a very similar myelination course, suggesting simultaneous maturation of the temporofrontal language network. The movie sequence of white matter images dynamically displayed the anatomic details of myelin deposition in this part of the brain. The analysis of language performance showed acceleration in children's vocabulary after 18 months, once a rapid myelination phase was attained in the language brain. CONCLUSIONS This volumetric study may contribute to further characterize the early stages of brain maturation by showing the fine progression of myelin deposition in the language domains and illustrating its relationship to children's vocabulary acquisition.
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Affiliation(s)
- J Pujol
- Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, Passeig Marítim 25-29, Barcelona 08003, Spain.
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