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Yadav J, Liang T, Qin T, Nathan N, Schwenger KJP, Pickel L, Xie L, Lei H, Winer DA, Maughan H, Robertson SJ, Woo M, Lou W, Banks K, Jackson T, Okrainec A, Hota SS, Poutanen SM, Sung HK, Allard JP, Philpott DJ, Gaisano HY. Gut microbiome modified by bariatric surgery improves insulin sensitivity and correlates with increased brown fat activity and energy expenditure. Cell Rep Med 2023; 4:101051. [PMID: 37196633 PMCID: PMC10213984 DOI: 10.1016/j.xcrm.2023.101051] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Alterations in the microbiome correlate with improved metabolism in patients following bariatric surgery. While fecal microbiota transplantation (FMT) from obese patients into germ-free (GF) mice has suggested a significant role of the gut microbiome in metabolic improvements following bariatric surgery, causality remains to be confirmed. Here, we perform paired FMT from the same obese patients (BMI > 40; four patients), pre- and 1 or 6 months post-Roux-en-Y gastric bypass (RYGB) surgery, into Western diet-fed GF mice. Mice colonized by FMT from patients' post-surgery stool exhibit significant changes in microbiota composition and metabolomic profiles and, most importantly, improved insulin sensitivity compared with pre-RYGB FMT mice. Mechanistically, mice harboring the post-RYGB microbiome show increased brown fat mass and activity and exhibit increased energy expenditure. Moreover, improvements in immune homeostasis within the white adipose tissue are also observed. Altogether, these findings point to a direct role for the gut microbiome in mediating improved metabolic health post-RYGB surgery.
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Affiliation(s)
- Jitender Yadav
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Tao Liang
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tairan Qin
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nayanan Nathan
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Lauren Pickel
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Li Xie
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Helena Lei
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Daniel A Winer
- Department of Immunology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Susan J Robertson
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Minna Woo
- Department of Immunology, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kate Banks
- Department of Comparative Medicine, University of Toronto, Toronto, ON, Canada
| | - Timothy Jackson
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Susy S Hota
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Infection Prevention and Control, University Health Network, Toronto, ON, Canada
| | - Susan M Poutanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Microbiology & Division of Infectious Diseases, University Health Network and Sinai Health, Toronto, ON, Canada
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Johane P Allard
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada.
| | - Dana J Philpott
- Department of Immunology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Herbert Y Gaisano
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Mukherjee T, Yadav J, Nathan N, Tsang D, Yan A, Cash S, Cummins C, Vlachou P, Girardin S, Philpott D. A5 A MOUSE MODEL TO UNRAVEL THE PATHOPHYSIOLOGICAL LINK BETWEEN CROHN’S DISEASE AND TYPE-2 DIABETES-ASSOCIATED METABOLIC DISORDERS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991282 DOI: 10.1093/jcag/gwac036.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Crohn’s disease (CD), an idiopathic inflammatory bowel disease (IBD), has been recently shown to increase the risk of developing type 2 diabetes (T2D). Moreover, treatment with anti-diabetic drugs has a protective role in preventing the severity and course of CD progression. However, the pathophysiological basis of T2D development in CD remains unclear. Findings have highlighted the contribution of adipose tissue (AT) to the development of chronic inflammatory diseases and have identified parallels between T2D and CD that may provide hints to common mechanisms of disease pathogenesis. Typically, microbial dysbiosis, hyperpermeable intestinal barrier, and intra-abdominal AT accumulation are the common features of both diseases, yet how the interplay of these factors contribute to pathogenesis is not known. Therefore, common pathogenic paradigms underlying both T2D and CD have led us to hypothesize that chronic intestinal inflammation serves as an initiator of AT dysfunction in CD, predisposing individuals to T2D. Further, the lack of appropriate animal models of CD with chronic intestinal inflammation that manifests accumulation of intra-abdominal AT, and extra-intestinal metabolic disorder as observed in CD and T2D patients has been a limitation. Purpose To develop a genetic mouse model to investigate if gut inflammation-mediated microbial dysbiosis and metabolic dysregulation of AT are at the nexus that cause T2D in CD. Method We developed a CD-mouse model, where we challenged Nod2-deficient mice (NOD2 being the strongest genetic risk factor contributing to CD) with a chronic inflammatory insult regime, using dextran sulfate sodium (cDSS) for 3 cycles. Subsequently, intraperitoneal insulin and oral glucose tolerance tests, metabolic caging, and MRI imaging of mice were performed. Changes in AT metabolism and microbial infiltration into AT were analyzed by quantitative real-time PCR (qRT-PCR) and/or immunohistochemistry (IHC). Result(s) Our new CD-mouse model revealed increased gut inflammation (TNF and type-I IFN) in Nod2-deficient mice compared to wild-type control mice post-cDSS. Surprisingly, Nod2-deficient mice gained body weight, which was at least in part accounted for by an increased intra-abdominal AT accumulation along with decreased AT fatty-acid metabolism (Cpt1a, Fabp4 expression) and AT browning (Ucp1, Cidea expression, and UCP-1 staining), reduced intestinal goblet cell numbers, increased gut bacterial infiltration within the fat, more insulin resistance and energy expenditure. Conclusion(s) This experimental mouse model mimicking CD-associated T2D will provide insights into how the microbiome-AT axis fuel chronic inflammation-mediated extra-intestinal metabolic disorder and immune dysregulation. Understanding these connections will be transformative, as it will help us devise novel therapeutic strategies to prevent T2D development in progressive CD patients. Disclosure of Interest None Declared
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Affiliation(s)
- T Mukherjee
- Department of Immunology/ Laboratory Medicine and Pathobiology
| | | | | | | | - A Yan
- Department of Pharmaceutical Sciences
| | - S Cash
- Department of Pharmaceutical Sciences
| | - C Cummins
- Department of Pharmaceutical Sciences
| | - P Vlachou
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - S Girardin
- Department of Immunology/ Laboratory Medicine and Pathobiology
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Tsankov B, Carr C, Luchak A, Nathan N, Girardin S, Philpott D. A173 ELUCIDATING THE EFFECTS OF NOD2-MEDIATED SIGNALLING ON INTESTINAL RESIDENT-MEMORY T-CELL FORMATION AND FUNCTION. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991289 DOI: 10.1093/jcag/gwac036.173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Aberrant resident memory T-cell (TRM) responses have been associated with increased intestinal inflammation and Crohn’s disease (CD) pathology in humans. Intestinal TRM cells are not only important for maintaining the integrity of the intestinal epithelial barrier, but also for the rapid clearance of pathogens in the intestine during infection. Understanding the signals received by the intestinal immune system to generate TRM responses is paramount to elucidating treatments for CD. Genetic mutations in NOD2 are associated with the highest risk of CD development. As a host intracellular sensor of bacterial peptidoglycan, NOD2 is critical for initiating both innate and adaptive immune responses. Furthermore, work from our lab as well as those of our collaborators suggest that NOD2 deficiency reduces systemic memory B and T-cell responses. However, the role of NOD2 in establishing memory T-cell responses in the intestine remains unclear. This work will therefore establish the role of NOD2 signaling in initiating and maintaining optimal TRM responses to achieve intestinal homeostasis and resilience to intestinal inflammation. Purpose It is the main objective of this project to determine whether NOD2-mediated signalling affects: 1. Antigen-specific T-cell priming in vivo 2. Bona fide intestinal TRM generation 3. Bona fide intestinal TRM function Method To address the effects of NOD2-signalling on intestinal T-cell priming in vivo, wildtype (WT) mice were adoptively transferred 50,000 naïve LCMV-specific (SMARTA) CD4+ T-cells. Mice were subsequently infected with LCMV-Armstrong in the presence or absence of the NOD2 agonist; MDP. 5-days following infection, the numbers and percentage of LCMV-specific T-cells in the mesenteric lymph nodes and spleen were examined. To examine the effects of NOD2 on intestinal TRM generation, littermate WT and NOD2 KO mice were infected with LCMV-Armstrong. Thirty-six-days following infection, the percentage and number of LCMV-specific CD4+ T-cells were profiled in the small and large intestinal lamina-propria by means of gp66-77 class-II MHC-tetramer staining. In another set of experiments, littermate WT and NOD2 KO mice were re-infected with LCMV-C13 30-days following LCMV-Armstrong immunization, and the interferon-response in the small intestine was profiled by quantitative PCR to assess the effect of NOD2-deficiency on antigen recall responses. Result(s) NOD2-stimulation by means of MDP injection increased the percentage and number of adoptively transferred SMARTA CD4+ T-cells in the mesenteric lymph nodes upon LCMV infection. Furthermore, NOD2-deficiency did not alter intestinal LCMV-specific CD4+ TRM seeding in the small and large intestinal lamina propria 36 days after infection. However, in vivo antigen recall experiments showed a decreased intestinal IFN response in NOD2 KO mice. Conclusion(s) Our findings reveal a potential role of NOD2 in the intestinal CD4+ T-cell priming and subsequent Ag-specific memory response. Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | | | - S Girardin
- Laboratory Medicine and Pathobiology, Medical Sciences Building, University of Toronto, Toronto, Canada
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Liu Y, Chen J, Raj K, Baerg L, Nathan N, Philpott DJ, Mahadevan R. A Universal Strategy to Promote Secretion of G+/G- Bacterial Extracellular Vesicles and Its Application in Host Innate Immune Responses. ACS Synth Biol 2023; 12:319-328. [PMID: 36592614 DOI: 10.1021/acssynbio.2c00583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Both Gram-positive and Gram-negative bacteria release nanosized extracellular vesicles called membrane vesicles (MVs, 20-400 nm), which have great potential in various biomedical applications due to their abilities to deliver effector molecules and induce therapeutic responses. To fully utilize bacterial MVs for therapeutic purposes, regulated and enhanced production of MVs would be highly advantageous. In this study, we developed a universal method to enhance MV yields in both G+/G- bacteria through an autonomous controlled peptidoglycan hydrolase (PGase) expression system. A significant increase (9.37-fold) of MV concentration was observed in engineered E. coli Nissle 1917 compared to the wild-type. With the help of this autonomous system, for the first time we experimentally confirmed horizontal gene transfer and nutrient acquisition in a cocultured bacterial consortium. Furthermore, the engineered probiotic E. coli strains with high yield of MVs showed higher activation of the innate immune responses in human embryonic kidney 293T (HEK293T) and human colorectal carcinoma cells (HCT116), thereby demonstrating the great potential of engineering probiotics in immunology and further living therapeutics in humans.
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Affiliation(s)
- Yilan Liu
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada
| | - Jinjin Chen
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada
| | - Kaushik Raj
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada
| | - Lauren Baerg
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Nayanan Nathan
- Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Dana J Philpott
- Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Radhakrishnan Mahadevan
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
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Martinussen H, Boersma L, Jacobs M, de Boer H, Cuijpers J, Dirkx M, De Jaeger K, Mast M, Mondriaan K, Monshouwer R, Nathan N, Slot A, Speijer G, de Vreugt F. MO-0057 Insights and challenges in innovation implementation in Dutch radiotherapy centers. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Broberg L, Rom A, De Wolff M, Høgh S, Nathan N, Paarlberg L, Damm P, Hegaard H. 413. Psychological well-being and worries among pregnant women during the first phase of the covid-19 pandemic compared to a historical group: A hospital-based cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2022. [PMCID: PMC8941278 DOI: 10.1016/j.ejogrb.2021.11.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hegard H, Rom A, Christensen K, Broberg L, Høgh S, Christiansen C, Nathan N, De Wolff M, Damm P. 369. Lifestyle habits among pregnant women in denmark during the first covid-19 lockdown compared with a historical period – a hospital-based cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2022. [PMCID: PMC8941252 DOI: 10.1016/j.ejogrb.2021.11.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nathan N, Hedegaard M, Karlsson G, Knudsen L, Mathiesen L. 322 Intrapartum transfer of oxytocin across the human placenta: An ex vivo perfusion experiment. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dos Santos G, Estabrooks P, Kennedy S, Lubans D, Morgan P, Nathan N, Noetel M, Salmon J, Smith J. State-wide dissemination of the Resistance Training for Teens program: An evaluation guided by the RE-AIM framework. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kennedy S, Smith J, Estabrooks P, McKay H, Noetel M, Nathan N, Lubans D. Scale-up and dissemination of a school-based resistance training program: RE-AIM evaluation of impact. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.174] [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: 10/25/2022]
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McCarthy N, Nathan N, Hope K, Sutherland R, Hodder R. Australian Secondary school student's attitudes to changing from traditional school uniforms to sports uniforms. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.116] [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: 10/25/2022]
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Yoong SL, Nathan N, Reilly K, Sutherland R, Straus S, Barnes C, Grady A, Wolfenden L. Adapting implementation strategies: a case study of how to support implementation of healthy canteen policies. Public Health 2019; 177:19-25. [PMID: 31494359 DOI: 10.1016/j.puhe.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/18/2019] [Revised: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Although evidence-based interventions (EBIs) and effective strategies to implement them exist, they cannot be used by policy makers and practitioners if they do not align with end users' needs. As such, adaptations to EBIs and implementation approaches are likely to occur to increase 'fit' with end users' capacity. This article describes an approach undertaken by a population health service delivery unit in one Australian state to develop an adapted implementation strategy to support the implementation of the mandatory healthy canteen policy (EBI) to all schools located in the service delivery region. STUDY DESIGN This is a case study of adapting an intervention to improve implementation of the healthy canteen policy. METHODS AND RESULTS This is a six-step pragmatic, empirically driven approach. The steps include (i) adapt, where appropriate, the EBI to facilitate implementation; (ii) identify end users' capacity for implementation; (iii) identify opportunities to adapt the implementation interventions while preserving meaningful intervention impact; (iv) undertake program adaptation; (v) develop training and resources to support delivery of implementation strategies and; (vi) evaluate the adapted intervention. This article describes the application of these steps by the authors to develop an adapted support strategy consistent with end users' needs. CONCLUSIONS This study provides some guidance on how to adapt implementation support approaches particularly when EBIs cannot be adapted. Future empirical research providing guidance on making practical adaptation decisions are needed.
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Affiliation(s)
- S L Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan NSW Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan NSW, Australia; Hunter Medical Research Institute, New Lambton Heights NSW, Australia.
| | - N Nathan
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan NSW Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan NSW, Australia; Hunter Medical Research Institute, New Lambton Heights NSW, Australia
| | - K Reilly
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan NSW Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan NSW, Australia; Hunter Medical Research Institute, New Lambton Heights NSW, Australia
| | - R Sutherland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan NSW Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan NSW, Australia; Hunter Medical Research Institute, New Lambton Heights NSW, Australia
| | - S Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | - C Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan NSW Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan NSW, Australia; Hunter Medical Research Institute, New Lambton Heights NSW, Australia
| | - A Grady
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights NSW, Australia
| | - L Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights NSW, Australia
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Yoong SL, Grady A, Stacey F, Polimeni M, Clayton O, Jones J, Nathan N, Wyse R, Wolfenden L. A pilot randomized controlled trial examining the impact of a sleep intervention targeting home routines on young children's (3-6 years) physical activity. Pediatr Obes 2019; 14:e12481. [PMID: 30417593 DOI: 10.1111/ijpo.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/19/2018] [Accepted: 09/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given evidence suggesting that sleep impacts on metabolic processes, interventions targeting sleep may improve child physical activity (PA). OBJECTIVES To describe the potential effect of an intervention to increase sleep on young children's (3-6 years) moderate to vigorous PA (MVPA) and total PA. To determine adherence to the intervention, impact on sleep duration as well as feasibility, uptake and acceptability was also assessed. METHODS Pilot randomized controlled trial with 76 parent-child dyads randomly allocated to an intervention (n = 38) or control group (n = 38). Parents in the intervention group received a 3-month theory-informed intervention consisting of an online video, a telephone call and two text messages. Child PA was assessed using accelerometers at baseline and approximately 3 months. Parents also completed a sleep log and a telephone interview. RESULTS The consent rate was 41% (76/186). Estimated effect size for the intervention relative to control was 10.8 min/day for MVPA, 2.7 min/day for PA and 0.9 h for sleep. Sixteen (44%) parents accessed the video, and 18 (50%) received the telephone call. Over 40% of parents found the video and telephone call useful/very useful. CONCLUSIONS This study reports promising effects that an intervention targeting sleep may improve child MVPA and sleep duration. Some modifications to data collection methods and intervention delivery are needed.
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Affiliation(s)
- S L Yoong
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - A Grady
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - F Stacey
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - M Polimeni
- Parenting Research Centre, East Melbourne, Victoria, Australia
| | - O Clayton
- Parenting Research Centre, East Melbourne, Victoria, Australia
| | - J Jones
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - N Nathan
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - R Wyse
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - L Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
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14
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Ashkenazi M, Nathan N, Sarouk I, Aluma BEB, Dagan A, Bezalel Y, Keler S, Vilozni D, Efrati O. Nutritional Status in Childhood as a Prognostic Factor in Patients with Cystic Fibrosis. Lung 2019; 197:371-376. [DOI: 10.1007/s00408-019-00218-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/12/2019] [Indexed: 01/01/2023]
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15
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Gruffi TR, Peralta FM, Thakkar MS, Arif A, Anderson RF, Orlando B, Coffman JC, Nathan N, McCarthy RJ, Toledo P, Habib AS. Anesthetic management of parturients with Arnold Chiari malformation-I: a multicenter retrospective study. Int J Obstet Anesth 2018; 37:52-56. [PMID: 30414718 DOI: 10.1016/j.ijoa.2018.10.002] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/18/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Consensus regarding the safest mode of delivery and anesthetic management for parturients with Arnold Chiari malformation-I (ACM-I) remains controversial. This study assessed their anesthetic management and reported anesthetic complications during hospitalization for delivery. METHODS This was a multicenter, retrospective, cohort study of patients with ACM-I undergoing vaginal or cesarean delivery. Data were obtained from the electronic databases of four United States academic institutions using International Classification of Diseases (ICD) codes from 2007-2017 at three sites and 2004-2017 at one site. The primary outcome was anesthetic complications. RESULTS Data were analyzed for 185 deliveries in 148 patients. Diagnosis of ACM-I was made prior to delivery in 147 (80%) cases. Pre-delivery neurosurgical consultation for management of ACM-I was performed in 53 (36%) patients. Pre-existing symptoms were recorded for 89 (48%) of the deliveries. Vaginal deliveries occurred in 80 (43%) cases, and 62 women (78%) received neuraxial labor analgesia. Cesarean delivery was performed in 105 (57%) cases, of which 70 women (67%) had neuraxial anesthesia and 34 (32%) received general anesthesia. Post-dural puncture headache was reported in three (2%) patients who had neuraxial anesthesia, and in two (12%) patients with syringomyelia. There was one (3%) reported case of aspiration pneumonia with general anesthesia. CONCLUSIONS The findings suggest that anesthetic complications occur infrequently in patients with ACM-I regardless of the anesthetic management. Although institutional preference in anesthetic and obstetric care appears to drive patient management, the findings suggest that an individualized approach has favorable outcomes in this population.
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Affiliation(s)
- T R Gruffi
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - F M Peralta
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - M S Thakkar
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - A Arif
- Department of Anesthesiology, Icahn School of Medicine, Mount Sinai West Hospital, New York, NY, United States
| | - R F Anderson
- Department of Anesthesiology, Duke University Hospital, Durham, NC, United States
| | - B Orlando
- Department of Anesthesiology, Icahn School of Medicine, Mount Sinai West Hospital, New York, NY, United States
| | - J C Coffman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - N Nathan
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - R J McCarthy
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States
| | - P Toledo
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - A S Habib
- Department of Anesthesiology, Duke University Hospital, Durham, NC, United States
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Kibler M, Marchandot B, Nathan N, Vincent F, Grunebaum L, Crimizade U, Kindo M, Hoang MT, Petit-Eisenmann H, Jesel L, Susen S, Van Belle E, Ohlmann P, Morel O. 4283Impact of primary hemostasis disorders on late (>30 days) major/life-threatening bleedings after TAVR. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Kibler
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - B Marchandot
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - N Nathan
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - F Vincent
- Cardiology Hospital of Lille, Lille, France
| | - L Grunebaum
- University Hospital of Strasbourg, Department of haemostasis, Strasbourg, France
| | - U Crimizade
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - M Kindo
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - M T Hoang
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - H Petit-Eisenmann
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - L Jesel
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | | | | | - P Ohlmann
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
| | - O Morel
- University Hospital of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Strasbourg, France
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Nathan N, Wiggers J, Wyse R, Williams CM, Sutherland R, Yoong SL, Lecathelinais C, Wolfenden L. Factors associated with the implementation of a vegetable and fruit program in a population of Australian elementary schools. Health Educ Res 2017; 32:197-205. [PMID: 28380629 DOI: 10.1093/her/cyx038] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/12/2017] [Indexed: 06/07/2023]
Abstract
Implementation of vegetable and fruit programs in schools is less than optimal. This study aimed to identify, using a theoretical framework, factors associated with implementation of a school vegetable and fruit program; that provides a time in class for children to consume a piece of vegetable or fruit they have brought from home. Three hundred and three randomly selected school principals across the state of New South Wales, Australia responded to a 25-min telephone survey. Principals were asked if their school had implemented a vegetable and fruit program, and which of 12 factors from Damschroder's consolidated framework for implementation research had facilitated or impeded implementation. Multiple logistic regression models examined the association between such factors and program implementation. Seventy-eight percent of schools had a vegetable and fruit program. Schools were significantly more likely to implement the program if the principal believed that: the program was effective (OR = 2.97; P < 0.02); they had sufficient resources to implement the program (OR = 4.22; P < 0.0001); the program would not be difficult to implement (OR = 10.16; P< 0.0001) and that the program was as important as other school priorities (OR = 2.45; P < 0.02). Realizing the intended benefits of vegetable and fruit programs requires widespread implementation by schools. Consideration of principal beliefs about the program effectiveness, resources, difficultly and relative importance in program implementation strategies appear key to increasing program implementation.
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Affiliation(s)
- N Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - J Wiggers
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - R Wyse
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - C M Williams
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - R Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - S L Yoong
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - C Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
| | - L Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
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18
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Borde R, Smith JJ, Sutherland R, Nathan N, Lubans DR. Methodological considerations and impact of school-based interventions on objectively measured physical activity in adolescents: a systematic review and meta-analysis. Obes Rev 2017; 18:476-490. [PMID: 28187241 DOI: 10.1111/obr.12517] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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: 10/24/2016] [Revised: 12/05/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aims of this systematic review and meta-analysis are (i) to determine the impact of school-based interventions on objectively measured physical activity among adolescents and (ii) to examine accelerometer methods and decision rule reporting in previous interventions. METHODS A systematic search was performed to identify randomized controlled trials targeting adolescents (age: ≥10 years), conducted in the school setting, and reporting objectively measured physical activity. Random effects meta-analyses were conducted to determine the pooled effects of previous interventions on total and moderate-to-vigorous physical activity. Potential moderators of intervention effects were also explored. RESULTS Thirteen articles met the inclusion criteria, and twelve were included in the meta-analysis. The pooled effects were small and non-significant for both total physical activity (standardized mean difference = 0.02 [95% confidence interval = -0.13 to 0.18]) and moderate-to-vigorous physical activity (standardized mean difference = 0.24 [95% confidence interval = -0.08 to 0.56]). Sample age and accelerometer compliance were significant moderators for total physical activity, with a younger sample and higher compliance associated with larger effects. CONCLUSION Previous school-based physical activity interventions targeting adolescents have been largely unsuccessful, particularly for older adolescents. There is a need for more high-quality research using objective monitoring in this population. Future interventions should comply with best-practice recommendations regarding physical activity monitoring protocols.
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Affiliation(s)
- R Borde
- Division of Training and Movement Sciences, University of Potsdam, Potsdam, Germany
| | - J J Smith
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - R Sutherland
- Hunter New England Population Health, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lambton, NSW, Australia
| | - N Nathan
- Hunter New England Population Health, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lambton, NSW, Australia
| | - D R Lubans
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
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19
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Desmet C, Sutherland R, Davies L, Wolfenden L, Butler P, McCarthy N, Cohen J, Nathan N. Objectively measuring children's physical activity levels in a free living environment. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.089] [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]
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20
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Nattes E, Lejeune S, Carsin A, Borie R, Gibertini I, Balinotti J, Nathan N, Marchand-Adam S, Thumerelle C, Fauroux B, Houdouin V, Delestrain C, Louha M, Couderc R, De Becdelievre A, Fanen P, Funalot B, Crestani B, Deschildre A, Dubus JC, Epaud R. Hétérogénéité de l’atteinte respiratoire associée aux mutations de NK2 homeobox 1. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.031] [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]
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21
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Sutherland R, Campbell E, Lubans D, Morgan P, Nathan N, Okely A, Gillham K, Davies L, Wiggers J. ‘Physical Activity 4 Everyone’ cluster RCT: 24-month physical activity outcomes of a school-based physical activity intervention targeting adolescents. Overall and school day physical activity outcomes. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Juge P, Borie R, Kannengiesser C, Gazal S, Revy P, Wemeau-Stervinou L, Debray M, Ottaviani S, Marchand-Adam S, Nathan N, Thabut G, Richez C, Nunes H, Callebaut I, Justet A, Leulliot N, Bonnefond A, Salgado D, Richette P, Desvignes J, Lioté H, Froguel P, Allanore Y, Sand O, Dromer C, Flipo R, Clément A, Béroud C, Sibilia J, Coustet B, Cottin V, Boissier M, Wallaert B, Schaeverbeke T, Moal FDL, Frazier A, Ménard C, Soubrier M, Saidenberg N, Valeyre D, Amselem S, Boileau C, Crestani B, Dieude P. Fond génétique partagé entre la pneumopathie interstitielle diffuse associée à la polyarthrite rhumatoïde et la fibrose pulmonaire idiopathique. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.133] [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]
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23
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Davies L, Sutherland R, Campbell E, Nathan N, Wolfenden L, Gillham K, Wiggers J. Longitudinal changes in adolescent sedentary behaviour in a school day. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2016.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Nathan N, Burke K, Moss J, Darling TN. A diagnostic and management algorithm for individuals with an isolated skin finding suggestive of tuberous sclerosis complex. Br J Dermatol 2016; 176:220-223. [PMID: 27167640 DOI: 10.1111/bjd.14724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Nathan
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD, U.S.A.,Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, U.S.A
| | - K Burke
- Department of Dermatology, Madigan Army Medical Center, Tacoma, WA, U.S.A
| | - J Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, U.S.A
| | - T N Darling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD, U.S.A
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Hollis JL, Sutherland R, Campbell L, Morgan PJ, Lubans DR, Nathan N, Wolfenden L, Okely AD, Davies L, Williams A, Cohen KE, Oldmeadow C, Gillham K, Wiggers J. Effects of a 'school-based' physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the 'Physical Activity 4 Everyone' RCT. Int J Obes (Lond) 2016; 40:1486-1493. [PMID: 27430652 PMCID: PMC5056957 DOI: 10.1038/ijo.2016.107] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES: Obesity prevention during adolescence is a health priority. The ‘Physical Activity 4 Everyone' (PA4E1) study tested a multi-component physical activity intervention in 10 secondary schools from socio-economically disadvantaged communities. This paper aimed to report the secondary outcomes of the study; to determine whether the intervention impacted on adiposity outcomes (weight, body mass index (BMI), BMI z-score), and whether any effect was moderated by sex, baseline BMI and baseline physical activity level, at 12 and 24 months. SUBJECTS/METHODS: A cluster randomised controlled trial was conducted in New South Wales, Australia. The school-based intervention included seven physical activity strategies targeting the following: curriculum (strategies to maximise physical activity in physical education, student physical activity plans, an enhanced school sport programme); school environment (physical activity during school breaks, modification of school policy); and parents and the community (parent engagement, links with community physical activity providers). Students' weight (kg), BMI and BMI z-score, were collected at baseline (Grade 7), 12 and 24 months. Linear Mixed Models were used to assess between-group mean difference from baseline to 12 and 24 months. Exploratory sub-analyses were undertaken according to three moderators of energy balance. RESULTS: A total of 1150 students (mean age=12 years) provided outcome data at baseline, 1051 (91%) at 12 months and 985 (86%) at 24 months. At 12 months, there were group-by-time effects for weight (mean difference=–0.90 kg (95% confidence interval (CI)=–1.50, −0.30), P<0.01) and BMI (−0.28 kg m−2 (−0.50, −0.06), P=0.01) in favour of the intervention group, but not for BMI z-score (−0.05 (−0.11; 0.01), P=0.13). These findings were consistent for weight (−0.62 kg (−1.21, 0.03), P=0.01) and BMI (−0.28 kg m−2 (−0.49, −0.06), P=0.01) at 24 months, with group-by-time effects also found for BMI z-score (−0.08 (−0.14; −0.02), P=0.02) favouring the intervention group. CONCLUSION: The PA4E1 school-based intervention achieved moderate reductions in adiposity among adolescents from socio-economically disadvantaged communities. Multi-component interventions that increase adolescents' engagement in moderate-to-vigorous physical activity (MVPA) may assist in preventing unhealthy weight gain.
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Affiliation(s)
- J L Hollis
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - R Sutherland
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
| | - L Campbell
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
| | - P J Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - D R Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - N Nathan
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
| | - L Wolfenden
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
| | - A D Okely
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - L Davies
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
| | - A Williams
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - K E Cohen
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - C Oldmeadow
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
| | - K Gillham
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
| | - J Wiggers
- Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Lambton, New South Wales, Australia
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Nathan N, Cavalin C, Macchi O, Abou Taam R, Valeyre D, Houdouin V, Corvol H, Perisson C, Tazi A, Amiot X, Ralph E, Houzel A, Hamami N, Catinon M, Deschildre A, De Blic J, Clement A, Vincent M, Rosental P. Exposome inorganique et sarcoïdose pulmonaire pédiatrique : l’étude PEDIASARC. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Nathan N, Wolfenden L, Williams CM, Yoong SL, Lecathelinais C, Bell AC, Wyse R, Sutherland R, Wiggers J. Adoption of obesity prevention policies and practices by Australian primary schools: 2006 to 2013. Health Educ Res 2015; 30:262-271. [PMID: 25516479 DOI: 10.1093/her/cyu068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite significant investment in many countries, the extent of schools' adoption of obesity prevention policies and practices has not been widely reported. The aims of this article are to describe Australian schools' adoption of healthy eating and physical activity policies and practices over an 8-year period and to determine if their adoption varies according to schools' size, geographic or socio-economic location. Between 2006 and 2013, a representative randomly selected cohort of primary schools (n = 476) in New South Wales, Australia, participated in four telephone interviews. Repeated measures logistic regression analyses using a Generalised Estimating Equation (GEE) framework were undertaken to assess change over time. The prevalence of all four of the healthy eating practices and one physical activity practice significantly increased, while the prevalence of one physical activity practice significantly decreased. The adoption of practices did not differ by school characteristics. Government investment can equitably enhance school adoption of some obesity prevention policies and practices on a jurisdiction-wide basis. Additional and/or different implementation strategies may be required to facilitate greater adoption of physical activity practices. Ongoing monitoring of school adoption of school policies and practices is needed to ensure the intended benefits of government investment are achieved.
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Affiliation(s)
- N Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - L Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - C M Williams
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - S L Yoong
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - C Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - A C Bell
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - R Wyse
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - R Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - J Wiggers
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia, Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia and Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
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Tabeze L, Borie R, Cottin V, Nathan N, Nunes H, Naccache J, Valeyre D, Cadranel J, Amselem S, Tazi A, Israel-Biet D, Marchand-Adam S, Prevot G, Reynaud Gaubert M, Clement A, Cordier J, Crestani B, Kannengiesser C. Prévalence de mutations identifiées dans les suspicions de formes génétiques de fibroses. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.11.054] [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: 10/24/2022]
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Ramirez L, Cros J, Marin B, Boulogne P, Bergeron A, de Lafont G, Renon-Carron F, de Vinzelles MA, Guigonis V, Nathan N, Beaulieu P. Analgesic interaction between ondansetron and acetaminophen after tonsillectomy in children: The Paratron randomized, controlled trial. Eur J Pain 2014; 19:661-8. [DOI: 10.1002/ejp.587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 12/21/2022]
Affiliation(s)
- L. Ramirez
- Department of Anaesthesia; CHU Limoges; France
| | - J. Cros
- Department of Anaesthesia; CHU Limoges; France
| | - B. Marin
- Unité Fonctionnelle de Recherche Clinique et de Biostatistique; CHU Limoges; France
| | - P. Boulogne
- Department of Anaesthesia; CHU Limoges; France
| | - A. Bergeron
- Unité Fonctionnelle de Recherche Clinique et de Biostatistique; CHU Limoges; France
| | - G.E. de Lafont
- Unité Fonctionnelle de Recherche Clinique et de Biostatistique; CHU Limoges; France
| | | | | | - V. Guigonis
- Department of Paediatrics; CHU Limoges; France
| | - N. Nathan
- Department of Anaesthesia; CHU Limoges; France
| | - P. Beaulieu
- Department of Anaesthesia; CHU Limoges; France
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Houdouin V, Pouessel G, Angoulvant F, Brouard J, Derelle J, Fayon M, Ferroni A, Gangneux JP, Hau I, Le Bourgeois M, Lorrot M, Menotti J, Nathan N, Vabret A, Wallet F, Bonacorsi S, Cohen R, de Blic J, Deschildre A, Gandemer V, Pin I, Labbe A, Le Roux P, Martinot A, Rammaert B, Dubus JC, Delacourt C, Marguet C. Erratum à l’article « Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois » [Arch. Pediatr. 21(4) (2014) 418–423]. Arch Pediatr 2014. [DOI: 10.1016/j.arcped.2014.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ponsonnard S, Duvoid T, Gagnoud R, Dalmay F, Cros J, Nathan N. [Survey national professional practice on the use of the laryngeal mask]. ACTA ACUST UNITED AC 2014; 33:405-10. [PMID: 24961706 DOI: 10.1016/j.annfar.2014.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND This survey aimed to describe the current use of laryngeal mask (LM) and to define the difference of use according to a group defined like experts. METHODS A self-questionnaire available on Internet was sent by e-mail to French anesthesiologists. Results were compared by a Chi(2) test between anesthesiologists according to their expertise defined by a >750 LM use. RESULTS Nine hundred and fifty-three anesthesiologists answered to the survey. Only 19 reported never using LM and 37% of responders were defined as expert. More than half of the MAR used the ideal weight to set the size of the MLA to use. Pressure leak was sought by less than one-third of the MAR. In case of leakage, a mobilization of the ML or the patient's head was performed first. In second intention, nearly a quarter of MAR changed technique for the benefit of oral intubation. Only 50% of responders used LM as a rescue technique in case of difficult intubation and ventilation. Experts had less insertion failure and laryngospasm. Complications and medico-legal suites are few. CONCLUSIONS Variability of practice may be explained by low-grade recommendations in the literature. LM insertion in case of difficult intubation/ventilation to provide adequate oxygenation and should be formally reminded to clinicians.
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Affiliation(s)
- S Ponsonnard
- Anesthésie-réanimation, hôpital Dupuytren, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France.
| | - T Duvoid
- Anesthésie-réanimation, hôpital Dupuytren, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - R Gagnoud
- Anesthésie-réanimation, hôpital Dupuytren, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - F Dalmay
- Unité fonctionnelle de recherche clinique et de biostatistique, faculté de médecine, université de Limoges, 87000 Limoges, France
| | - J Cros
- Anesthésie-réanimation, hôpital mère et enfant, CHU de Limoges, 87042 Limoges, France
| | - N Nathan
- Anesthésie-réanimation, hôpital Dupuytren, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France; Faculté de médecine, université de Limoges, 87000 Limoges, France
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Gagnoud R, Woillard JB, Ponsonnard S, Cros J, Youssef B, Nathan N. [Epidural analgesia apart from obstetrics: a survey of practice]. ACTA ACUST UNITED AC 2014; 33:318-25. [PMID: 24845409 DOI: 10.1016/j.annfar.2014.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the current use of epidural anesthesia (EA) apart from obstetrics, and to explain the reasons of its low utilization. STUDY DESIGN Observational study. METHODS A survey of practice with a self-questionnaire was sent by e-mail and available on Internet. Answers were compared between groups doing or not an epidural analgesia with exact Fisher tests (P<0.05 statistically significant). RESULTS Among the 176 anesthesiologists who answered to the questionnaire, only 21.4% never used epidural analgesia. The main reasons were alternatives therapeutics such as PCA with opioids or TAP block (24/38 vs. 46/140). TAP block was the most common alternative used by more than 50% of anesthesiologists. Loss of competence (4/30 vs. 0/39) was rarely the reason to its low utilization. The low accessibility to specialized postoperative units was recognized in both groups as a limiting factor to do an epidural but not the fear of neurological complications. Those who never perform epidural analgesia were statistically more often physicians between 40 and 50 years (12/38 vs. 19/140). Heparin, aspirin and clopidogrel are no longer contraindications according to anesthesiologists less than 40 years old (50/68 vs. 31/68; 44/68 vs. 31/68; 37/68 vs. 23/68 respectively) but not for older. CONCLUSIONS Epidural analgesia is performed more often by younger anesthesiologists. This survey suggests the need of specific postoperative area to allow anesthesiologist to perform and supervise safely this technique. Recommendations of the French society of Anesthesiologists are also poorly applied.
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Affiliation(s)
- R Gagnoud
- Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France.
| | - J B Woillard
- Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France; Inserm, UMR-S850, Limoges, France
| | - S Ponsonnard
- Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - J Cros
- Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France
| | - B Youssef
- Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - N Nathan
- Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France
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Frade F, Auber F, Larroquet M, Nathan N, Guilbert J, Grapin Dagorno C, Renolleau S, Audry G. SFCP CO-53 - Hernie de coupole diaphragmatique et ECMO : résultats à court terme. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Houdouin V, Pouessel G, Angoulvant F, Brouard J, Derelle J, Fayon M, Ferroni A, Gangneux JP, Hau I, Le Bourgeois M, Lorrot M, Menotti J, Nathan N, Vabret A, Wallet F, Bonacorsi S, Cohen R, de Blic J, Deschildre A, Gandemer V, Pin I, Labbe A, Le Roux P, Martinot A, Rammaert B, Dubus JC, Delacourt C, Marguet C. Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois. Arch Pediatr 2014; 21:418-23. [DOI: 10.1016/j.arcped.2014.01.004] [Citation(s) in RCA: 3] [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] [Received: 09/24/2013] [Revised: 11/16/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Corvol H, Taytard J, Thouvenin G, Périsson C, Nathan N, Clement A. [Why use long-term macrolide therapy in pediatric pulmonology?]. Arch Pediatr 2014; 21:314-21. [PMID: 24503457 DOI: 10.1016/j.arcped.2013.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/31/2013] [Accepted: 12/11/2013] [Indexed: 12/16/2022]
Abstract
Macrolides are well-known antibiotics exerting antimicrobial as well as anti-inflammatory and immunomodulatory effects. Since the observation of a dramatic improvement in lung disease and survival in patients with diffuse panbronchiolitis, macrolides have been used over the long term in several chronic respiratory diseases. This review describes the results of trials that have evaluated long-term macrolides in the treatment of cystic fibrosis, non-cystic fibrosis bronchiectasis, and asthma, particularly focusing on the impact on children. It also provides new insights on the potential effects of macrolides on diffuse parenchymal lung diseases.
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Affiliation(s)
- H Corvol
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France.
| | - J Taytard
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - G Thouvenin
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - C Périsson
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - N Nathan
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - A Clement
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
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Meau-Petit V, Thouvenin G, Guillemot-Lambert N, Champion V, Tillous-Borde I, Flamein F, de Saint Blanquat L, Essouri S, Guilbert J, Nathan N, Guellec I, Kout S, Epaud R, Lévy M. [Bronchopulmonary dysplasia-associated pulmonary arterial hypertension of very preterm infants]. Arch Pediatr 2012; 20:44-53. [PMID: 23266170 DOI: 10.1016/j.arcped.2012.10.017] [Citation(s) in RCA: 10] [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: 03/07/2012] [Revised: 09/05/2012] [Accepted: 10/26/2012] [Indexed: 11/17/2022]
Abstract
Bronchopulmonary dysplasia (BPD) of very preterm infants is a multifactorial chronic lung disease and its incidence has not decreased despite improvements in neonatal intensive care, including lung protective strategies. Pulmonary hypertension (PH) can complicate the course of BPD. Mortality in infants with BPD-associated PH is thought to be very high, but its incidence is unknown and a standard diagnostic and therapeutic strategy has not been well defined. In this article, we will first describe the current knowledge on the BPD-associated PH and the current treatments available for this pathology. We will then present the HTP-DBP Study, carried out in Paris (France) starting in 2012. The diagnosis of PH is suspected on echocardiographic criteria, but cardiac catheterization is considered the gold standard for diagnosis and evaluation of the severity of PH. Moreover, pulmonary vasoreactivity testing is used to guide the management of patients with PH. The pathogenesis of BPD-associated PH is poorly understood and even less is known about appropriate therapy. Today, optimizing ventilation and reducing the pulmonary vascular tone with specific pulmonary vasodilatator drugs are the main goals in treating HTP-associated DBP. Animal studies and a few clinical studies suggest that medications targeting the nitric oxide (NO) signaling pathway (NO inhalation, oral sildenafil citrate) could be effective treatments for BPD-associated PH, but they have not been approved for this indication. The HTP-DBP study is a French multicenter prospective observational study. The objective is to evaluate the frequency of BPD-associated PH, to describe its physiopathology, its severity (morbidity and mortality), and the effectiveness of current treatments.
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Affiliation(s)
- V Meau-Petit
- Service de maternité, réanimation, soins intensifs et pédiatrie néonatales, hôpital Necker-Enfants-Malades, AP-HP, Paris, France.
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Abstract
Multible organ failure (MOF) induced by mesenteric infarction is associated with a high mortality rate. This study reports eicosanoid and cytokine levels in the blood of three atherosclerotic patients who ultimately died from MOF induced by mesenteric infarction. High plasma levels of 6- keto-prostaglandin (PG) F1α (the stable metabolite of
PGI2), interleukin (IL)-6 and IL-8 are observed whereas plasma tumour necrosis factor alpha (TNFα),
TxB2 (the stable metabolite of TxA2), PGE2, leukotrienes (LT)B4 and LTC4, and whole blood platelet-activating factor levels are not different from values obtained in similarly severe atherosclerotic patients. This short report questioned the clinical involvement of TNFα during such a pathology where a persistent translocation of endotoxin has been observed through the gut endothelial barrier. Activation of phospholipase A2 is suggested by the increase in the stable metabolite of PGI2 and might be by itself or through lipidic metabolites, a major systemic stimulus of IL-6 and IL-8 production.
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Affiliation(s)
- N Nathan
- Department of Anaesthesia CHU Dupuytren 2 Avenue Martin Luther King Limoges 87042 France
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Bardou P, Orabona M, Vincelot A, Maubon A, Nathan N. Faux anévrisme d’une artère utérine après césarienne : une cause atypique d’hémorragie du post-partum. ACTA ACUST UNITED AC 2010; 29:909-12. [DOI: 10.1016/j.annfar.2010.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/29/2010] [Indexed: 12/11/2022]
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Beydon L, Dureuil B, Nathan N, Piriou V, Steib A. [High fidelity simulation in Anesthesia and Intensive Care: context and opinion of performing centres--a survey by the French College of Anesthesiologists and Intensivists]. ACTA ACUST UNITED AC 2010; 29:782-6. [PMID: 20934299 DOI: 10.1016/j.annfar.2010.08.013] [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] [Received: 04/24/2010] [Accepted: 08/21/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES High fidelity simulation is rapidly expanding in France. The question of knowing how to accredit this new mode of continuous education and how far it is available for this purpose is pending. The purpose of this survey was to collect how active centres operate and which criteria they would prefer to accredit this form of continuing medical education. STUDY DESIGN National survey. METHODS A questionnaire was sent to all centres using high fidelity simulation in France (December 2009). RESULTS Eighteen of 21 centres answered (86%; all university hospitals). These centres are equipped with adult high fidelity simulation and procedural heads for intubation. Funding is achieved via multiple sources and one third of centres benefit from manufacturers' lending. Centres are mostly located within the university premises (70%). One or more staff practitioners are involved in 78% and the majority of centres are operated by more than three. Nurse anaesthetists are not involved in most centres. Operating procedures are similar and high fidelity simulation is mostly used for in-site resident training. At present, centres are only marginally able to train non-resident senior anaesthesiologists. Sessions extend over one day (72%). The majority of centres is prone to share scenarios (75%) and pedagogic aids (93%). Basic scenarios (e.g., cardiopulmonary resuscitation) are mainstream objectives for 85% of centres. CONCLUSION high fidelity simulation is rapidly expending in France but its ability to contribute to continuous medical education is still limited to date.
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Affiliation(s)
- L Beydon
- Commission formation initiale du Cfar, pôle d'anesthésie réanimation, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France.
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Steib A, Barre J, Mertes M, Morel MH, Nathan N, Ozier Y, Treger M, Samama CM. Can oral vitamin K before elective surgery substitute for preoperative heparin bridging in patients on vitamin K antagonists? J Thromb Haemost 2010; 8:499-503. [PMID: 19912513 DOI: 10.1111/j.1538-7836.2009.03685.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND After a vitamin K antagonist (VKA) overdose, 1-2 mg of oral vitamin K can lower the International Normalized Ratio (INR) to the therapeutic range. OBJECTIVE To establish whether oral vitamin K can substitute for heparin bridging and decrease the INR to < or = 1.5 before elective surgery. METHODS Patients on long-term VKAs were randomized either to heparin bridging after the last VKA dose on day -5 before surgery (group H) or to VKA treatment until day -2, followed by 1 mg of oral vitamin K on the day before surgery (group K). Blood clotting variables were assessed on days -5/-2, 1 and 0, and postoperatively. If the target INR was not achieved 2 h before incision, surgery was deferred or performed after injection of prothrombin complex concentrate (PCC). RESULTS In 30 of 94 included patients, baseline INR was outside the chosen range (18, INR < 2; 12, INR > 3.5), leaving 34 eligible patients in group H and 30 in group K. The groups were balanced in terms of body mass index, VKA treatment duration and indication, scheduled surgery, preoperative and postoperative hemoglobin, and blood loss. The INR was significantly higher in group K on days -1 and 0 than in group H. An INR < or = 1.5 was not achieved in 20 group K patients (66%). Surgery was postponed or performed after PCC injection in 12 of these 20 patients. CONCLUSIONS Oral vitamin K (1 mg) cannot substitute for heparin bridging before surgery. In addition, one-third of patients on VKAs were exposed to a risk of bleeding (overdose) or thrombosis (underdose), thus highlighting the need for new oral anticoagulants.
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Affiliation(s)
- A Steib
- Department of Anaesthesia and Intensive Care, Nouvel Hôpital Civil Strasbourg (University Hospitals), Strasbourg Cedex, France.
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Landreau B, Odin I, Nathan N. Inhalation gastrique : épidémiologie et facteurs de risque. ACTA ACUST UNITED AC 2009; 28:206-10. [DOI: 10.1016/j.annfar.2009.01.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 01/14/2009] [Indexed: 11/30/2022]
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Abstract
Anaphylaxis during anaesthesia is a rare event which is mainly related to neuromuscular blocking agents. Latex and antibiotics are less frequently incriminated. However, allergy may be triggered by other less frequent and hidden allergen. Among these, povidone is largely used in numerous therapeutics and cosmetics. We report here an exceptional case of grade 3 anaphylactic shock with iodinated povidone administered via a rectal route.
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Affiliation(s)
- C Palobart
- Département d'anesthésie-réanimation, CHU Dupuytren, 2 avenue Martin-Luther-King, Limoges cedex, France.
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Pepino F, Granchamp P, Odin I, Decroisette E, Nathan N. [Labour epidural analgesia for a woman with a factor XI deficiency: an illconsidered risk?]. Ann Fr Anesth Reanim 2008; 28:86-90. [PMID: 19101109 DOI: 10.1016/j.annfar.2008.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 10/03/2008] [Indexed: 11/18/2022]
Abstract
Inherited bleeding disorders contraindicate epidural analgesia because of the risk of epidural haematoma. However, there is no consensus about a minimal rate of factor XI required for its performance. We report here a case of epidural analgesia in a pregnant woman with a moderate and symptomatic factor XI deficiency, despite this theoretical contraindication. Indeed, the factor XI deficiency results in a haemorrhagic risk which is variable and not easily foreseeable. Nevertheless, no neurological after-effect or excessive bleeding occurred although no specific prophylaxis had been performed.
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Affiliation(s)
- F Pepino
- Service d'anesthésie-réanimation, hôpital de mère et de l'enfant, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France.
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Guillemot N, Blanchon S, Nathan N, Corvol H, Fauroux B, Aubertin G, Clement A, Epaud R. [Pneumocystis jiroveci pneumonia during prolonged corticosteroid therapy in an immunocompetent infant]. Rev Pneumol Clin 2008; 64:225-228. [PMID: 18995150 DOI: 10.1016/j.pneumo.2008.06.012] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 05/28/2008] [Accepted: 06/01/2008] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Pneumocystis jiroveci (PJ) infection is rare in infants and is suggestive of primary or secondary immunodeficiency. We report on a case of severe PJ pneumonia in an immunocompetent infant after prolonged corticosteroid treatment. CASE REPORT A 5 1/2 month-old girl presented with hypoxemic respiratory distress. Her medical record was remarkable only for a bulky parotid haemangioma, which was treated with prolonged oral corticosteroid therapy. The chest X-ray showed a mixed alveolar-interstitial pattern, and bronchoalveolar lavage revealed the presence of PJ. A favourable outcome was obtained after three weeks of intravenous trimethoprim-sulfamethoxazole treatment. CONCLUSION PJ infection should be suspected in infants presenting with progressive respiratory distress associated with a mixed alveolar-interstitial pattern. Its potential seriousness justifies prophylactic therapy during prolonged immunosuppressive treatment (chemotherapy, corticosteroid treatment).
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Affiliation(s)
- N Guillemot
- Unité de pneumologie pédiatrique, hôpital d'Enfants Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75571 Paris cedex 12, France
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Guillemot N, Chadelat K, Nathan N, Aubertin G, Ducou le pointe H, Clément A, Fauroux B, Epaud R. Tuméfaction sternale chez un enfant de neuf ans. Med Mal Infect 2008; 38:278-80. [DOI: 10.1016/j.medmal.2007.11.013] [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] [Received: 06/20/2007] [Accepted: 11/11/2007] [Indexed: 10/22/2022]
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Grais RF, Dubray C, Gerstl S, Guthmann JP, Djibo A, Nargaye KD, Coker J, Alberti KP, Cochet A, Ihekweazu C, Nathan N, Payne L, Porten K, Sauvageot D, Schimmer B, Fermon F, Burny ME, Hersh BS, Guerin PJ. Unacceptably high mortality related to measles epidemics in Niger, Nigeria, and Chad. PLoS Med 2007; 4:e16. [PMID: 17199407 PMCID: PMC1761051 DOI: 10.1371/journal.pmed.0040016] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 11/14/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the comprehensive World Health Organization (WHO)/United Nations Children's Fund (UNICEF) measles mortality-reduction strategy and the Measles Initiative, a partnership of international organizations supporting measles mortality reduction in Africa, certain high-burden countries continue to face recurrent epidemics. To our knowledge, few recent studies have documented measles mortality in sub-Saharan Africa. The objective of our study was to investigate measles mortality in three recent epidemics in Niamey (Niger), N'Djamena (Chad), and Adamawa State (Nigeria). METHODS AND FINDINGS We conducted three exhaustive household retrospective mortality surveys in one neighbourhood of each of the three affected areas: Boukoki, Niamey, Niger (April 2004, n = 26,795); Moursal, N'Djamena, Chad (June 2005, n = 21,812); and Dong District, Adamawa State, Nigeria (April 2005, n = 16,249), where n is the total surveyed population in each of the respective areas. Study populations included all persons resident for at least 2 wk prior to the study, a duration encompassing the measles incubation period. Heads of households provided information on measles cases, clinical outcomes up to 30 d after rash onset, and health-seeking behaviour during the epidemic. Measles cases and deaths were ascertained using standard WHO surveillance-case definitions. Our main outcome measures were measles attack rates (ARs) and case fatality ratios (CFRs) by age group, and descriptions of measles complications and health-seeking behaviour. Measles ARs were the highest in children under 5 y old (under 5 y): 17.1% in Boukoki, 17.2% in Moursal, and 24.3% in Dong District. CFRs in under 5-y-olds were 4.6%, 4.0%, and 10.8% in Boukoki, Moursal, and Dong District, respectively. In all sites, more than half of measles cases in children aged under 5 y experienced acute respiratory infection and/or diarrhoea in the 30 d following rash onset. Of measles cases, it was reported that 85.7% (979/1,142) of patients visited a health-care facility within 30 d after rash onset in Boukoki, 73.5% (519/706) in Moursal, and 52.8% (603/1,142) in Dong District. CONCLUSIONS Children in these countries still face unacceptably high mortality from a completely preventable disease. While the successes of measles mortality-reduction strategies and progress observed in measles control in other countries of the region are laudable and evident, they should not overshadow the need for intensive efforts in countries that have just begun implementation of the WHO/UNICEF comprehensive strategy.
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Borel T, Rose AMC, Guillerm M, Sidikou F, Gerstl S, Djibo A, Nathan N, Chanteau S, Guerin PJ. High sensitivity and specificity of the Pastorex® latex agglutination test for Neisseria meningitidis serogroup A during a clinical trial in Niger. Trans R Soc Trop Med Hyg 2006; 100:964-9. [PMID: 16730766 DOI: 10.1016/j.trstmh.2006.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 03/28/2006] [Accepted: 03/29/2006] [Indexed: 10/24/2022] Open
Abstract
There is a great need for a rapid diagnostic test to guide vaccine choice during outbreaks of meningococcal meningitis in resource-poor countries. During a randomised clinical trial conducted during an epidemic of Neisseria meningitidis serogroup A in Niger in 2003, the sensitivity and specificity of the Pastorex latex agglutination test for this serogroup under optimal field conditions were assessed, using culture and/or PCR as the gold standard. Results from 484 samples showed a sensitivity of 88% (95% CI 85-91%) and a specificity of 93% (95% CI 90-95%). Pastorex could be a good alternative to current methods, as it can be performed in a local laboratory with rapid results and is highly specific. Sensitivity can be improved with prior microscopy where feasible. A study specifically to evaluate the Pastorex test under epidemic conditions, using laboratories with limited resources, is recommended.
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Affiliation(s)
- T Borel
- Epicentre, 8 rue St Sabin, 75011 Paris, France
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Samama CM, Djoudi R, Lecompte T, Nathan N, Schved JF. Perioperative platelet transfusion. Recommendations of the French Health Products Safety Agency (AFSSAPS) 2003. Minerva Anestesiol 2006; 72:447-52. [PMID: 16682914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The aim of this paper is to present the recommendations of the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSaPS; French Safety Agency for Health Products). A panel of experts reviewed and graded the literature on platelet transfusions; recommendations were formulated. Threshold platelet counts (PC) for transfusions in the perioperative context have not been clearly defined and should be determined by the existence of hemorrhagic risk factors. In the case of commonly practiced invasive procedures, the recommendation is to transfuse in order to achieve PC > 50,000 x microL-1. In the absence of platelet dysfunction, regardless of the type of surgery, the standard hemorrhagic risk threshold for surgery is 50,000 x microL-1. It has not been proven that the risk threshold is different according to the type of surgery. For neurosurgery and ophthalmologic surgery involving the posterior segment of the eye, a PC of 100,000 x microL-11 is required. For axial regional anesthesia, a PC of 50,000 x microL-11 is sufficient for spinal anesthesia; a PC of 80,000 x microL-11 has been proposed for epidurals. During massive transfusion, prophylactic platelet infusion cannot be recommended beyond a loss of two blood volumes in less than 24 h (Professional Consensus). As for the therapeutic transfusion of plasma and/or platelets, as much as possible, platelet deficit should be documented with test results (PC and fibrinogen) before transfusing. In the event of bleeding, platelet transfusion may precede plasma infusion. However, although this recommendation has been the subject of several professional consensus agreements, it is not based on any randomized studies. Threshold PC for perioperative transfusions have not been clearly defined and most recommendations are the result of a professional consensus.
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Affiliation(s)
- C M Samama
- Department of Anesthesiology and Resuscitation, Avicenne Hospital, Bobigny cedex, France.
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Abstract
Because of specific paediatric respiratory physiology (mainly decreased compliance and functional residual capacity, increased O2 demand and CO2 production), ventilators for paediatric anaesthesia need to be powerful and able to deliver small volumes at a high rate without compression volume loss. The compensation of compliance now available on every anaesthesia machine, compensates for the volume of gas lost by compression in the circuit tubing allowing the tidal volume to reach preset commands, even for bellow in box respirators. Preset tidal volume is then totally delivered to the lung by volume-controlled ventilation because it becomes independent of total pulmonary compliance and fresh gas flow. Increased precision of electronic flowmeters and better air-tightness of circuits allow reducing with precision fresh gas flow to values approaching children's O2 consumption and N2O diffusion. New modes of ventilation are now available on anaesthesia machine. Pressure controlled mode, by increasing and maintaining mean airway pressures, ameliorates intrapulmonary gas distribution and compensates for the gas leak from uncuffed tracheal tubes. Unsteady tidal volume resulting from variation of total compliance, is the main drawback of pressure-controlled ventilation that may be overcome by using the "autoflow" mode (better described as a pressure controlled mode ensuring tidal volume) available with one of the last generation of ventilators. Increased accuracy and security of the mode "pressure assist" might increase the use of spontaneous ventilation in paediatric anaesthesia even for low weight children. However tidal volume remains variable with compliance and depth of anaesthesia, which may require several adjustments of ventilator's settings. The clinical conditions (mainly airway control) of pressure assist use for children less than 10 kg should be elucidated before recommending its use.
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Affiliation(s)
- I Odin
- Département d'anesthésie-réanimation chirurgicale, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
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Stewart PA, Nathan N, Nyhof-Young J. Design characteristics that affect speed of information access and clarity of presentation in an electronic neuroanatomy atlas. Clin Anat 2005; 20:93-110. [PMID: 16317741 DOI: 10.1002/ca.20250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Functional Neuroanatomy, an interactive electronic neuroanatomical atlas, was designed for first year medical students. Medical students have much to learn in a limited time; therefore a major goal in the atlas design was that it facilitate rapid, accurate information retrieval. To assess this feature, we designed a testing scenario in which students who had never taken a neuroanatomy course were asked to complete two equivalent tests, one using the electronic atlas and one using a comparable hard copy atlas, in a limited period of time. The tests were too long to be completed in the time allotted, so test scores were measures of how quickly correct information could be retrieved from each source. Statistical analysis of the data showed that the tests were of equal difficulty and that accurate information retrieval was significantly faster using the electronic atlas when compared with the hard copy atlas (P < 0.0001). Post-test focus groups (n = 4) allowed us to infer that the following design features contributed to rapid information access: the number of structures in the database was limited to those that are relevant to a practicing physician; all of the program modules were presented in both text and image form on the index screen, which doubled as a site map; pages were layered electronically such that information was hidden until requested, structures available on each page were listed alphabetically and could be accessed by clicking on their name; and an illustrated glossary was provided and equipped with a search engine.
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Affiliation(s)
- P A Stewart
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Canada.
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