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Christiaens A, Simon-Tillaux N, Thompson W, Sinclair AJ, Henrard S, Boland BB, Slaouti-Jégou Y, Lekens B, Bonnet-Zamponi D, Tubach F, Zerah L. Impact of deintensifying hypoglycaemic drugs in older adults with type 2 diabetes: protocol for an emulation of a target trial. BMJ Open 2023; 13:e073081. [PMID: 37984943 PMCID: PMC10660441 DOI: 10.1136/bmjopen-2023-073081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION In older adults with type 2 diabetes (T2D), overtreatment with hypoglycaemic drugs (HDs: sulfonylureas, glinides and/or insulins) is frequent and associated with increased 1-year mortality. Deintensification of HD is thus a key issue, for which evidence is though limited. The primary objective of this study will be to estimate the effect of deintensifying HD on clinical outcomes (hospital admission or death) within 3 months in older adults (≥75 years) with T2D. METHODS We will emulate with real-world data a target trial, within The Health Improvement Network cohort, a large-scale database of data collected from electronic medical records of 2000 general practitioners in France. From 1 January 2010 to 28 February 2019, we will include eligible patients ≥75 years who will have T2D, a stable dose of HDs, glycated haemoglobin A1c (HbA1c) value <75 mmol/mol (9.0%) and no deintensification in the past year. The target trial will be sequentially emulated (ie, eligibility assessed) every month in the database. Patients will be classified at baseline of each sequential trial in the intervention arm (deintensification of HDs: decrease of ≥50% in the total dose of HDs, including complete cessation) or control arm (no deintensification of HDs). The pooled dataset for all sequential emulated trials will be analysed. The primary outcome will be time to first occurrence of hospital admission or death, within 3 months. Secondary outcomes will be hospitalisation, death, appropriateness of glycaemic control and occurrence of HbA1c >75 mmol/mol within 1 year. Participants will be followed from baseline to 12 months after randomisation, administrative censoring, or death, whichever occurs first. A pooled logistic regression will be used to estimate the treatment effect on the incidence of the outcomes. DISSEMINATION AND ETHICS No ethical approval is needed for using retrospectively this fully anonymised database. The results will be disseminated during conferences and through publications in scientific journals.
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Affiliation(s)
- Antoine Christiaens
- FNRS, Fund for Scientific Research, Bruxelles, Belgium
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, Île-de-France, France
| | - Noémie Simon-Tillaux
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, Île-de-France, France
- Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité́ de Recherche Clinique PSL-CFX, CIC-1901, Assistance Publique - Hôpitaux de Paris, Paris, Île-de-France, France
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Alan J Sinclair
- Care for long term conditions - Diabetes research group, King's College London, London, UK
- Foundation for Diabetes Research in Older People, Taplow, UK
| | - Séverine Henrard
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Benoit B Boland
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- Geriatric Department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | | | | | - Dominique Bonnet-Zamponi
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, Île-de-France, France
- Observatoire des médicaments, dispositifs médicaux, innovations thérapeutiques d'Île-de-France, Paris, France
| | - Florence Tubach
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, Île-de-France, France
- Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité́ de Recherche Clinique PSL-CFX, CIC-1901, Assistance Publique - Hôpitaux de Paris, Paris, Île-de-France, France
| | - Lorène Zerah
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, Île-de-France, France
- Hôpital Pitié Salpêtrière, Département de gériatrie, Assistance Publique - Hôpitaux de Paris, Paris, Île-de-France, France
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Massol J, Simon-Tillaux N, Tohme J, Hariri G, Dureau P, Duceau B, Belin L, Hajage D, De Rycke Y, Charfeddine A, Lebreton G, Combes A, Bouglé A. Levosimendan in patients undergoing extracorporeal membrane oxygenation after cardiac surgery: an emulated target trial using observational data. Crit Care 2023; 27:51. [PMID: 36750852 PMCID: PMC9906922 DOI: 10.1186/s13054-023-04328-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Retrospective cohorts have suggested that levosimendan may facilitate the weaning of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We therefore studied this clinical question by emulating a randomized trial with observational data. METHODS All patients with refractory postcardiotomy cardiogenic shock and assisted with VA-ECMO, admitted to a surgical intensive care unit at La Pitié-Salpêtrière Hospital between 2016 and 2019, were eligible. To avoid immortal-time bias, we emulated a target trial sequentially comparing levosimendan administration versus no levosimendan administration in patients treated with VA-ECMO. The primary outcome was time to successful ECMO weaning. The secondary outcomes were 30-day and 1-year mortality. We performed a multivariable analysis to adjust for confounding at baseline. RESULTS Two hundred and thirty-nine patients were included in the study allowing building a nested trials cohort of 1434 copies of patients. No association of levosimendan treatment and VA-ECMO weaning was found (HR = 0.91, [0.57; 1.45], p = 0.659 in multivariable analysis), or 30-day mortality (OR = 1.03, [0.52; 2.03], p = 0.940) and 1-year mortality (OR = 1.00, [0.53; 1.89], p = 0.999). CONCLUSIONS Using the emulated target trial framework, this study did not find any association of levosimendan treatment and ECMO weaning success after postcardiotomy cardiogenic shock. However, the population of interest remains heterogeneous and subgroups might benefit from levosimendan.
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Affiliation(s)
- Julien Massol
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Noémie Simon-Tillaux
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Joanna Tohme
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Geoffroy Hariri
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Pauline Dureau
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Baptiste Duceau
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Lisa Belin
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - David Hajage
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Yann De Rycke
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Ahmed Charfeddine
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Guillaume Lebreton
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Alain Combes
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
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Simon-Tillaux N, Gerard AL, Rajendrabose D, Tubach F, Dechartres A. A methodological review with meta-epidemiological analysis of preclinical systematic reviews with meta-analyses. Sci Rep 2022; 12:20066. [PMID: 36414712 PMCID: PMC9681751 DOI: 10.1038/s41598-022-24447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
Systematic reviews and meta-analyses have been proposed as an approach to synthesize the literature and counteract the lack of power of small preclinical studies. We aimed to evaluate (1) the methodology of these reviews, (2) the methodological quality of the studies they included and (3) whether study methodological characteristics affect effect size. We searched MEDLINE to retrieve 212 systematic reviews with meta-analyses of preclinical studies published from January, 2018 to March, 2020. Less than 15% explored the grey literature. Selection, data extraction and risk of bias assessment were performed in duplicate in less than two thirds of reviews. Most of them assessed the methodological quality of included studies and reported the meta-analysis model. The risk of bias of included studies was mostly rated unclear. In meta-epidemiological analysis, none of the study methodological characteristics was associated with effect size. The methodological characteristics of systematic reviews with meta-analyses of recently published preclinical studies seem to have improved as compared with previous assessments, but the methodological quality of included studies remains poor, thus limiting the validity of their results. Our meta-epidemiological analysis did not show any evidence of a potential association between methodological characteristics of included studies and effect size.
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Affiliation(s)
- Noémie Simon-Tillaux
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Anne-Laure Gerard
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Deivanes Rajendrabose
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Florence Tubach
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Agnès Dechartres
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
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Simon-Tillaux N, Massol J, Hajage D, De rycke Y, Tubach F, Tohme J, Bouglé A, Belin L. Utilisation des essais ciblés émulés pour limiter les biais dans les études observationnelles: étude de l'effet du levosimendan dans le sevrage de l'ECMO-VA. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.099] [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] Open
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Vatier C, Carrié A, Renaud MC, Simon-Tillaux N, Hertig A, Jéru I. Reply to Morje et al. Adv Physiol Educ 2021; 45:811. [PMID: 34581618 PMCID: PMC8486432 DOI: 10.1152/advan.00140.2021] [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] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Camille Vatier
- Faculté de Médecine, Sorbonne Université, Paris, France
- Service de Diabétologie et Endocrinologie de la Reproduction, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Carrié
- Faculté de Médecine, Sorbonne Université, Paris, France
- Service de Biochimie Endocrinienne et Oncologie, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière, Paris, France
| | | | - Noémie Simon-Tillaux
- Faculté de Médecine, Sorbonne Université, Paris, France
- Département de Santé Publique, Hôpital de La Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Hertig
- Faculté de Médecine, Sorbonne Université, Paris, France
- Service de Néphrologie et Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Jéru
- Faculté de Médecine, Sorbonne Université, Paris, France
- Laboratoire Commun de Biologie et Génétique Moléculaires, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
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Serresse L, Simon-Tillaux N, Decavèle M, Gay F, Nion N, Lavault S, Guerder A, Châtelet A, Dabi F, Demoule A, Morélot-Panzini C, Moricot C, Similowski T. Lifting dyspnoea invisibility: COVID-19 face masks, the experience of breathing discomfort, and improved lung health perception - a French nationwide survey. Eur Respir J 2021; 59:13993003.01459-2021. [PMID: 34475232 DOI: 10.1183/13993003.01459-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/03/2021] [Indexed: 11/05/2022]
Abstract
QUESTION ADDRESSED In contrast with pain, dyspnoea is not visible to the general public who lack the corresponding experiential baggage. We tested the hypotheses that the generalised use of face masks to fight SARS-CoV2 dissemination could change this and sensitise people to respiratory health. METHODS General population polling (1012-person panel demographically representative of the adult French population -quota sampling method-; 517 women, 51%). 860 (85%) answered "no" to "treated for a chronic respiratory disease" ("respiratory healthy", RH) and 152 "yes" ("respiratory disease", RD). 14% of RH respondents reported having a close family member treated for a chronic respiratory disease (RH-family+ and RH-family-). Respondents described mask-related attitudes, beliefs, inconveniencies, dyspnoea, and changes in their respiratory health vision . RESULTS: Compliance with masks was high (94.7%). Dyspnoea ranked first among mask inconveniencies (RD 79.3%, RH 67.3%, p=0.013). "Air hunger" was the main sensory dyspnoea descriptor. Mask-related dyspnoea was independently associated with belonging to RH-family+ (Odds Ratio [OR] [95% confidence interval (CI)]: 1.85 [1.16-2.98]) and removing masks to improve breathing (OR 5.21 [3.73-7.28]). It was negatively associated with considering masks effective to protect others (OR]: 0.42 [0.25-0.75]). Half the respondents were more concerned with their respiratory health since wearing masks; 41% reported better understanding patients' experiences. ANSWER TO THE QUESTION Wearing protective face masks leads to the mass discovery of breathing discomfort. It raises the public's awareness of what respiratory diseases involve and sensitises to the importance of breathing. These data should be used as the fulcrum of respiratory-health-oriented communication actions.
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Affiliation(s)
- Laure Serresse
- Unité Mobile de Soins Palliatifs, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,co-first authors
| | - Noémie Simon-Tillaux
- Département de Santé Publique, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.,co-first authors
| | - Maxens Decavèle
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation, Paris, France
| | - Frederick Gay
- Laboratoire de parasitologie-mycologie, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Nathalie Nion
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Sophie Lavault
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Paris, France
| | - Antoine Guerder
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Soins de Suite et de Réadaptation Respiratoire, Paris, France
| | | | - Frédéric Dabi
- Institut Français d'Opinion Publique (IFOP), Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Capucine Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Paris, France
| | - Caroline Moricot
- Département de Sociologie & EA 2483 Centre d'étude des techniques, des connaissances et des pratiques -CETCOPRA-, Université Paris I Panthéon Sorbonne, Paris, France.,co-last authors
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France .,Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,co-last authors
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Vatier C, Carrié A, Renaud MC, Simon-Tillaux N, Hertig A, Jéru I. Lessons from the impact of COVID-19 on medical educational continuity and practices. Adv Physiol Educ 2021; 45:390-398. [PMID: 33961515 PMCID: PMC8384569 DOI: 10.1152/advan.00243.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 05/27/2023]
Abstract
The COVID-19 crisis necessitated abrupt transition to remote learning in medical schools. We aimed to assess the impact of COVID-19 on French undergraduate students and teachers, to identify practice changes, and to evaluate successes and areas for improvement of this remote learning experience. Data from 2 online questionnaires were analyzed with 509 participants among students and 189 among teachers from Sorbonne University. Responses to multiple choice, Likert response scale, and open-ended questions were evaluated. COVID-19 had negative impact on teaching continuity. Sixty-seven percent of students were in a dropout situation, and many suffered from psychological stress, leading to set up of a psychological support unit. Although most teachers (81%) and students (72%) had limited knowledge of digital resources, distance learning was quickly implemented, with a predominant use of Zoom. The analysis of several parameters revealed that students were significantly more satisfied than teachers by remote learning. Nevertheless, both students and teachers agreed to replace classical lectures by digital media and to promote in-person teaching in small interactive groups. This paper shares tips for faculty rapidly establishing remote learning. This comparative study of the students' and teachers' points of view underlines that new medical curricula should include more digital contents. We make recommendations regarding general university organization, equipment, and curricular development for long-term implementation of digital resources with reinforced relationships between faculty and students.
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Affiliation(s)
- Camille Vatier
- Faculté de Médecine, Sorbonne Université, Paris, France
- Service de Diabétologie et Endocrinologie de la Reproduction, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Carrié
- Faculté de Médecine, Sorbonne Université, Paris, France
- Service de Biochimie Endocrinienne et Oncologie, Hôpital de La Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Noémie Simon-Tillaux
- Faculté de Médecine, Sorbonne Université, Paris, France
- Département de Santé Publique, Hôpital de La Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Hertig
- Faculté de Médecine, Sorbonne Université, Paris, France
- Service de Néphrologie et Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Jéru
- Faculté de Médecine, Sorbonne Université, Paris, France
- Laboratoire Commun de Biologie et Génétique Moléculaires, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
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Gérard AL, Simon-Tillaux N, Yordanov Y, Cacoub P, Tubach F, Saadoun D, Dechartres A. Efficacy and safety of steroid-sparing treatments in giant cell arteritis according to the glucocorticoids tapering regimen: A systematic review and meta-analysis. Eur J Intern Med 2021; 88:96-103. [PMID: 33879385 DOI: 10.1016/j.ejim.2021.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of adjuvant therapies in newly diagnosed or relapsing giant cell arteritis (GCA) in terms of relapse rate at week 52 (primary outcome) and to assess the impact of GC tapering regimen on adjuvant effectiveness. METHODS For this systematic review and meta-analysis, we searched PubMed, EMBASE, CENTRAL, trial registries, from inception to November 2020. We included all randomized controlled trials (RCTs) and controlled prospective studies evaluating adjuvant treatments in GCA, without date or language restriction. Two reviewers independently selected studies, extracted data and assessed risk of bias. Quality of evidence was summarised with GRADE. RESULTS Of the 680 records identified, 16 studies were included (1,068 participants) evaluating various adjuvant therapies compared to GC only. No study compared adjuvants with each other. Risk of bias was high in 5/7 trials evaluating our primary outcome. Risk of relapse at week 52 was reduced for only the anti-IL6 and IL6-receptor drug class versus the control (RR=0.45, 95%CI 0.30-0.66, I2=38%), particularly tocilizumab (RR=0.38, 95%CI 0.23-0.63, I2=42%) with a moderate quality of evidence. We found no significant interaction according to GC tapering regimen. Our meta-analysis did not show a significant benefit for methotrexate. Except for dapsone, ciclosporine and hydroxychloroquine, other adjuvants did not seem to show increased risk of adverse events. CONCLUSIONS Tocilizumab seems to reduce the relapse rate in GCA at week 52 but the quality of evidence was moderate. No other molecule has shown efficacy. No significant interaction on relapse rate by GC tapering regimen was found. STUDY REGISTRATION PROSPERO CRD42020172011.
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Affiliation(s)
- Anne-Laure Gérard
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Noémie Simon-Tillaux
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Youri Yordanov
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Patrice Cacoub
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - David Saadoun
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France.
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France.
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Beurton A, Haudebourg L, Simon-Tillaux N, Demoule A, Dres M. Limiting positive end-expiratory pressure to protect renal function in SARS-CoV-2 critically ill patients. J Crit Care 2020; 59:191-193. [PMID: 32683213 PMCID: PMC7348607 DOI: 10.1016/j.jcrc.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/28/2020] [Accepted: 07/06/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Alexandra Beurton
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013 Paris, France
| | - Luc Haudebourg
- AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013 Paris, France
| | - Noémie Simon-Tillaux
- APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Biostatistique Santé Publique et Information Médicale, F-75013 Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013 Paris, France
| | - Martin Dres
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013 Paris, France.
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Simon-Tillaux N, Chauvet S, Devêvre E, Fohrer-Ting H, Marinozzi M, Frémeaux-Bacchi V. Développement d’une nouvelle technique de détection du C3 Nephritic Factor : impact sur la prise en charge de la glomérulonéphrite à dépôts de C3. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.046] [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: 10/26/2022]
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Simon-Tillaux N, Lecarpentier E, Tsatsaris V, Hertig A. Sildenafil for the treatment of preeclampsia, an update: should we still be enthusiastic? Nephrol Dial Transplant 2018; 34:1819-1826. [DOI: 10.1093/ndt/gfy328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/18/2018] [Indexed: 01/15/2023] Open
Abstract
Abstract
Preeclampsia is a hypertensive disorder of pregnancy and the clinical manifestation of severe endothelial dysfunction associated with maternal and foetal morbidity and mortality. The primum movens of the disease is the defect of invasion of the uterine arteries by foetal syncytiotrophoblasts, which causes a maladaptive placental response to chronic hypoxia and the secretion of the soluble form of type 1 vascular growth endothelial factor receptor, also called soluble fms-like tyrosine kinase 1 (sFlt-1), the major player in the pathophysiology of the disease. Among its different effects, sFlt-1 induces abnormal sensitivity of the maternal vessels to the vasoconstrictor angiotensin II. This leads to the hypertensive phenotype, recently shown to be abrogated by the administration of sildenafil citrate, which can potentiate the vasodilatory mediator nitrite oxide. This review focuses on the mechanisms of maternal endothelial dysfunction in preeclampsia and discusses the therapeutic window of sildenafil use in the context of preeclampsia, based on the results from preclinical studies and clinical trials. Safety issues recently reported in neonates have considerably narrowed this window.
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Affiliation(s)
- Noémie Simon-Tillaux
- Department of Nephrology and Kidney Transplantation, Hôpital Tenon, Assistance publique - Hôpitaux de Paris, Paris, France
| | - Edouard Lecarpentier
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil, France
| | - Vassilis Tsatsaris
- Department of Obstetrics and Gynecology, Port-Royal Maternity, Assistance publique - Hôpitaux de Paris, Cochin Hospital, Paris, France
- Paris Descartes University, Paris, France
| | - Alexandre Hertig
- Department of Nephrology and Kidney Transplantation, Hôpital Tenon, Assistance publique - Hôpitaux de Paris, Paris, France
- Sorbonne Université, UPMC Université Paris 06, UMR_S 1155, Paris, France
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Bataille A, Galichon P, Chelghoum N, Oumoussa BM, Ziliotis MJ, Sadia I, Vandermeersch S, Simon-Tillaux N, Legouis D, Cohen R, Xu-Dubois YC, Commereuc M, Rondeau E, Le Crom S, Hertig A. Increased Fatty Acid Oxidation in Differentiated Proximal Tubular Cells Surviving a Reversible Episode of Acute Kidney Injury. Cell Physiol Biochem 2018; 47:1338-1351. [PMID: 29929186 DOI: 10.1159/000490819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/19/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Fatty acid oxidation (FAO), the main source of energy produced by tubular epithelial cells in the kidney, was found to be defective in tubulo-interstitial samples dissected out in kidney biopsies from patients with chronic kidney disease (CKD). Experimental data indicated that this decrease was a strong determinant of renal fibrogenesis, hence a focus for therapeutic interventions. Nevertheless, whether persistently differentiated renal tubules, surviving in a pro-fibrotic environment, also suffer from a decrease in FAO, is currently unknown. METHODS To address this question, we isolated proximal tubules captured ex vivo on the basis of the expression of an intact brush border antigen (Prominin-1) in C57BL6/J mice subjected to a controlled, two-hit model of renal fibrosis (reversible ischemic acute kidney injury (AKI) or sham surgery, followed by angiotensin 2 administration). A transcriptomic high throughput sequencing was performed on total mRNA from these cells, and on whole kidneys. RESULTS In contrast to mice subjected to sham surgery, mice with a history of AKI displayed histologically more renal fibrosis when exposed to angiotensin 2. High throughput RNA sequencing, principal component analysis and clustering showed marked consistency within experimental groups. As expected, FAO transcripts were decreased in whole fibrotic kidneys. Surprisingly, however, up- rather than down-regulation of metabolic pathways (oxidative phosphorylation, fatty acid metabolism, glycolysis, and PPAR signalling pathway) was a hallmark of the differentiated tubules captured from fibrotic kidneys. Immunofluorescence co-staining analysis confirmed that the expression of FAO enzymes was dependent of tubular trophicity. CONCLUSIONS These data suggest that in differentiated proximal tubules energetic hyperactivity is promoted concurrently with organ fibrogenesis.
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Affiliation(s)
- Aurélien Bataille
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France.,Department of Anesthesiology and Critical Care Medicine, Lariboisiere Hospital, University Paris 7 Diderot, U942, Inserm, Paris, France
| | - Pierre Galichon
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France
| | - Nadjim Chelghoum
- APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, 4 rue de la Chine, Paris, France
| | | | | | - Iman Sadia
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France
| | | | | | - David Legouis
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France
| | - Raphaël Cohen
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France
| | - Yi-Chun Xu-Dubois
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France
| | - Morgane Commereuc
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France
| | - Eric Rondeau
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France.,APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, 4 rue de la Chine, Paris, France
| | - Stéphane Le Crom
- Sorbonne Universités, UPMC Université Paris 06, CNRS, Institut de Biologie Paris-Seine (IBPS), Evolution Paris Seine, Paris, France
| | - Alexandre Hertig
- Sorbonne Universités, INSERM UMR S 1155, Hôpital Tenon, Paris, France
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Abstract
Snail family zinc finger 1 (SNAI1) is a transcription factor expressed during renal embryogenesis, and re-expressed in various settings of acute kidney injury (AKI). Subjected to tight regulation, SNAI1 controls major biological processes responsible for renal fibrogenesis, including mesenchymal reprogramming of tubular epithelial cells, shutdown of fatty acid metabolism, cell cycle arrest and inflammation of the microenvironment surrounding tubular epithelial cells. The present review describes in detail the interactions of SNAI1 with AKI-associated signalling pathways. We also discuss how this central factor has been iteratively (and promisingly) targeted in a number of animal models in order to prevent or slow down renal fibrogenesis.
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Affiliation(s)
- Noémie Simon-Tillaux
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Paris, France
| | - Alexandre Hertig
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Paris, France.,Sorbonne Universités, UPMC Paris 06, UMR S_1155, Paris, France
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