1
|
Cheze S, Quittet P, Adoue D, Viallard J, Sève P, Bonnotte B, Laribi K, Tardy S, Henique H, Graveleau J, Hacini M, Santagostino A, Aroichane M, Leclerc-Teffahi S, Niarra R, Guillemin S, Malatesta A, Michel M. Étude observationnelle prospective sur les Patients attEints de Purpura Thrombopénique Idiopathique (PTI) traités par des agonisTEs des R-TPO (ARTPO) : Eltrombopag et Romiplostim (Étude PEPITE). Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.046] [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: 12/12/2022]
|
2
|
Meyer N, Pérol D, Duval-Modeste AB, El Adaoui L, Lelarge Y, Niarra R, Mateus C. Survival in adult patients with BRAFV600 mutation-positive advanced melanoma: a noninterventional ambispective study of patients with cobimetinib combined with vemurafenib during the French early access program: MELANIS study. Melanoma Res 2022; 32:269-277. [PMID: 35635532 DOI: 10.1097/cmr.0000000000000833] [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: 11/26/2022]
Abstract
Cobimetinib combined with vemurafenib was available in France in 2015 through a 'Temporary Authorization for Use' program (TAU, preapproval access pending its marketing on 2016) for patients with v-raf murine sarcoma viral oncogene homolog B1-mutant advanced melanoma. This study aimed to provide real-world outcomes in patients previously registered in this TAU. This noninterventional, ambispective, multicentre French study, conducted in patients previously registered in TAU, aimed to estimate overall survival (OS) and progression-free survival (PFS) and to describe the tolerability of the therapeutic combination. At first cobimetinib intake (in combination with vemurafenib), 88% of the 185 evaluable patients had disease stage IV (brain metastasis: 70% of them), 31% had elevated lactate dehydrogenases, and 10% had an Eastern Cooperative Oncology Group (ECOG) index ≥2. Median OS was 16.1 months (95% CI, 12.5-20.7). Brain metastasis ( P < 0.001), ECOG index ≥2 ( P = 0.007), and hepatic impairment ( P = 0.037) were found as independent factors significantly associated with shorter survival. Median PFS was 7.3 months (95% CI, 5.2-8.4). ECOG index ≥2 ( P = 0.006) was significantly associated with shorter PFS. Between cobimetinib start and inclusion, increased CPK (3% of patients), retinal serous detachment (3%), decreased left ventricular ejection fraction (3%), increased transaminases (3%), and rash (3%) were the most reported serious adverse events. This study provides real-world outcomes in France for the vemurafenib-cobimetinib combination available in patients with BRAF-mutant-advanced melanoma. Our data tend to confirm in the real-life setting that this combination therapy is effective in such patients, with a safety profile consistent with previous interventional studies.
Collapse
Affiliation(s)
| | - David Pérol
- Biostatistic Unit, DRCI Léon Berard Centre, Lyon
| | | | | | | | | | - Christine Mateus
- Dermatology Department, Gustave Roussy Institute, Villejuif, France
| |
Collapse
|
3
|
Altman J, Niarra R, Balkau B, Vincent‐Cassy C. The JUBILE cohort: Quality of life after more than 40 years with type 1 diabetes. Diabet Med 2021; 38:e14460. [PMID: 33197286 PMCID: PMC8451770 DOI: 10.1111/dme.14460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
AIM The incidence of type 1 diabetes is increasing, and more people are going to live many years with the disease. Quality of life might become the most challenging long-term complication. The JUBILE study describes the quality of life of people living with type 1 diabetes for more than 40 years. METHODS Patients were recruited from 35 French regional or university hospitals: patients and physicians completed questionnaires, validated by the Delphi method. From 1200 questionnaires circulated, 808 patients and their physicians returned questionnaires. RESULTS The duration of type 1 diabetes was 49 ± 6 years (mean±SD), age at diagnosis 15 ± 10 years, HbA1c 7.4 ± 0.9% [58 ± 10 mmol/mol] and 52% were men. Macrovascular disease was present in 32%, 46% had no or only mild non proliferative retinopathy. Insulin pumps were used by 25% and insulin pen/syringe users injected 3.9 ± 2.1 times per day. Blood glucose was self monitored at least five times per day by 67% of patients. Men had 1.8 ± 1.2 children, women 1.4 ± 1.0. More than half (55%) of this population was working, 38% had a university degree. Patients still had a busy life, going out (59%), eating out (82%), playing sports (38%) and travelling (66%). No differences appeared based on age, duration of diabetes, demography or social features. CONCLUSIONS Living a long and pleasant life is possible with type 1 diabetes. Diabetes does not prevent people from having children, working at highly qualified jobs, travelling abroad: a message of hope that is comforting for patients, their family, relatives and the medical teams.
Collapse
Affiliation(s)
- Jean‐Jacques Altman
- Service de Diabétologie‐Nutrition‐EndocrinologieAssistance Publique‐Hôpitaux de ParisHôpital Européen Georges Pompidou et Université Paris‐DescartesParisFrance
| | - Ralph Niarra
- Service d’Epidémiologie CliniqueAssistance Publique‐Hôpitaux de ParisHôpital Européen Georges Pompidou et Université Paris‐DescartesParisFrance
| | - Beverley Balkau
- Clinical EpidemiologyUniversity Paris SaclayUVSQCESPVillejuifInsermFrance
| | - Christophe Vincent‐Cassy
- Service des urgences adultesAssistance Publique‐Hôpitaux de ParisHôpital Kremlin Bicêtre and Université Paris‐SaclayParisFrance
| | | |
Collapse
|
4
|
Durand E, Bauer F, Mansencal N, Azarine A, Diebold B, Hagege A, Perdrix L, Gilard M, Jobic Y, Eltchaninoff H, Bensalah M, Dubourg B, Caudron J, Niarra R, Chatellier G, Dacher JN, Mousseaux E. Head-to-head comparison of the diagnostic performance of coronary computed tomography angiography and dobutamine-stress echocardiography in the evaluation of acute chest pain with normal ECG findings and negative troponin tests: A prospective multicenter study. Int J Cardiol 2017; 241:463-469. [DOI: 10.1016/j.ijcard.2017.02.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/10/2016] [Accepted: 02/24/2017] [Indexed: 11/15/2022]
|
5
|
Garrigou S, Perkins G, Garlan F, Normand C, Didelot A, Le Corre D, Peyvandi S, Mulot C, Niarra R, Aucouturier P, Chatellier G, Nizard P, Perez-Toralla K, Zonta E, Charpy C, Pujals A, Barau C, Bouché O, Emile JF, Pezet D, Bibeau F, Hutchison JB, Link DR, Zaanan A, Laurent-Puig P, Sobhani I, Taly V. A Study of Hypermethylated Circulating Tumor DNA as a Universal Colorectal Cancer Biomarker. Clin Chem 2016; 62:1129-39. [DOI: 10.1373/clinchem.2015.253609] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/28/2016] [Indexed: 12/18/2022]
Abstract
Abstract
BACKGROUND
Circulating tumor DNA (ctDNA) has emerged as a good candidate for tracking tumor dynamics in different cancer types, potentially avoiding repeated tumor biopsies. Many different genes can be mutated within a tumor, complicating procedures for tumor monitoring, even with highly sensitive next-generation sequencing (NGS) strategies. Droplet-based digital PCR (dPCR) is a highly sensitive and quantitative procedure, allowing detection of very low amounts of circulating tumor genetic material, but can be limited in the total number of target loci monitored.
METHODS
We analyzed hypermethylation of 3 genes, by use of droplet-based dPCR in different stages of colorectal cancer (CRC), to identify universal markers for tumor follow-up.
RESULTS
Hypermethylation of WIF1 (WNT inhibitory factor 1) and NPY (neuropeptide Y) genes was significantly higher in tumor tissue compared to normal tissue, independently of tumor stage. All tumor tissues appeared positive for one of the 2 markers. Methylated ctDNA (MetctDNA) was detected in 80% of metastatic CRC and 45% of localized CRC. For samples with detectable mutations in ctDNA, MetctDNA and mutant ctDNA (MutctDNA) fractions were correlated. During follow-up of different stage CRC patients, MetctDNA changes allowed monitoring of tumor evolution.
CONCLUSIONS
These results indicate that MetctDNA could be used as a universal surrogate marker for tumor follow-up in CRC patients, and monitoring MetctDNA by droplet-based dPCR could avoid the need for monitoring mutations.
Collapse
Affiliation(s)
- Sonia Garrigou
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Geraldine Perkins
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
- Department of Digestive Oncology, AP-HP, European Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Fanny Garlan
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Corinne Normand
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Audrey Didelot
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Delphine Le Corre
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Sanam Peyvandi
- Department of Gastroenterology, Henri-Mondor Hospital-APHP and EA 7375-EC2M3 Laboratory, University of Paris Est Creteil Val de Marne, Creteil, France
| | - Claire Mulot
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
- CRB Epigenetec, INSERM UMR-S1147, Centre Universitaire des Saints-Pères, Paris Cedex 06, France
| | - Ralph Niarra
- CIC-EC4 URC HEGP, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | | | - Gilles Chatellier
- CIC-EC4 URC HEGP, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Philippe Nizard
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Karla Perez-Toralla
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Eleonora Zonta
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| | - Cecile Charpy
- Department of Gastroenterology, Henri-Mondor Hospital-APHP and EA 7375-EC2M3 Laboratory, University of Paris Est Creteil Val de Marne, Creteil, France
| | - Anais Pujals
- INSERM U955, University of Paris Est Creteil Val de Marne and Department of Pathology, AP-HP, Henri-Mondor Hospital, Créteil, France
| | | | - Olivier Bouché
- Service d'hépatogastroentérologie et de cancérologie digestive, CHU de Reims, Hôpital Robert-Debré, Reims Cedex, France
| | - Jean-François Emile
- Department of Pathology, Hôpital Ambroise Paré, AP-HP, Université de Versailles St Quentin en Yvelines, Boulogne-Billancourt, France
| | - Denis Pezet
- CHU Clermont Ferrand, Clermont Ferrand Cedex 1, France
| | - Frederic Bibeau
- Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier, France
| | | | | | - Aziz Zaanan
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
- Department of Digestive Oncology, AP-HP, European Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Pierre Laurent-Puig
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
- Department of Biology, European Georges Pompidou Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Iradj Sobhani
- Department of Gastroenterology, Henri-Mondor Hospital-APHP and EA 7375-EC2M3 Laboratory, University of Paris Est Creteil Val de Marne, Creteil, France
| | - Valerie Taly
- Université Paris Sorbonne Cité, INSERM UMR-S1147, CNRS SNC5014, Centre Universitaire des Saints-Pères, Paris Cedex 06, France. Equipe labélisée Ligue contre le cancer
| |
Collapse
|
6
|
Perkins G, Garrigou S, Garlan F, Normand C, Didelot A, Le Corre D, Mulot C, Niarra R, Aucouturier P, Chatellier G, Peyvandi S, Bouche O, Emile JF, Pezet D, Bibeau F, Link DR, Zaanan A, Sobhani I, Laurent-Puig P, Taly V. Hypermethylated circulating DNA detection using picoliter droplet-based PCR in colorectal cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
622 Background: Circulating tumor DNA (ctDNA) is thoroughly investigated as a surrogate biomarker of tumor follow-up, in different cancer types, such as colorectal cancer (CRC). Droplet-based digital PCR (ddPCR) is a highly sensitive and also quantitative method for detection of very low amount of ctDNA. Since many different genes can be mutated within a specific tumor type and also wide mutation spectrum can occur within a specific gene, procedures for ctDNA monitoring can be time consuming and need to be improved for a routinely use. To overcome these drawbacks, we characterized the methylation status of 3 genes frequently hypermethylated in CRC to identify universal markers for tumor follow-up. Methods: The characterization of the methylated status of the WIF, NPY and PENK genes in the tumor DNA was performed in 56 CRC of different stages and 45 corresponding plasma samples using droplet-based dPCR, after DNA bisulfite conversion. A two-panels assay (with albumin as a reference) was developed. Methylation level of these 3 genes in tumor tissues was compared to corresponding normal tissues (n = 22) and plasma samples (MetctDNA). To validate, plasma samples of additional 91 patients were analyzed for the presence of ctDNA both by the characterization of KRAS, BRAF, TP53 and PIK3CA mutations (MutctDNA) and of MetctDNA, at various stages of their follow-up, and 9 of them had MetctDNA assessment during treatment follow-up. Results: All tumor samples were positive for WIF1 and/or NPY markers. Hypermethylation of these two genes was significantly higher in tumor tissue compared to normal, independently of the tumor stage (p < 0.0001). MetctDNA could be detected in 75% of metastatic CRC patients and 24% of localized CRC patients (stage 1 to 3). MetctDNA and MutctDNA fractions were strongly correlated (R2 > 0.9, p < 0.0001). During follow-up, MetctDNA levels changes allowed monitoring of tumor evolution in different stages CRC patients. Conclusions: These results indicate that determination of MetctDNA by droplet-based dPCR can reach same efficiency than MutctDNA for ctDNA assessment, using only 2 markers, and thus could be considered as a universal surrogate marker of tumor follow-up in CRC patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ralph Niarra
- Georges Pompidou European Hospital, Paris, France
| | | | | | - Sanam Peyvandi
- Université Paris Est Créteil Val de Marne et Service de Gastroentérologie Hôpital Henri Mondor, Paris, France
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | | | - Denis Pezet
- Service de Chirurgie, Centre Hospitalier Universitaire, Clermond-Ferrand, France
| | | | | | - Aziz Zaanan
- Department of Gastroenterology, HEGP, Paris, France
| | | | | | | |
Collapse
|
7
|
Malinvaud D, Londero A, Niarra R, Peignard P, Warusfel O, Viaud-Delmon I, Chatellier G, Bonfils P. Auditory and visual 3D virtual reality therapy as a new treatment for chronic subjective tinnitus: Results of a randomized controlled trial. Hear Res 2016; 333:127-135. [PMID: 26773752 DOI: 10.1016/j.heares.2015.12.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 12/03/2015] [Accepted: 12/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subjective tinnitus (ST) is a frequent audiologic condition that still requires effective treatment. This study aimed at evaluating two therapeutic approaches: Virtual Reality (VR) immersion in auditory and visual 3D environments and Cognitive Behaviour Therapy (CBT). METHODS This open, randomized and therapeutic equivalence trial used bilateral testing of VR versus CBT. Adult patients displaying unilateral or predominantly unilateral ST, and fulfilling inclusion criteria were included after giving their written informed consent. We measured the different therapeutic effect by comparing the mean scores of validated questionnaires and visual analog scales, pre and post protocol. Equivalence was established if both strategies did not differ for more than a predetermined limit. We used univariate and multivariate analysis adjusted on baseline values to assess treatment efficacy. In addition of this trial, purely exploratory comparison to a waiting list group (WL) was provided. RESULTS Between August, 2009 and November, 2011, 148 of 162 screened patients were enrolled (VR n = 61, CBT n = 58, WL n = 29). These groups did not differ at baseline for demographic data. Three month after the end of the treatment, we didn't find any difference between VR and CBT groups either for tinnitus severity (p = 0.99) or tinnitus handicap (p = 0.36). CONCLUSION VR appears to be at least as effective as CBT in unilateral ST patients.
Collapse
Affiliation(s)
- D Malinvaud
- Department of ENT and CNRS UMR 8119, Hôpital Européen Georges Pompidou, Faculté de médecine Paris Descartes, Université Paris 5, Paris, France; Center of Neurophysics, Physiology and Pathology (CN2P), CNRS UMR 8119, Université Paris Descartes, Paris, France.
| | - A Londero
- Department of ENT and CNRS UMR 8119, Hôpital Européen Georges Pompidou, Faculté de médecine Paris Descartes, Université Paris 5, Paris, France
| | - R Niarra
- Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Epidemiology and Clinical Research Unit, Paris, France; INSERM, Epidemiological Investigation Center 4, Paris, France
| | - Ph Peignard
- Department of ENT and CNRS UMR 8119, Hôpital Européen Georges Pompidou, Faculté de médecine Paris Descartes, Université Paris 5, Paris, France
| | - O Warusfel
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, IRCAM, Sciences et Techniques de la Musique et du Son, Paris, France
| | - I Viaud-Delmon
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, IRCAM, Sciences et Techniques de la Musique et du Son, Paris, France
| | - G Chatellier
- Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Epidemiology and Clinical Research Unit, Paris, France; INSERM, Epidemiological Investigation Center 4, Paris, France
| | - P Bonfils
- Department of ENT and CNRS UMR 8119, Hôpital Européen Georges Pompidou, Faculté de médecine Paris Descartes, Université Paris 5, Paris, France; Cognition and Action Group, CNRS MD 8257, SSA and University Paris 5, Paris, France
| |
Collapse
|
8
|
Marais L, Boutouyrie P, Khettab H, Boulanger C, Lorthioir A, Franck M, Niarra R, Renard JM, Chambon Y, Jeunemaitre X, Zidi M, Plouin PF, Laurent S, Azizi M. 9.10 STRUCTURAL AND FUNCTIONAL ARTERIAL ABNORMALITIES IN FIBROMUSCULAR DYSPLASIA ARE IN THE CONTINUUM OF HYPERTENSION: AN IMAGING AND BIOMECHANICAL STUDY. Artery Res 2016. [DOI: 10.1016/j.artres.2016.10.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
9
|
Lahlou-Laforêt K, Ledru F, Niarra R, Consoli SM. Validity of Beck Depression Inventory for the assessment of depressive mood in chronic heart failure patients. J Affect Disord 2015; 184:256-60. [PMID: 26118753 DOI: 10.1016/j.jad.2015.05.056] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
Prevalence of depression is high in patients with chronic heart failure (CHF), and depressive mood is considered as a risk factor for major cardiovascular events and mortality in CHF patients. The validity of self-administered 21-item Beck Depression Inventory (BDI) in CHF patients might be questioned. CHF actually shares overlapping symptoms with depression and such an overlap may overestimate the impact of depression on cardiac outcomes. We tested the convergent validity of the French version of BDI by reference to the interview-based Montgomery Asberg Depression Rating Scale (MADRS) in a population of 73 patients participating in the multicenter French PANIC Cohort of 321 CHF patients. Both depression scores were associated with NYHA functional class and the number of previous hospitalizations related to CHF, but not with the other indexes of cardiac severity (left ventricular ejection fraction and 6-min-walk test). MADRS scores were also associated with gender and history of depression. A strong correlation was found between BDI and MADRS scores (rho = 0.72; p < 0.001). This correlation persisted after adjustment for gender, NYHA functional class, number of previous hospitalizations and history of depression (rho = 0.68; p < 0.001). Moreover, the z score difference between standardized BDI and standardized MADRS scores was associated with none of the sociodemographic or clinical characteristics of our population, except for the depression severity at MADRS. In particular, no overestimation or underestimation of self-assessed depression was found in case of more severe CHF. These findings suggest that the BDI is a reliable instrument to assess depression in CHF patients.
Collapse
Affiliation(s)
- K Lahlou-Laforêt
- Consultation Liaison and Emergency Psychiatry Unit, European Georges-Pompidou Hospital, Department of adult and elderly psychiatry, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - F Ledru
- Cardiac Rehabilitation Center, Corentin-Celton Hospital, Issy-les-Moulineaux, France
| | - R Niarra
- Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Epidemiology and Clinical Research Unit, Paris, France; INSERM, Epidemiological Investigation Center 4, Paris, France
| | - S M Consoli
- Consultation Liaison and Emergency Psychiatry Unit, European Georges-Pompidou Hospital, Department of adult and elderly psychiatry, Assistance Publique - Hôpitaux de Paris, Paris, France; Paris Descartes University of Medicine, Paris-Sorbonne Cité, Paris, France
| | | |
Collapse
|
10
|
Laurent-Puig P, Bouché O, Niarra R, Aucouturier P, Benhaim L, Landi B, Berger A, Lecomte T, Normand C, Le Corre D, Didelot A, Mallet K, Perez Toralla K, Hor T, El Harrak Z, Chatellier G, Hutchison B, Link D, Taly V. Abstract 5235: Circulating tumor DNA as a prognostic marker in colorectal cancer: Preliminary results of a prospective trial. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-5235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Circulating tumor DNA has been suggested to be a prognostic factor in different types of tumors. In order to investigate this role, we prospectively enrolled 250 patients with stage II and stage III colorectal cancer (NCT01198743). Plasma samples were collected before surgery (D0) and 5 days later (D5), then every 4 months during the 3 years of follow-up. The end of follow-up will be May 2017. The primary tumors were characterized for KRAS, NRAS, BRAF, PIK3CA, APC and TP53 mutation by sequencing. The circulating DNA was assessed by picoliter digital droplet PCR (dPCR) using the Raindrop instrument (Raindance technologies) with Taqman probes for the 7 most frequent mutations of KRAS and for the BRAF V600E mutation. The survival without recurrence curves were estimated with the Kaplan- Meier method. Differences between groups of patients were analyzed using unstratified log-rank tests. For comparisons of baseline characteristics, categorical outcomes were analyzed with χ2 tests and continuous outcomes were compared with standard parametric or nonparametric tests. Continuous variables are presented as the mean (SD) and median interquartile rang. We present here the results of tumor circulating DNA for the first 56 patients with KRAS or a BRAF mutated tumors. The mean age was 65.3±11 years [37-84], the gender ratio M/F was 0.9. The tumor location was proximal or distal in 55% and 45% respectively. TNM classification showed 49% and 51% of stage II and stage III respectively. The tumors were found mutated for BRAF in 9 cases (16%) and mutated for KRAS in 47 cases (84%). Finally 54% of the patients received an adjuvant chemotherapy. Tumor circulating DNA was found in 12 patients out of the 56 tested patients (23%). A mutation identical to that found in the tumor was identified at D0 or D5 after surgery before any chemotherapy treatment in the plasma of 12 patients (21.4%). For the patients with circulating tumor DNA, the mutated allele frequency in the plasma range from 0.2‰ to 1.4% (median 2.4‰). The detection of circulating tumor DNA was more frequent in patients with recurrence or death from the disease during the follow-up than those without at the time of diagnosis (45.4% versus 15.6%, p = 0.03). Patients without circulating tumor DNA before or 5 days after surgery have a significant better survival without recurrence than those with circulating tumor DNA detectable in univariate analysis (HR: 7.3 CI95% [1.7-31.5] p = 0.006). After adjustment on tumor stage this result remains significant (HR: 6.9 CI95% [1.5-32.9] p = 0.01) During the follow-up DNA was detected in 36.7% of patients who recurred or died from the disease as compared to 2.2% of those who do not (P = 0.004). These preliminary results showed a strong prognostic impact of circulating tumor DNA at the time of surgery and need to be confirmed in the whole series of 250 patients and with the complete follow-up of 5 years.
Citation Format: Pierre Laurent-Puig, Olivier Bouché, Ralph Niarra, Pascaline Aucouturier, Leonor Benhaim, Bruno Landi, Anne Berger, Thierry Lecomte, Corinne Normand, Delphine Le Corre, Audrey Didelot, Karine Mallet, Karla Perez Toralla, Thevy Hor, Zakaria El Harrak, Gilles Chatellier, Brian Hutchison, Darren Link, Valerie Taly. Circulating tumor DNA as a prognostic marker in colorectal cancer: Preliminary results of a prospective trial. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5235. doi:10.1158/1538-7445.AM2015-5235
Collapse
Affiliation(s)
| | - Olivier Bouché
- 2Assistance Publique-Hôpitaux de Paris European Georges Pompidou Hospital, Paris, France
| | - Ralph Niarra
- 3CIC-EC4 URC HEGP, Hôpitaux Universitaires Paris Ouest (APHP), Paris Cedex 15, France
| | - Pascaline Aucouturier
- 3CIC-EC4 URC HEGP, Hôpitaux Universitaires Paris Ouest (APHP), Paris Cedex 15, France
| | - Leonor Benhaim
- 1UMR 1147 - Univ. of Paris-Descartes, Paris Cedex 06, France
| | - Bruno Landi
- 2Assistance Publique-Hôpitaux de Paris European Georges Pompidou Hospital, Paris, France
| | - Anne Berger
- 2Assistance Publique-Hôpitaux de Paris European Georges Pompidou Hospital, Paris, France
| | | | - Corinne Normand
- 1UMR 1147 - Univ. of Paris-Descartes, Paris Cedex 06, France
| | | | - Audrey Didelot
- 1UMR 1147 - Univ. of Paris-Descartes, Paris Cedex 06, France
| | - Karine Mallet
- 5CIC-EC4 URC HEGP, Hôpitaux Universitaires Paris Ouest (APHP), Paris, France
| | | | - Thevy Hor
- 1UMR 1147 - Univ. of Paris-Descartes, Paris Cedex 06, France
| | | | - Gilles Chatellier
- 3CIC-EC4 URC HEGP, Hôpitaux Universitaires Paris Ouest (APHP), Paris Cedex 15, France
| | | | | | - Valerie Taly
- 7CNRS UMR S1147 - Univ. of Paris-Descartes, Paris Cedex 06, France
| |
Collapse
|
11
|
Darlington M, Gueret P, Laissy JP, Pierucci AF, Maoulida H, Quelen C, Niarra R, Chatellier G, Durand-Zaleski I. Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography. Eur J Health Econ 2015; 16:647-655. [PMID: 24990117 DOI: 10.1007/s10198-014-0616-2] [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] [Received: 08/20/2013] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the costs and cost-effectiveness of a diagnostic strategy including computed tomography coronary angiography (CTCA) in comparison with invasive conventional coronary angiography (CA) for the detection of significant coronary artery disease from the point of view of the healthcare provider. METHODS The average cost per CTCA was determined via a micro-costing method in four French hospitals, and the cost of CA was taken from the 2011 French National Cost Study that collects data at the patient level from a sample of 51 public or not-for-profit hospitals. RESULTS The average cost of CTCA was estimated to be 180<euro> (95 % CI 162-206<euro>) based on the use of a 64-slice CT scanner active for 10 h per day. The average cost of CA was estimated to be 1,378<euro> (95 % CI 1,126-1,670<euro>). The incremental cost-effectiveness ratio of CA for all patients over a strategy including CTCA triage in the intermediate risk group, no imaging test in the low risk group, and CA in the high risk group, was estimated to be 6,380<euro> (95 % CI 4,714-8,965<euro>) for each additional correctly classified patient. This strategy correctly classifies 95.3 % (95 % CI 94.4-96.2) of all patients in the population studied. CONCLUSIONS A strategy of CTCA triage in the intermediate-risk group, no imaging test in the low-risk group, and CA in the high-risk group, has good diagnostic accuracy and could significantly cut costs. Medium-term and long-term outcomes need to be evaluated in patients with coronary stenosis potentially misclassified by CTCA due to false negative examinations.
Collapse
Affiliation(s)
- Meryl Darlington
- URC Eco IdF, Paris Health Economics and Health Services Research Unit, AP-HP, Hôtel Dieu, 1 Place du Parvis Notre Dame, 75004, Paris, France,
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Picard FA, Gueret P, Laissy JP, Champagne S, Leclercq F, Carrié D, Juliard JM, Henry P, Niarra R, Chatellier G, Steg PG. Epicardial adipose tissue thickness correlates with the presence and severity of angiographic coronary artery disease in stable patients with chest pain. PLoS One 2014; 9:e110005. [PMID: 25335187 PMCID: PMC4204866 DOI: 10.1371/journal.pone.0110005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Epicardial adipose tissue (EAT) is suggested to correlate with metabolic risk factors and to promote plaque development in the coronary arteries. We sought to determine whether EAT thickness was associated or not with the presence and extent of angiographic coronary artery disease (CAD). Methods We measured epicardial fat thickness by computed tomography and assessed the presence and extent of CAD by coronary angiography in participants from the prospective EVASCAN study. The association of EAT thickness with cardiovascular risk factors, coronary artery calcification scoring and angiographic CAD was assessed using multivariate regression analysis. Results Of 970 patients (age 60.9 years, 71% male), 75% (n = 731) had CAD. Patients with angiographic CAD had thicker EAT on the left ventricle lateral wall when compared with patients without CAD (2.74±2.4 mm vs. 2.08±2.1 mm; p = 0.0001). The adjusted odds ratio (OR) for a patient with a LVLW EAT value ≥2.8 mm to have CAD was OR = 1.46 [1.03–2.08], p = 0.0326 after adjusting for risk factors. EAT also correlated with the number of diseased vessels (p = 0.0001 for trend). By receiver operating characteristic curve analysis, an EAT value ≥2.8 mm best predicted the presence of>50% diameter coronary artery stenosis, with a sensitivity and specificity of 46.1% and 66.5% respectively (AUC:0.58). Coronary artery calcium scoring had an AUC of 0.76. Conclusion Although left ventricle lateral wall EAT thickness correlated with the presence and extent of angiographic CAD, it has a low performance for the diagnosis of CAD.
Collapse
Affiliation(s)
- Fabien A. Picard
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
| | - Pascal Gueret
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Université Paris-Est-Créteil, Créteil, France
| | - Jean-Pierre Laissy
- Radiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
- Département Hospitalo-Universitaire FIRE, INSERM U-1148, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
| | - Stéphane Champagne
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Université Paris-Est-Créteil, Créteil, France
| | - Florence Leclercq
- Cardiology Department, Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier, France
| | - Didier Carrié
- Cardiology Department, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Jean-Michel Juliard
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
| | - Patrick Henry
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
| | - Ralph Niarra
- Epidemiology and Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
- Unité INSERM Centre D'investigation Épidémiologique 4, Paris, France
| | - Gilles Chatellier
- Epidemiology and Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
- Unité INSERM Centre D'investigation Épidémiologique 4, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Philippe Gabriel Steg
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
- Département Hospitalo-Universitaire FIRE, INSERM U-1148, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
- NHLI Imperial College, ICMS Royal Brompton Hospital, London, United Kingdom
- * E-mail:
| |
Collapse
|
13
|
Mirault T, Frank M, Pernot M, Couade M, Tanter M, Niarra R, Azizi M, Albuisson J, Jeunemaitre X, Messas E. Lack of systolic arterial stiffening in vascular Ehlers-Danlos syndrom. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
Colombet I, Montheil V, Durand JP, Gillaizeau F, Niarra R, Jaeger C, Alexandre J, Goldwasser F, Vinant P. Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients. BMJ Support Palliat Care 2012; 2:239-47. [DOI: 10.1136/bmjspcare-2011-000157] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
Revel MP, Sanchez O, Couchon S, Planquette B, Hernigou A, Niarra R, Meyer G, Chatellier G. Diagnostic accuracy of magnetic resonance imaging for an acute pulmonary embolism: results of the 'IRM-EP' study. J Thromb Haemost 2012; 10:743-50. [PMID: 22321816 DOI: 10.1111/j.1538-7836.2012.04652.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [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: 12/25/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has not been validated as an alternative diagnostic test to computed tomography angiography (CTA) in patients with suspicion of a pulmonary embolism (PE). OBJECTIVES To evaluate performance of current MRI technology in diagnosing PE, in reference to a 64-detector CTA. PATIENTS/METHODS Prospective investigation including 300 patients with a suspected PE, referred for CTA after assessment of clinical probability and D-dimer testing. MRI protocol included unenhanced, perfusion and angiographic sequences. MRI results were interpreted by two independent readers, to evaluate inter-reader agreement. Sensitivity and specificity were evaluated globally and according to PE location and to clinical probability category. RESULTS Of 300 enrolled patients, 274 were analyzed and 103 (37.5%) had a PE diagnosed by CTA. For patients with conclusive MRI results (72% for reader 1, 70% for reader 2), sensitivity and specificity were 84.5% (95% confidence interval [CI], 74.9-91.4%) and 99.1% (95% CI, 95.1-100.0%), respectively, for reader 1, and 78.7% (95% CI, 68.2-87.1%) and 100% (95% CI, 96.7-100.0%) for reader 2. After exclusion of inconclusive MRI results for both readers, inter-reader agreement was excellent (kappa value: 0.93, 95% CI: 0.88-0.99). Sensitivity was better for proximal (97.7-100%) than for segmental (68.0-91.7%) and sub-segmental (21.4-33.3%) PE (P < 0.0001). Sensitivity was similar for both readers within each clinical probability category. CONCLUSIONS Current MRI technology demonstrates high specificity and high sensitivity for proximal PE, but still limited sensitivity for distal PE and 30% of inconclusive results. Although a positive result can aid in clinical decision making, MRI cannot be used as a stand-alone test to exclude PE.
Collapse
Affiliation(s)
- M P Revel
- Department of Radiology, Hôpital Européen Georges Pompidou, APHP, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|