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Dimancea A, Mattioni S, Nouet A, Drir M, Santin A, Marrot B, Shotar E, Corcy C, Bottin L, Sourour NA, Premat K, Alamowitch S, Carpentier A, Degos V, Clarençon F, Lionnet F, Lenck S. Preventive treatment of unruptured intracranial aneurysms in adult patients with sickle cell anemia: A cohort study. J Neuroradiol 2023; 50:511-517. [PMID: 36781119 DOI: 10.1016/j.neurad.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms are frequent in patients with sickle cell anemia, while subarachnoid hemorrhage is a major cause of death and disability in young adult patients. Several characteristics, such as younger age and smaller size at rupture, may incline therapeutic decision towards exclusion treatments. Clinical guidelines on treatment of unruptured intracranial aneurysms in this population are still missing. We aimed to assess the safety and efficacy of the treatment of unruptured intracranial aneurysm in patients with sickle cell anemia, using an adapted hematological preparation regimen. PATIENTS AND METHODS Adult patients with sickle cell anemia and treated unruptured aneurysms by endovascular therapy or neurosurgery were included in this retrospective cohort study. Treatment decision was reached after multi-disciplinary assessment. A pre-operative blood transfusion protocol was undertaken targeting a HbS below 30%. Demographic data, hematological preparation parameters and clinical and radiological outcomes were documented. RESULTS AND CONCLUSIONS Twenty-five procedures were performed in 18 patients encompassing 19 aneurysms treated by embolization and 6 by surgery. Median age at treatment was 34 years-old and median aneurysm dome size was 4.4 mm. Immediate aneurysm exclusion rate was 85.7% after endovascular therapy and 100% after neurosurgery. Median follow-up was 6 months, with all patients being asymptomatic at last follow-up. Two transitory ischemic neurological deficits, as well as four cases of iodine-induced encephalopathy were identified after embolization. No complication occurred after surgery. Endovascular therapy by coiling and neurosurgical treatment of unruptured intracranial aneurysms appears to be safe in patients with sickle cell anemia and should be considered given the specific hemorrhagic risk observed in this population. A rigorous hematological preparation, associated with a dedicated peri‑operative protocol and an adequate therapeutic strategy are essential prerequisites.
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Affiliation(s)
- A Dimancea
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Mattioni
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - A Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - M Drir
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France
| | - A Santin
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - B Marrot
- Department of Radiology, Tenon University Hospital, Paris, France
| | - E Shotar
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - C Corcy
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - L Bottin
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France
| | - N A Sourour
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - K Premat
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Alamowitch
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - A Carpentier
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - V Degos
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - F Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; GRC BioFast. Paris VI University. Paris. France
| | - F Lionnet
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - S Lenck
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; Inserm UMR 1127, Paris Brain Institute, Paris, France.
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2
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Sonneville R, Mazighi M, Bresson D, Crassard I, Crozier S, de Montmollin E, Degos V, Faugeras F, Gayat E, Josse L, Lamy C, Magalhaes E, Maldjian A, Ruckly S, Servan J, Vassel P, Vigué B, Timsit JF, Woimant F. Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study. Neurocrit Care 2021; 32:624-629. [PMID: 32026446 DOI: 10.1007/s12028-019-00907-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/25/2022]
Abstract
BACKGROUND Care pathways and long-term outcomes of acute stroke patients requiring mechanical ventilation have not been thoroughly studied. METHODS AND RESULTS Stroke Prognosis in Intensive Care (SPICE) is a prospective multicenter cohort study which will be conducted in 34 intensive care units (ICUs) in the Paris, France area. Patients will be eligible if they meet all of the following inclusion criteria: (1) age of 18 years or older; (2) acute stroke (i.e., ischemic stroke, intracranial hemorrhage, or subarachnoid hemorrhage) diagnosed on neuroimaging; (3) ICU admission within 7 days before or after stroke onset; and (4) need for mechanical ventilation for a duration of at least 24 h. Patients will be excluded if they meet any of the following: (1) stroke of traumatic origin; (2) refusal to participate; and (3) privation of liberty by administrative or judicial decision. The primary endpoint is poor functional outcome at 1 year, defined by a score of 4 to 6 on the modified Rankin scale (mRS), indicating severe disability or death. Main secondary endpoints will include decisions to withhold or withdraw care, mRS scores at 3 and 6 months, and health-related quality of life at 1 year. CONCLUSIONS The SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation. TRIAL REGISTRATION NCT03335995.
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Affiliation(s)
- R Sonneville
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France. .,APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
| | - M Mazighi
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.,Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Neuroradiology, Rothschild Hospital, Paris, France
| | - D Bresson
- Department of Neurosurgery, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - I Crassard
- Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Agence Régionale de Santé, Paris, France
| | - S Crozier
- Department of Neurology, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - E de Montmollin
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - V Degos
- Department of Critical Care, Anesthesia and Perioperative Medicine, Pitié-Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris-Sorbonne University, Paris, France.,GRC ARPE, Sorbonne University, Paris, France
| | - F Faugeras
- Department of Neurology, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, EQuipe E01 Neuropsychologie Interventionnelle, 94000, Créteil, France
| | - E Gayat
- Department of Anesthesiology and Critical Care, DMU Parabol, APHP Nord, Université de Paris, Paris, France.,UMR-S 942, Inserm, MASCOT, Paris, France
| | - L Josse
- Department of Rehabilitation Medicine, Fernand Widal University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - C Lamy
- Department of Neurology, Saint Anne Hospital, Paris, France.,INSERM U1266, Université Paris Descartes, Paris, France
| | - E Magalhaes
- Department of Intensive Care Medicine, Sud Francilien Hospital, Corbeil, France
| | - A Maldjian
- Department of Rehabilitation Medicine, 317 Lostihuel Braz, 56250, Sulniac, France
| | - S Ruckly
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - J Servan
- Department of Neurology, André Mignot Hospital, Le Chesnay, France
| | - P Vassel
- Department of Rehabilitation Medicine, Le Parc, Pontault-Combault, France
| | - B Vigué
- Department of Anesthesiology and Critical Care, Kremlin Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-F Timsit
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - F Woimant
- Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Agence Régionale de Santé, Paris, France
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Shotar E, Pouliquen G, Premat K, Pouvelle A, Mouyal S, Meyblum L, Lenck S, Degos V, Abi Jaoude S, Sourour N, Mathon B, Clarençon F. CTA-Based Patient-Tailored Femoral or Radial Frontline Access Reduces the Rate of Catheterization Failure in Chronic Subdural Hematoma Embolization. AJNR Am J Neuroradiol 2021; 42:495-500. [PMID: 33541902 DOI: 10.3174/ajnr.a6951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chronic subdural hematoma embolization, an apparently simple procedure, can prove to be challenging because of the advanced age of the target population. The aim of this study was to compare 2 arterial-access strategies, femoral versus patient-tailored CTA-based frontline access selection, in chronic subdural hematoma embolization procedures. MATERIALS AND METHODS This was a monocentric retrospective study. From the March 15, 2018, to the February 14, 2019 (period 1), frontline femoral access was used. Between February 15, 2019, and March 30, 2020 (period 2), the choice of the frontline access, femoral or radial, was based on the CTA recommended as part of the preoperative work-up during both above-mentioned periods. The primary end point was the rate of catheterization failure. The secondary end points were the rate of access site conversion and fluoroscopy duration. RESULTS During the study period, 124 patients (with 143 chronic subdural hematomas) underwent an embolization procedure (mean age, 74 [SD, 13] years). Forty-eight chronic subdural hematomas (43 patients) were included during period 1 and were compared with 95 chronic subdural hematomas (81 patients) during period 2. During the first period, 5/48 (10%) chronic subdural hematoma embolizations were aborted due to failed catheterization, significantly more than during period 2 (1/95, 1%; P = .009). The rates of femoral-to-radial (P = .55) and total conversion (P = .86) did not differ between the 2 periods. No significant difference was found regarding the duration of fluoroscopy (P = .62). CONCLUSIONS A CTA-based patient-tailored choice of frontline arterial access reduces the rate of catheterization failure in chronic subdural hematoma embolization procedures.
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Affiliation(s)
- E Shotar
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
| | - G Pouliquen
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
| | - K Premat
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.).,Sorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
| | - A Pouvelle
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
| | - S Mouyal
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
| | - L Meyblum
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
| | - S Lenck
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
| | - V Degos
- Neurosurgical Anesthesiology and Critical Care (V.D.).,Sorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
| | - S Abi Jaoude
- Neurosurgery (S.A.J., B.M.), Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
| | - N Sourour
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
| | - B Mathon
- Neurosurgery (S.A.J., B.M.), Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
| | - F Clarençon
- From the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.).,Sorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
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Bouchereau E, Degos V. Neuro-prognostication: Don't forget that time is brain! Anaesth Crit Care Pain Med 2020; 38:415-417. [PMID: 31585758 DOI: 10.1016/j.accpm.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- E Bouchereau
- Department of anaesthesiology and intensive care, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France
| | - V Degos
- Department of Anaesthesia and Critical Care, Pitié Salpetrière Hospital, AP-HP-SU, Paris, France; Groupe recherche clinique BIOSFAST, Sorbonne University, 47-83, boulevard de l'Hopital, 75013 Paris, France.
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Chougar L, Mathon B, Weiss N, Degos V, Shor N. Atypical Deep Cerebral Vein Thrombosis with Hemorrhagic Venous Infarction in a Patient Positive for COVID-19. AJNR Am J Neuroradiol 2020; 41:1377-1379. [PMID: 32554423 DOI: 10.3174/ajnr.a6642] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/14/2020] [Indexed: 01/13/2023]
Abstract
There is growing evidence that Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has a neurotropic and neuroinvasive potential. In particular, neurologic complications associated with the infection by SARS-CoV-2 include strokes that may result from a dysregulated inflammatory response to the infection. We report an atypical deep cerebral vein thrombosis complicated with hemorrhagic venous infarction in a patient positive for SARS-CoV-2 with no risk factors for thrombosis.
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Affiliation(s)
- L Chougar
- From the Service de Neuroradiologie (L.C., N.S.) .,Service de Neurochirurgie (B.M.).,Anesthesia, Critical Care and Perioperative Medicine (V.D.)
| | - B Mathon
- Service de Neurochirurgie (B.M.).,Anesthesia, Critical Care and Perioperative Medicine (V.D.).,Médecine Intensive Réanimation Neurologique (N.W.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Weiss
- Service de Neurochirurgie (B.M.).,Institut du Cerveau et de la Moelle épinière (L.C., B.M.), National Institute for Health and Medical Research U 1127, Centre National de la Recherche Scientifique, Une Unité Mixte de Recherche, 7225, Sorbonne Université, Pierre and Marie Curie University, Une Unité Mixte de Recherche S 1127, Centre National de la Recherche Scientifique, Une Unité Mixte de Recherche 7225, Paris, France
| | - V Degos
- Service de Neurochirurgie (B.M.).,Sorbonne Université (L.C., B.M., N.W., V.D., N.S.), Paris, France
| | - N Shor
- From the Service de Neuroradiologie (L.C., N.S.).,Service de Neurochirurgie (B.M.)
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Clarençon F, Baronnet F, Shotar E, Degos V, Rolla-Bigliani C, Bartolini B, Veznedaroglu E, Budzik R, English J, Baxter B, Liebeskind DS, Krajina A, Gupta R, Miralbes S, Lüttich A, Nogueira RG, Samson Y, Alamowitch S, Sourour NA. Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry. Eur J Neurol 2020; 27:787-792. [PMID: 31997505 DOI: 10.1111/ene.14154] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/09/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the safety and effectiveness of mechanical thrombectomy (MT) in patients with acute ischaemic stroke related to isolated and primary posterior cerebral artery (PCA) occlusions amongst the patients enrolled in the multicentre post-market Trevo Registry. METHOD Amongst the 2008 patients enrolled in the Trevo Registry with acute ischaemic stroke due to large vessel occlusion treated by MT, 22 patients (1.1%) [10 females (45.5%), mean age 66.2 ± 14.3 years (range 28-91)] had a PCA occlusion [17 P1 (77.3%) and five P2 occlusions (22.7%)]. Recanalization after the first Trevo (Stryker, Fremont, CA, USA) pass and at the end of the procedure was rated using the modified Thrombolysis in Cerebral Infarction (mTICI) score. Procedure-related complications (i.e. groin puncture complication, perforation, symptomatic haemorrhage, embolus in a new territory) were also recorded. The modified Rankin Scale at 90 days was assessed. RESULTS Median National Institutes of Health Stroke Scale at admission was 14 (interquartile range 8-16). Stroke aetiology was cardio-embolic in 68.2% of cases. Half of the patients (11/22) received intravenous tissue plasminogen activator. 54.5% of the patients were treated under general anaesthesia. Reperfusion (i.e. mTICI 2b or 3) after first pass was obtained in 65% of cases. Final mTICI 2b-3 reperfusion was obtained in all cases. Only one (4.5%) procedure-related complication was recorded (puncture site) that resolved after surgery. At 90-day follow-up, modified Rankin Scale 0-2 was obtained in 59% of the patients and 9.1% died within the first 3 months after MT. CONCLUSION Mechanical thrombectomy for PCA occlusions seems to be safe (<5% procedure-related complications) and effective. Larger repository datasets are needed.
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Affiliation(s)
- F Clarençon
- Sorbonne University, Paris, France.,Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - F Baronnet
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - E Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - V Degos
- Sorbonne University, Paris, France.,Department of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France
| | - C Rolla-Bigliani
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - B Bartolini
- Department of Radiology, Interventional Neuroradiology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - E Veznedaroglu
- Endovascular Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA, USA
| | - R Budzik
- Interventional Neuroradiology, Riverside Methodist Hospital/Ohio Health Research Institute, Columbus, OH, USA
| | - J English
- Interventional Neurology, California Pacific Medical Center, San Francisco, CA, USA
| | - B Baxter
- Interventional Neuroradiology, Erlanger, Chattanooga, TN, USA
| | - D S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - A Krajina
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - R Gupta
- Interventional Neurology, Wellstar Health System, Atlanta, GA, USA
| | - S Miralbes
- Hospital Universitario Son Espases, Mallorca, España
| | - A Lüttich
- Hospital de Donostia, San Sebastian, España
| | - R G Nogueira
- Department of Neurology, Marcus Stroke and Neuroscience Center/Grady Memorial Hospital/Emory University, Atlanta, GA, USA
| | - Y Samson
- Sorbonne University, Paris, France.,Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - S Alamowitch
- Sorbonne University, Paris, France.,Department of Vascular Neurology, Saint Antoine University Hospital, Paris, France
| | - N-A Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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Trosini-Désert V, Jeny F, Maksud P, Giron A, Degos V, Similowski T. Contribution of endobronchial ultrasound elastography to the characterization of mediastinal lymphadenopathy: A single-center, prospective, observational study. Respir Med Res 2019; 76:28-33. [PMID: 31505324 DOI: 10.1016/j.resmer.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a reliable technique providing high diagnostic yield in mediastinal lymphadenopathy. However, mediastinoscopy is sometimes necessary to eliminate false-negative results. Elastography is a recent technique that can be combined with EBUS to evaluate the elasticity and consequently the nature of a tissue. The primary objective was to evaluate the diagnostic performance of EBUS-TBNA combined with elastography for the assessment of mediastinal lymph nodes. METHODS Single-center, prospective study in patients with mediastinal lymphadenopathy. EBUS-TBNA combined with elastography was performed in each patient. Several elastographic parameters were studied: colorimetric score, average elasticity, elasticity ratio, percentage of hard areas. The final diagnosis was that obtained by TBNA cytology, histology of a surgical biopsy, when performed, or follow-up CT and PET-CT at 6 months. RESULTS Overall, 110 lymph nodes were examined in 87 patients: 44 were malignant according to TBNA. These nodes had significantly higher elasticity ratio, percentage of hard areas and colorimetric score and significantly lower average elasticity compared to benign nodes (P<0.001). With a negative predictive value of 100%, the cut-offs defined by receiver operating characteristic curves were 1.4 for elasticity ratio, 84.8 for average elasticity, 32.6 for percentage of hard areas and 3 for colorimetric score. No adverse events were observed. CONCLUSION Endobronchial ultrasound elastography is a non-invasive technique that can contribute to prediction of the nature of lymph nodes by distinguishing malignant from benign nodes. Although EBUS cannot replace histological examination, elastography can provide reliable complementary information when combined with EBUS.
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Affiliation(s)
- V Trosini-Désert
- AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie, médecine intensive et réanimation, département R3S, 75013 Paris, France; Groupe d'endoscopie de langue française (GELF), Société de pneumologie de langue française, 75011 Paris, France.
| | - F Jeny
- AP-HP - hôpitaux de Paris, hôpital Avicenne, groupe hospitalier hôpitaux universitaires Paris Seine-Saint-Denis, service de pneumologie, 75013 Bobigny France
| | - P Maksud
- AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de médecine nucléaire, 75013 Paris, France
| | - A Giron
- Laboratoire d'imagerie biomédicale, inserm-CNRS-UPMC UMR-S 1146, 75013 Paris, France
| | - V Degos
- Department of anesthesia, critical care and perioperative medicine, Pitié Salpêtrière Hospital, 75013 Paris France; Sorbonne université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, 75005 Paris, France
| | - T Similowski
- AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie, médecine intensive et réanimation, département R3S, 75013 Paris, France; Sorbonne université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, 75005 Paris, France
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8
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Clarençon F, Rosso C, Degos V, Shotar E, Rolla-Bigliani C, Samson Y, Alamowitch S, Sourour NA. Triage in the Angiography Suite for Mechanical Thrombectomy in Acute Ischemic Stroke: Not Such a Good Idea. AJNR Am J Neuroradiol 2018; 39:E59-E60. [PMID: 29567649 DOI: 10.3174/ajnr.a5610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- F Clarençon
- Paris VI University, Pierre et Marie Curie Paris, France.,Department of Neuroradiology, Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital Paris, France
| | - C Rosso
- Paris VI University, Pierre et Marie Curie Paris, France.,Urgences Cérébro-Vasculaires, Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital Paris, France.,INSERM U 1127, CNRS UMR 7225 Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127 Institut du Cerveau et de la Moelle Épinière, ICM, F-75013 Paris, France
| | - V Degos
- Paris VI University, Pierre et Marie Curie Paris, France.,Department of Anesthesiology, Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital Paris, France
| | - E Shotar
- Paris VI University, Pierre et Marie Curie Paris, France.,Department of Neuroradiology, Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital Paris, France
| | - C Rolla-Bigliani
- Department of Neuroradiology, Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital Paris, France
| | - Y Samson
- Paris VI University, Pierre et Marie Curie Paris, France.,INSERM U 1127, CNRS UMR 7225 Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127 Institut du Cerveau et de la Moelle Épinière, ICM, F-75013 Paris, France.,Department of Anesthesiology, Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital Paris, France
| | - S Alamowitch
- Paris VI University, Pierre et Marie Curie Paris, France.,Department of Vascular Neurology Saint-Antoine Hospital Paris, France
| | - N-A Sourour
- Department of Neuroradiology, Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital Paris, France
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9
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Guédon A, Shotar E, Thepenier C, Gabrieli J, Rolla-Bigliani C, Nouet A, Degos V, Sourour N, Clarençon F. Facteurs prédictifs d’occlusion anévrismale après pose d’un stent à diversion de flux. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Rolla-Bigliani C, Gabrieli J, Shotar E, Di Maria F, Al Raaisi A, Degos V, Nouet A, Sourour N, Clarençon F. Anévrismes disséquants rompus de l’artère cérébelleuse postéro-inférieure : incidence, stratégies thérapeutiques et évolution neurologique. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.01.025] [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: 10/17/2022]
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11
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Clarençon F, Di Maria F, Gabrieli J, Shotar E, Degos V, Nouet A, Biondi A, Sourour NA. Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents. AJNR Am J Neuroradiol 2017; 38:1966-1972. [PMID: 28818824 DOI: 10.3174/ajnr.a5343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The deployment of flow-diverter stents may be difficult to analyse on regular DSA. The purpose of our study was to investigate the clinical impact of stent-dedicated flat panel volume CT angiography to evaluate intraoperatively the satisfactory deployment of flow-diverter stents. MATERIALS AND METHODS From January 2009 to April 2015, 83 consecutive patients (mean age, 51 years; 62 women) were treated in our institution with flow-diverter stents. Eighty-seven aneurysms (82 unruptured, 5 ruptured; 77 anterior, 10 posterior circulation) were treated in these 83 patients (4 patients had 2 aneurysms, both treated by means of flow-diverter stents). One patient was treated for a traumatic carotid cavernous fistula. In 80% of the cases (68/85) a flat panel volume CT angiography was performed in the angiographic suite just after the flow-diverter stent deployment. Stent visualization was assessed by 2 independent reviewers. The clinical impact of stent malapposition was evaluated. RESULTS Flow-diverter stent visualization was satisfactory in 73.5% of the cases. In 2 cases (2.9%) the flat panel volume CT angiography prompted the operator to perform an additional intrastent angioplasty for a condition that was previously underestimated. Four patients (4.7%) experienced acute thromboembolic complications; 3 others had delayed thromboembolic complications. Only 1 of these patients had thromboembolic complications (acute or delayed) related to stent misdeployment, which was easily managed intraoperatively with no clinical consequence. CONCLUSIONS Flat panel volume CT angiography is an interesting tool to depict flow-diverter stent misdeployment and may encourage the operator to perform intrastent angioplasty (2.9% of the cases in our experience) to reduce the risks of thromboembolic complications.
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Affiliation(s)
- F Clarençon
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.) .,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - F Di Maria
- Department of Interventional Neuroradiology (F.D.M.), Foch Hospital, Suresnes, France
| | - J Gabrieli
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.).,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - E Shotar
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.).,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - V Degos
- Anesthesiology (V.D.).,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - A Nouet
- Neurosurgery (A.N.), Pitié-Salpêtrière Hospital. Paris France
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A.B.), Besançon University Hospital, Besançon, France
| | - N-A Sourour
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.)
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12
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Bombled C, André A, Jacquens A, Clarençon F, Degos V. Postoperative neurosurgery complication in 2017: A new window to take into account surgical ischaemic events. Anaesth Crit Care Pain Med 2017; 36:203-204. [PMID: 28780988 DOI: 10.1016/j.accpm.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- C Bombled
- Department of Neuro-Anesthesiology and Intensive Care, Pitié-Salpêtrière University Hospital, Assistance-publique - hôpitaux de Paris, Paris, France; Sorbonne Université, UPMC Paris 6 University, Paris, France
| | - A André
- Sorbonne Université, UPMC Paris 6 University, Paris, France; Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance-publique - hôpitaux de Paris, Paris, France
| | - A Jacquens
- Department of Neuro-Anesthesiology and Intensive Care, Pitié-Salpêtrière University Hospital, Assistance-publique - hôpitaux de Paris, Paris, France; Sorbonne Université, UPMC Paris 6 University, Paris, France
| | - F Clarençon
- Sorbonne Université, UPMC Paris 6 University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Assistance-publique - hôpitaux de Paris, Paris, France
| | - V Degos
- Department of Neuro-Anesthesiology and Intensive Care, Pitié-Salpêtrière University Hospital, Assistance-publique - hôpitaux de Paris, Paris, France; Sorbonne Université, UPMC Paris 6 University, Paris, France; Hôpital Robert-Debré, inserm UMR 1141, 48, boulevard Sérurier, 75016 Paris, France.
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13
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Gambús P, Trocóniz I, Feng X, Gimenez-Milá M, Mellado R, Degos V, Vacas S, Maze M. Relation between acute and long-term cognitive decline after surgery: Influence of metabolic syndrome. Brain Behav Immun 2015; 50:203-208. [PMID: 26164200 PMCID: PMC4631699 DOI: 10.1016/j.bbi.2015.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 05/08/2015] [Revised: 06/21/2015] [Accepted: 07/04/2015] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The relationship between persistent postoperative cognitive decline and the more common acute variety remains unknown; using data acquired in preclinical studies of postoperative cognitive decline we attempted to characterize this relationship. METHODS Low capacity runner (LCR) rats, which have all the features of the metabolic syndrome, were compared postoperatively with high capacity runner (HCR) rats for memory, assessed by trace fear conditioning (TFC) on the 7th postoperative day, and learning and memory (probe trial [PT]) assessed by the Morris water-maze (MWM) at 3 months postoperatively. Rate of learning (AL) data from the MWM test, were estimated by non-linear mixed effects modeling. The individual rat's TFC result at postoperative day (POD) 7 was correlated with its AL and PT from the MWM data sets at postoperative day POD 90. RESULTS A single exponential decay model best described AL in the MWM with LCR and surgery (LCR-SURG) being the only significant covariates; first order AL rate constant was 0.07 s(-1) in LCR-SURG and 0.16s(-1) in the remaining groups (p<0.05). TFC was significantly correlated with both AL (R=0.74; p<0.0001) and PT (R=0.49; p<0.01). CONCLUSION Severity of memory decline at 1 week after surgery presaged long-lasting deteriorations in learning and memory.
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Affiliation(s)
- P.L Gambús
- Department of Anesthesia and Perioperative Care, University of
California San Francisco (UCSF), San Francisco, CA, USA,Systems Pharmacology Effect Control & Modeling (SPEC-M)
Research Group, Anesthesiology Department, Hospital CLINIC de Barcelona, Barcelona,
Spain,NeuroImmunology Research Group, Institut d'Investigacions
Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Corresponding author at: SPEC-M Research Group,
Anesthesiology Department, Hospital CLINIC de Barcelona, Villarroel 170, 08036
Barcelona, Spain. (P.L.
Gambús)
| | - I.F. Trocóniz
- Department of Pharmacy and Pharmaceutical Technology, School of
Pharmacy, Universidad de Navarra, Pamplona, Spain
| | - X. Feng
- Department of Anesthesia and Perioperative Care, University of
California San Francisco (UCSF), San Francisco, CA, USA
| | - M. Gimenez-Milá
- Systems Pharmacology Effect Control & Modeling (SPEC-M)
Research Group, Anesthesiology Department, Hospital CLINIC de Barcelona, Barcelona,
Spain
| | - R. Mellado
- Systems Pharmacology Effect Control & Modeling (SPEC-M)
Research Group, Anesthesiology Department, Hospital CLINIC de Barcelona, Barcelona,
Spain
| | - V. Degos
- Department of Anesthesia and Perioperative Care, University of
California San Francisco (UCSF), San Francisco, CA, USA,Department of Anesthesiology and Critical Care, Hôpital
Pitié Salpetrière, Assistance Publique-Hopitaux de Paris (APHP),
Université Pierre et Marie Curie-Paris VI and UMR INSERM 1141, Paris,
France
| | - S. Vacas
- Department of Anesthesia and Perioperative Care, University of
California San Francisco (UCSF), San Francisco, CA, USA
| | - M. Maze
- Department of Anesthesia and Perioperative Care, University of
California San Francisco (UCSF), San Francisco, CA, USA
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Aymeric A, Trunet S, Degos V, Cornu P, Hans S, Chauvet D. Anatomical Features of Skull Base and Oral Cavity: A Pilot Study to Determine the Accessibility of the Sella by Transoral Robotic-Assisted Surgery. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384202] [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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15
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Shotar E, Clarençon F, Sourour N, Di Maria F, Debare M, Degos V, Nouet A, Zeghal C, Chiras J. Facteurs prédictifs de l’évolution neurologique des patients présentant un hématome intra-cérébral secondaire à une rupture de malformation artério-veineuse intracrânienne. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.091] [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: 11/17/2022]
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16
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17
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Degos V, Lescot T, Puybasset L. Quantitative CT Scan and CT-Estimated Brain Specific Gravity in TBI. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_38] [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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18
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Degos V, Teissier N, Gressens P, Puybasset L, Mantz J. [Inflammation and acute brain injuries in intensive care]. ACTA ACUST UNITED AC 2008; 27:1008-15. [PMID: 19010639 DOI: 10.1016/j.annfar.2008.07.099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 07/17/2008] [Indexed: 11/26/2022]
Abstract
Patients with acute brain injuries or susceptibility to post-surgery stroke are a major therapeutic challenge for intensive care and anaesthesiology medicine. The control of systemic stress involved in brain damage is necessary to reduce the frequency and severity of secondary brain lesions. Inflammation is known to be directly involved in acute brain lesions. The brain is a major participant in inflammation control through activation or inhibition effects. The exact mechanisms involved in deleterious effects following acute brain injuries due to inflammation are still unknown. This non-exhaustive study will expose the principal processes involved in inflammatory brain disease and explain the consequences of peripheral inflammation for the brain. Neuroprotection strategies in acute neuroinflammation will be reported with a focus on anaesthetic agents and the inflammation cascade.
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Affiliation(s)
- V Degos
- Unité Inserm U676, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France.
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19
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Fontaine RH, Cases O, Lelièvre V, Mesplès B, Renauld JC, Loron G, Degos V, Dournaud P, Baud O, Gressens P. IL-9/IL-9 receptor signaling selectively protects cortical neurons against developmental apoptosis. Cell Death Differ 2008; 15:1542-52. [PMID: 18551134 DOI: 10.1038/cdd.2008.79] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In mammals, programmed cell death (PCD) is a central event during brain development. Trophic factors have been shown to prevent PCD in postmitotic neurons. Similarly, cytokines have neurotrophic effects involving regulation of neuronal survival. Nevertheless, neuronal PCD is only partially understood and host determinants are incompletely defined. The present study provides evidence that the cytokine interleukin-9 (IL-9) and its receptor specifically control PCD of neurons in the murine newborn neocortex. IL-9 antiapoptotic action appeared to be time-restricted to early postnatal stages as both ligand and receptor transcripts were mostly expressed in neocortex between postnatal days 0 and 10. This period corresponds to the physiological peak of apoptosis for postmitotic neurons in mouse neocortex. In vivo studies showed that IL-9/IL-9 receptor pathway inhibits apoptosis in the newborn neocortex. Furthermore, in vitro studies demonstrated that IL-9 and its receptor are mainly expressed in neurons. IL-9 effects were mediated by the activation of the JAK/STAT (janus kinase/signal transducer and activator of transcription) pathway, whereas nuclear factor-kappaB (NF-kappaB) or Erk pathways were not involved in mediating IL-9-induced inhibition of cell death. Finally, IL-9 reduced the expression of the mitochondrial pro-apoptotic factor Bax whereas Bcl-2 level was not significantly affected. Together, these data suggest that IL-9/IL-9 receptor signaling pathway represents a novel endogenous antiapoptotic mechanism for cortical neurons by controlling JAK/STAT and Bax levels.
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20
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Degos V, Gressens P. Plasticité postlésionnelle après lésion cérébrale traumatique. Arch Pediatr 2007; 14:522-3. [PMID: 17391947 DOI: 10.1016/j.arcped.2007.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/17/2022]
Affiliation(s)
- V Degos
- Inserm, U676, hôpital Robert-Debre, Paris, France
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