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A Pragmatic Randomized Trial Comparing Surgical Clipping and Endovascular Treatment of Unruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2023; 44:634-640. [PMID: 37169541 PMCID: PMC10249696 DOI: 10.3174/ajnr.a7865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Surgical clipping and endovascular treatment are commonly used in patients with unruptured intracranial aneurysms. We compared the safety and efficacy of the 2 treatments in a randomized trial. MATERIALS AND METHODS Clipping or endovascular treatments were randomly allocated to patients with one or more 3- to 25-mm unruptured intracranial aneurysms judged treatable both ways by participating physicians. The study hypothesized that clipping would decrease the incidence of treatment failure from 13% to 4%, a composite primary outcome defined as failure of aneurysm occlusion, intracranial hemorrhage during follow-up, or residual aneurysms at 1 year, as adjudicated by a core lab. Safety outcomes included new neurologic deficits following treatment, hospitalization of >5 days, and overall morbidity and mortality (mRS > 2) at 1 year. There was no blinding. RESULTS Two hundred ninety-one patients were enrolled from 2010 to 2020 in 7 centers. The 1-year primary outcome, ascertainable in 290/291 (99%) patients, was reached in 13/142 (9%; 95% CI, 5%-15%) patients allocated to surgery and in 28/148 (19%; 95% CI, 13%-26%) patients allocated to endovascular treatments (relative risk: 2.07; 95% CI, 1.12-3.83; P = .021). Morbidity and mortality (mRS >2) at 1 year occurred in 3/143 and 3/148 (2%; 95% CI, 1%-6%) patients allocated to surgery and endovascular treatments, respectively. Neurologic deficits (32/143, 22%; 95% CI, 16%-30% versus 19/148, 12%; 95% CI, 8%-19%; relative risk: 1.74; 95% CI, 1.04-2.92; P = .04) and hospitalizations beyond 5 days (69/143, 48%; 95% CI, 40%-56% versus 12/148, 8%; 95% CI, 5%-14%; relative risk: 0.18; 95% CI, 0.11-0.31; P < .001) were more frequent after surgery. CONCLUSIONS Surgical clipping is more effective than endovascular treatment of unruptured intracranial aneurysms in terms of the frequency of the primary outcome of treatment failure. Results were mainly driven by angiographic results at 1 year.
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Stent-Assisted Coiling in the Treatment of Unruptured Intracranial Aneurysms: A Randomized Clinical Trial. AJNR Am J Neuroradiol 2023; 44:381-389. [PMID: 36927759 PMCID: PMC10084896 DOI: 10.3174/ajnr.a7815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND PURPOSE Stent-assisted coiling may improve angiographic results of endovascular treatment of unruptured intracranial aneurysms compared with coiling alone, but this has never been shown in a randomized trial. MATERIALS AND METHODS The Stenting in the Treatment of Aneurysm Trial was an investigator-led, parallel, randomized (1:1) trial conducted in 4 university hospitals. Patients with intracranial aneurysms at risk of recurrence, defined as large aneurysms (≥10 mm), postcoiling recurrent aneurysms, or small aneurysms with a wide neck (≥4 mm), were randomly allocated to stent-assisted coiling or coiling alone. The composite primary efficacy outcome was "treatment failure," defined as initial failure to treat the aneurysm; aneurysm rupture or retreatment during follow-up; death or dependency (mRS > 2); or an angiographic residual aneurysm adjudicated by an independent core laboratory at 12 months. The primary hypothesis (revised for slow accrual) was that stent-assisted coiling would decrease treatment failures from 33% to 15%, requiring 200 patients. Primary analyses were intent to treat. RESULTS Of 205 patients recruited between 2011 and 2021, ninety-four were allocated to stent-assisted coiling and 111 to coiling alone. The primary outcome, ascertainable in 203 patients, was reached in 28/93 patients allocated to stent-assisted coiling (30.1%; 95% CI, 21.2%-40.6%) compared with 30/110 (27.3%; 95% CI, 19.4%-36.7%) allocated to coiling alone (relative risk = 1.10; 95% CI, 0.7-1.7; P = .66). Poor clinical outcomes (mRS >2) occurred in 8/94 patients allocated to stent-assisted coiling (8.5%; 95% CI, 4.0%-16.6%) compared with 6/111 (5.4%; 95% CI, 2.2%-11.9%) allocated to coiling alone (relative risk = 1.6; 95% CI, 0.6%-4.4%; P = .38). CONCLUSIONS The STAT trial did not show stent-assisted coiling to be superior to coiling alone for wide-neck, large, or recurrent unruptured aneurysms.
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Les données PMSI de l'activité ambulatoire du champ de la psychiatrie. Est-ce que le chaînage avec DCIR est devenu possible en 2021 ? Rev Epidemiol Sante Publique 2023. [DOI: 10.1016/j.respe.2023.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Utilisation d'anxiolytiques, d'hypnotiques et d'antidépresseurs dans les deux ans après la délivrance d'un Système Intra-Utérin à 52 mg de lévonorgestrel comparativement à celle d'un sytème contenant 19,5 mg de lévonorgestrel en France : une étude nationale de cohorte appariée. Rev Epidemiol Sante Publique 2023. [DOI: 10.1016/j.respe.2023.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Design cas témoins apparié sur score de risque : un outil méthodologique original pour une étude de l'efficacité vaccinale et des conséquences médicales de l'hospitalisation pour COVID-19 en France. Rev Epidemiol Sante Publique 2023. [PMCID: PMC9950199 DOI: 10.1016/j.respe.2023.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Introduction L’étude de l'efficacité vaccinale d'une part, et des conséquences médicales du COVID-19 d'autre part, nécessitent généralement la mise en place de deux designs spécifiques. La construction d'un cas témoins apparié sur un score de risque d'hospitalisation pour COVID-19 est un design original visant à répondre à ces deux objectifs. Méthodes A partir des données du Système national des données de santé (SNDS), nous avons construit pour les 67 millions de résidents, un score individuel de risque d'hospitalisation pour COVID-19 à partir d'un modèle de Cox prenant en compte l’âge, le genre, la région, l'indice de défavorisation, 50 facteurs de risque médicaux, et la prise d'immunosuppresseurs ou de corticoïdes. Ce score a été discrétisé en 20 classes de même effectif, basées sur la répartition de ce score chez les cas d'hospitalisation pour COVID-19 survenus entre le 01/06/2022 et le 15/10/2022. Chaque cas d'hospitalisation a ensuite été apparié sur l'année de naissance, le genre, le département et sa tranche de score de risque, à 1-10 témoins non hospitalisés pour COVID-19. Le schéma vaccinal (base SI-VAC) et les résultats des tests (SI-DEP), ont été chainés. Résultats La quasi-totalité des 39 059 cas a pu être appariée à ≥1 individu non hospitalisé comparables en termes de facteurs médicaux: respectivement 24 % versus 25 % de diabète, 19 % de maladies respiratoires chroniques, 65% d'hypertension artérielle et 1 % de cancer du poumon dans les deux groupes, etc. L'administration d'une dose additionnelle de vaccin (3e ou 4e dose) comparativement à des patients vaccinés ne bénéficiant pas de cette dose additionnelle, non récemment infectés, permettait de réduire de 50 % le risque d'hospitalisation sur une durée de 4 mois. Discussion/Conclusion L'appariement sur le score de risque a permis de prendre en compte un grand nombre de facteurs de confusion. A partir de ce design original, nous avons pu étudier l'efficacité vaccinale et nous étudierons lors d'un suivi longitudinal les conséquences médicales de l'hospitalisation pour COVID-19 dans un contexte de prédominance du sous-lignage BA5 du variant Omicron. Mots-clés Covid-19 ; Score de risque ; Vaccination ; Efficacité ; SNDS Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
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Caractéristiques sociodémographiques et médicales associées au risque d’échec d'un schéma vaccinal deux doses contre la COVID-19 en France. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634433 DOI: 10.1016/j.respe.2022.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Contexte Bien qu'il ait été démontré une efficacité majeure des vaccins contre la COVID-19 pour prévenir les formes sévères de la maladie, il se pose la question d'une meilleure compréhension des facteurs de risque d'échec des vaccins. Objectif Identifier les caractéristiques sociodémographiques et médicales associées au risque d'hospitalisation et/ou de décès hospitalier pour COVID-19 en France après un schéma vaccinal complet. Méthodes L'étude porte sur les données de la base nationale de vaccination COVID-19 VAC-SI couplées au Système national des données de santé (SNDS). L'ensemble des personnes présentant un schéma vaccinal complet en France au 31 juillet 2021 de deux injections vaccinales par mRNA BNT162b2 (Pfizer©), mRNA-1273 (Moderna©), ou ChAdOx1 nCoV-19 (Astrazeneca©), ou d'une unique injection lors d'un diagnostic d'infection préalable au SARS-COV-2, ont été incluses et suivies jusqu'au 31 août 2021. Des modèles de Cox ont été utilisés pour estimer les Hasards Ratios ajustés (HRa) d'hospitalisation et de décès hospitalier pour COVID-19 associés à l'âge, au sexe, à l'indice de défavorisation sociale, aux comorbidités et à la prise de traitements immunosuppresseurs ou de corticoïdes oraux 14 jours après un schéma vaccinal complet. Résultats Un total de 28 031 641 personnes avec un schéma vaccinal complet ont été incluses et suivies pendant en moyenne 80 jours (médiane de 67 jours, IQR 48-105). Au cours de ce suivi, 5 345 (19 pour 100 000) ont été hospitalisées et 996 (4 pour 100 000) sont décédées à l'hôpital pour COVID-19. Dans cette population de sujets vaccinés, les risques respectifs d'hospitalisation et de décès hospitalier pour COVID-19 étaient associés à l'âge (85-89 ans versus 45-54 ans : HRa 4,0 [3,5- 4,7] et HRa 38 [19-75]), au genre masculin (HRa 1,6 [1,5-1,7] et HRa 2,0 [1,7-2,3]) et au niveau de défavorisation sociale (communes les plus défavorisées vs les plus favorisées : HRa 1,3 [1,2-1,4] et HRa 1,5 [1,2-1,9]). Les 47 affections chroniques testées étaient positivement associées à des risques accrus à l'exception de la dyslipidémie. Les associations les plus fortes étaient retrouvées pour la transplantation rénale (HRa 32 [28-37] et 34 [24-47]), la transplantation du poumon (HRa 14 [8,1-23] et 11 [1,5-88]), l'insuffisance rénale en dialyse (HRa 7,0 [5,9-8,2] et HRa 8,6 [6,3-12]), la trisomie 21 (HRa 3,9 [2,1- 7,3] et 45 [16-127]), le retard mental (HRa 3,6 [2,5-5,0] et 3,1 [1,0-10]) et le cancer actif du poumon (HRa 3,5 [2,7-4,4] et 6,5 [4,2-10]). Les risques étaient également augmentés chez les personnes vaccinées traitées par immunosuppresseurs (HRa 3,3 [2,8-3,8] et 2,4 [1,7-3,5]) ou corticoïdes oraux (HRa 2,8 [2,5-3,1] et 4,1 [3,3-5,1]). Moins de 10 % des personnes hospitalisées et 2 % des personnes décédées à l'hôpital ne présentaient aucune comorbidité. Après ajustement, les risques d'hospitalisation et de décès hospitalier augmentaient fortement avec le nombre de comorbidités, atteignant chez les personnes présentant au moins 5 comorbidités des risques multipliés par 10 (HRa 10 [9,0- 11]) et 18 (HRa 18 [11- 27]) respectivement. Conclusion Bien que la vaccination ait très fortement réduit la fréquence des formes sévères de COVID-19, un risque résiduel persistait en particulier dans les populations âgées, immunodéprimées et/ou polypathologiques. Des mesures de prévention complémentaires (gestes barrières) restent nécessaires pour réduire le risque résiduel de formes sévères de COVID-19. Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
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8Association entre les vaccins COVID-19 à ARN messager et la survenue de myocardite et péricardite chez les personnes de 12 à 50 ans en France. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634427 DOI: 10.1016/j.respe.2022.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Successful Reperfusion is Associated with Favorable Functional Outcome despite Vessel Perforation during Thrombectomy: A Case Series and Systematic Review. AJNR Am J Neuroradiol 2022; 43:1633-1638. [PMID: 36175082 PMCID: PMC9731237 DOI: 10.3174/ajnr.a7650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/17/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arterial perforation is a potentially serious complication during endovascular thrombectomy. PURPOSE Our aim was to describe interventional approaches after arterial perforation during endovascular thrombectomy and to determine whether reperfusion remains associated with favorable outcome despite this complication. DATA SOURCES Data from consecutive patients with acute stroke undergoing endovascular thrombectomy were retrospectively collected between 2015 to 2020 from a single-center cohort, and a systematic review was performed using PubMed, EMBASE, and Ovid MEDLINE up to June 2020. STUDY SELECTION Articles reporting functional outcome after arterial perforation during endovascular thrombectomy were selected. DATA ANALYSIS Functional outcomes of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion in our single-center cohort. We then summarized the literature review to describe interventional approaches and outcomes after arterial perforation during endovascular thrombectomy. DATA SYNTHESIS In our single-center cohort, 1419 patients underwent endovascular thrombectomy, among whom 32 (2.3%) had vessel perforation and were included in the analysis. The most common hemostatic strategy was watchful waiting (71% of cases). Patients with successful reperfusion had a higher proportion of favorable 90-day mRS scores (60% versus 12.5%; P = .006) and a lower mortality rate (13.3% versus 56.3%, P = .01) than patients without successful reperfusion. Thirteen articles were included in the systematic review. Successful reperfusion also appeared to be associated with better outcomes. LIMITATIONS Given the low number of published reports, we performed only a descriptive analysis. CONCLUSIONS Arterial perforation during endovascular thrombectomy is rare but is associated with high mortality rates and poor outcome. However, successful reperfusion remains correlated with favorable outcome in these patients.
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Impact des mesures de minimisation des risques de méningiome liés à l'utilisation de l'acétate de cyprotérone en France. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study. AJNR Am J Neuroradiol 2022; 43:1437-1444. [PMID: 36137654 PMCID: PMC9575541 DOI: 10.3174/ajnr.a7648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE MCA aneurysms are still commonly clipped surgically despite the recent development of a number of endovascular tools and techniques. We measured clinical uncertainty by studying the reliability of decisions made for patients with middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS A portfolio of 60 MCA aneurysms was presented to surgical and endovascular specialists who were asked whether they considered surgery or endovascular treatment to be an option, whether they would consider recruitment of the patient in a randomized trial, and whether they would provide their final management recommendation. Agreement was studied using κ statistics. Intrarater reliability was assessed with the same, permuted portfolio of cases of MCA aneurysm sent to the same specialists 1 month later. RESULTS Surgical management was the preferred option for neurosurgeons (n = 844/1320; [64%] responses/22 raters), while endovascular treatment was more commonly chosen by interventional neuroradiologists (1149/1500 [76.6%] responses/25 raters). Interrater agreement was only "slight" for all cases and all judges (κ = 0.094; 95% CI, 0.068-0.130). Agreement was no better within specialties or with more experience. On delayed requestioning, 11 of 35 raters (31%) disagreed with themselves on at least 20% of cases. Surgical management and endovascular treatment were always judged to be a treatment option, for all patients. Trial participation was offered to patients 65% of the time. CONCLUSIONS Individual clinicians did not agree regarding the best management of patients with MCA aneurysms. A randomized trial comparing endovascular with surgical management of patients with MCA aneurysms is in order.
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Flow Diversion in the Treatment of Intracranial Aneurysms: A Pragmatic Randomized Care Trial. AJNR Am J Neuroradiol 2022; 43:1244-1251. [PMID: 35926886 PMCID: PMC9451626 DOI: 10.3174/ajnr.a7597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion is a recent endovascular treatment for intracranial aneurysms. We compared the safety and efficacy of flow diversion with the alternative standard management options. MATERIALS AND METHODS A parallel group, prerandomized, controlled, open-label pragmatic trial was conducted in 3 Canadian centers. The trial included all patients considered for flow diversion. A Web-based platform 1:1 randomly allocated patients to flow diversion or 1 of 4 alternative standard management options (coiling with/without stent placement, parent vessel occlusion, surgical clipping, or observation) as prespecified by clinical judgment. Patients ineligible for alternative standard management options were treated with flow diversion in a registry. The primary safety outcome was death or dependency (mRS > 2) at 3 months. The composite primary efficacy outcome included the core lab-determined angiographic presence of a residual aneurysm, aneurysm rupture, progressive mass effect during follow-up, or death or dependency (mRS > 2) at 3-12 months. RESULTS Between May 2011 and November 2020, three hundred twenty-three patients were recruited: Two hundred seventy-eight patients (86%) had treatment randomly allocated (139 to flow diversion and 139 to alternative standard management options), and 45 (14%) received flow diversion in the registry. Patients in the randomized trial frequently had unruptured (83%), large (52% ≥10 mm) carotid (64%) aneurysms. Death or dependency at 3 months occurred in 16/138 patients who underwent flow diversion and 12/137 patients receiving alternative standard management options (relative risk, 1.33; 95% CI, 0.65-2.69; P = .439). A poor primary efficacy outcome was found in 30.9% (43/139) with flow diversion and 45.6% (62/136) of patients receiving alternative standard management options, with an absolute risk difference of 14.7% (95% CI, 3.3%-26.0%; relative risk, 0.68; 95% CI, 0.50-0.92; P = .014). CONCLUSIONS For patients with mostly unruptured, large, anterior circulation (carotid) aneurysms, flow diversion was more effective than the alternative standard management option in terms of angiographic outcome.
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Erythema multiforme associated with anti-plakin antibodies: a multicentric retrospective case series. J Eur Acad Dermatol Venereol 2022; 36:2438-2442. [PMID: 35607912 DOI: 10.1111/jdv.18259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Erythema multiforme (EM) is a muco-cutaneous inflammatory disease mainly triggered by herpes simplex virus (HSV) recurrences. Association of EM and circulating auto-antibodies against plakins (anti-PLK-Abs [EM-PLK+]) has been reported. However, little is known about this subset of EM. OBJECTIVES We aimed to describe the clinical and immunological features and response to treatment of EM-PLK+. METHODS We conducted a retrospective multicentric study of EM-PLK+ selected from the database of the immunological laboratory of Bichat hospital, Paris, France, from January 2009 to December 2020. Anti-PLK-Abs were detected in ≥1 immunological tests: immunofluorescence assay, immunoblotting and/or ELISA. Patients with alternative diagnoses were excluded. RESULTS We included 29 patients (16 women, median age 25 [range 2-58] years). EM-PLK+ were mostly major (EM with ≥2 mucosal involvements; n = 24, 83%) and relapsing (≥2 flares; n = 23, 79%). Cutaneous lesions were target (n = 13, 54%) and target-like lesions (n = 9, 38%) with usual topography (acral, n = 19, 79%; limbs, n = 21, 88%). Mucosal lesions affected the mouth (n = 27, 96%) and genitalia (n = 19, 68%), with a median of 2 [range 0-5] mucous membranes. EM-PLK+ were suspected as certain or possible postherpetic (EM-HSV) in 19 cases (65.5%); no triggering factors were detected in 9 (31%) patients. Desmoplakin-I/II Abs were the most frequent anti-PLK-Abs (n = 20, 69%); envoplakin and periplakin Abs were detected in 11 and 9 cases. Relapsing EM-PLK+ (n = 23) were still active (≥1 flare within 6 months) in 13 (57%) patients despite immunosuppressive therapy (n = 8, 62%). Antiviral drugs were ineffective in preventing relapse in 15/16 (94%) EM-HSV. CONCLUSION The rationale for anti-PLK-Ab detection in EM is not elucidated. More systematic research of anti-PLK-Abs is warranted to better understand whether this association reflects humoral immune activity in a subset of EM or is fortuitous, related to an epitope spreading process. However, EM-PLK+ seems to be associated with major and relapsing subtypes, and difficult-to-treat cases.
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Impact de l’épidémie COVID-19 sur l'utilisation des contraceptifs en France en 2020 et jusqu'en avril 2021. Rev Epidemiol Sante Publique 2022. [PMCID: PMC8907811 DOI: 10.1016/j.respe.2022.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Des difficultés d'accès aux services de santé sexuelle ont été rapportées dans le monde entier pendant l’épidémie de COVID-19. En France, les trois confinements ainsi que les couvre-feux ont pu modifier l'accès aux contraceptifs et leur utilisation. Méthodes Nous avons mené une étude observationnelle nationale grâce aux données de remboursement du Système national des données de santé (SNDS), qui couvre 99,5 % de la population française. Nous avons extrait le nombre de délivrances de contraception orale (CO, progestatifs et contraception oestroprogestative remboursée), de contraception d'urgence (CU), de dispositifs intra-utérins en cuivre (DIU-C) et hormonaux (DIU-H) et d'implants contraceptifs en 2018, 2019, 2020 et au premier quadrimestre de 2021. Nous avons calculé les nombres attendus de consommation de chacune de ces contraceptions en 2020 et 2021, en se basant sur les utilisations de 2018 et 2019, et en tenant compte des jours fériés et des tendances annuelles de consommations. Nous avons comparé les chiffres observés et attendus par contraceptif et par âge d'utilisatrices (âge ≤ 25 ans, entre 25 et 35 ans, > à 35 ans). Résultats L'usage des contraceptifs a diminué de façon globale par rapport à l'attendu après 15 mois de pandémie : -2,0 % pour la CO, -5,0 % pour la CU, -9,5 % pour les DIU-H, -8,6 % pour les DIU-C, et -16,4 % pour l'implant. La baisse d'utilisation a concerné majoritairement les femmes âgées de moins de 25 ans. Un phénomène de stockage de la CO a été observé au début des deux premiers confinements. Discussion/Conclusion Il existe une différence d'impact selon les contraceptifs, les degrés de restriction et les âges des consommatrices. La baisse d'utilisation des contraceptifs peut être expliquée partiellement par la baisse des interactions sociales notamment chez les plus jeunes. Même si les chiffres d'interruption volontaire de grossesse sont stables en 2020, l'accès à la contraception doit être une priorité de santé publique pour limiter l'impact de la pandémie sur le taux de grossesses non désirées
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Utilisation des dispositifs intra-utérins en 2019 et taux de continuation un an après en France : une étude nationale observationnelle en vie réelle. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Axonal Guillain-Barré syndrome and toxic epidermal necrolysis: two cases. J Eur Acad Dermatol Venereol 2021; 36:e373-e376. [PMID: 34928508 DOI: 10.1111/jdv.17894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
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Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study. AJNR Am J Neuroradiol 2021; 42:1615-1620. [PMID: 34326106 DOI: 10.3174/ajnr.a7236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Noninvasive angiography is commonly used to assess the outcome of surgical or endovascular treatment of intracranial aneurysms in clinical series or randomized trials. We sought to assess whether a standardized 3-grade classification system could be reliably used to compare the CTA and MRA results of both treatments. MATERIALS AND METHODS An electronic portfolio composed of CTAs of 30 clipped and MRAs of 30 coiled aneurysms was independently evaluated by 24 raters of diverse experience and training backgrounds. Twenty raters performed a second evaluation 1 month later. Raters were asked which angiographic grade and management decision (retreatment; close or long-term follow-up) would be most appropriate for each case. Agreement was analyzed using the Krippendorff α (αK) statistic, and the relationship between angiographic grade and clinical management choice, using the Fisher exact and Cramer V tests. RESULTS Interrater agreement was substantial (αK = 0.63; 95% CI, 0.55-0.70); results were slightly better for MRA results of coiling (αK = 0.69; 95% CI, 0.56-0.76) than for CTA results of clipping (αK = 0.58; 95% CI, 0.44-0.69). Intrarater agreement was substantial to almost perfect. Interrater agreement regarding clinical management was moderate for both clipped (αK = 0.49; 95% CI, 0.32-0.61) and coiled subgroups (αK = 0.47; 95% CI, 0.34-0.54). The choice of clinical management was strongly associated with the size of the residuum (mean Cramer V = 0.77 [SD, 0.14]), but complete occlusions (grade 1) were followed more closely after coiling than after clipping (P = .01). CONCLUSIONS A standardized 3-grade scale was found to be a reliable and clinically meaningful tool to compare the results of clipping and coiling of aneurysms using CTA or MRA.
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Psoriasis-related treatment exposure and hospitalization or in-hospital mortality due to COVID-19 during the first and second wave of the pandemic: cohort study of 1 326 312 patients in France. Br J Dermatol 2021; 186:59-68. [PMID: 34310699 PMCID: PMC8444811 DOI: 10.1111/bjd.20659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
Background Data on treatment exposures for psoriasis and poor COVID‐19 outcomes are limited. Objectives To assess the risk of hospitalization or in‐hospital mortality due to COVID‐19 by treatment exposure in patients with psoriasis. Methods All adults with psoriasis registered in the French national health‐insurance (Système National des Données de Santé, SNDS) database between 2008 and 2019 were eligible. Two study periods were considered: 15 February to 30 June 2020 and 1 October 2020 to 31 January 2021, the first and second waves of the COVID‐19 pandemic in France, respectively. Patients were classified according to their baseline treatment: biologics, nonbiologics, topicals or no treatment. The primary endpoint was hospitalization for COVID‐19 using Cox models with inverse probability of treatment weighting. The secondary endpoint was in‐hospital mortality due to COVID‐19. Results We identified 1 326 312 patients with psoriasis (mean age 59 years; males, 48%). During the first study period, 3871 patients were hospitalized for COVID‐19 and 759 (20%) died; during the second period 3603 were hospitalized for COVID‐19 and 686 (19%) died. In the propensity score‐weighted Cox models, risk of hospitalization for COVID‐19 was associated with exposure to topicals or nonbiologics [hazard ratio (95% confidence interval): 1·11 (1·04–1·20) and 1·27 (1·09–1·48), respectively] during the first period, and with all exposure types, during the second period. None of the exposure types was associated with in‐hospital mortality due to COVID‐19. Conclusions Systemic treatments for psoriasis (including biologics) were not associated with increased risk of in‐hospital mortality due to COVID‐19. These results support maintaining systemic treatment for psoriasis during the pandemic. Whatis already known about this topic? Almost all chronic diseases have emerged as risk factors for hospitalization for COVID‐19 and poor COVID‐19 outcomes. Multimorbidity is frequent in psoriasis. In France, psoriasis was found to be associated with increased risk of hospitalization for COVID‐19 but not in‐hospital mortality due to COVID‐19. Biologics are associated with an increased risk of infection. Few data have been published on the course of COVID‐19 in patients with psoriasis receiving biologics.
Whatdoes this study add? Systemic treatments for psoriasis (including nonbiologics and biologics) were not associated with an increased risk of in‐hospital mortality due to COVID‐19. Our results did not support a prophylactic effect of long‐term use of biologics on risk of hospitalization for COVID‐19 or in‐hospital mortality. These results provide evidence supporting the continuity of care for psoriasis and maintaining systemic treatment for psoriasis during the pandemic.
Linked Comment: S. Cazzaniga and L. Naldi. Br J Dermatol 2022; 186:7–8. Plain language summary available online
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Myopathies inflammatoires induites par les inhibiteurs de point de contrôle immunitaire : spectre clinique et traitements. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Myopathies inflammatoires induites par les inhibiteurs de point de contrôle immunitaire : la reprise d’une immunothérapie est possible. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Drop in biological initiation for patients with psoriasis during the COVID-19 pandemic. Br J Dermatol 2021; 185:671-673. [PMID: 33894022 PMCID: PMC8250964 DOI: 10.1111/bjd.20406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022]
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Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study. AJNR Am J Neuroradiol 2021; 42:501-507. [PMID: 33509923 DOI: 10.3174/ajnr.a7021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment. MATERIALS AND METHODS Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study. RESULTS The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14-0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4). CONCLUSIONS Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.
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Risque infectieux à fort impact des nouvelles thérapeutiques immunomodulatrices dans le psoriasis. Étude de cohorte de 48 476 patients à partir des données du SNDS. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Epidemiologic study in a real‐world analysis of patients with treatment for psoriasis in the French national health insurance database. J Eur Acad Dermatol Venereol 2020; 35:411-416. [DOI: 10.1111/jdv.16566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
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Exophthalmos following mechanical thrombectomy for anterior circulation stroke: A retrospective study and review of literature. Interv Neuroradiol 2020; 26:416-419. [PMID: 32408783 DOI: 10.1177/1591019920926079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anecdotal cases of exophthalmos after acute mechanical thrombectomy have been described. We sought to estimate the incidence in a large cohort of patients with acute anterior circulation stroke treated with mechanical thrombectomy. Secondarily, we aimed to evaluate the underlying mechanism and to differentiate it on imaging from other pathology with similar clinical orbital features. METHODS Between November 2016 and November 2018, we performed a retrospective single-center study of 250 patients who underwent anterior circulation mechanical thrombectomy. Development of exophthalmos was independently evaluated by two readers on preprocedure and 24-h postprocedure non-contrast cerebral CT. RESULTS In the mechanical thrombectomy cohort, six individuals (2.4%) developed interval ipsilateral exophthalmos at 24 h. Of these, at least two patients developed clinical symptoms. There was almost perfect agreement between assessments of the two readers (Cohen's kappa = 0.907 (95% confidence interval: 0.726, 1.000)). In two patients, there was delayed ophthalmic artery filling on digital subtraction angiography. None of the patients had features of a direct carotid-cavernous fistula. CONCLUSIONS Exophthalmos is not uncommon after mechanical thrombectomy (2.4%). The underlying mechanism is difficult to confirm, but it is most likely due to orbital ischemia from hypoperfusion or distal emboli.
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Reliability of CT Angiography in Cerebral Vasospasm: A Systematic Review of the Literature and an Inter- and Intraobserver Study. AJNR Am J Neuroradiol 2020; 41:612-618. [PMID: 32217551 DOI: 10.3174/ajnr.a6462] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Computed tomography angiography offers a non-invasive alternative to DSA for the assessment of cerebral vasospasm following subarachnoid hemorrhage but there is limited evidence regarding its reliability. Our aim was to perform a systematic review (Part I) and to assess (Part II) the inter- and intraobserver reliability of CTA in the diagnosis of cerebral vasospasm. MATERIALS AND METHODS In Part I, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm (≥ 50% narrowing) and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. Four raters took part in the intraobserver reliability study. RESULTS In Part I, the systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, we found interrater reliability to be moderate at best (κ ≤ 0.6), even when results were stratified according to specialty and experience. Intrarater reliability was substantial (κ > 0.6) in 3/4 readers. In the per arterial segment analysis, substantial agreement was reached only for the middle cerebral arteries, and only when senior raters' judgments were dichotomized (presence or absence of ≥50% narrowing). Agreement on the medical or angiographic management of vasospasm based on CTA alone was less than substantial (κ ≤ 0.6). CONCLUSIONS The diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.
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Evolution of topical steroids consumption before and after initiation of systemic treatment in psoriasis: epidemiologic study in a real‐world analysis of the French national health insurance database. J Eur Acad Dermatol Venereol 2020; 34:e259-e262. [DOI: 10.1111/jdv.16238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Exposition prolongée à de fortes doses d’acétate de cyprotérone et risque de méningiome chez la femme : une recherche-action de santé publique en France. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Estimation de l’effet de l’arrêt d’un traitement préventif chez les sujets âgés à partir des données médico-administratives : exploration de l’utilisation des modèles structuraux marginaux sur l’exemple des statines. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Does Increasing Packing Density Using Larger Caliber Coils Improve Angiographic Results of Embolization of Intracranial Aneurysms at 1 Year: A Randomized Trial. AJNR Am J Neuroradiol 2020; 41:29-34. [PMID: 31896568 DOI: 10.3174/ajnr.a6362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The impact of increased aneurysm packing density on angiographic outcomes has not been studied in a randomized trial. We sought to determine the potential for larger caliber coils to achieve higher packing densities and to improve the angiographic results of embolization of intracranial aneurysms at 1 year. MATERIALS AND METHODS Does Embolization with Larger Coils Lead to Better Treatment of Aneurysms (DELTA) was an investigator-initiated multicenter prospective, parallel, randomized, controlled clinical trial. Patients had 4- to 12-mm unruptured aneurysms. Treatment allocation to either 15- (experimental) or 10-caliber coils (control group) was randomized 1:1 using a Web-based platform. The primary efficacy outcome was a major recurrence or a residual aneurysm at follow-up angiography at 12 ± 2 months adjudicated by an independent core lab blinded to the treatment allocation. Secondary outcomes included indices of treatment success and standard safety outcomes. Recruitment of 564 patients was judged necessary to show a decrease in poor outcomes from 33% to 20% with 15-caliber coils. RESULTS Funding was interrupted and the trial was stopped after 210 patients were recruited between November 2013 and June 2017. On an intent-to-treat analysis, the primary outcome was reached in 37 patients allocated to 15-caliber coils and 36 patients allocated to 10-caliber coils (OR = 0.931; 95% CI, 0.528-1.644; P = .885). Safety and other clinical outcomes were similar. The 15-caliber coil group had a higher mean packing density (37.0% versus 26.9%, P = .0001). Packing density had no effect on the primary outcome when adjusted for initial angiographic results (OR = 1.001; 95% CI, 0.981-1.022; P = .879). CONCLUSIONS Coiling of aneurysms randomized to 15-caliber coils achieved higher packing densities compared with 10-caliber coils, but this had no impact on the angiographic outcomes at 1 year, which were primarily driven by aneurysm size and initial angiographic results.
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Nationwide incidence of patients hospitalized for a mitral regurgitation: Patient characteristics and temporal trends in France 2006–2016. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nationwide incidence of patients hospitalized for a valvular heart disease according to etiology: Patient characteristics and temporal trends in France 2006–2016. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nationwide incidence of patients hospitalized for an aortic stenosis: Patient characteristics and temporal trends in France 2006–2016. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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A randomized trial of endovascular versus surgical management of ruptured intracranial aneurysms: Interim results from ISAT2. Neurochirurgie 2019; 65:370-376. [DOI: 10.1016/j.neuchi.2019.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/09/2019] [Accepted: 05/30/2019] [Indexed: 01/08/2023]
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Persistence of treatment with conventional systemic agents for patients with psoriasis: a real-world analysis of 73 168 new users from the French National Health Insurance database. Br J Dermatol 2019; 182:1483-1484. [PMID: 31758801 DOI: 10.1111/bjd.18734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Factors associated with mechanical and systemic adverse events after colonoscopy (France, 2010-2015). Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
More than one million colonoscopies are performed every year in France. They are associated with risks of mechanical and systemic serious adverse events (SAEs) which can be associated with patient, procedure, endoscopist, and facility characteristics. We tried to identify the factors associated with colonic perforation, gastrointestinal bleeding, splenic injury, shock, myocardial infarction, stroke, pulmonary embolism, acute renal failure, and urolithiasis after colonoscopy.
Methods
We analysed data from the French national claims databases (SNDS). A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy between 2010 and 2015 were identified. SAE rates were estimated, and risk factors associated with SAEs were identified using multilevel logistic regression models, adjusted for patient, colonoscopy, endoscopist, and facility characteristics.
Results
Increasing age was associated with an increasing incidence of mechanical and systemic SAEs. Cancer and cardiovascular comorbidities were associated with mechanical SAEs, and a higher number of pre-existing conditions was associated with shock and acute renal failure. Polypectomy, especially of polyps larger than 1 cm, was associated with an increased risk of perforation (OR = 4.1; 95% CI, 3.4-5.0) and bleeding (OR = 13.3; 95% CI, 11.7-15.1). Mechanical SAEs were associated with the endoscopist’s experience, while systemic SAEs were more frequent in public hospitals than in private clinics.
Conclusions
SAEs related to colonoscopy were more frequent in older patients and in those with comorbidities. Mechanical SAEs were more frequent when colonoscopy was performed by less experienced endoscopists. Systemic SAEs were more frequent in public hospitals, reflecting patient selection processes. The risk of both mechanical and systemic SAEs should be taken into account when deciding to perform colonoscopy, particularly in older patients with multiple pre-existing conditions.
Key messages
Systemic SAEs are not uncommon after colonoscopy and, together with intestinal SAEs, should be considered when considering the need for colonoscopy. Patients at risk of SAEs should be identified and colonoscopy should be performed by experienced endoscopists in these patients. Less invasive alternatives should also be considered in these patients.
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Persistence of apremilast in moderate-to-severe psoriasis: a real-world analysis of 14 147 apremilast- and methotrexate-naive patients in the French National Health Insurance database. Br J Dermatol 2019; 182:690-697. [PMID: 31021438 DOI: 10.1111/bjd.18047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Real-world data on the persistence of apremilast vs. methotrexate are inconclusive. OBJECTIVES To assess and compare the long-term persistence of apremilast and methotrexate in a large cohort of patients with psoriasis. METHODS All adult patients with psoriasis registered in the French national health insurance database ('Système National des Données de Santé') between 2009 and 2017 were eligible for inclusion. The study population comprised apremilast- and methotrexate-naive patients, defined as those with a first prescription of apremilast or methotrexate. Levels of persistence were compared using a Cox model with propensity-score matching that included potential confounders (notably age, sex, psoriatic arthritis, comorbidities and previous exposure to topical and systemic treatments). RESULTS In this nationwide population-based cohort, 14 147 adult patients with psoriasis (mean age 52·3 years, 55·2% male) were found to be naive to both apremilast and methotrexate. After propensity-score matching, two subgroups of 4805 patients with similar baseline characteristics were included, of whom 3207 apremilast-treated patients and 2736 methotrexate-treated patients discontinued their treatment. Kaplan-Meier survival propensity-score analyses revealed a discontinuation rate of 69% for apremilast and 59% for methotrexate in the first year of treatment. Apremilast-treated patients had a higher risk of discontinuation than methotrexate-treated patients when considering the study population as a whole (hazard ratio 1·28, 95% confidence interval 1·23-1·34) or in a propensity-score-matched analysis (hazard ratio 1·34, 95% confidence interval 1·27-1·41; P < 0·001). CONCLUSIONS Our real-world data suggest that in the first year of treatment, the discontinuation rate was significantly higher for apremilast-treated patients than for methotrexate-treated patients, regardless of the previous therapeutic lines received. What's already known about this topic? Psoriasis is a common chronic, relapse-remitting, inflammatory skin disease associated with severe psychosocial impact. Apremilast, a phosphodiesterase 4 inhibitor, is one of the most recently commercialized psoriasis drugs. Little is known about the long-term clinical effectiveness of apremilast. What does this study add? The discontinuation rate at 1 year for apremilast was 69%, compared with 58% for methotrexate, in a nationwide population-based cohort including 14 147 nonselected adult patients with psoriasis. Patients in the apremilast cohort had a higher risk of discontinuation than patients in the methotrexate cohort using propensity-score matching, including potentially relevant individual risk factors such as age, sex, comorbidities and psoriatic arthritis, and regardless of the previous therapeutic lines received. In daily practice, physicians should take these results into account when choosing between methotrexate and apremilast as a first-line systemic therapy.
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Incidence des patients hospitalisés pour valvulopathie en France : caractéristiques des patients et évolution 2006–2016. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Vaccination antigrippale et risque de syndrome de Guillain-Barré : étude par la méthode d’analyse des séries de cas à partir des données du Système national des données de santé (2010–2014). Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Évolution de la consommation de dermocorticoïdes avant et après initiation d’un traitement systémique dans le psoriasis : étude en vie réelle en France à partir des données du SNDS. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Utilisation et persistance de l’aprémilast dans le psoriasis : étude comparative en vie réelle en France à partir des données du SNDS. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Enquête épidémiologique en vie réelle des patients traités pour un psoriasis, en France à partir des données du SNDS. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Persistence of treatment with biologics for patients with psoriasis: a real‐world analysis of 16 545 biologic‐naïve patients from the French National Health Insurance database (SNIIRAM). Br J Dermatol 2018; 180:86-93. [DOI: 10.1111/bjd.16809] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 01/04/2023]
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Vaccins anti-HPV et risque de pathologie thyroïdienne chez les jeunes filles âgées de 13 à 17 ans. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Risque de syndrome de Guillain-Barré après une chirurgie : une étude de type « case-crossover » à partir des données du Sniiram (2009–2014). Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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47
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Persistance des traitements systémiques dans le psoriasis : étude en vie réelle en France à partir des données du SNIIRAM. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Establishing the appropriate primary endpoint in haemophilia gene therapy pivotal studies. Haemophilia 2017; 23:643-644. [DOI: 10.1111/hae.13313] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 02/05/2023]
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49
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Utilisation des données de l’assurance maladie française pour étudier l’usage et les effets des médicaments en vie réelle : revue de 216 articles publiés entre 2007 et 2016. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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50
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Validation et calibration de l’approche cas–population dans le Sniiram en vue de la génération de signaux de pharmacovigilance : projet ALCAPONE. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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