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Wennekes MD, Eilers R, Caputo A, Gagneux-Brunon A, Gavioli R, Nicoli F, Quatrehomme MMM, Vokó Z, Timen A. Vaccines for older adults; the low-hanging fruit of disease prevention. Eur J Public Health 2022. [PMCID: PMC9620792 DOI: 10.1093/eurpub/ckac131.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The COVID-19 pandemic highlighted the significance of vaccination for older adults (OA), however, more health benefits could be gained with vaccination against influenza, pneumococcal disease, herpes zoster and tetanus as their uptake remains rather low. As healthcare professionals (HCP) play an important role in the vaccination decision making of OA, this study identifies obstacles in vaccination communication between HCP and OA. Methods 80 in-depth structured interviews have been conducted with HCPs in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR). Participants were general practitioners, medical specialists, public health physicians, occupational physicians, pharmacists, geriatricians, specialists elderly care and nurses. The interview included questions on HCPs’ perceptions regarding information provision to OA on vaccines. Data were analyzed cross-country, using thematic analysis. Results Preliminary results reveal that a factor hindering HCPs to initiate conversations with OA on vaccines was lack of time (FR, IT, HU, NL). In hospitals this was often due to (acute) clinical problems taking precedence over discussing vaccines (IT, NL). In ambulatory settings the high number of patients waiting to be seen prevented discussing vaccines with OA (HU). Moreover, HCPs sometimes forgot to discuss vaccines with OA (NL, HU, IT). Patient factors hindering the conversation of HCPs on OA vaccines were a negative attitude (IT, HU) and lack of understanding the information provided (IT, HU). Also, misinformation on vaccines (FR, HU), as well as anti-vax beliefs from patients (NL) or their relatives (FR, IT) hampered the conversation on vaccines. HCPs mentioned their need to learn communication skills to convince OA on vaccines (FR, IT, HU). Conclusions HCPs encounter various obstacles in communicating with OA about vaccines. Lack of time and not recognizing the opportunity to discuss vaccines are important barriers for initiating vaccine conversations. Key messages • Providing HCPs with communication strategies is important to support HCPs in discussing vaccines with OA. • Reminder systems are important to help HCPs remember address vaccination.
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Affiliation(s)
- MD Wennekes
- National Coordination Centre for Communicable Disease Control, RIVM , Bilthoven, Netherlands
- Athena Institute, Free University , Amsterdam, Netherlands
- WP4, VITAL , Netherlands
| | - R Eilers
- National Coordination Centre for Communicable Disease Control, RIVM , Bilthoven, Netherlands
| | - A Caputo
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara , Ferrara, Italy
| | - A Gagneux-Brunon
- Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, University Jean Monnet , Saint-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne , Saint-Etienne, France
| | - R Gavioli
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara , Ferrara, Italy
| | - F Nicoli
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara , Ferrara, Italy
| | - MMM Quatrehomme
- Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, University Jean Monnet , Saint-Etienne, France
| | - Z Vokó
- Syreon Research Institute , Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University , Budapest, Hungary
| | - A Timen
- National Coordination Centre for Communicable Disease Control, RIVM , Bilthoven, Netherlands
- Athena Institute, Free University , Amsterdam, Netherlands
- Department of Primary and Community Care, Radboud University Medical Center , Nijmegen, Netherlands
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2
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Mohamed A, Georgiopoulos G, Faconti L, Vennin S, McNally R, Hugelshofer S, Nicoli F, Alfakih K, Alastruey-Arimon J, Ferreira J, Lamata P, Keehn L, Chiribiri A, Masci P, Chowienczyk P. In-depth phenotyping by cardiovascular magnetic resonance uncovering differences between ethnic groups in hypertensive heart disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Black African/African-Caribbean individuals with hypertension (BH) are at greater risk of heart failure than those of white European ethnicity (WH). The mechanisms underlying this dissimilarity remain poorly understood.
Purpose
To investigate the influence of ethnicity on left ventricular (LV) remodelling using multi-parametric cardiovascular magnetic resonance (CMR).
Methods
BH (n=44), WH (n=38) and healthy-volunteers (HV; n=25, 5 of black ethnicity) underwent comprehensive CMR. The exam included: i) Arterial Stiffness/Afterload pulse-wave-velocity (PWV), aortic elastance (Ea) and systemic vascular resistance (SVR) by phase-contrast velocity-encoding imaging; ii) Ventricular remodelling/Function LV and right ventricular (RV) volumes, mass, ejection fraction (EF), LV peak-filling rate by short-axis cine images; myocardial strains were measured by feature tracking; iii) Left atrial (LA) remodelling/Function volumes and functions by long-axis cine images; iv) Tissue characterisation: extracellular volume by pre/post-contrast T1-mapping and late gadolinium enhancement (LGE) for interstitial and replacement myocardial fibrosis, respectively. Multivariate linear regression models were developed to investigate how LV remodelling associates with ethnicity, arterial afterload, including elastance (Ea) and stiffness [PW], and SVR. Models were adjusted for age, gender, body-mass-index, LV volumes or function and LA volumes.
Results
Subject characteristics are summarised in the Table. PWV and Ea and SVR were greater in hypertensives, particularly in BH, than HV; this was paralleled by higher LV mass, interventricular septum thickness (IVS), LA volumes but lower LV-EF. These findings were confirmed after adjusting for age.
On the Model-1, IVS was associated with Ea (β=0.335, P=0.008) and black ethnicity (β=0.226, P=0.019) but not with SVR or PWV. For each increment of Ea there was a similar increase of IVS in BH and WH (P=0.602 for interaction), however BH had greater IVS than WH at each Ea value (Figure, fully-adjusted Model-1). On Model-2, LV end-diastolic volume was associated with Ea (β=−0.268, P=0.001), SVR (β=−0.319, P=0.019) but not with PWV or ethnicity. However, the inverse relation between LV size and Ea was significantly attenuated in BH (P=0.039 for interaction), (Figure, fully-adjusted Model-2). On model-3, LV-EF was associated with Ea (β=0.223, P=0.009) but not with ethnicity, PWV or SVR. LV-EF reduction for each Ea increment was similar for BH and WH (P=0.597 for interaction).
Conclusion
BH and WH show a distinctive LV remodelling phenotype. BH had a greater susceptibility to hypertrophy and an attenuated reduction of chamber size in response to arterial afterload. Further research to disentangle the genetic and environmental factors underlying these ethnic group-specific differences is utterly required.
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- A.T Mohamed
- King's College London, GKT School of Medical Education, London, United Kingdom
| | - G Georgiopoulos
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, United Kingdom
| | - L Faconti
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom
| | - S Vennin
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom
| | - R McNally
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom
| | | | - F Nicoli
- Humanitas Research Hospital, Bergamo, Italy
| | - K Alfakih
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - J Alastruey-Arimon
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, United Kingdom
| | - J Ferreira
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, United Kingdom
| | - P Lamata
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, United Kingdom
| | - L Keehn
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom
| | - A Chiribiri
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, United Kingdom
| | - P.G Masci
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, United Kingdom
| | - P Chowienczyk
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom
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3
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Georgiopoulos G, Vennin S, Faconti L, Mc Nally R, Mohamed A, Hugelshofer S, Nicoli F, Alfakih K, Mughal N, Bosio F, Alastruey-Arimon J, Keehn L, Chiribiri A, Chowienczyk P, Masci PG. Unravelling racial differences in hypertensive heart disease by multiparametric cardiovascular magnetic resonance: a phenotype-wide association study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dr Georgiopoulos was supported by the Onassis Foundation under the special grant & support program for scholars" association members
Introduction – Black Afro-Caribbean hypertensives (BAHs) are exposed to a higher risk of heart failure (HF) than white hypertensives (WHs). Arterial afterload is higher in BAHs due to increased arterial stiffness and vascular volume; BAHs develop more often left ventricular (LV) hypertrophy, dilatation and systolic dysfunction than WHs. However, it is unclear whether other racial differences concur to the more pronounced LV remodelling in BAHs.
Methods – This cross-sectional study included hypertensive patients undergoing cardiovascular magnetic resonance for their clinical work-up (1.5T Aera Siemens-Healthcare). Clinical history and haemodynamic parameters were collected in all participants; a subset of patients had complete bio-humoral assay of the renin-angiotensin-aldosterone system (RAAs). Arm cuff pressure was measured during CMR. The CMR protocol included: i) Arterial afterload / LV arterial-coupling - pulse-wave-velocity (PWV), aortic (Ea) and LV elastance (Ees) by aorta anatomic and phase-contrast velocity-encoding imaging; ii) ventricular remodelling and function - LV and right ventricular (RV) volumes, mass, EF, LV peak-filling rate by short-axis cine images; global circumferential and longitudinal strains by cine feature tracking; iii) left atrial (LA) remodelling volumes and reservoir, conduit and booster functions by long-axis cine images; iv) tissue characterisation: T2 and pre/post-contrast T1 relaxation times, extracellular volume (ECV) by single mid-ventricular short-axis T1/T2-mapping.
Results – 34 BAHs and 35 WHs (52 ± 12 vs 45 ± 14 years, P < 0.05; 61% vs 65% males P = NS) were included in the study. Baseline features are summarised in the Table. LV systolic dysfunction was more prevalent in BAH than WHs (P = 0.038). Of note, BAHs tended to have greater LV volumes and significantly higher LV mass and septal thickness than WHs. In BAHs, but not in WHs, PWV was associated with increased septal thickness after correction for blood pressure and age (β-value: 0.447, P = 0.02). Normalised RV mass was greater in BHA than WHs; RV mass suits for the identification of racial or circulating factors predisposing to hypertrophy being largely unaffected by systemic afterload. In our study LV diastolic function and LA volumes were similar between BAHs and WHs, and none of the subjects had conditions associated with pre-capillary pulmonary hypertension. Hence, higher RV-mass in BAHs pinpoints a racial susceptibility to myocardial hypertrophy. Finally, in a subset of patients with RAAs assays (n = 43), the aldosterone/renin ratio was higher in BAHs than WHs (67.04 [IQR: 19.37-209.73] vs 13.77 [IQR: 7.47-40.43], P = 0.01).
Conclusion – BAHs have heightened LV remodelling than WHs because of racial predisposition to develop hypertrophy which also encompasses derangements in RAAs. Altogether, these findings may account for the greater risk for HF in BAHs than WHs.
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Affiliation(s)
- G Georgiopoulos
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Vennin
- King"s College London, School of Cardiovascular Medicine & Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - L Faconti
- King"s College London, School of Cardiovascular Medicine & Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - R Mc Nally
- King"s College London, School of Cardiovascular Medicine & Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - A Mohamed
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Hugelshofer
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - F Nicoli
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - K Alfakih
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - N Mughal
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - F Bosio
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J Alastruey-Arimon
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - L Keehn
- King"s College London, School of Cardiovascular Medicine & Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - A Chiribiri
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - P Chowienczyk
- King"s College London, School of Cardiovascular Medicine & Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - PG Masci
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
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4
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Di Stefano M, Federici S, Giovanelli L, Nadiani B, Nicoli F, Trevisan M. The informative experience of endocrine residents with COVID-19. J Endocrinol Invest 2020; 43:1669-1670. [PMID: 32686041 PMCID: PMC7368924 DOI: 10.1007/s40618-020-01365-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 01/05/2023]
Affiliation(s)
- M Di Stefano
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
| | - S Federici
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
| | - L Giovanelli
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
| | - B Nadiani
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
| | - F Nicoli
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy.
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy.
| | - M Trevisan
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
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5
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Andreini D, Conte E, Casella M, Mushtaq S, Pontone G, Dello Russo A, Nicoli F, Catto V, Vettor G, Sommariva E, Rizzo S, Basso C, Tondo C, Pepi M. Cardiac magnetic resonance features of left dominant arrhythmogenic cardiomyopathy: differential diagnosis with myocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To identify potential imaging features at cardiac magnetic resonance (CMR) specific for left-dominant arrhythmogenic cardiomyopathy (LDAC) diagnosis.
Materials and methods
Between January 2011 and May 2016, we considered 36 consecutive stable patients with a recent diagnosis of significant VA and ECG morphology consistent with a LV origin, detection of potential LV arrhythmic substrate at CMR, undergoing a clinically-indicated LV endomyocardial biopsy. Exclusion criteria were history of known cardiac disease, contraindications to CMR and impaired CMR image quality. After application of these criteria, in 9 patients endomyocardial biopsy showed tissue abnormalities consistent with the diagnosis of LDAC. From the same CMR-endomyocardial biopsy registry, a second group of 9 consecutive patients with a histological diagnosis of previous myocarditis were identified.
Results
Mid-wall LGE in the interventricular septum was detected in 5 myocarditis, without findings in LDAC group (p=0.03), whereas subepicardial LGE at the level of posterolateral wall of LV was detected in 8 cases of LDAC vs. 2 cases of myocarditis (p=0.02). Fat infiltration, and particularly subepicardial posterolateral fat infiltration, was found in all LDAC patients vs. one myocarditis only (p<0.01). No differences in other CMR findings or in any clinical or echocardiographic parameters were found between patients with a biopsy consistent with LDAC vs. patients in whom biopsy suggested myocarditis.
Conclusions
In patients with significant VA and ECG morphology consistent with a LV origin, identification of morpho-functional involvement of the subepicardial layer of LV posterolateral wall at CMR (LGE, fat infiltration, wall dyskinesis) is consistent with a diagnosis of LDAC.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Andreini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Conte
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Mushtaq
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Pontone
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - F Nicoli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Catto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Vettor
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Sommariva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Rizzo
- University of Padova, Department of Cardiovascular Pathology, Padua, Italy
| | - C Basso
- University of Padova, Department of Cardiovascular Pathology, Padua, Italy
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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6
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Caputo A, Eilers R, Gagneux-Brunon A, Gavioli R, Jakab I, Nicoli F, Timen A, Vokó Z, Wennekes MD. Information needs on vaccinations for older adults and the role of health care professionals in this. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
On behalf of all members of work package 4 from the VITAL project
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Affiliation(s)
- A Caputo
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - R Eilers
- National Coordination Centre for Communicable Disease Control, RIVM, Bilthoven, Netherlands
| | - A Gagneux-Brunon
- Groupe Immunité des Muqueuses et Agents Pathogènes, University Jean Monnet, Saint-Etienne, France
- Department of infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - R Gavioli
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - I Jakab
- Syreon Research Institute, Budapest, Hungary
| | - F Nicoli
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - A Timen
- National Coordination Centre for Communicable Disease Control, RIVM, Bilthoven, Netherlands
- Athena Institute, VU University Amsterdam, Amsterdam, Netherlands
| | - Z Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - M D Wennekes
- National Coordination Centre for Communicable Disease Control, RIVM, Bilthoven, Netherlands
- Athena Institute, VU University Amsterdam, Amsterdam, Netherlands
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7
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Conte E, Mushtaq S, Dello Russo A, Guglielmo M, Baggiano A, Nicoli F, Tanzilli A, Carbucicchio C, Casella M, Gripari P, Melotti E, Tondo C, Pontone G, Pepi M, Andreini D. 321Cardiac magnetic resonance for identifying the substrate of ventricular arrhythmias in patients with normal echocardiography. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez102.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Conte
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Mushtaq
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - M Guglielmo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Baggiano
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Nicoli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Tanzilli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Melotti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Pontone
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Andreini
- University of Milan, Department of Clinical Sciences and Community Health, Cardiovascular Section, Milan, Italy
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8
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Conte E, Mushtaq S, Pontone G, Baggiano A, Guglielmo M, Nicoli F, Annoni A, Mancini E, Formenti A, Muscogiuri G, Pepi M, Andreini D. P119Comprehensive evaluation of newly diagnosed left ventricle dysfunction by a novel whole-heart coverage cardiac CT: preliminary results of the E-PLURIBUS study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Conte
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Mushtaq
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Pontone
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Baggiano
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Guglielmo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Nicoli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Annoni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Mancini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Formenti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Andreini
- Cardiology Center Monzino IRCCS, Milan, Italy
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9
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Affiliation(s)
- D Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy.
| | - F Nicoli
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
- Plastic Reconstructive and Aesthetic Surgery Unit, Tor Vergata University, Rome, Italy
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10
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Roggi S, Testa J, Gasparetto A, Nicoli F, Ferioli E, Picozzi M. The criterion of proportionality in the activation of Left Ventricular Assist Device implants: the method of "four boxes" to analyze the pre-implant phase. Clin Ter 2019; 170:e61-e67. [PMID: 30789199 DOI: 10.7417/ct.2019.2109] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Life-saving technologies have completely changed the normal conception of medical treatments. Left Ventricular Assist Devices (LVAD) can prolong survival for patients who are not candidates for heart transplantation. In order to analyze the pre-implantation phase, which involves a shared-decision making process before activation of the device, attention should be paid to the criterion of "proportionality" in order to properly assess the risks and benefits of implantation. AIM The aim of our analysis is to provide an useful tool for the assessment of LVAD proportionality during the physicians' decision making. METHODS The method of the "four boxes", developed by Jonsen et al, was chosen to analyze the notion of proportionality and the other main ethical issues regarding LVAD activation in adult patients. RESULTS Medical issues are not the sole factors, which influence the choice of implantation by patients. Indeed, patient preferences, his/her quality of life, and contextual features should be taken into consideration when proposing LVADs: these factors are as important as clinical issues where outcomes are concerned. CONCLUSIONS In order to assess the proportionality of such a device, we present, discuss and examine, in the framework of the pre-implant phase, the content of each topic treated by the "four boxes method", that is, an essential tool for the assessment of the proportionality of the treatment for LVAD candidates.
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Affiliation(s)
- S Roggi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University
| | - J Testa
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University; Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar (Verona)
| | - A Gasparetto
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University
| | - F Nicoli
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University; Clinical Ethics Service, Domus Salutis Clinic, Teresa Camplani Foundation, Brescia, Italy
| | - E Ferioli
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University
| | - M Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University
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11
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Maruccia M, Elia R, Ciudad P, Nacchiero E, Nicoli F, Vestita M, Chen HC, Giudice G. Postmastectomy upper limb lymphedema: Combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients' related outcomes. A retrospective comparative study. J Plast Reconstr Aesthet Surg 2019; 72:892-901. [PMID: 30819649 DOI: 10.1016/j.bjps.2019.01.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/15/2018] [Accepted: 01/18/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Lymphedema resulting from breast cancer treatment is a chronic condition that can significantly compromise quality of life. Several works have documented the efficacy of vascularized lymph node flap transfer (VLNT) for the treatment of advanced-stage lymphedema. Given that the axillary scar may contribute to the patient's existing lymphedema, the authors assumed that combining VLNT and scar release with fat graft could be an effective strategy of treatment. The purpose of this study is to compare the efficacy in the reduction of limb circumference and health-related quality of life between a combined strategy, namely, VLN transfer (VLNT) and axillary scar release with fat grafting, and only VLNT for patients affected by postmastectomy upper limb lymphedema. The idea. MATERIALS AND METHODS All patients with stage II and III breast cancer-related lymphedema operated between January 2012 and January 2016 were retrospectively identified, and only those treated by combined VLNT and scar release (Group A) or only VLNT (Group B) were included. The outcomes were assessed clinically by limb circumference measurement and radiologically by lymphoscintigraphy. Lymphedema-related quality of life was evaluated preoperatively and at 1 year follow-up through the LYMQOL questionnaire. RESULTS Thirty-nine patients met inclusion criteria (Group A = 18; Group B = 21). Mean follow-up was 29 months for Group A and 32 months for Group B. Flap survival rate was 100%, with no donor site morbidity in all patients. A statistically significant difference between the circumference reduction rates (RR) at above elbow level was observed at 3 and 6 months of follow-up comparing the two groups (p<0.00001), with higher values in Group A than in Group B. No significant difference was detected comparing RR values at above and below elbow at 12 and 24 months postoperatively. LYMQOL metrics showed significantly better scores (p<0.0001) in all domains at all follow-up appointments in Group A. CONCLUSIONS Patients with postmastectomy upper limb lymphedema can benefit from combined lymph node transfer and axillary scar release with fat graft, as this approach seems to fasten the onset of improvement and to have a positive impact on patients' quality of life.
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Affiliation(s)
- M Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
| | - R Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy.
| | - P Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - E Nacchiero
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
| | - F Nicoli
- Department of Plastic and Reconstructive Surgery, University of Rome ``Tor Vergata'', Rome, Italy
| | - M Vestita
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
| | - H C Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - G Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy
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Sileri P, Mastrovito S, Nicoli F, Orlandi A, Shalaby M. Autotransplantation of autologous adipose tissue-derived mesenchymal stem cells to treat complex fistula-in-ano - the FLiRT technique - a video vignette. Colorectal Dis 2019; 21:247-249. [PMID: 30548913 DOI: 10.1111/codi.14531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Sileri
- Department of General Surgery UOC C, University of Rome Tor Vergata, Rome, Italy
| | - S Mastrovito
- Department of General Surgery UOC C, University of Rome Tor Vergata, Rome, Italy
| | - F Nicoli
- Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A Orlandi
- Department of Biomedicine and Prevention, Anatomic Pathology Section, University of Rome Tor Vergata, Rome, Italy
| | - M Shalaby
- Department of General Surgery UOC C, University of Rome Tor Vergata, Rome, Italy.,Department of General Surgery '8', University of Mansoura, Mansoura, Egypt
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Picozzi M, Grossi AA, Ferioli E, Nicoli F, Gasparetto A. Donation After Circulatory Death: When Withdrawing Life-Sustaining Treatments Is Ethically Acceptable. Transplant Proc 2019; 51:117-119. [PMID: 30655134 DOI: 10.1016/j.transproceed.2018.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/04/2018] [Accepted: 05/21/2018] [Indexed: 11/15/2022]
Abstract
The possibility to determine death based on cardiocirculatory criteria in controlled cases, namely when there is a request to withhold treatment-or, more frequently, withdraw it-specifically recalls the recent Italian law on advance treatment directives and leaves the following question unanswered: Under what conditions is the patient's request legally and ethically acceptable? We present three ethical proportionality criteria for supporting physicians' decision-making facing patients' requests of treatment withdrawal, namely: 1. irreversible pathology with an ominous and worsening prognosis; 2. within an evaluation considering both clinical data and the patient's history; and 3. facing burdens that are no longer bearable. We finally argue that reflection over controlled donor may be a model for giving medicine the chance to responsibly deal with broader end-of-life issues.
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Affiliation(s)
- M Picozzi
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - A A Grossi
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy.
| | - E Ferioli
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy
| | - F Nicoli
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy; Center for Clinical Ethics, University of Insubria, Varese, Italy; Clinical Ethics Service, Domus Salutis Clinic, Teresa Camplani Foundation, Brescia, Italy
| | - A Gasparetto
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
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Lazzeri D, Constantinides J, D'Ambrosia C, Nicoli F. Goiter in the "Venus at a mirror" (1615) by Peter Paul Rubens (1577-1640). J Endocrinol Invest 2017; 40:893-894. [PMID: 28271464 DOI: 10.1007/s40618-017-0625-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Affiliation(s)
- D Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
| | - J Constantinides
- Department of Plastic and Reconstructive Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C D'Ambrosia
- School of Medicine, Columbia University, New York, NY, USA
| | - F Nicoli
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy.
- Department of Plastic and Reconstructive Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.
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Affiliation(s)
- G Cianchini
- Department of Dermatology, Cristo Re Hospital, 00167, Rome, Italy
| | - D Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, 00167, Rome, Italy
| | - F Nicoli
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, 00167, Rome, Italy.,Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", 00167, Rome, Italy
| | - M Pierotti
- Gubbio and Gualdo Tadino General Hospital, Gubbio, Italy
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Abstract
Jusepe or Jòse de Ribera (1591-1652), known as Lo Spagnoletto ("the Little Spaniard"), has been a leading painter of the Spanish Baroque movement. In one of the portraits, de Ribera represented a scene in which the Magdalene shows a swelling at the base of the neck suggestive of a thyroid nodule.
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Affiliation(s)
- F Nicoli
- Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy.
| | - D Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
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Affiliation(s)
- F Nicoli
- Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
| | - P Pozzilli
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - D Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy.
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Nicoli F, Sabatti E, Picozzi M. P-123 The psychology and the clinical ethics consultations: Different fields in the palliative care-hospice unit. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.252] [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: 11/04/2022]
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Soulleihet V, Nicoli F, Trouve J, Girard N, Jacquin L. Optimized acute stroke pathway using medical advanced regulation for stroke and repeated public awareness campaigns. Am J Emerg Med 2013; 32:225-32. [PMID: 24361139 DOI: 10.1016/j.ajem.2013.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the efficiency of a specific organizational model for early stroke management associated with repeated public awareness campaigns on stroke warning signs. METHOD Our model is based on initial telephone triage of potential candidates for an intravenous thrombolysis by an emergency physician before a 3-party conference including basic life support team on scene and a stroke neurologist. We performed a time series analysis for a period of 5 years and a half, comparing the number of emergency telephone calls with that of intravenous thrombolysis treatment realized. RESULTS In our organizational model, repeated awareness public campaigns increased both the number of emergency calls for suspected stroke and the selection of potential candidates for intravenous thrombolysis. Results from the time series analysis suggest that educational campaigns are a major factor influencing our emergency medical service activity. This result is correlated with the number of performed intravenous thrombolyses by the stroke center especially within a 3-hour delay (Spearman ρ, P = .621, P = .000 and P = .439, P = .000, respectively). CONCLUSION Educational programs repeated each year are useful to the population for learning how to recognize stroke symptoms and send straight away an emergency call. Combining the emergency action with an early remote evaluation by the stroke center team and a direct admission in imaging department shortens the time-to-treatment delay. This model is reproducible in different health care systems.
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Affiliation(s)
- Valéry Soulleihet
- Assistance Publique-Hôpitaux de Marseille, CHU Timone, SAMU 13, 13005 Marseille, France
| | - François Nicoli
- OLEA Medical, 13600 La Ciotat, France; Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service d'urgences neurovasculaires, 13005 Marseille, France
| | - Jacques Trouve
- Centre Hospitalier Henri Duffaut, SAMU 84, 84903 Avignon cedex 09, France
| | - Nadine Girard
- Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service de Neuroradiologie, 13005 Marseille, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences Médicales, 69003 Lyon, France.
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Repossini A, Di Bacco L, Rosati F, Kotelnikov I, Nicoli F, Muneretto C. 093 * LONG-TERM RESULTS OF MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS: TEN-YEAR EXPERIENCE AND FOLLOW-UP. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.93] [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: 11/14/2022] Open
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21
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Nicoli F, Lafaye de Micheaux P, Girard N. Perfusion-weighted imaging-derived collateral flow index is a predictor of MCA M1 recanalization after i.v. thrombolysis. AJNR Am J Neuroradiol 2013; 34:107-14. [PMID: 22766675 PMCID: PMC7966327 DOI: 10.3174/ajnr.a3174] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/02/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recent studies highlight the role of CC in preserving ischemic penumbra. Some authors suggested the quality of CC could also impact recanalization. The purpose of this study is to test this hypothesis in patients who were treated with i.v. thrombolysis for MCA-M1 occlusion. MATERIALS AND METHODS A normalized index derived from Tmax maps (MR-PWI) was defined to quantify the CC deficit (nCCD) in 64 patients with stroke who underwent i.v. thrombolysis. Correlations between nCCD and parameters that may be altered by CC quality were tested (baseline NIHSS, volume of diffusion abnormalities, modified Rankin Scale at 3 months). The correlation between baseline nCCD and MCA-M1 recanalization rate at 24 hours was tested. RESULTS The nCCD is significantly correlated with NIHSS and with lesional volume (Pearson correlation test, positive correlations, respectively, 0.40, 0.57; P = .00089, P = 8.7e-07). The nCCD also has a significant predictive value on the full recanalization at 24 hours that decreases as TTT increases (logistic regression, P = .021). Furthermore, among patients who were treated within 3 hours, nCCD and recanalization are significantly correlated (correlation ratio test, eta2 = 0.23, P = .0023): Patients who did not achieve full recanalization have significantly higher nCCD than fully recanalized patients (Mann-Whitney U test, P = .007). In addition, the probability of full recanalization decreases as the nCCD increases (P = .021). nCCD (OR 0.988, 95% CI 0.977-0.999, P = .042) and full recanalization at 24 hours (OR 4.539, 95% CI 1.252-16.456, P = .021) are independent predictors of functional independence at 3 months. CONCLUSIONS The nCCD index is a predictor of full MCA-M1 recanalization in patients treated with i.v. thrombolysis.
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Affiliation(s)
- F Nicoli
- Service d'Urgences Neuro-Vasculaires, Assistance Publique-Hôpitaux de Marseille (APHM), CHU de la Timone, Marseille, France.
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Nicolini A, Tonveronachi E, Navalesi P, Antonelli M, Valentini I, Melotti RM, Pigna A, Carrassi A, Righini P, Ferrari Bravo M, Pelosi P, Nicoli F, Cosentini R, Vaschetto R, Faenza S, Nava S. Effectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: a multicenter study. Minerva Anestesiol 2012; 78:1333-1340. [PMID: 23032930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure. METHODS In this prospective multicenter study, 98 patients with new pulmonary infiltrate(s) sustained by H1N1 virus and a PaO(2)/FiO2<300 were eligible for study; 38/98 required immediate ETI, while the others received NIV as a first line therapy; 13/60 patients failed NIV and were intubated after 5.8+5.5 hours from enrolment. The remaining 47/60 patients were successfully ventilated with NIV. RESULTS Hospital mortality was significantly higher in those patients who failed NIV vs. those who succeeded (53.8% vs. 2.1%; OR=0.52, P<0.001). ETI was associated with higher number of infectious complications, mainly sepsis and septic shock. The OR of having one of these events in the NIV failure group vs. NIV success was 16.7, P<0.001. According to logistic regression model, a SAPS II>29 and a PaO(2)/FIO(2)≤127 at admission and PaO2/FIO(2)≤149 after 1 hr of NIV were independently associated with the need for ETI. CONCLUSION The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality.
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Affiliation(s)
- A Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
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Balzani A, Pagnotta A, Montesi G, Gravante G, Nicoli F, Cervelli V. A case of psoriasis with secondary amyloidosis, associated symbrachydactyly of the hand and a transverse deficiency of the foot. Eur Rev Med Pharmacol Sci 2012; 16:983-985. [PMID: 22953651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Secondary amyloidosis is associated with a variety of chronic inflammatory diseases such as rheumatoid arthritis, ankylosing spondylitis, familial Mediterranean fever, osteomyelitis, inflammatory bowel diseases and infective or neoplastic conditions. Few cases of secondary amyloidosis complicating psoriasis have been reported. We describe a 58-year-old patient with secondary amyloidosis, psoriasis, an associated symbrachydactyly of the hand and a transverse deficiency of the foot. To the best of our knowledge, no case of this association has been previously reported.
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Affiliation(s)
- A Balzani
- Department of Plastic Surgery, School of Medicine, University of Tor Vergata, Rome, Italy
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Bartoli MA, Squarcioni C, Nicoli F, Magnan PE. Management of symptomatic carotid stenosis after IV thrombolysis: a word of caution. J Cardiovasc Surg (Torino) 2012; 53:407-408. [PMID: 21769083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Cervelli V, Nicoli F, Spallone D, Verardi S, Sorge R, Nicoli M, Balzani A. Treatment of traumatic scars using fat grafts mixed with platelet-rich plasma, and resurfacing of skin with the 1540 nm nonablative laser. Clin Exp Dermatol 2011; 37:55-61. [DOI: 10.1111/j.1365-2230.2011.04199.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sarlon-Bartoli G, Boudes A, Buffat C, Bartoli MA, Piercecchi-Marti MD, Sarlon E, Arnaud L, Bennis Y, Thevenin B, Squarcioni C, Nicoli F, Dignat-George F, Sabatier F, Magnan PE. Circulating lipoprotein-associated phospholipase A2 in high-grade carotid stenosis: a new biomarker for predicting unstable plaque. Eur J Vasc Endovasc Surg 2011; 43:154-9. [PMID: 22075154 DOI: 10.1016/j.ejvs.2011.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 10/10/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with high-grade carotid stenosis according to plaque histology. METHODS This cross-sectional single-centre study included patients with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) carotid stenosis, who were treated surgically. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were determined on the day of surgery. Histopathological analysis classified carotid plaque as stable or unstable, according to AHA classification. RESULTS Of the 42 patients (mean age 70.4 ± 10.5 years; 67% men), neurological symptoms were present in 16 (38%). Unstable plaques were found in 23 (55%). Median plasma level of Lp-PLA2 was significantly higher in patients with unstable plaque compared to those with stable plaque (222.4 (174.9-437.5) interquartile range (IQR) 63.5 vs. 211.1 (174.9-270.6) IQR 37.2 ng ml(-1); p = 0.02). Moreover, median Lp-PLA2 level were higher in asymptomatic patients with unstable plaque (226.8 ng ml(-1) (174.9-437.5) IQR 76.8) vs. stable plaque (206.9 ng ml(-1) (174.9-270.6) IQR 33.7; p = 0.16). Logistic regression showed that only the neurological symptoms (OR = 30.9 (3.7-244.6); p < 0.001) and the plasma Lp-PLA2 level (OR = 1.7 (1.1-12.3); p = 0.03) were independently associated with unstable carotid plaque as defined by histology. CONCLUSIONS This study showed that circulating Lp-PLA2 was increased in patients with high-grade carotid stenosis and unstable plaque. Lp-PLA2 may be a relevant biomarker to guide for invasive therapy in asymptomatic patients with carotid artery disease.
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Affiliation(s)
- G Sarlon-Bartoli
- Service de Chirurgie Vasculaire, Faculté de Médecine de Marseille, Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, 13005 Marseille, France.
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Nicoli F, Faivre A, Squarcioni C, Combaz X, Girard N. Repeated MR-based intravenous thrombolysis in a patient with short interval stroke recurrences. J Neuroradiol 2011; 38:256-8. [DOI: 10.1016/j.neurad.2010.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 06/07/2010] [Accepted: 09/14/2010] [Indexed: 11/28/2022]
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Fenollar F, Nicoli F, Paquet C, Lepidi H, Cozzone P, Antoine JC, Pouget J, Raoult D. Progressive dementia associated with ataxia or obesity in patients with Tropheryma whipplei encephalitis. BMC Infect Dis 2011; 11:171. [PMID: 21676235 PMCID: PMC3141410 DOI: 10.1186/1471-2334-11-171] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 06/15/2011] [Indexed: 12/18/2022] Open
Abstract
Background Tropheryma whipplei, the agent of Whipple's disease, causes localised infections in the absence of histological digestive involvement. Our objective is to describe T. whipplei encephalitis. Methods We first diagnosed a patient presenting dementia and obesity whose brain biopsy and cerebrospinal fluid specimens contained T. whipplei DNA and who responded dramatically to antibiotic treatment. We subsequently tested cerebrospinal fluid specimens and brain biopsies sent to our laboratory using T. whipplei PCR assays. PAS-staining and T. whipplei immunohistochemistry were also performed on brain biopsies. Analysis was conducted for 824 cerebrospinal fluid specimens and 16 brain biopsies. Results We diagnosed seven patients with T. whipplei encephalitis who demonstrated no digestive involvement. Detailed clinical histories were available for 5 of them. Regular PCR that targeted a monocopy sequence, PAS-staining and immunohistochemistry were negative; however, several highly sensitive and specific PCR assays targeting a repeated sequence were positive. Cognitive impairments and ataxia were the most common neurologic manifestations. Weight gain was paradoxically observed for 2 patients. The patients' responses to the antibiotic treatment were dramatic and included weight loss in the obese patients. Conclusions We describe a new clinical condition in patients with dementia and obesity or ataxia linked to T. whipplei that may be cured with antibiotics.
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Affiliation(s)
- Florence Fenollar
- Unité des rickettsies, URMITE CNRS-IRD UMR 6236, IFR 48, Faculté de médecine, Université de la Méditerranée, Marseille, France
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Faivre A, Chapon F, Combaz X, Nicoli F. INTERNAL CAROTID ARTERY DISSECTION OCCURRING DURING INTENSIVE PRACTICE WITH WII(R) VIDEO SPORTS GAMES. Neurology 2009; 73:1242-3. [DOI: 10.1212/wnl.0b013e3181bc0172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Faivre A, Abdelfettah Z, Rodriguez S, Nicoli F. Neurological picture. Bilateral internal carotid artery dissection due to elongated styloid processes and shaking dancing. J Neurol Neurosurg Psychiatry 2009; 80:1154-5. [PMID: 19762905 DOI: 10.1136/jnnp.2008.159954] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A Faivre
- Soins Intensifs Neuro-Vasculaires, Pr F NICOLI, Hôpital la Timone, Marseille Cedex 05, France.
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Fromont I, Nicoli F, Valéro R, Felician O, Lebail B, Lefur Y, Mancini J, Paquis-Flucklinger V, Cozzone PJ, Vialettes B. Brain anomalies in maternally inherited diabetes and deafness syndrome. J Neurol 2009; 256:1696-704. [DOI: 10.1007/s00415-009-5185-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 01/16/2009] [Accepted: 03/11/2009] [Indexed: 11/28/2022]
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Bartoli M, Squarcioni C, Nicoli F, Magnan PE, Malikov S, Berger L, Lerussi G, Branchereau A. Early Carotid Endarterectomy after Intravenous Thrombolysis for Acute Ischaemic Stroke. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.03.033] [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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Ghinoi A, Zuccoli G, Nicolini A, Pipitone N, Macchioni L, Bajocchi GL, Nicoli F, Silingardi M, Catanoso MG, Boiardi L, Salvarani C. 1T magnetic resonance imaging in the diagnosis of giant cell arteritis: comparison with ultrasonography and physical examination of temporal arteries. Clin Exp Rheumatol 2008; 26:S76-S80. [PMID: 18799059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the usefulness of 1T magnetic resonance imaging (MRI) of temporal arteries and to compare 1T MRI with duplex ultrasonography (US) and physical examination of temporal arteries for the diagnosis of giant cell arteritis (GCA) in patients with suspected GCA. METHOD The superficial temporal arteries of 20 consecutive patients with a suspected diagnosis of GCA were examined using a 1T MRI scanner. Fat-saturated multislice T1-weighted spin-echo images were acquired perpendicularly to the orientation of the vessel. In all cases, MRI results were compared to US and temporal artery examination findings. Temporal artery biopsies were performed in all patients. RESULTS Mural contrast enhancement of the temporal arteries on MRI had a sensitivity of only 33.3% and a specificity of 87.5% for the diagnosis of biopsy-proven GCA. Compared with the diagnosis of GCA by the American College of Rheumatology criteria, MRI had a sensitivity and specificity of 27.2% and 88.9%, respectively. Temporal artery abnormalities on physical examination and the presence of a hypoechoic halo on US had a higher sensitivity (66.7% and 77.7%, respectively) and a higher specificity (100% for both) compared to MRI findings. CONCLUSION 1T MRI is not useful for the diagnosis of GCA because of its low sensitivity. US and physical examination of temporal arteries had a better diagnostic accuracy. However, our data does not exclude a diagnostic role for higher-resolution MRI.
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Affiliation(s)
- A Ghinoi
- Division of Rheumatology, 31st Division of Internal Medicine, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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Gravante G, Araco A, Sorge R, Caruso R, Nicoli F, Araco F, Delogu D, Cervelli V. Postoperative wound infections after breast reductions: the role of smoking and the amount of tissue removed. Aesthetic Plast Surg 2008; 32:25-31. [PMID: 17985175 DOI: 10.1007/s00266-007-9048-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND This prospective study followed patients who underwent breast reductions to determine the influence of smoking and the amount of tissue removed on postoperative wound infections. METHODS Patients who had received breast reductions were considered eligible for the study. The study excluded postbariatric patients and those with ongoing clinical infections, a recent antibiotic course, or systemic diseases that could impair tissue oxygenation. Smokers were instructed to quit smoking at least 4 weeks before surgery. RESULTS By March 2004, the study had enrolled 87 patients. Postoperative infections were present in 24 cases (27.9%). Infections included 16 in smokers (37.2%), 8 in nonsmokers (18.2%; p < 0.05), 14 in patients with large resections (>0.85 kg; 70%), and 10 in patients with small resections (14.9%; p < 0.001). Significant differences were found between the patients who experienced infections and those who were infection free in terms of the overall estimated cigarettes smoked (mean, 146,000; range, 29,200-228,125 vs mean, 10,950; range, 9,125-54,750; p < 0.001), the number of pack years (mean, 20; range, 4-31 vs mean, 2; range, 1-8; p < 0.001), and the amount of tissue removed (mean, 0.9 kg; range, 0.5-2 kg vs mean, 0.5 kg; range, 0.2-1.4 kg; p < 0.001). The analysis for all the patients determined an odds ratio of 2.04 for smoking and 4.7 for the amount of tissue removed. CONCLUSIONS Smoking and the amount of tissue removed are important issues in aesthetic breast surgery that need to be addressed accurately by the plastic surgeon. If future larger studies confirm these data, surgeons could have a simple and easy method for stratifying patients according to their risk for the development of wound infections and for prescribing specific preventive measures.
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Affiliation(s)
- G Gravante
- Department of General Surgery, Plastic Surgery and Laboratory of Biometry, University of Tor Vergata in Rome, Rome, Italy.
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Callot V, Galanaud D, Figarella-Branger D, Lefur Y, Metellus P, Nicoli F, Cozzone P. Correlations between MR and endothelial hyperplasia in low-grade gliomas. J Magn Reson Imaging 2007; 26:52-60. [PMID: 17659539 DOI: 10.1002/jmri.20995] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the capacity of multimodal MR to detect endothelial hyperplasia (EH), which has been linked to the aggressiveness of gliomas and which is so far only detected by biopsy, an invasive technique that prevents repeated measurements and early detection. MATERIALS AND METHODS A total of 26 patients with low-grade gliomas participated in the study. All underwent a histopathological analysis and a multimodal MR examination (spectroscopic, anatomic, diffusion, perfusion, and postcontrast imaging). RESULTS EH was present (EH+) in 15 patients and absent (EH-) in 11. No differences were observed between EH- and EH+ groups when comparing spectroscopic and diffusion parameters. Perfusion measurements, however, allowed us to distinguish EH+ from EH-: the relative regional cerebral blood flow (rCBF) was found equal to 3.23 +/- 2.05 for EH+ and 1.33 +/- 0.46 for EH- (P = 0.006). CONCLUSION We have observed a strong correlation between the presence of EH and the increase of rCBF. Compared to conventional imaging, MR perfusion provides additional and complementary information that may be used for biopsy guidance, early detection of tumor aggressiveness, and noninvasive follow-ups.
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Affiliation(s)
- Virginie Callot
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine de Marseille, Université de la Méditerranée, Marseille, France.
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Abstract
MR spectroscopy (MRS) sequences allow noninvasive exploration of brain metabolism during a MRI examination. Their day-to-day use in a clinical setting has recently been improved by simple programming of sequences and automated quantification of metabolites. However, a few simple rules should be observed in the choice of sequences and the location of the voxels so as to obtain an informative, high-quality examination. The research applications of MR spectroscopy, where use of this examination seeks to better understand the pathophysiology of the disease, must be distinguished from its clinical indications, where MRS provides information that can be used directly in patient management. The most significant of the clinical uses are imaging intracranial tumors (positive and differential diagnosis, extension, treatment follow-up), diffuse brain injury, encephalopathies (especially hepatic and HIV-related), and the diagnosis of metabolic disorders.
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Affiliation(s)
- D Galanaud
- Service de Neuroradiologie, Hôpital La Pitié Salpêtrière, 47, boulevard de l'Hôpital, 75651 Paris cedex 13.
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Labauge P, Roullet E, Boespflug-Tanguy O, Nicoli F, Le Fur Y, Cozzone PJ, Ducreux D, Rodriguez D. Familial, Adult Onset Form of Leukoencephalopathy with Brain Stem and Spinal Cord Involvement: Inconstant High Brain Lactate and Very Slow Disease Progression. Eur Neurol 2007; 58:59-61. [PMID: 17483590 DOI: 10.1159/000102171] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 12/21/2006] [Indexed: 11/19/2022]
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Galanaud D, Nicoli F, Confort-Gouny S, Le Fur Y, Ranjeva JP, Viola A, Girard N, Cozzone PJ. [Indications for cerebral MR proton spectroscopy in 2007]. Rev Neurol (Paris) 2007; 163:287-303. [PMID: 17404517 DOI: 10.1016/s0035-3787(07)90402-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is being increasingly performed alongside the more conventional MRI sequences in the exploration of neurological disorders. It is however important to clearly differentiate its clinical applications aiming at improving the differential diagnosis or the prognostic evaluation of the patient, from the research protocols, when MRS can contribute to a better understanding of the pathophysiology of the disease or to the evaluation of new treatments. The most important applications in clinical practice are intracranial space occupying lesions (especially the positive diagnosis of intracranial abscesses and gliomatosis cerebri and the differential diagnosis between edema and tumor infiltration), alcoholic, hepatic, and HIV-related encephalopathies and the exploration of metabolic diseases. Among the research applications, MRS is widely used in multiple sclerosis, ischemia and brain injury, epilepsy and neuro degenerative diseases.
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Affiliation(s)
- D Galanaud
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine et Hôpital La Timone, Marseille, France
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Galanaud D, Nicoli F, Deltour S, Le Fur Y, Rosso C, Crozier S, Dormont D, Cozzone P, Chiras J. Imagerie à la phase aiguë des AVC. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90914-5] [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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Galanaud D, Nicoli F, Figarella-Branger D, Roche P, Confort-Gouny S, Le Fur Y, Cozzone PJ. Spectroscopie par résonance magnétique des tumeurs cérébrales. ACTA ACUST UNITED AC 2006; 87:822-32. [PMID: 16778750 DOI: 10.1016/s0221-0363(06)74090-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
MR spectroscopy (MRS) can complement MRI in the evaluation of intracranial tumors. Before treatment, MRS can contribute to the differential diagnosis between tumor and non tumoral lesion (especially intracranial abscesses), to assess the aggressiveness of a glial tumor or to determine its extension to better delineate the surgical removal or the target volume of radiotherapy. During treatment follow-up, MRS helps differentiate recurrent tumor from radionecrosis or physiological post-surgical contrast enhancement. The current studies are trying to determine if the indications of MRS, alone or in association with other MR sequences can further be extended in the study of brain tumors, in particular the follow-up of lesions undergoing chemo or radiotherapy.
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Affiliation(s)
- D Galanaud
- CRMBM CEMEREM UMR CRNS 6612, Faculté de Médecine, 27, boulevard Jean Moulin, 13005 Marseille.
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Guis S, Figarella-Branger D, Mattei JP, Nicoli F, Le Fur Y, Kozak-Ribbens G, Pellissier JF, Cozzone PJ, Amabile N, Bendahan D. In vivo and in vitro characterization of skeletal muscle metabolism in patients with statin-induced adverse effects. ACTA ACUST UNITED AC 2006; 55:551-7. [PMID: 16874775 DOI: 10.1002/art.22100] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Statins (3-hydroxymethylglutaryl-coenzyme A reductase inhibitor) are widely used to treat hypercholesterolemia. They are generally well tolerated, but myotoxic effects have been reported and the corresponding mechanisms are still a matter of debate. The aim of the present study was to determine whether impairment of calcium homeostasis and/or mitochondrial impairment could account for the adverse effects of statins in skeletal muscle. METHODS Eleven patients with increased creatine kinase levels and myalgias after statin treatment were evaluated using in vitro contracture tests (IVCTs), histology, and 31P magnetic resonance spectroscopy (31P-MRS). RESULTS IVCT results were abnormal in 7 of the 9 patients, indicating an impaired calcium homeostasis. The 31P-MRS investigation disclosed no anomaly at rest, and the aerobic function assessed during the postexercise recovery period was normal. On the contrary, the pH recovery kinetics was significantly slowed down as indicated by a reduced proton efflux, which could be ultimately linked to a failure of calcium homeostasis. Overall, our observations indicate a normal mitochondrial function and raise the possibility that statins may unmask a latent pathology involving an impairment of calcium homeostasis such as malignant hyperthermia (MH). CONCLUSION In case of susceptibility to MH, statins treatment must be administered with caution, and signs of adverse effects should be checked.
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Affiliation(s)
- S Guis
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS number 6612, Hôpital de la Conception, INSERM UMR S639, Marseille, France
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Galanaud D, Nicoli F, Chinot O, Confort-Gouny S, Figarella-Branger D, Roche P, Fuentès S, Le Fur Y, Ranjeva JP, Cozzone PJ. Noninvasive diagnostic assessment of brain tumors using combined in vivo MR imaging and spectroscopy. Magn Reson Med 2006; 55:1236-45. [PMID: 16680716 DOI: 10.1002/mrm.20886] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine the potential value of multimodal MRI for the presurgical management of patients with brain tumors, we performed combined magnetic resonance imaging (MRI) and proton MR spectroscopy (MRS) in 164 patients who presented with tumors of various histological subtypes confirmed by surgical biopsy. Univariate statistical analysis of metabolic ratios carried out on the first 121 patients demonstrated significant differences in between-group comparisons, but failed to provide sufficiently robust classification of individual cases. However, a multivariate statistical approach correctly classified the tumors using linear discriminant analysis (LDA) of combined MRI and MRS data. After initial separation of contrast-enhancing and non-contrast-enhancing lesions, 91% of the former and 87% of the latter were correctly classified. The results were stable when this diagnostic strategy was tested on the additional 43 patients included for validation after the initial statistical analysis, with over 90% of correct classification. Combined MRI and MRS had superior diagnostic value compared to MRS alone, especially in the contrast-enhancing group. This study shows the clinical value of a multivariate statistical analysis based on multimodal MRI and MRS for the noninvasive evaluation of intracranial tumors.
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Affiliation(s)
- Damien Galanaud
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée and Hôpital de La Timone, Marseille, France
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Spaggiari L, Sverzellati N, Versari A, Paci M, Ferrari G, Nicoli F, Zompatori M. Evaluation of N parameter in the staging of non-small cell lung cancer: role of CT and PET. Radiol Med 2005; 109:449-59. [PMID: 15973219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To determine diagnostic accuracy of CT and FDG-PET for the evaluation of N status in non-small cell lung cancer. MATERIALS AND METHODS Thirty-eight CT scans and PET scans of patients with non small-cell lung cancer were retrospectively reviewed. The data of the noninvasive techniques about N status were compared with the pathology findings obtained by standard lymphadenectomy. RESULTS The CT results were concordant with surgery in 24 out of 38 cases (63%); in discordant cases CT understaged 8 patients and overstaged 6. The PET images were concordant with surgery in 29 cases (76%); of the remaining 9, PET understaged 5 cases and overstaged 4. Concerning the N parameter, CT had a sensitivity of 42.8% and a specificity of 83.3%, while PET had a sensitivity of 71.4% and a specificity of 91.6%. CONCLUSIONS In our experience the diagnostic accuracy of PET is superior to that of CT, in agreement with the most important studies in the literature. On only one occasion did PET fail to differentiate between hilar uptake (N1) and the central primary tumour, an area in which CT provided more precise anatomic details. Nonetheless, we believe that PET should be performed in all patients affected by lung cancer, with the only exception of patients shown to be not suitable for surgery after CT examination.
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Affiliation(s)
- L Spaggiari
- Dipartimento di Scienze Cliniche, Sezione Diagnostica per Immagini, Università degli Studi di Parma, Parma, Italy
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Labauge P, Fogli A, Castelnovo G, Le Bayon A, Horzinski L, Nicoli F, Cozzone P, Pagès M, Briere C, Marty-Double C, Delhaume O, Gelot A, Boespflug-Tanguy O, Rodriguez D. Dominant form of vanishing white matter-like leukoencephalopathy. Ann Neurol 2005; 58:634-9. [PMID: 16047349 DOI: 10.1002/ana.20573] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Leukoencephalopathy with vanishing white matter syndrome (childhood ataxia with central nervous system hypomyelination/vanishing white matter disease) is an autosomal recessive disorder characterized by the occurrence of acute episodes of deterioration after minor head trauma or infection, and symmetrical demyelination on magnetic resonance with cavitation aspects. Mutations in each of the five subunits of eIF2B have been identified. We report in an affected man and his mother an adult-onset form of childhood ataxia with central nervous system hypomyelination/vanishing white matter disease-like disorder with no mutations in the EIF2B genes and normal guanine nucleotide exchange factor eIF2B activity, suggesting a new dominant inheritance of this syndrome that may involve other genes.
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Affiliation(s)
- Pierre Labauge
- Service de Neurologie, CHU Montpellier-Nîmes, Hôpital Caremeau, Nîmes, France.
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Guis S, Mattei JP, Pellissier JF, Nicoli F, Figarella-Branger D, Le Fur Y, Kaplanski G, Pelletier J, Harle JR, Cozzone PJ, Bendahan D. MRI and 31PMR spectroscopy investigations of muscle function disclose no abnormality in macrophagic myofasciitis. J Rheumatol 2004; 31:2313-4. [PMID: 15517654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Viola A, Nicoli F, Denis B, Confort-Gouny S, Le Fur Y, Ranjeva JP, Viout P, Cozzone PJ. High cerebral scyllo-inositol: a new marker of brain metabolism disturbances induced by chronic alcoholism. MAGMA 2004; 17:47-61. [PMID: 15340856 DOI: 10.1007/s10334-004-0044-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 06/07/2004] [Accepted: 06/07/2004] [Indexed: 11/25/2022]
Abstract
Cerebral metabolic changes that concur to motor and/or cognitive disorders in actively drinking alcoholics are not well established. We tested the hypothesis that chronic alcoholics exhibit profound alterations in the cerebral metabolism of scyllo-inositol. Brain metabolism was explored in nine actively drinking and 11 recently detoxified chronic alcoholics by in vivo brain (1)H-MRS and in vitro(1)H-MRS of blood serum and cerebrospinal fluid. The cohort was composed of individuals with acute, subacute or chronic encephalopathy or without any clinical encephalopathy. Chronic alcoholism is associated with a hitherto unrecognized accumulation of brain scyllo-inositol. Our results suggest that scyllo-inositol is produced within the central nervous system and shows a diffuse but heterogenous distribution in brain where it can persist several weeks after detoxification. Its highest levels were observed in subjects with a clinically symptomatic alcohol-related encephalopathy. When detected, brain scyllo-inositol takes part in a metabolic encephalopathy since it is associated with reduced N-acetylaspartate and increased creatine. High levels of cerebral scyllo-inositol are correlated with altered glial and neuronal metabolism. Our findings suggest that the accumulation of scyllo-inositol may precede and take part in the development of symptomatic alcoholic metabolic encephalopathy.
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Affiliation(s)
- A Viola
- Centre de Résonance Magnétique, Biologique et Médicale UMR CNRS 6612, Faculté de Médecine, 27 Bd J. Moulin, 13005 Marseille, France.
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Galanaud D, Nicoli F, Le Fur Y, Guye M, Ranjeva JP, Confort-Gouny S, Viout P, Soulier E, Cozzone PJ. Multimodal magnetic resonance imaging of the central nervous system. Biochimie 2004; 85:905-14. [PMID: 14652179 DOI: 10.1016/j.biochi.2003.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The physiological and biochemical properties of the diseased brain that can be explored with magnetic resonance imaging (MRI) are increasing. Progress in MR-based technology affords a large panel of MRI sequences that explore different phenomena and, thus, provide complementary informations. The diagnostic accuracy of MRI is improved by the combination of all MR modalities. However, this abundance of data requires an efficient multiparametric analysis to fully achieve the goal of the multimodal strategy. We will discuss the potential impact of this advanced MRI analysis in the clinical management and the therapeutical strategies of the most common brain pathologies (intracranial tumors, multiple sclerosis, stroke, epilepsy and dementia). This non-invasive approach is of utmost importance since it already improves the diagnosis and the therapeutic choice in the management of several central nervous system diseases.
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Affiliation(s)
- D Galanaud
- UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée, 27 boulevard Jean-Moulin, 13005 Marseille, France
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Nicoli F, Lefur Y, Denis B, Ranjeva JP, Confort-Gouny S, Cozzone PJ. Metabolic counterpart of decreased apparent diffusion coefficient during hyperacute ischemic stroke: a brain proton magnetic resonance spectroscopic imaging study. Stroke 2003; 34:e82-7. [PMID: 12817104 DOI: 10.1161/01.str.0000078659.43423.0a] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Recent studies have shown that the brain ischemic area defined by the map of decreased apparent diffusion coefficient (ADC) obtained by diffusion-weighted imaging (DWI) during the first hours of ischemic stroke includes a significant part of ischemic penumbra. We hypothesize that the misjudgment of the final infarct size by ADC mapping may be related to a restricted ability of DWI to capture variations in the intensity of cellular suffering. In an attempt to characterize metabolically the hypoperfused brain parenchyma, we studied the relationship between ADC values and brain metabolic parameters measured by proton MR spectroscopic imaging (SI). METHODS Six patients with hyperacute ischemic stroke were explored within the first 7 hours after onset with the use of a MR protocol including T2*-weighted MRI, DWI, SI, perfusion-weighted imaging, and MR angiography. RESULTS This study demonstrates, for the first time, a wide gradient of ischemia-related metabolic anomalies within the abnormal area delineated by DWI during hyperacute ischemic stroke. In the narrow range of decreased mean ADC values (0.60 to 0.40 x 10(-9) m2 x s(-1)), a 33% decrease in mean ADC is associated with a 122% increase in lactate/N-acetyl aspartate ratio. Mean ADC values never fall below 0.40 x 10(-9) m2 x s(-1) within the severely affected ischemic tissue, while SI still detects a large metabolic heterogeneity inside areas showing similar decreased mean ADC values close to this threshold. CONCLUSIONS Our results indicate that the region of very low mean ADC values observed during hyperacute ischemic stroke contains areas of various tissue damage intensity characterized by SI in relation to different stages of cellular metabolic injury. This observation may explain why ADC mapping does not reliably predict final infarct size.
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Affiliation(s)
- F Nicoli
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS No. 6612, Faculté de Médecine de Marseille, France
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Galanaud D, Chinot O, Nicoli F, Confort-Gouny S, Le Fur Y, Barrie-Attarian M, Ranjeva JP, Fuentès S, Viout P, Figarella-Branger D, Cozzone PJ. Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma. J Neurosurg 2003; 98:269-76. [PMID: 12593610 DOI: 10.3171/jns.2003.98.2.0269] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Gliomatosis cerebri (GC), a rare entity characterized by a widespread infiltration of brain by tumor, lacks objective and quantitative diagnostic criteria. Single-voxel spectroscopy and chemical shift imaging (two-dimensional proton magnetic resonance [MR] spectroscopy) were performed using both short (20- or 22-msec) and long (135-msec) echo times in nine patients suffering from GC, nine patients with low-grade gliomas (LGGs), and 25 healthy volunteers to establish the precise metabolic pattern of this uncommon brain neoplasm. METHODS The gliomatosis infiltration was characterized by markedly elevated levels of creatine-phosphocreatine (Cr) and mvo-inositol (Ins), a reduced level of N-acetyl aspartate (NAA), and a moderately elevated level of choline-containing compounds (Cho). This pattern differs strikingly from LGGs, which are characterized by elevated levels of Cho and Ins, markedly reduced levels of NAA, and low-to-normal Cr concentrations. Although the distinction between GC and LGG, based on histological and MR imaging criteria, is a matter of debate, MR spectroscopy produces valuable information for the differentiation between these two entities and, hence, the choice of therapeutic strategy. It also provides new insight into the pathophysiology of GC because elevated Cr and Ins levels may be related to proliferation of glial elements or, more probably, activation of normal glia. Elevated levels of Cho reflect cellular proliferation and reduced NAA corresponds to reversible neuronal injury and/or focal invasion by the tumor process. CONCLUSIONS Owing to the unfavorable clinical outcome associated with GC compared with that associated with LGG, the findings of this study illustrate the diagnostic and prognostic value of proton MR spectroscopy in the characterization of infiltrating gliomas.
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Affiliation(s)
- Damien Galanaud
- Centre de Resonance Magnétique Biologique et Médicale, Unité Mixte de Recherche, Centre National de Recherche Scientifique 6612, Faculté de Médecine, Université de la Méditerranée, and Hôpital de La Timone, Marseille, France
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Galanaud D, Nicoli F, Le Fur Y, Roche P, Confort-Gouny S, Dufour H, Ranjeva JP, Peragut JC, Viout P, Cozzone PJ. [Contribution of magnetic resonance spectrometry to the diagnosis of intracranial tumors]. Ann Med Interne (Paris) 2002; 153:491-8. [PMID: 12610422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Magnetic resonance spectroscopy (MRS) is a method enabling the analysis of the tissue metabolic content. It may offer a more accurate diagnosis of the intracranial tumors than conventional MRI sequences. MRS of normal brain parenchyma displays 4 main metabolites: N-acetyl aspartate (neuronal marker), creatine (cellular density marker), choline (membrane activity marker) and myoinositol (glial marker); pathological processes lead to variations of the level of these metabolites and/or the appearance of abnormal metabolites (lactate), following different patterns according to pathological process involved: glioma, meningioma, metastasis, bacterial or toxoplasmic abscess, radionecrosis. The potential clinical use of this method includes positive, differential and etiological diagnosis of tumors, determination of the level of malignancy of gliomas, screening for tumor recurrence following treatment. Our laboratory has been performing MR spectroscopic explorations of brain tumors for many years. Based on this experience, we show how MRS can be routinely performed in the clinical setting, what are its limitations and potential, and what kind of information can be supplied to the clinician.
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Affiliation(s)
- Damien Galanaud
- Centre de Résonance Magnétique Biologique et Médicale, CNRS UMR 6612, Faculté de Médecine, 27, boulevard Jean-Moulin, 13005 Marseille
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